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| shally |
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Posted: 1/30/2008 7:35 AM |
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Subject: HRT |
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WomanSaver MoFo
Female Member
Age: 3
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Hi doc!
What is your opinion of HRT?
Have a great day! Thank you!
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| Dr.WomanSaverM.D. |
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Posted: 1/31/2008 9:42 PM |
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Subject: HRT |
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WomanSaver MoFo
Female Member
Age: 100
Total Posts: 553
Doctor's Office
Costa Rica
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| shally wrote: |
Hi doc!
What is your opinion of HRT?
Have a great day! Thank you!
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Hi Shally.
Wow, this is a huge topic.
Hormone replacement therapy (aka HT or Hormone Therapy) can be
beneficial to some post menopausal women for the purpose of controlling
hot flashes, preventing vaginal dryness, and protecting against
osteoporosis. However HT has also been linked to some adverse effects
and isn‘t for everyone. A doctor usually takes one‘s age, family
history, personal past medical history, etc into consideration before
making a determination about whether to start HT, what type and for how
long.
Here is some more information:
http://www.mayoclinic.com/health/hormone-therapy/WO00046
I hope this helps, and let me know if you have any more specific questions about this.
-DrWS
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| hopeless_dreamer |
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Posted: 1/31/2008 9:48 PM |
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Subject: HRT |
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WomanSaver MoFo
Male Member
Age: 23
Total Posts: 697
Los Angeles
California
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I wanted the doc to answer before I chimed in on this one. Basically, there‘s a rather large rift between older docs and newer ones on HRT. Since the studies have come out (in the last five years) that HRT has a correlation with breast cancer and cardiovascular disease, most new docs are very very hesitant on giving any patient estrogen. It simply mucks up too much stuff. The symptoms of menopause are far less severe than things like cancer, so why take the risk?
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| shally |
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Posted: 2/6/2008 7:24 AM |
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Subject: HRT |
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WomanSaver MoFo
Female Member
Age: 3
Total Posts: 7709
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doc, I had a complete hysterectomy soon after my only child was born. I was in my 20‘s, I‘m 50 now. I‘m on Estrace 2mg and have been since my surgery. I‘ve never had any problems, don‘t smoke, rarely drink. So, I just wanted your opinion and I knew you would post some reading for me. Thank you.
hd, unless something new comes out to scare the hell out of me, I‘m not giving up the pills.
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| Dr.WomanSaverM.D. |
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Posted: 2/8/2008 10:58 AM |
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Subject: HRT |
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WomanSaver MoFo
Female Member
Age: 100
Total Posts: 553
Doctor's Office
Costa Rica
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| hopeless_dreamer wrote: | |
I wanted the doc to answer before I chimed in on this one. Basically, there‘s a rather large rift between older docs and newer ones on HRT. Since the studies have come out (in the last five years) that HRT has a correlation with breast cancer and cardiovascular disease, most new docs are very very hesitant on giving any patient estrogen. It simply mucks up too much stuff. The symptoms of menopause are far less severe than things like cancer, so why take the risk?
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Hi Hopeless_Dreamer.
This is a must read for you: http://www.nhlbi.nih.gov/whi/
It is about the WHI (Women‘s Health Intiative) Study of the NIH which you may already know about.
The WHI Study which started in 1991 was a huge multi-million dollar
research program, and probably one of the largest prevention studies to
date. The point was to evaluate quality of life, as well as causes of
morbidity and mortality in postmenopausal women. The study examined
cancer, cardiovascular disease, and osteoporosis. Over 100,000 healthy
postmenopausal women participated in this study. The clinical trials
consisted of 3 arms where the researchers observed the effects of: 1.
HT, 2. Diet modification, and 3. Calcium and Vit. D, and how these
three affected the risk of 1. Cardiovascular Disease (including DVT,
and Stroke), 2. Cancer (breast and colorectal), and 3. Osteoporotic
fractures.
