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TODAY’S DOSE OF HONESTY

Do IUDs cause breast cancer? Dr. Jen weighs in.

In my 14 years with ABC News and “Good Morning America,” my daily job was to provide analysis of the latest medical study getting attention. What I loved about this was that it kept me on the cutting edge of the medical literature in a way that most physicians occupied with day-to-day clinical practice are not (through no fault of their own; there simply isn’t enough time to do it). And while I left ABC to devote my attention to my new women’s health company, Ajenda, the daily practice of reading the latest studies and published papers is still part of my routine. 

So I want to address a headline you may have seen in the past few days about IUDs and breast cancer risk. The study was published in JAMA online last Wednesday, October 16. Here’s what you need to know.

This study was conducted in Denmark, where they keep excellent medical records and health outcomes data. Researchers enrolled roughly 156,000 women, ages 15-49, and followed them for an average of 6.8 years. The women were divided into two groups—one who used a progesterone-containing IUD, and one who did not use any form of hormonal contraception. 

The study found that those who used a progesterone-releasing IUD had a 30-40% increased “relative” risk of developing breast cancer than those who did not use a hormonal IUD. This number (30-40%) sounds huge, but that’s the relative risk. The absolute risk is something very different, and very important. The absolute risk is what gives us a real number—and in this instance, it translates to an additional 14 cases of breast cancer per 10,000 women.  

How do we interpret this data?

Let’s start with what we know about hormones and breast cancer. Take estrogen first. The most recent, high-level medical and scientific evidence is that estrogen does NOT cause breast cancer. If this were the case, then women with breast cancer who were given high doses of estrogen (yes, many studies are reporting on this) would get worse—and they don’t. Even breast cancers that are defined as ER+/PR+—meaning estrogen-receptor positive—are not “caused” by estrogen. What this means is that although the cells are malignant, they have retained their surface appearance by continuing to display an estrogen receptor and progesterone receptor.

This is a good sign, as it means the cells have not been so transformed by malignancies that they’ve lost these surface receptors. Conversely, you may have heard about breast cancer that is “triple negative”; this is a much more aggressive cancer, where cells have deteriorated so much that they no longer show estrogen receptors and can’t respond well to hormonal treatments like tamoxifen.

But all hormones do not act the same in the body—and in the breast specifically—and the data on progesterone is slightly different than the evidence regarding estrogen. Some recent data on progesterone has suggested that it, not estrogen, is the new culprit in breast cancer. Is it? The logical interpretation of the evidence says no. Observational studies have found that women with low progesterone levels (such as those with PCOS or who don’t ovulate regularly) have a HIGHER risk of breast cancer.  Furthermore, prospective clinical trials in women with metastatic or advanced breast cancer who were treated with high doses of progesterone had a higher rate of remission compared to women treated with tamoxifen. If progesterone caused breast cancer, neither of these findings would be true.

So, what about the IUDs?

First, there are two general types of IUDs: ones that release progesterone (or its synthetic form, progestin) and ones made of copper. The progestin-releasing IUDs are more common in the US today because 1) they often promote very light periods or even no bleeding at all—a big plus—and 2) they can remain in place for 2, 5, or 7 years vs. the copper form, which stays in for 10 years. Many women like a shorter-term option. 

IUDs are vastly underutilized, in my medical opinion, but they’re not for everyone. There’s often pain associated with insertion, and IUDs don’t offer any of the non-contraceptive benefits that low-dose birth control pills do, such as reduced acne and PMS, as well as reduced risk of ovarian cysts and ovarian and uterine cancers. Also, breast cancer is generally less common in women aged 20-49 than it is in older women, so the considerations are not comparable across age groups. As is the case in many medical situations, the decision of whether to use an IUD comes down to risk vs. benefit.

We need to ask at least FOUR key questions:

• What is the risk of breast cancer with a progesterone IUD? (Low.)  

• What is the risk of breast cancer WITHOUT a progesterone IUD? (Still low, maybe slightly lower.)

• What are the benefits of using a progesterone IUD? (99% contraceptive effectiveness.)

• What are the benefits of NOT using one? (One can argue there are actually higher risks of unintended pregnancy, so no benefits).

Finally, a word about the disease itself.

Breast cancer is a complex malignancy with multiple forms and contributing factors. It’s a risk we all face…and that risk increases as we age.

The single most powerful thing we can do to lower our risk is to avoid or significantly minimize our consumption of alcohol. You’ve heard me say this before, but few women—or men—actually do it. It comes down to controlling the things we can while continuing to live our lives. These things are not mutually exclusive. Personally, as I have shared recently, I’ve cut my alcohol consumption to the point of having less than 6 drinks a MONTH, if that. It wasn’t just to lower my breast cancer risk, either. It was for head-to-toe wellness—brain, heart, waistline, skin, breasts, everything.

Also, breast cancer is uncommon in women in their 20s and 30s, while unintended pregnancy is NOT. So, the smart way to approach this is to address the larger statistical risk, not the rare one. We have a saying in medicine: Common things occur commonly; an increased risk of a rare event is still a RARE event. 

My dose of honesty on this—even with this new data: I believe the benefits of a progesterone-releasing IUD still outweigh any risks. As always, though, discuss any questions with your personal physician/OB-GYN.

SYMPTOM SOLUTIONS

Can green tea reduce women’s health issues?

Here’s good news for women with fibroids, as well as PCOS, endometriosis, and/or dysmenorrhea (painful heavy bleeding during periods): In a recent review of studies published in the journal Nutrients, researchers at Johns Hopkins Medicine have theorized that symptoms of common female reproductive maladies might be reduced by simply drinking green tea.

