Search results for HRT

Under pressure: still drinking the HRT kool-aid?

Posted by Liz on Jul 16, 2012 in heart disease, HRT | 0 comments

Proponents of hormone replacement therapy (HRT) want you to believe that the only negative analyses that are being published are the ones that examine data from the Women’s Health Initiative study. Guess what? That is not true. In fact, there is an evolving body of literature looking at other studies that are coming to similar conclusions: HRT may be a panacea for hot flashes, night sweats and mood swings. But when it comes to cancer and heart disease, you’ve got to be vigilant and aware of your risks. And yet, women continue to be ‘under pressure’ to look the other way, embrace the ‘same as it ever was’ and sift through the facts and fallacies.

Nowhere is the confusion greater than with heart disease. Some data show that long-term HRT protects against heart disease while others suggest that HRT does not.

So does it or doesn’t it?

According to study findings published this month in PLOS ONE, it does not. In fact, the longer you use HRT, the greater your risk of developing high blood pressure, a major, proven factor in heart disease. Here’s what you need to know about this latest information:

• Researchers examined information collected on over 43,000 Australian women who were part of a large-scale study on aging. The women were 45 and older, postmenopausal, had an intact uterus and had not been diagnosed with high blood pressure prior to entering menopause.
• Factors that might influence high blood pressure risk, such as obesity, smoking or lack of physical activity were also examined. On average, the women in the study who used HRT reported having sufficient levels of physical activity, were past (but not current) smokers, drank alcohol and had a healthy body-mass index.
• In the study, the average age that women entered menopause and had ever used HRT was 48 years and most were about 52 years old when they started hormone replacement. Comparatively, women who used HRT developed high blood pressure by age 58.
• The findings showed that younger women (<55 to 61 years) who used HRT had 1.5 times the odds of developing high blood pressure than women who did not. The risk dropped slightly as women got older (between the ages of 62 and 70, HRT users had 1.2 times greater odds of high blood pressure).
• The longer that HRT was used, the greater the odds of developing high blood pressure, with highest risk among women who had used hormone replacement for 6 to 10 years or more. Again, as women in the study age, this risk appeared to decline.

One of the biggest criticisms of the Women’s Health Initiative was that it looked at an older group of women who were not representative of the average age that menopause starts. Here, the data show that in younger women, the odds of HRT being associated with high blood pressure are significant regardless of other potential confounding lifestyle factors. The investigators say that women should be prescribed HRT for the shortest time as possible and that they should be closely monitored for blood pressure before, during and after they stop hormones. Further, they state that “high blood pressure should be conveyed as a health risk for people considering MHT (menopausal hormonal therapy) use.” They also add that these recommendations are aligned with current recommendations for hormone use by the US Food & Drug Administration.

Are you still drinking the HRT kool-aid? You may want to switch beverages, especially if you care about your heart.

Newsflash! U.S. Preventive Services Task Force Weighs in on HRT

Posted by Liz on Jun 4, 2012 in estrogen, HRT | 2 comments

Just like the Energizer bunny. HRT and bad news. When are women and practitioners going to believe the data and stop trying to find the silver lining?

This month’s news is from the U.S. Preventive Services Task Force, who issued a recent update of the evidence for or against the use of hormone replacement for menopausal symptoms; that update appears in the online edition of Annals of Internal Medicine.

Rather than bore you with the details, I’m going to cut to the chase and get to the heart of their findings:

• Estrogen plus progestin or estrogen alone provides significant protection against hip and vertebral fractures that result from osteoporosis and aging.
• Contrary to initial results from the Women’s Health Initiative study, use of estrogen plus progestin significantly increases the risk for invasive breast cancer.  Estrogen alone offers some protection against invasive breast cancer.
• Updated analyses also demonstrate that combination HRT also significantly increases risk for stroke, blood clot events, death from lung cancer, gallbladder disease and urinary incontinence.
• Estrogen alone increases the risk for stroke, blood clot events, gallbladder disease and urinary incontinence.

One of the primary arguments that proponents of hormone therapy have used consistently is that these data are restricted to women who are older and are not applicable to women who are perimenopausal or in the earliest stages of menopause. And yet, a variety of medical organizations caution against using HRT as a chronic disease prevention strategy, including the Canadian Task Force on Preventive Health Care, American Heart Association and American College of Obstetricians and Gynecologists.

