Newer versions of oral contraceptives -- with lower levels of estrogen and progestin -- reduce the risk of ovarian cancer more than older concoctions of birth control pills

Researchers at the University of Hawaii in Honolulu, whose work is published in the Journal of Obstetrics & Gynecology, say birth control pills have long decreased the risk of ovarian cancer. But over the years, doses of hormones in these pills have been decreased to reduce side effects -- and this seems to have an even stronger protective effect against the disease.

Studies show for women who had used any oral contraceptive a 50 percent reduction in risk of developing ovarian cancer compared to women who had never taken the pills. This risk was reduced by 38 percent
for women who took high estrogen and high progestin pills and by 81 percent for those taking pills with low levels of these hormones.

"Up to 42 percent of ovarian cancers might have been avoided if all women used some form of combined oral contraceptive pills," say researchers.

"An estimated 73 percent of ovarian cancers might have been avoided if all women used oral contraceptive pill formulation of low estrogen and low progestin."

An Arkansas woman claiming the hormone replacement drug Prempro caused her breast cancer just won her legal battle against Wyeth, the maker of the drug.

Mary Daniel was awarded $1 million in compensatory damages thanks to a Philadelphia jury decision stating Wyeth acted with malice or reckless disregard for selling Prempro -- the drug Daniels took for 16 months to relieve hot flashes. The next step for Daniels, whose husband will receive $500,000, is a hearing to consider punitive damages.

Wyeth's lawyer argues that Prempro -- a combination of estrogen and progestin -- is still prescribed to women and suggests Daniel's breast cancer was caused by other risk factors, such as family history of the disease.

Before 2002, hormone replacement therapy (HRT) was believed to prevent many conditions, and doctors routinely prescribed hormone pills. But when a 2002 study found HRT raises the risk of breast cancer, heart disease, and other problems, the use of hormones plummeted.

On Thursday, researchers reported that the rate of breast cancer cases in the United States dropped more than seven percent in 2003 -- the year after the landmark study that caused a backlash against hormones. This backlash is considered the leading cause for the now-reported decline in breast cancer cases.

Now, even more women are expected to abandon the pills. And doctors worry that women with severe menopausal symptoms -- who need the treatment -- will deny themselves the benefits hormones can offer.

There are ways to take advantage of the benefits, however, and still minimize the risks. One gynecology group shares the following suggestions.

• Take the lowest dose for the shortest time -- two or three years if possible. Start out small and add more medication if symptoms do not decrease.

• Do not take hormones to try to prevent heart disease -- because they do not prevent it.
  

• Never take estrogen without progestin if you still have a uterus. This raises the risk of uterine cancer.

• Try periodically to cut your dose and wean yourself off.

For those who don't definitively need hormone therapy, it's important to discontinue use. But some women truly do need the treatment and should not abruptly stop their therapy in light of news that is not definitive in itself. As always, consultation with a physician is the best first step.

Previous posts on the topic of HRT and breast cancer are as follows.

• Different perspective on drop in breast cancer cases
• HRT use drops breast cancer rates drop
• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

Double the hormone, double the risk. Or so says one study of older women who take hormone pills. When estrogen and testosterone are combined, women face twice the chance of getting breast cancer, according to a study of more than 70,000 nurses. This type of combination therapy may help with mood, libido, and bone density -- but the possible risk of breast cancer may just outweigh these benefits. These findings, published in Monday's Archives of Internal Medicine, add to the evidence that certain types of hormone supplements -- like estrogen-progestin pills -- increase risk of breast cancer, strokes, and heart attacks in women. Other research points to a link between breast cancer and high natural levels of testosterone.

Women's natural levels of estrogen and testosterone decrease with menopause. Use of supplements has climbed over the past 24 years, perhaps putting more women at more risk. Estrogen-testosterone pills are sold under the brand names Estratest and Estratest H.S. and appear on a Washington-based advocacy group's "Worst Pills" list because of breast cancer risk.

New birth control pills and contraceptives are already on the market -- or about to be released -- that allow women the option of ending monthly menstruation for good. This option is becoming increasingly popular with women at both the beginning stage and ending stage of their reproductive life.

For women who suffer greatly each month with the physical pain and emotional upsets that can occur during periods, this might be a good option. For other women, it might be a matter of convenience and a way of improving sex life. If you are not actively attempting to get pregnant, this seems like a reasonable option in eliminating periods that do not seem to serve a practical purpose. As I understand it, the pills are far safer than the contraceptive pills of the past, with much lower doses of estrogen and progestin. However, it is still a birth control type pill, and the warnings remain the same. If you are over 35 and smoke, you are advised not to use it. If you are a cancer survivor diagnosed with cancers fueled by hormones, you are advised not to use this method of controlling monthly menstrual cycles. This pill still increases the risk of heart attack, stroke and blood clots.

On the other side of the coin -- according to research -- these birth control type pills might lower risk of endometrial and ovarian cancer. But, hormones operate in the body on so many complex levels, and regulate so many other systems within the body, I do not know that scientists understand the complexities enough to tell women that halting a hormone process for an indefinite amount of time by manipulating estrogen and progestin is safe for long-term health. Especially when it comes to cancers that are hormone-driven.

Sometimes, it is a dizzying stomach lurching head rush roller coaster ride trying to hang on to the handle bar of truth when it comes to the latest in research findings regarding estrogen therapy. It puts women at a higher risk for breast cancer. No, it doesn't show any increased risks for breast cancer. Up and down, loop-de-loop we go.

Originally, studies showed that the estrogen progestin combination of hormone therapy for postmenopausal women did raise the risks for breast cancer. Then, along comes the results from the Women's Health Initiative stating there was no increased risk of breast cancer for women taking estrogen therapy alone, in women who took estrogen therapy for seven years.

Now, a new study, heralded as the study to clear up any confusion, states that postmenopausal women who have had a hysterectomy and used estrogen therapy for 15 years are indeed at a higher risk for breast cancer. Perhaps we should just accept that hormone therapy is probably not the best solution for any of the reasons women are using it, and seriously start looking at alternative methods. Breast cancer is a high price to pay for any benefit estrogen therapy might provide.