Weighing the Risks and Benefits of Hormone Replacement Therapy
Dr. Mooser, you inaccurately summarized the WHI breast cancer results. For the E-alone group, the risk of breast cancer was actually REDUCED, 28/10,000 for E group, 34/10,000 for placebo group. For the E+P group, the risk of breast cancer was increased. One could conclude the the progestin used in the study, Provera (medroxyprogesterone acetate) was the culprit.
I think it's important to not use the terms "estrogen" and "progestin" but use the actual chemical names. You know that the conjugated equine estrogens are not chemically identical to estradiol, and that MPA or any of the other synthetic progestins are not identical to progesterone. So if you're going to quote studies about ill effects of HRT, make sure you are honest in reporting that the studies used non-bioidentical hormones. One can conclude pretty much nothing about bioidentical hormones from these studies.
And one more thing ... part of being well is feeling good and enjoying life. After fewer than 3 weeks of hot flashes and other miserable symptoms, I gave estradiol a try and I'm LOVING it. Within 2 days I had complete relief not only from the physical symptoms but the mental ones as well, most notably a depression that I had slid into very gradually and didn't even notice until estradiol picked me back up again. I'm getting more exercise, sleeping better, eating better, and have a renewed interest in activities that had ceased to excite me.
You cannot provide the best advice if the only things you are considering is breast cancer, which even for the WHI E+P group were still relatively rare (304/10,000, only 3%, compared to placebo's 228/10,000). Also, what about the benefits of HRT, significant reduced risk of bone fractures and reduced risk of diabetes?
Not to sound too insulting, but I advise women to do their own research, make a plan, and then find a doctor willing to follow that plan. After visiting 2 doctors, one who wanted me to take birth control pills and the other who wanted me to eat more soy, dress lightly (in 10 degree Chicago weather?), and take black cohosh, I found a progressive doctor who is totally on board with bioidenticals. I was already using progesterone and she prescribed estradiol gel. I feel better now at 49 than I did at 40.
Dr. Mooser, you inaccurately summarized the WHI breast cancer results. For the E-alone group, the risk of breast cancer was actually REDUCED, 28/10,000 for E group, 34/10,000 for placebo group. For the E+P group, the risk of breast cancer was increased. One could conclude the the progestin used in the study, Provera (medroxyprogesterone acetate) was the culprit.
I think it's important to not use the terms "estrogen" and "progestin" but use the actual chemical names. You know that the conjugated equine estrogens are not chemically identical to estradiol, and that MPA or any of the other synthetic progestins are not identical to progesterone. So if you're going to quote studies about ill effects of HRT, make sure you are honest in reporting that the studies used non-bioidentical hormones. One can conclude pretty much nothing about bioidentical hormones from these studies.
And one more thing ... part of being well is feeling good and enjoying life. After fewer than 3 weeks of hot flashes and other miserable symptoms, I gave estradiol a try and I'm LOVING it. Within 2 days I had complete relief not only from the physical symptoms but the mental ones as well, most notably a depression that I had slid into very gradually and didn't even notice until estradiol picked me back up again. I'm getting more exercise, sleeping better, eating better, and have a renewed interest in activities that had ceased to excite me.
You cannot provide the best advice if the only things you are considering is breast cancer, which even for the WHI E+P group were still relatively rare (304/10,000, only 3%, compared to placebo's 228/10,000). Also, what about the benefits of HRT, significant reduced risk of bone fractures and reduced risk of diabetes?
Not to sound too insulting, but I advise women to do their own research, make a plan, and then find a doctor willing to follow that plan. After visiting 2 doctors, one who wanted me to take birth control pills and the other who wanted me to eat more soy, dress lightly (in 10 degree Chicago weather?), and take black cohosh, I found a progressive doctor who is totally on board with bioidenticals. I was already using progesterone and she prescribed estradiol gel. I feel better now at 49 than I did at 40.
Posted by Tamara | October 3, 2009 12:03 PM