Even the FDA posits that if you are going to use hormone replacement, you should use it in the short-term and only for ameliorating menopausal symptoms or preventing bone loss. And yet, if you read through four years of Flashfree or click on the tag cloud, you’ll find a number of alternative strategies to offer relief without the slippery risk slope.

What more can I say? Be informed so that you can make informed decisions. If a few less hot flashes or night sweats in the short term means a potential road of illness in the long-term, the benefit-risk ratio may not be worth it. Then again? Only you can decide.

Newsflash! Trust your gut: HRT and ulcerative colitis

Posted by Liz on Apr 20, 2012 in estrogen, HRT | 2 comments

Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and sores in the lining of the large intestine. The disease affects men and women in equal numbers and risk is higher among Caucasians and Jews. Yet, although it most commonly develops between the ages of 15 and 30, ulcerative colitis has a brand new bag, so to speak: women in menopause taking hormone replacement therapy (HRT). Yikes! Another nail in that HRT coffin. And this time, both combination hormone therapy (i.e. estrogen plus progesterone) and estrogen only appear to play a role.

Investigators will be reporting study findings (which are derived from following more than 108,000 postmenopausal women enrolled in the Nurses Health Study) at the American Gastrointestinal Association’s Annual meeting next month. Information on this group of women was updated every two years for 32 years, including menopausal status, use of hormones and medical diagnoses. The findings? Compared to women who never used hormones, women who did, regardless of type, had a 1.7 times greater risk for developing ulcerative colitis. Notably, this risk increased with longer duration of hormone use and decreased the longer the time period since stopping hormones. In fact, risk declined by almost 25% in women who had discontinued hormones for five or more years.

It was once believed that stress caused ulcerative colitis but experts now hypothesize that it’s triggered by a virus or bacteria that attacks the immune system, or is hereditary. So where do hormones come into play? Apparently, estrogen may play a role in controlling how the lining of the intestine functions to keep out toxins but let in nutrients, electrolytes and water as well as inflammation. Replacing estrogen with hormone therapy may act to create an imbalance that sends the system into overdrive but researchers are still not clear how and why.

Meanwhile? Hormone replacement therapy may increase your risk for developing ulcerative colitis as you age. You should always trust your gut. What is it telling you about HRT?

Breathe. What you need to know about asthma and HRT

Posted by Liz on Sep 30, 2011 in asthma, HRT, menopause | 0 comments

If you suffer from asthma, you will want to take note: researchers presenting at this week’s European Respiratory Society AnnualConference have shown that female asthmatics have an increased risk of landing in the hospital if they take hormone replacement therapy (HRT). Yet another nail in the HRT coffin, once again demonstrating that the health risks of taking hormone replacement may outweigh the benefits.

Notably, studies have shown that asthma risk increases in women after puberty. Moreover, hormones, most specifically fluctuating estrogen levels, can impact airways as much as allergies and hay fever (fluctuating estrogen levels can produce an inflammatory response and exacerbate breathing difficulties). On average, asthma symptoms develop in about 21% of menopausal women and more than twice as many using hormone therapy.

In this study of over 23,000 Danish women with documented asthma, researchers looked specifically at hospitalizations for severe reactions. They also collected information on smoking, exposure to smoke, body mass index, level of physical activity, history of hysterectomy and use of HRT.  The findings? Using HRT increased the risk for hospitalization for severe asthma reactions by as much as 40% compared to not using hormone therapy. What’s more, the longer the women used HRT, the higher their risk of ending up in the hospital; for example, if they used it for less than 3 years, they have a 29% increased risk and if they used it for more than 10, a 51% increased risk. Even more troubling was the fact that women didn’t smoke appeared to have the highest risk for being hospitalized in association with their HRT use.

Although this isn’t a randomized trial, and more information is needed, the researchers still recommend that practitioners be made aware of these findings. They say that the relationship between asthma and female sex hormones is hardly new, but that their findings confirm the relationship and further our understanding of it by showing the extent of severe asthma reactions that occur when women take hormones. “If a patient develops asthma or has a severe worsening of symptoms after taking HRT, they may need to stop hormone therapy altogether,” they add.

