FEMALE HORMONE REPLACEMENT

HRT & Heart Benefits--etc.
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HRT for Postmenopausal Women, and PhARMA Profits First
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healther skin with HRT
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HRT & Heart Benefits--etc.
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Testosterone, Sex Drive, Feeling Better, etc--Mayo Clinic
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FDA Article on Menopause and HRT
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alcohol and higher estradiol and testosterone levels in postmenopausal women

This is not a new finding:  In the pharmacology textbook by Goodman

and Gilman Furthermore, estrogens produced a favorable lipoprotein

profile, promote vasodilation, inhibit the response to vascular injury

[the mechanism which produces plaque], and reduce atherosclerosis

(1553). 

    

By Joseph M. Kowalski, M.D.
Director of Investigational Interventions
Cardiovascular Institute of the South

From http://www.cardio.com/using.html, the Cariovascular Institute of South Lousiana. 

A new epidemiological study suggests that the heart benefits of estrogen supplements for post menopausal women continue quite late in life.

The study by the University of Pittsburgh Medical School found a 30 percent reduction in heart disease in white women age 65 to 74 who take estrogen supplements. The findings reinforce previous government research that revealed a 25 percent reduction in heart disease among women age 45 to 64 who took estrogen supplements.

Women rarely experience heart attacks before menopause. Researchers believe that estrogen offers some protection against the blood vessel blockage that causes heart attacks and strokes. Studies suggest that estrogen increases the "good" high-density lipoprotein (HDL) and lowers the "bad" low-density lipoprotein (LDL) in the blood, thus slowing the rate at which plaque builds up in the arteries.

Another recent report that strongly suggested a connection between estrogen levels and lower rates of heart attack came out of ongoing research at Harvard Medical School. The analysis of 32,000 nurses for four years in the Nurses Cohort Study showed that those taking estrogen appeared to have one half the risk of heart attack of those not taking the hormone.

The Harvard study also showed that women who go through early menopause (before age 40) have a significantly higher risk of heart disease. The study and its findings link the ovaries and its hormones --- estrogen and progesterone --- to heart health.

According to an article in the New England Journal of Medicine co-authored by investigators at Harvard Medical School and its affiliated Brigham and Women's Hospital, "...post menopausal women who take estrogen generally have lower rates of cardiovascular disease than women of similar age who do not take estrogen."

In the 1970s, when estrogen was first prescribed as a birth control measure for women, researchers feared elevated doses of estrogen would put women at higher risk for stroke and high blood pressure. Studies in the past 35 years have not confirmed those fears. Instead, they persist in showing that estrogen supplements for post-menopausal women provide a prolongation of the natural protection from heart disease they enjoyed in their child-bearing years.

Nevertheless, women enjoying the heart disease-resisting benefits of estrogen are in a minority. Only 15 to 30 percent of post-menopausal women in this country now take estrogen supplements -- in part because of concerns that it may be linked to an increase in the incidence of some cancers.

 

 

Gooman & Gilman and other journal articles

 

The numbers are for Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 11th edition (2006), which I bought--a balanced source for information. 

 

Estrogen increases the risk of endometrial cancer about 5 fold (thus the use of a prostaglandin). (1552). 

 

Loss of tissue lining the vagina or bladder leads to a variety of symptoms in many postmenopausal women.  These include dryness and itching of the vagina, dyspareunia, swelling of tissue in the genital region, pain during urination, a need to urinate urgently or ofte3n, and sudden or unexpected urinary incontinence. (1553)

 

Gallbladder disease 2-3 fold.

 

Breast cancer through (a) stimulating the growth rate of such cancer, (b) increase breast cell proliferation including those with mutations, (c) possible directly through the production of a reactive chemical (4-hydroxycatechol) from the production of catechol estrogens. (1553). 

 

Estrogens produce a favorable lipoprotein profile, promote vasodilatation, inhibit the response to vascular injury, and reduce atherosclerosis.  These effects should produce a reduction in cardiovascular disease in postmenopausal women; who ever in a couple of clinical trials this was not substantiated.  It is not clear if similar results would occur with different drugs/dose in different patient populations.  (1553)

 

 The Women’s Health Initiative also demonstrated that conjugated estrogen in combination with a progestin reduces the risk of colon cancer by roughly one-half in postmenopausal women. (1554). As I commented on my website, this more than makes up for the increased risk of breast cancer.

 

Osteoporosis: The primary mechanism by which estrogens act is to decrease bone resorption; consequently, estrogens are more effective at preventing rather than restoring bone loss.  Estrogens are most effective if treatment is initiated before significant bone loss occurs, and their maximal beneficial effects require continuous use; bone loss continues if treatment is discontinued. (1553).

 

About 1980, epidemiological studies indicated that this treatment increased the incidence of endometrial carcinoma.  This led to the use of HRT that includes a progestin to limit estrogen-related hyperplasia.   (1555).

 

Cardiovascular Disease:  The incidence of cardiovascular disease is low in premenopausal women, rising rapidly after menopause, and epidemiological studies consistently showed an association between estrogen use and reduced cardiovascular disease in postmenopausal women (1553).

