If it was possible to clutch a uterus for dear life...that's what the attendees at Dr Carol Fabian's Early Menopause and Hormones session would have been doing.
This 30 year veteran of breast cancer research and oncology had some pretty clear views about the usefulness of the uterus after childbearing, and was firmly in the 'rip-em-out-once-you're-done' camp.
It was an uncomfortable eye opener for those of us whose surgeons had only gone as far as ovaries and tubes, and you could almost see a collective 'whaaaaaat??' thought bubble forming over our heads.
So why take things that step further? It's a bit technical, so bear with me. Dr F did a fantastic job of making it all make sense in the session, but my medic-translation skills are challenged by this one.
According to Dr Fabian the safest HRT is the estrogen-only kind. But taking estrogen on its own bumps up your breast and uterine cancer risk. And so the need to add progesterone or progestin to the mix to reduce THAT risk. But progesterone/progestin bring another set of risks of their own. And so on and so forth.
Confused? You're not the only one. And don't think you're safest just to do away with the hormones altogether if you're a young woman contemplating (or in) surgical menopause.
Dr Fabian's bottom line is that, despite the increased cancer risk it brings, estrogen is essential if you are going to remove your ovaries very early, as it protects young women who wouldn't otherwise be menopausal, against a raft of other serious conditions that can develop as a result of it - heart attack(84% increased risk(, cognitive impairment (46%) and Parkinsons Disease (68%).
She says that the evidence shows that eight years or less of estrogen-only use (which you can only safely do without a uterus) doesn't increase breast cancer. And even COMBINED HRT (the kind you take if you are unfortunate enough to still be with-uterus)may lower the risk of death across the board, despite bringing a small breast cancer risk.
Just how big is that risk?
Well, here's a reality check. And a very interesting way to look at what can be very confusing numbers.
Using a combined hormone replacement therapy (estrogen plus either progesterone or progestin) increases breast cancer risk in the same amount that two drinks a day does. And even that elevated risk disappears within a few years of stopping HRT.
For women with major risk factors - the BRCA 1 and 2ers - Dr Fabian says the additional risk that HRT poses is next to nothing, when you compare it with the 20-fold increase the genetic bum-card deals them. Imagine a bar graph with whopping great bars for BRCA risk (at 20) a bar half that size again for Lobular Carcinoma in Situ, and 'AH+FH' (whatever thay may be), a '7' sized bar for AH only and then teeny, tiny almost imperceptible blips for obesity and alcohol use (scoring a 2).
So why the worry about HRT?
I'm not sure I've entirely got my head around it, but I'll do my best.
First off, there has been a great deal of conflicting evidence in this area and loads of very heated scientific debate that's been going on for three decades now. Study after conflicting study has come out with great fanfare, and then, for one reason or another, been shot down. That's without even getting started on all the politics so rampant in womens' health issues. Everybody is confused - doctors and patients alike.
Then there's the relative newness of the whole BRCA/HBOC phenomenon. They just haven't been able to study us long enough to come up with definitive answers.
Then there are all the inherent contradictions and confusions of HRT that are hard to for everyone to get their heads around - the protective effect against heart disease and stroke in young menopausal women, for example, turns into an attack in older post-menopausal women (it's to do with whether you have plaque buildups in your arteries or not). And the weirdness of some of the evidence - that while it can increase breast cancer, the overall death rates in women taking HRT are lower (something to do with a reduction in symptoms leading to fewer accidents etc - interesting!).
In the same vein, Dr Fabian did quote from one 2008 study called HABITS (HRT in breast cancer survivors) that found that while there was a 22% increase in new breast cancers within 5 years for those high risk women in the study taking HRT (8% of those not taking it developed new breast cancers), there was no difference in survival between those taking HRT and those who didn't.
Dr Fabian's final words were that HRT isn't a no-no (or contraindicated, if you prefer) for higher risk women - especially if it's ERT alone, and that those undergoing prematured menopause under 45 should consider it - whether they are symptomatic or not.
She also says the type, dose and route of delivery can lessen the health risks. ERT plus or minus testosterone is better than combined estrogen and progesterone. Progesterone is better than progestins, low dose beats moderate, and patches or vaginal delivery is safer than oral.
So what's a girl to do?
Well, if I was to do it all over, I'd push to dump my uterus along with the rest of those bits I no longer have a use for. But that's just me. I'm not going to line up for any more surgery, but if they're in the neighbourhood anyway, any time in the future...that's another whole story.
I'll definitely be talking with my endocrinologist about transitioning to a patch and having a conversation about the progesterone/progestin thing. It'll be a fun conversation, doctors just love it when we front up with a heft of somebody elses conference slides. It's right up there with an internet print out.