Hormone Therapy, The Pros And Cons

Hormone Therapy, The Pros And Cons

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Academic Journal
Main Category: Menopause
Also Included In: Women's Health / Gynecology
Article Date: 28 May 2012 - 17:00 PDT

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An updated report on the benefits and harms of HRT (hormone replacement therapy) has found that estrogen plus progestin and estrogen alone reduce fracture risk but raise the risk of stroke, gallbladder disease, urinary incontinence and thromboembolism events. Estrogen plus progestin raise the chances of developing breast cancer and probably dementia, while estrogen alone decreases breast cancer risk.

This review, written by researchers from Oregon Health Science University, and Providence Cancer Center, and published in Annals of Internal Medicine, was conducted to help USPSTF (US Preventive Services Task Force) issue its new recommendations on hormone therapy.

As background information, the researchers explained that menopausal hormone therapy to prevent chronic diseases is not recommended today, because of the high risk of serious adverse events.

The researchers set out to update evidence regarding how effective hormone therapy is in reducing the risk of developing chronic conditions, as well as studying the impact and severity of adverse effects. They also wanted to see what the outcomes might be among females in different subgroups.

They gathered and analyzed data from MEDLINE (Jan 2002 - Nov 2011), the Cochrane Central Register for Controlled Database of Systematic Reviews (up to September 2011), Scopus and some other reference lists. They also looked at randomized, placebo-controlled trials of HRT (hormone replacement therapy) that had been published in the English language since 2002 - the trials were all focused on preventing chronic conditions.

They studied a short-list of 9 trials which met their inclusion criteria - the trials were assessed as being of fair-quality.

Below are some of the findings from this study:

• Estrogen plus progestin therapy
  reduced fractures (46 fewer per 10,000 woman-years)
  increased invasive breast cancer (8 more per 10,000 woman-years)
  increased deep venous thrombosis (12 more per 10,000 woman-years)
  increased dementia (22 more per 10,000 woman-years)
  increased gallbladder disease (20 more per 10,000 woman-years)
  increased lung cancer death (5 more per 10,000 woman-years)
  increased pulmonary embolism (9 more per 10,000 woman-years)
  increased stroke (9 more per 10,000 woman-years)
  increased urinary incontinence (872 more per 10,000 woman-years)


• Estrogen-only therapy
  reduced fractures (56 fewer per 10,000 woman-years)
  reduced invasive breast cancer incidence (8 fewer per 10,000 woman-years)
  reduced death (2 fewer per 10,000 woman-years)
  increased stroke (11 more per 10,000 woman-years)
  increased deep venous thrombosis (7 more per 10,000 woman-years)
  increased gallbladder disease (33 more per 10,000 woman-years)
  increased urinary incontinence (1271 more per 10,000 woman-years)

There were no consistent differences in outcomes related to comorbid conditions or age.

The study did not look into compliance (adherence), some outcome risks, and some other regimens.

In an abstract in the same journal, the authors concluded:

"Estrogen plus progestin and estrogen alone decreased risk for fractures but increased risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence. Estrogen plus progestin increased risk for breast cancer and probable dementia, whereas estrogen alone decreased risk for breast cancer. "

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Visitor Opinions (latest shown first)

Does the means by which estrogen is introduced into the body make a difference? ed into the body may make a differanceced

posted by mary lake on 28 May 2012 at 7:11 pm

I have been wearing a low dose estrogen patch since menopause for many years. When studies are written on this topic it should be stated what the method of introduction into the body was used. I would imagine taking a pill, massaging ointment into the skin or wearing an estrogen patch would have different out comes. I I am healthy, sexual, great skin, healthy bones no aches or pains, good memory have not been sick in over 10 years. I never took progestin. I have taken high dose D for over 20 years. I am 68.

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I thought HRT was done.

posted by Julie Clarity on 28 May 2012 at 6:31 pm

The other problem with the HRT is it makes one gain weight. My mom was slender like me before she went on it. Now she is of a weight that, for me, requires insulin, and, for her is fat.

My Doctor told me "We don't do HRT, anymore, so, I was surprised to see this article. Then, I read it, and, now I know why my Doctor told me "We don't do HRT, anymore." There is hope, though,I know a woman wise in the womanly health arts, and, there are different more healthful ways to deal with the journey to menopause.

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bioidentical or not - estrogen replacement

posted by Jeffrey Holman on 28 May 2012 at 6:26 pm

does any one know if estrogen replacement was bioidentical or equine?

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Progesterone, DHEA, Testosterone

posted by Amy on 28 May 2012 at 6:15 pm

What about other hormones that support and work in concert with estrogen? If only these tests would consider progesterone in lieu of progestin.

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MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.