Tips & Advice

From Dr. Liz Herself

February 19, 2014
HRT and Pancreatitis
Woman Hiking

I read an article the other day and I have to say as a doctor I was outraged. The scary headline reads, “Hormone Replacement Therapy Associated with Increased Pancreatitis Risk”. It goes on to commit the 2 most common sins that make it impossible for you, the savvy health reader, to really be able to tell what the study actually found.

The first sin

The first sin is not identifying what hormones the women were actually given in the study. We now know that oral estrogen increases cardiovascular risk, and that synthetic progestins increase the risk of breast cancer. So, in this study in Norway of over 30,000 women, “Women who had ever used HRT had a 57% increase in the risk for acute pancreatitis compared with women who had never used HRT.” But we literally never find out in the whole article which hormones they were taking! (I even read the actual published study and can’t find more detail about what hormones the women actually took.)

The second sin

The second sin is giving the percentage increase (“relative risk”) and not the actual numbers (“absolute risk”) until way deeper into the article. Here’s what we see when we look that closely: out of 100,000 women who never used HRT there were 57 cases of pancreatitis compared to 71 cases among 100,000 women who used HRT during the study period. This means that there were 19 more women who got pancreatitis and took hormones compared to women who didn’t take hormones. The way the statistical calculations are done results in the “57% increase”, which sounds huge and scary!

What is Pancreatitis?

Let me briefly address pancreatitis itself, which is inflammation of the pancreas. Inflammation is the body’s attempt at self-protection; it is part of the body’s immune response. The aim of inflammation is to remove harmful stimuli, including damaged cells, irritants, or pathogens, and begin the healing process. Inflammation does not mean infection, even though an infection can lead to inflammation. For the pancreas, factors such as alcohol consumption can increase the risk of pancreatitis.

Almost anything can cause inflammation. Hormones can actually help decrease inflammation when used in a proper manner.

To look at just one area, it turns out that the association of arthritic aches and pains with low estrogen levels is well documented in the mainstream rheumatology literature. For example, an article published in Sept 2005 in Arthritis & Rheumatism, showed that menopausal women treated with estrogen depleting medications tend to develop aches and pains in their joints. Another report in The Lancet Oncology, September 2008 showed the same finding that estrogen depletion is associated with joint aches and pains. They state that “Low estrogen levels and postmenopausal status are associated with the development of symptoms of arthralgias and arthritis.”

Debunking the myth

I am forever debunking the myth that hormones are harmful. I have always believed women do not need to suffer during any process of living including menopause.

This headline emphasizes the scary side of hormones by referring to the percentage increase or the relative risk instead of actually showing how small the numbers really are and how those patients may have had a precondition to the pancreas inflammation. It also doesn’t give us the information we need about what hormones were actually used. Not all hormone therapies are created equal.

I really want women to understand how helpful hormones can be during perimenopausal and menopause. Having a doctor working and checking your hormones with regular blood tests to keep anything that might be harmful in check, you can be on your way to feeling good and living well.

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