Newsflash: International Menopause Society has issued updated guidelines on HRT

Posted by Liz on Jun 10, 2011 in HRT | 7 comments

Got news?

I sure do!

The International Menopause Society has issued updated recommendations on the use of hormone replacement therapy (HRT, a term that they use to refer to estrogen, progesterone, combined therapies, androgens and tibolone). They note that the current guidelines are similar to those issued in 2007 but “include additional clinical data where needed.” And while they claim that there are “no reasons to place mandatory limitations on how long HRT is used (which by the way, runs counter to current recommendations of several major national and international medical associations), they do emphasize that HRT “should not be recommended without a clear indication for use, i.e. significant symptoms or physical effects of estrogen deficiency.”

The following are some highlights of the updated report:

• HRT should be used at the lowest effective dose to effectively reduce symptoms and maintain life quality
• Women who enter early menopause either spontaneously or due to hysterectomy or other condition before age 45 and particularly before age 40 may be at increased risk for heart disease, osteoporosis, mental disorders or dementia. Notably, the evidence of reduction of this risk via HRT is limited but is nevertheless recommended to preserve bone and reduce symptoms, at least until they enter the average age for menopause (i.e. ~52)
• Progestogen should be added to estrogen in all women with an intact uterus to prevent endometrial malignancies and cancer (except for in the case of low-dose estrogen)
• HRT is recommended to preserve bone health although it should not be started after age 60 and loses its effectiveness once therapy is stopped.
• Despite the controversy as to whether or not HRT is heart protective, the IMS says that it has the potential to boost or improve one’s risk profile because of how it affects the vascular system, metabolism of blood sugar, blood pressure and cholesterol levels. However, this recommendation is also framed within the recommendation that women adopt major primary prevention measures, such as stopping smoking, regular exercise, weight control, blood pressure reduction, and control of diabetes and blood pressure.

So, what about the risks of HRT that I’ve long written about on this blog? The convened panel disputes the conclusion of the Women’s Health Initiative (due to average older age of participants and when they started HRT) as well as data that have come down the pike since 2002. In fact, they say that the link with breast cancer is controversial and that HRT doesn’t initiate cancer (but rather, promotes an existing tumour). They also concur that data are still lacking with regards to type of HRT, doses, and administration type and incidence of breast cancer. And, with regards to endometrial cancer or stroke? They write that women with a uterus should be certain to add a progesterone component to their hormones to counteract any undue stimulation of their endometrium, and that stroke risk is related to increasing age and obesity, noting that risks may be avoided by using an estrogen patch or stopping use of hormones after the age of 60.

In general, the conclusion of the panel is than “most menopausal women have little to fear from the adverse effects of HRT” and that the benefits of hormone therapy outweigh the risks. Still, they do suggest that the decision to take HRT should be discussed with a physician and reviewed annually.

Not surprisingly, alternative therapies are completely
discounted in the IMS guidelines and they do not support the use of any bioidentical hormones whatsoever. Moreover, they make a point to place blame on the media without providing clear examples of their claims for “superficial and uncritical evaluations” of HRT, as if all media were one and the same.

I am not quite sure what to make of these recommendations. On one hand, they claim to have reviewed all the data since WHI but this panel convened four years ago. And while they are sure to promote HRT within a cautious framework, menopause continues to be positioned as a disease requiring treatment.Indeed, one of the report authors, Dr. Roger Lobos (Columbia University, New York), says that “the bottom line is that most doctors nowadays should feel comfortable about prescribing HRT to most women going through the menopause [but] like most medicines, you need to look at individual circumstances before deciding to taken it.”

Notably, media are once again positioned as the big bad wolf that misconstrue findings and attack  pharmaceutical companies for their profit motivations.

Has anything really changed except the date of the report? Well, the good news is that the IMS acknowledges that there are risks associated with HRT, at least for some women. And yet, the report still appears lack objectivity.

Do yourself a favour. Speak to your practitioner. HRT will shut down your symptoms. Period. But you must ask yourself, at what cost? Do your research. Ask the hard questions. And then ask them again.

You may be sweating. But the issue is greater than the sum of all sweats.