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| Dr.WomanSaverM.D. |
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Posted: 2/8/2008 10:59 AM |
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Subject: HRT |
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WomanSaver MoFo
Female Member
Age: 100
Total Posts: 553
Doctor's Office
Costa Rica
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| shally wrote: | doc, I had a complete hysterectomy soon after my only child was born. I was in my 20‘s, I‘m 50 now. I‘m on Estrace 2mg and have been since my surgery. I‘ve never had any problems, don‘t smoke, rarely drink. So, I just wanted your opinion and I knew you would post some reading for me. Thank you.
hd, unless something new comes out to scare the hell out of me, I‘m not giving up the pills.
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Hi Shally
Since hormone therapy is still somewhat of a controversial topic, I‘ll try to give you more of the the known facts and fewer of my own opinions on this, but I promise to try to answer your question in this post. :)
You are welcome to read about the WHI Study as well -See link in my last post to HD... But I‘ll summarize the results of the HT portion of the WHI Study here.
There were about 27,000 healthy postmenopausal women who participated in the HT (Hormone Therapy) part of the WHI Study. The women were broken down into two groups:
1. Women with a Uterus on HT (Hormone Therapy: both Estrogen and Progestin)
2. Hysterectomized women on ET (Estrogen only)
-The reason for the difference in type of therapy is because Estrogen alone (without the effects of progesterone) can cause the endometrium (the inner lining of the uterus) to proliferate and grow out of control (called endometrial hyperplasia), which can then lead to endometrial cancer. Progesterone stabilizes the endometrium, and prevents endometrial cancer. Thus progestin (a synthetic progesterone) was given to the women with a uterus. In women who have had a hysterectomy, this is not an issue because no uterus, no chance of endometrial hyperplasia or endometrial cancer.
Women were randomly assigned either a placebo or the hormone treatment and then observed and evaluated. The results of the study (comparing the benefits and risks of hormone versus placebo in terms of heart disease, cancer and osteoporosis) were the following:
Benefits:
In BOTH groups there was a decreased risk of osteoporotic fractures
In the HT group there was a decreased risk of colorectal cancer
Risks:
In BOTH groups there was an increase in DVT (blood clots)
In BOTH groups there was an increase risk of Stroke
In the HT group there was also an increased risk of heart attack AND breast cancer (which was not found in the ET group)
As you can clearly see, the risks way outweigh the benefits. Infact the HT study was stopped in 2002 because of the increased risk of breast cancer, and the ET study was stopped around 2004 because of the increased risk of stroke and blood clots. Although the studies have ended, the women who participated are still being evaluated in the follow-up phase which will last 2-3 more years.
Here are my personal opinions...
-Despite the risks, estrogen therapy is still the most effective FDA-approved method to treat menopausal symptoms like hot flashes and vaginal dryness. However there are other treatment options available.
-In a woman with a personal history of breast or endometrial cancer, thrombosis (blood clots), heart disease, liver disease, or unexplained vaginal bleeding, I would advise AGAINST HT or ET.
-In general, HT can be considered for the purpose of relieving severe postmenopausal symptoms, but I would prefer to use the lowest dose possible for the shortest amount of time and re-evaluate on an annual basis. -In the HT study, the risk of breast cancer was not found prior to 4 years, so the shorter time used, the better off you are.
-HT shouldn‘t be given for the sole purpose of preventing osteoporosis due the the increased risk of cardiovascular disease and stroke. I would consider other non-estrogen medications which are also effective.
For more information:
Women‘s Health Initiative:
http://www.nhlbi.nih.gov/whi/
http://www.whi.org/
WHI Estrogen Alone Study:
http://www.nhlbi.nih.gov/whi/estro_alone.htm
Facts about Menopausal Hormonal Therapy
http://www.nhlbi.nih.gov/health/public/heart/other/pht_fact.htm
(good to read and discuss with your doctor)
Should I use Estrogen Replacement Therapy after a Hysterectomy and Oopherectomy?
http://women.webmd.com/should-i-use-estrogen-replacement-therapy-ert-after-a-hysterectomy-and-oophorectomy
(reasons to continue or discontinue hormone therapy based on your situation -discuss with your doctor)
I know this is a lot of overwhelming and sometimes confusing information but I hope this helps clear it up a bit. Feel free to ask any more questions if you wish, but also please discuss this with your doctor.
Thanks. Have a nice weekend.
-DrWS
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