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Postmenopausal Hormone Therapy and the Risks of Coronary Heart Disease, Breast Cancer, and Stroke
Semin Reprod Med 2014; 32: 419-425DOI: 10.1055/s-0034-1384624The principal findings are briefly reviewed from the Women's Health Initiative trials of the most commonly used postmenopausal hormone regimens in the United States—conjugated equine estrogens and these same estrogens plus medroxyprogesterone acetate. A more detailed review is presented for three major clinical outcomes: coronary heart disease (CHD), the primary trial outcome for which a major benefit was hypothesized; invasive breast cancer, the primary safety outcome for which some adverse effect was expected; and stroke which surfaced as an important adverse...
Source: Seminars in Reproductive Medicine - October 16, 2014 Category: Reproduction Medicine Authors: Prentice, Ross L. Source Type: research

Women's Health Initiative clinical trials: potential interactive effect of calcium and vitamin D supplementation with hormonal therapy on cardiovascular disease
Conclusions: CaD did not consistently modify the effect of CEE therapy or CEE + MPA therapy on CVD events. However, the increased risk of stroke due to CEE therapy appears to be mitigated by CaD supplementation. In contrast, CaD supplementation did not influence the risk of stroke due to CEE + MPA.
Source: Menopause - August 1, 2019 Category: OBGYN Tags: Original Articles Source Type: research

Current recommendations: what is the clinician to do?
Menopausal hormone therapy (HT) has complex biologic effects but continues to have an important clinical role in the management of vasomotor and other menopausal symptoms. The rational use of menopausal HT requires balancing the potential benefits and risks of treatment. Findings from the Women's Health Initiative (WHI) and other randomized clinical trials have helped to clarify the benefits and risks of HT and have provided insights to improve decision making. Several clinical characteristics have utility in identifying women for whom benefits of HT are likely to outweigh the risks. Age and time since menopause are strong...
Source: Fertility and Sterility - March 31, 2014 Category: Reproduction Medicine Authors: JoAnn E. Manson Tags: Views and reviews Source Type: research

Women's Health Initiative estrogen plus progestin clinical trial: a study that does not allow establishing relevant clinical risks
Conclusions: The differences in RMST for the outcomes of the WHI study are too small to establish clinical risks related to hormone therapy use.
Source: Menopause - December 1, 2015 Category: OBGYN Tags: Original Articles Source Type: research

Hormone therapy not recommended for chronic disease prevention in menopausal women
Commentary on: Nelson HD, Walker M, Zakher B, et al.. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the US Preventive Services Task Force recommendations. Ann Intern Med 2012;157:104–13. Context In 2005, the US Preventive Services Task Force (USPSTF) updated its 2002 hormone replacement therapy recommendations, advising against the routine use of oestrogen and progestin (E+P) and unopposed oestrogen (E) to prevent chronic conditions in menopausal women. Menopausal hormone therapy (MHT) had been commonly prescribed to prevent conditions such as cardiovascula...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Wenger, N. K. Tags: Pancreas and biliary tract, Epidemiologic studies, Drugs: cardiovascular system, Dementia, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism, Memory disorders (psychiatry), Source Type: research

Menopausal hormone therapy has risks and benefits during the intervention and poststopping phase
This report summarises the previous WHI reports alongside 13 years of follow-up in 81.1% of surviving participants. Some selection bias may have occurred in the postintervention phase due to occurrences in the intervention phase. Methods Women were recruited from 1993 to 1998...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Warren, M. P. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism, Injury Prevention Source Type: research

Menopausal hormone therapy and ovarian cancer: putting risk into perspective
The wide use of menopausal hormone therapy (MHT) rapidly declined a decade ago after the results of the Women's Health Initiative (WHI) showed that women treated with conjugated equine estrogens plus medroxyprogesterone acetate had an increased risk of breast cancer, coronary heart disease, stroke, and pulmonary embolism [1]. Increased ovarian cancer risk was not reported in the randomized WHI intervention trial nor in the extended poststopping phases of the study [2].
Source: Maturitas - February 26, 2015 Category: Primary Care Authors: Faustino R. Pérez-López, Margaret Rees Source Type: research