I confess, up front, that I’m not a huge fan. To me, green tea tastes like water that’s been strained through a dirty sock, so I add honey and lemon to mine. Regardless, this tea is a globally cherished beverage, both hot or cold; it also comes in powdered form (think matcha) that appears in everything from skincare products to ice cream. Renowned for its health benefits, green tea is packed with catechins, flavonoids with powerful antioxidant properties that protect cells from free radical damage and inflammation. Among these, epigallocatechin-3-gallate (EGCG) is the most prominent, playing a significant role in improving various health conditions and disease markers.

The Johns Hopkins review discussed previous studies in which EGCG was the focus—and specifically, whether the level of EGCG in green tea might help alleviate symptoms of benign reproductive disorders in women. The data was promising.

Uterine fibroids: Depending on the size and location of the fibroid(s), symptoms can range from painful and prolonged periods to constipation, pelvic pressure, and frequent urination. Fibroids also affect fertility, and in severe cases require hysterectomies or myomectomies. Studies in animal models and humans have shown that EGCG successfully reduced the size of fibroids and improved women’s overall quality of life by alleviating symptoms.

Dysmenorrhea: This common and often very painful condition is linked to higher levels of prostaglandins produced in the uterus. Studies have shown that EGCG can reduce the production of prostaglandins, offering a natural alternative to the nonsteroidal anti-inflammatory drugs that are typically prescribed for dysmenorrhea.

Endometriosis: This disorder is marked by the implantation of benign lesions outside the uterus, causing pain during intercourse, periods, and even pooping. Experiments with rats showed that EGCGs reduced the size of endometrial lesions and prevented the formation of new ones.

Additionally, study reviewers found that the EGCG in green tea may also help in treating PCOS (polycystic ovary syndrome) as well as traditional menopausal symptoms. And while more evaluation is needed, EGCG showed promise in improving in vitro fertilization success rates.

How much green tea should you drink to achieve these benefits? The jury’s still out on this. But having a cup or three a day can’t hurt. One note: It’s best to drink regular green tea—which contains caffeine—and not decaf. The decaffeination process may substantially reduce the tea’s antioxidant effects. Just have your cuppas before it’s too late, as it may have you making potty trips in the night.

The study authors all agreed that more formal, clinical studies are essential to unlock the full benefit of EGCGs on women’s reproductive health. But it’s nice to know that something as simple and relaxing as sipping tea may be the key.

My go to holiday drink!

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COMMUNITY

“Can you share your ‘bean snack’ recipe?”

This has been a happy surprise for the nutritionist in me! I mentioned my bean salad in a previous issue of TODAY’S AJENDA, then resurfaced my earlier Instagram post about it—because there’s so much BEAN LOVE out there, y’all! I’m glad this recipe is resonating so well with you.

As I freely admit, I’m a passable cook at best, and when I AM in the kitchen, I don’t have time for much more than throwing things together. Which is why I love this recipe, if you can even call it that. I would call it more of a “toss”: Toss stuff into a bowl, toss it together, then toss it down. Easy to make, pretty hard to screw up. Here’s what else is good about this bean TOSS:

• It’s packed with nutrition. Besides several kinds of beans, this dish has corn, tomatoes, peppers, and lots of great spice. In a 1-cup serving, you get filling amounts of plant-based protein, probiotic fiber, good carbs, antioxidants, flavonoids, and a cavalcade of vitamins and minerals. All for an expense of just 243 calories.

• It’s incredibly versatile. Don’t like spice? Leave it out. Want some sweetness? Add a bit of honey. Have other veggies (onion, carrots, mushrooms, etc.) on hand? Throw ’em in. You can even add more beans—use any kind you like. It’s a TOSS, so it can handle jukes and jives.

• You can use cooked dried beans or canned. I use canned—no extra cooking necessary, but rinse and drain these beans to dial down the sodium content. I also try to buy BPA-free cans whenever possible.

• It’s good any time of day—as a hearty lunch salad, an afternoon snack with tortilla chips, or with fresh fruit for a light and delicious entree.

• I’ve added a little olive oil for a nice hit of MUFA (monounsaturated fat) but leave it out if you want.

• It loves the fridge! Because they absorb all that flavor, these beans taste even better the next day…and the day after that too. But eat up within 5 days.

Dr. Jen’s Tasty Bean Toss

Makes 10 1-cup servings.

½ cup organic garbanzo beans
½ cup organic black beans
½ cup organic kidney beans
½ cup organic white/pinto beans or black-eyed peas
½ cup canned frozen or canned corn
½ cup diced tomatoes or halved cherry tomatoes
½ cup diced red onion
½ cup diced bell pepper, any color
1 jalapeño pepper, seeded and finely diced
½ tsp ground black pepper
Hot sauce (to taste)
1-2 Tbsp olive oil
2 tsp balsamic vinegar (or your favorite)
½ small lime
Chopped cilantro, avocado, etc., for garnish.

Instructions:

1. Drain and rinse beans.

2. Gently toss together the beans, corn, tomatoes, and green pepper in a large bowl.

3. Toss in (see, we’re tossing!) the jalapeño pepper, black pepper, and hot sauce.

4. In a smaller bowl, whisk together the peppers, olive oil, and red wine vinegar. Pour over beans and veggies and toss to coat. Cover and refrigerate for at least 4 hours or overnight for full flavor.

5. Toss beans once more before serving. Give it a squeeze of lime and some tasty garnish—then enjoy!

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She is founder and CEO of Ajenda, a company that focuses on helping women enjoy optimal fitness, health, and well-being, and has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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