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The evidence base for HRT: what can we believe?

The evidence base for HRT: what can we believe? Climacteric. 2017 Mar 10;:1-6 Authors: Langer RD Abstract Prior to the unexpected early termination of the Women's Health Initiative (WHI) trial of continuous conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA), the prevailing view was that hormone replacement therapy (HRT) was a low-risk intervention with immediate value for symptom relief in recently menopausal women, and that it probably conferred long-term protection against the major chronic diseases that affect women after menopause. Rather than replicating prior studies, the WHI was designed to test whether the beneficial associations consistently seen in women starting HRT near menopause would be found in women well beyond menopause. Views of the benefits and risks of HRT changed dramatically in 2002 with the unexpected early termination of the CEE + MPA trial and the alarming initial WHI report. HRT use plummeted world-wide, driven by fear of breast cancer and skepticism about cardiovascular benefits. Stunningly, the contrasting findings of the WHI trial of CEE alone reported 2 years later - suggesting prevention of coronary heart disease in women who began HRT at age
Source: Climacteric - Category: Geriatrics Authors: Tags: Climacteric Source Type: research

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This study, the first to examine potential adverse health effects in users of vaginal estrogen compared with non-users, suggests that vaginal estrogen therapy is a safe treatment for genitourinary symptoms such as burning, discomfort, and pain during intercourse associated with menopause.AUTHORSThe paper ’s authors are Dr. Carolyn Crandall of UCLA; Kathleen Hovey of the State University of New York at Buffalo; Christopher Andrews of the University of Michigan; Dr. Rowan Chlebowski of City of Hope; Marcia Stefanick of Stanford University; Dr. Dorothy Lane of the State University of New York at Ston y Brook; Dr. Jan Sh...
Source: UCLA Newsroom: Health Sciences - Category: Universities & Medical Training Source Type: news
Abstract The US Preventive Services Task Force (USPSTF) Draft Recommendation statement on Menopausal Hormone Therapy: Primary Prevention for Chronic Diseases, released in May 2017, perpetuates a major disconnect between the primary population affected, women within roughly 10 years of menopause, and the data cited. Furthermore, major elements of the evidence relied upon have been misinterpreted or misstated, particularly in regard to coronary heart disease and breast cancer, for which there is no statistically significant evidence of harm. As currently drafted, the recommendations reiterate the USPSTF statements o...
Source: Climacteric - Category: Geriatrics Authors: Tags: Climacteric Source Type: research
FINDINGSWhen it comes to assessing the risk of estrogen therapy for menopause, how the therapy is delivered — taking a pill versus wearing a patch on one’s skin — doesn’t affect risk or benefit, researchers at UCLA and elsewhere have found. But with the commonly used conjugated equine estrogen, plus progestogen, the dosage does. Higher doses, especially over time, are associated with greater risk of problems, including heart disease and some types of cancer, especially among obese women.BACKGROUNDThe Women ’s Health Initiative established the potential of estrogen therapy to increase or decrea...
Source: UCLA Newsroom: Health Sciences - Category: Universities & Medical Training Source Type: news
Conclusion Current population risk assessment of dietary Cd intake relies on estimates of dietary Cd intake and/or maintenance of threshold levels of urinary Cd that should protect the kidney from Cd-induced damage. Risk assessment using dietary Cd intake estimates has been questioned because they show only a marginal correlation with urinary Cd levels, a well-founded measure of lifetime intakes. Blood Cd levels, however, show a correlation with urinary Cd levels, and they could thus be of value in risk assessment; blood Cd levels ≥ 1 μg/L were associated with CKD, while blood Cd levels above 0.5 μg/L were associa...
Source: EHP Research - Category: Environmental Health Authors: Tags: Commentaries March 2017 Source Type: research
Authors: Parish SJ, Gillespie JA Abstract This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women's Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased th...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
Conclusions: In black postmenopausal women with prior hysterectomy, estrogen alone significantly reduced breast cancer incidence with no adverse influence on CHD, venous thromboembolism, or all-cause mortality. Favorable estrogen-alone global index effects in younger black women warrant further study.
Source: Menopause - Category: OBGYN Tags: Original Articles Source Type: research
Authors: van Leeuwen FE, Ng AK Abstract Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two- to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5- to 15-fol...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
In the late 1980s, several observational studies and meta-analyses suggested that hormone replacement therapy (HRT) was beneficial for prevention of osteoporosis, coronary heart disease, dementia and decreased all-cause mortality. In 1992, the American College of Physicians recommended HRT for prevention of coronary disease. In the late 1990s and early 2000s, several randomized trials in older women suggested coronary harm and that the risks, including breast cancer, outweighed any benefit. HRT stopped being prescribed at that time, even for women who had severe symptoms of menopause.
Source: Atherosclerosis - Category: Cardiology Authors: Tags: Review article Source Type: research
Commentary on: Dam M, Hvidtfeldt U, Tjønneland A, et al.. Five year change in alcohol intake and risk of breast cancer and coronary heart disease among postmenopausal women: prospective cohort study. BMJ 2016;353:i2314 . Context The hypothesis that alcohol consumption leads to reduced risk of coronary heart disease (CHD) has immense clinical and public policy implications. Some meta-analyses of observational epidemiological studies have reported that ‘moderate’ alcohol use significantly reduces CHD risk. However, this has been contested on multiple theoretical and empirical grounds,1–3 including ar...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Diet, Menopause (including HRT), Ischaemic heart disease, Alcohol, Health education, Smoking Aetiology/harm Source Type: research
Abstract Many menopause specialists follow the principle of prescribing postmenopausal hormone therapy (HT) for the shortest duration needed, in order to decrease the risk of some related serious adverse effects, such as breast cancer. Based on several large studies, it seems, however, that withdrawal of HT may be associated with immediate, though small increased risk of coronary heart disease and stroke. Cessation of HT correlates with increased risk of fractures as well. This information should be relayed to hormone users while discussing the continuation of HT with their health-care provider, but, since the pot...
Source: Climacteric - Category: Geriatrics Authors: Tags: Climacteric Source Type: research
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