'Ask an Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.
Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.
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Answering your questions for this edition of 'Ask an Expert: Q&A' is Dr Sonia Davison, Jean Hailes endocrinologist and president of the Australasian Menopause Society.
I am wondering whether Tibolone or transdermal oestrogen with micronised progesterone has the lowest breast cancer risk?
From Jean Hailes endocrinologist Dr Sonia Davison
There haven’t been any prospective studies directly comparing the breast cancer risk associated with Tibolone compared with body-identical combined menopausal hormone therapy (MHT). The only information we have is from cohort studies. A meta-analysis of cohort studies in The Lancet in 2019 reported on breast cancer risk with various forms of MHT. (Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019; 394:1159-68.) This meta-analysis reported that the breast cancer risk with Tibolone is lower than combined oestrogen and synthetic progestogenic MHT.
That paper also included very small numbers of women on body-identical MHT, and there was no statistically significant increase in breast cancer risk over 5 years, but there was beyond this timeframe. The direct answer to your question is that no-one really knows the exact answer! However, there are some excellent information sheets that may help on the Australasian Menopause Society website:
I have a 52 year-old patient who has asked if Slinda (Drospirenone progesterone-only pill) would be okay for her. She has a history of provoked venous thromboembolism (VTE). The manufacturer states that in trials there were no VTE events (10,000 pts), but trying to prescribe brings up a warning regarding VTE. Do you have any suggestions or guidance?
From Jean Hailes endocrinologist Dr Sonia Davison
I suspect that the warning comes up due to a combination of the patient’s age in the setting of prior VTE. Drospirenone progesterone-only pill (POP) is designed for, and has been tested in the reproductive age group, and its contraceptive use is recommended in that age group, although guidelines state that POPs can be used until age 55 years. There is some excellent information about other types of contraception on our website, including a health professional webinar that was conducted with colleagues from Family Planning Victoria, in 2021.
The Australasian Menopause Society has an excellent information page with a focus on women of perimenopausal or menopausal age.
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