Subcutaneous
Hormone Implants:
Relief
for Persistant Menopausal Symptoms and Sexual Dysfunction
HRT
Therapy
Part 1: Hormone Replacement Therapy,
Panacia or Poison?
Part 2: Hormone Replacemnet Therapy
Is a Personal Choice
Part 3: What Is Optimum Hormone Replacement?
How
To Find A HRT Program That Works For You...
Part 1: Finding An Ideal Regimen
Part 2: Unpleasant Side Effects
Part 3: Progesterone, Progestins
& Progesterone Cream
Sex:
Sex and Menopause
Menopause:
Menopause Overview
Hysterectomy:
Hysterectomy Overview
Ovarian Failure Following Hysterectomy
I Want To Know If I Should I Keep My Ovaries
HRT
& Hormones:
About HRT
Ask
Dr N:
Questions & Answers
Hormone Replacement Therapy, PANACEA OR POISON?
Appropriate Hormone Replacement Therapy known as HRT, remains a viable and important health care option for postmenopausal women.
The most significant effects of HRT are increased longevity, a better quality of life and prevention of the accelerated aging associated with hormone deficiency. This remains true despite a media conflagration generated by the publication of the findings of two studies: 1) The Heart and Estrogen/progestin Replacement Study Follow Up (HERS II) and 2) The Women’s Health Initiative (WHI) study. Both studies were published in the Journal of the American Medical Association (JAMA) in July 2002. The articles seem to question the wisdom of hormone replacement.
The media response was explosive. While some of the coverage was accurate and representative, much of it pandered to fears of women and health providers alike. Although there was no difference in all-cause mortality in either study between hormone users and non-users, many postmenopausal women felt that the underlying message was that hormone replacement represented a health risk and discontinued their therapy. This impression was reinforced as scores of physicians informed their menopausal patients -based on the results of the studies, which most had not read - that it was time to discontinue hormone replacement therapy.
Are these legitimate responses that reflect the findings of the published studies? It doesn’t seem so. Five key points follow:
1) It was not clear to most women that both studies did not address hormone replacement in general, but was limited to users of Prempro, which is a sub-optimal hormone replacement preparation distributed by Wyeth-Ayerst. Prempro is a combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) and is taken daily as continuous combined therapy. It is indicated for use in women who have not had a hysterectomy and require protection of the uterine lining with a form of progesterone, in this case MPA.2) Hormone replacement with Prempro appears to have a less favorable risk/benefit profile than other replacement preparations, particularly those that are non-oral and those in which a progestin component is not used continuously. Studies completed following the commencement of the HERS II and WHI trials suggested that the specific combination in Prempro demonstrated both: 1) a less favorable effect on coronary arteries than other regimens and 2) a small, but significant excess of a relatively uncommon form of breast cancer, which has not been associated with use of other forms of hormone replacement. Had this information been available it is unlikely that HERS II or WHI studies would have been initiated.
3) The weight of previous research utilizing other regimens of hormone replacement had suggested a more positive outcome. The commentary in both studies did state that it was “possible” that the unexpected negative findings were due to the combination in Prempro. Surprisingly, unencumbered by the limitations of the data, the researchers included all forms of hormone replacement in their conclusions and recommendations. Dr. Wulf H. Utian, MD, PhD, Executive Director and Honorary Founding President of The North American Menopause Society and a pioneer in menopause research, stated that the financial relationship existing between authors of both studies and Wyeth-Ayerst (the manufacturer of Prempro), raised issues of ethics and potential bias.
4) Physicians are encouraging women to stop using HRT, without a legitimate rationale. This is an irresponsible and potentially life-altering recommendation. The Director of the WHI study Dr. Jacque E. Rossouw, of the National Institutes of Health, stated that it was his impression that few physicians had actually read the studies or had an in-depth knowledge of the details, or conclusions. Dr. Rossouw went on to say that in his opinion appropriate hormone replacement does not cause breast cancer, or coronary artery disease and that he was “comfortable” with this type of hormone use “for as long as it is necessary.”
5) The big losers are menopausal women who have been deterred from using hormone replacement as a valuable health care and quality of life enhancing strategy.
Dr. Trudy L. Bush, who was one of the nation's preeminent researchers and teachers of issues related to women's health - particularly the effects of hormones and replacement therapy on the cardiovascular and reproductive systems - published a hallmark study in the Journal of the American Medical Association in February of 1983. This examined all-cause mortality in estrogen users compared with non-users. During the 5.6 years of the study, the risk of death among non-users was twice as high as users of estrogen if they had no gynecological surgery. It was three times higher if they had a hysterectomy and eight times higher if both ovaries had been removed. Since that time, Dr. Bush and a number of other respected authors, have published numerous articles confirming the association of estrogen use with lower all-cause mortality.
Accordingly, it is reasonable to postulate that the difference in the HERS II and WHI studies was likely due to the specific hormone preparation. Therefore, it is not possible to extrapolate any conclusions, or recommendations to other forms and types of hormone replacement. This was confirmed recently by both the North American Menopause Society Advisory Panel on Postmenopausal Hormone Therapy and the Executive Committee of the International Menopause Society.
When it comes to the question of whether to use hormone replacement therapy the answer is always one of personal choice.
What is OPTIMUM HORMONE REPLACEMENT?
In this section, Dr N discusses optimal hormone replacement regimens.
Appointments
with Dr. Nosanchuk can be made by contacting Caroline
(248) 644-7200 from 10:00am to 6:00pm Monday - Friday (EST).
This web site is for educational purposes only. It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician/patient relationship.