Postmenopausal Hormone Use and Primary Prevention of Heart Disease and Stroke in Healthy Women

19 December 2000 | Volume 133 Issue 12 | Page S60

Summary on the web at http://www.annals.org/cgi/content/summary/133/12/933

The researchers studied 70,533 postmenopausal female nurses who had no known history of previous cardiovascular disease.

Starting in 1978, the researchers began collecting information on the type of hormones taken and, starting in 1980, on the dose of estrogen. Further follow-up surveys continued to update information on hormone use and asked whether the women had had a heart attack or stroke. The researchers confirmed all reported events, including deaths, by examining medical records and death certificates.

Women who took hormones were 40% less likely to have a heart attack than those who never used hormones. The risk was reduced by about the same amount regardless of whether women had taken high or low doses of estrogen. No difference in the risk for stroke was found between hormone users and nonusers. However, women who took 0.625 mg or more of oral conjugated estrogen per day (an average dose) and those who took estrogen with a progestin hormone had a higher risk for stroke than women who never used hormones. Overall, women who had used postmenopausal hormones were about 23% less likely to have a heart attack or stroke than women who had never taken them.

 

The Journal of Clinical Endocrinology & Metabolism Vol. 87, No. 4 1509-1516. 

Differential Effects of Oral Estrogen versus Oral Estrogen-Androgen Replacement Therapy on Body Composition in Postmenopausal Women

Adrian S. Dobs, Tam Nguyen, Cindy Pace and Carla P. Roberts
Copyright 2002 by The Endocrine Society.

 Estrogen-androgen (E/A) therapy is also used for vasomotor symptom relief and has been shown to increase lean body mass while decreasing fat mass.   After E/A treatment, there were statistically significant increases in lean body mass by 1.232 kg.  When subjects were given self-reporting questionnaires, more improvement was noted in sexual functioning and quality of life in the E/A group when compared with patients receiving E alone. There were no noteworthy side effects. When subjects were given self-reporting questionnaires, more improvement was noted in sexual functioning and quality of life in the E/A group when compared with patients receiving E alone. There were no noteworthy side effects. In conclusion, E/A replacement therapy can improve body composition, lower-body muscle strength, quality of life, and sexual functioning in postmenopausal women.

 

J Reprod Med. 1998 Oct;43(10):847-56

Estrogen and estrogen-androgen replacement in postmenopausal women dissatisfied with estrogen-only therapy. Sexual behavior and neuroendocrine responses.

 

RESULTS: Estrogen-androgen therapy significantly improved sexual sensation and desire after four and eight weeks of double-blind treatment in comparison to previous estrogen therapy and postplacebo baseline assessments.

CONCLUSION: Sexual desire, satisfaction and frequency in postmenopausal women taking hormonal therapy were improved significantly by combined estrogen-androgen therapy but not by estrogen or estrogen-progestin therapy.

 

 

 

Journal of the National Cancer Institute, Vol. 92, No. 4, 328-332, February 16, 2000
2000 Oxford University Press

 

Effect of Hormone Replacement Therapy on Breast Cancer Risk: Estrogen Versus Estrogen Plus Progestin

 

{Estrogen alone 6% higher, estrogen + prosgestin 24% higher}

 

BACKGROUND: Hormone replacement therapy (HRT) given as unopposed estrogen replacement therapy (ERT) gained widespread popularity in the United States in the 1960s and 1970s. Recent prescribing practices have favored combination HRT (CHRT), i.e., adding a progestin to estrogen for the entire monthly cycle (continuous combined replacement therapy [CCRT]) or a part of the cycle (sequential estrogen plus progestin therapy [SEPRT]). Few data exist on the association between CHRT and breast cancer risk. We determined the effects of CHRT on a woman's risk of developing breast cancer in a population-based, case-control study. METHODS: Case subjects included those with incident breast cancers diagnosed over 4 years in Los Angeles County, CA, in the late 1980s and 1990s. Control subjects were neighborhood residents who were individually matched to case subjects on age and race. Case subjects and control subjects were interviewed in person to collect information on known breast cancer risk factors as well as on HRT use. Information on 1897 postmenopausal case subjects and on 1637 postmenopausal control subjects aged 55-72 years who had not undergone a simple hysterectomy was analyzed. Breast cancer risks associated with the various types of HRT were estimated as odds ratios (ORs) after adjusting simultaneously for the different forms of HRT and for known risk factors of breast cancer. All P values are two-sided.

RESULTS: HRT was associated with a 10% higher breast cancer risk for each 5 years of use (OR5 = 1.10; 95% confidence interval [CI] = 1.02-1.18). Risk was substantially higher for CHRT use (OR5 = 1.24; 95% CI = 1.07-1.45) than for ERT use (OR5 = 1.06; 95% CI = 0.97-1.15). Risk estimates were higher for SEPRT (OR5 = 1.38; 95% CI = 1.13-1.68) than for CCRT (OR5 = 1.09; 95% CI = 0.88-1.35), but this difference was not statistically significant. Conclusions: This study provides strong evidence that the addition of a progestin to HRT enhances markedly the risk of breast cancer relative to estrogen use alone. These findings have important implications for the risk-benefit equation for HRT in women using CHRT.

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