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.