Reprint of “Use of medroxyprogesterone acetate for hormone therapy in postmenopausal women: Is it safe?”
Publication date: Available online 19 August 2015 Source:The Journal of Steroid Biochemistry and Molecular Biology Author(s): Frank Z. Stanczyk, Bhagu R. Bhavnani Medroxyprogesterone acetate (MPA) has been in clinical use for over 30 years, and was generally considered to be safe until the results of long-term studies of postmenopausal hormone therapy (HT) using treatment with conjugated equine estrogens (CEE) combined with MPA and CEE alone suggested that MPA, and perhaps other progestogens, may play a role in the increased risk of breast cancer and cardiovascular diseases. This review examines critically the safety o...
Source: The Journal of Steroid Biochemistry and Molecular Biology - August 21, 2015 Category: Biochemistry Source Type: research

The evolving role of oral hormonal therapies and review of conjugated estrogens/bazedoxifene for the management of menopausal symptoms.
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 - February 1, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review
ConclusionsEvidence supporting bone and cardiovascular benefits of HT in women with POI is limited by high risk of bias, reliance on surrogate outcomes, and heterogeneity of trials regarding the formulation, dose, route of administration, and regimen of HT. Further research addressing patient important outcomes such as fractures, stroke, and cardiovascular mortality are crucial to optimize benefits of this therapy.
Source: Endocrine - October 16, 2017 Category: Endocrinology Source Type: research

In Defense of Progesterone: A Review of the Literature.
Conclusions • Physicians should have no hesitation prescribing natural progesterone. The evidence is clear that progesterone does not cause breast cancer. Indeed, progesterone is protective and preventative of breast cancer. PMID: 29055286 [PubMed - as supplied by publisher]
Source: Alternative Therapies in Health and Medicine - October 21, 2017 Category: Complementary Medicine Authors: Lieberman A, Curtis L Tags: Altern Ther Health Med Source Type: research

MHT in myocardial infarction and stroke survivors
30 years ago, it was believed that there is a clear cut protective effect of estrogen in women with coronary artery disease. This was based on studies that monitored the outcomes of postmenopausal hormone therapy (MHT) in women with various basal clinical scenarios, such as myocardial infarction, coronary angiography or coronary artery bypass. These studies were observational, and treatment usually comprised of conjugated equine estrogen alone or combined with medroxyprogesterone acetate. However, results of randomized, placebo-controlled trials (secondary prevention, but mainly primary prevention) pointed at neutrality or...
Source: Maturitas - May 14, 2019 Category: Primary Care Authors: Amos Pines Tags: INV25 Source Type: research

Randomized Trial Evaluation of Benefits and Risks of Menopausal Hormone Therapy Among Women Aged 50-59.
Abstract The health benefits and risks of menopausal hormone therapy among women aged 50-59 years are examined in the Women's Health Initiative randomized, placebo-controlled trials using long-term follow-up data and a parsimonious statistical model that leverages data from older participants to increase precision. These trials enrolled 27,347 healthy post-menopausal women aged 50-79 at 40 U.S. clinical centers during 1993-1998, including 10,739 post-hysterectomy participants in a trial of conjugated equine estrogens, and 16,608 participants with uterus in the trial of these estrogens plus medroxyprogesterone acet...
Source: Am J Epidemiol - October 7, 2020 Category: Epidemiology Authors: Prentice RL, Aragaki AK, Chlebowski RT, Rossouw JE, Anderson GL, Stefanick ML, Wactawski-Wende J, Kuller LH, Wallace R, Johnson KC, Shadyab AH, Gass M, Manson JAE Tags: Am J Epidemiol Source Type: research

Menopausal hormone therapy with conjugated equine estrogen is associated with a higher risk of hemorrhagic stroke than therapy with estradiol: a retrospective population-based cohort study
Estrogen therapy is prescribed for women without a uterus. For women with intact uteri, progestogens should be added to protect against endometrial hyperplasia. Different estrogen profiles may cause different side effects and beneficial clinical outcomes [1]. Different forms of estrogen also have different serum E2 concentrations; a previous study demonstrated that 1  mg E2 was equivalent to 0.4 mg CEE [1]. Progestin includes medroxyprogesterone acetate (MPA) and norethindrone acetate (NE). In Taiwan, the most common MHT for patients with an intact uterus are CEE (0.625 mg) or E2 (2 mg) combined with 5 mg MPA or 1 mg NE [2,3].
Source: Maturitas - August 1, 2022 Category: Primary Care Authors: Wei-Chuan Chang, Jen-Hung Wang, Dah-Ching Ding Tags: Original article Source Type: research