Hormone Replacement (Therapy): A Time for Interrogation, Information and Further Studies
The treatment of menopause relies mainly upon the use of estrogens to alleviate climacteric symptoms, increase bone mass, and consequently, potentially improve quality of life. Although a great deal of experimental data supports the beneficial effects of estrogen treatments on (arterial) cardiovascular prevention and brain function, it was recently discovered that some of the doses used, as well as certain routes of administration or different combinations with varying forms and doses of progestins, could increase the risk of cardiovas-cular events, breast cancer, and even dementia. The current literature clearly demonstrates the major controversy of administering hormone replacement therapy to women with increased risk of breast cancer and arterial cardiovascular complications because of their age notwithstanding the further risk due to some comorbid risk factors such as diabetes, high blood pressure, hyperlipidemia, etc. At this stage in our knowledge, a profound gap still exists between our hope, experimental information, and evidence-based medicine. Until this gap is closed or corrected, physicians must be very critical in their use of Hormone Replacement (HR), and use minimal doses in selected volunteer women that demand such a treatment to alleviate symptoms.
KeywordsPlacebo Estrogen Osteoporosis Dementia Estrogen Antagonist
Unable to display preview. Download preview PDF.
- Archer DF, Dorin M, Lewis V, Schneider DL, Pickar JH (2001) Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on endometrial bleeding. In: HOPE (Women’s Health, Osteoporosis, Progestin, Estrogen trial). Fertil Steril 75:1080–1087Google Scholar
- Barrett-Connor E, Grady D, Sashegyi A et al., for the MORE Investigators (Multiple Outcomes of Raloxifene Evaluation) (2002) Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 287:847–857CrossRefPubMedGoogle Scholar
- Cauley JA, Norton L, Lippman ME et al. (2001) Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation (erratum appears in Breast Cancer Res Treat 67:191). Breast Cancer Res Treat 65:125–134CrossRefPubMedGoogle Scholar
- Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, Rodabough RJ, Gilligan MA, Cyr MG, Thomson CA, Khandekar J, Petrovitch H, McTiernan A, for the WHI Investigators (2003) Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA 289:3243–3253Google Scholar
- Clarkson TB (2002) The new conundrum: do estrogens have any cardiovascular benefits. Int J Fertil 47(2):61–68Google Scholar
- Greendale GA, Wells B, Marcus R, Barrett-Connor E, for the Postmenopausal Estrogen/Progestin Interventions Trial Investigators (2000) How many women lose bone mineral density while taking hormone replacement therapy? Results from the Postmenopausal Estrogen/Progestin Interventions trial. Arch Intern Med 160:3065–3071CrossRefPubMedGoogle Scholar
- Greendale GA, Espeland M, Slone S, Marcus R, Barrett-Connor E, for the PEPI Safety Follow-up Study (PSFS) Investigators (2002) Bone mass response to discontinuation of long-term hormone replacement therapy: results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) safety follow-up study. Arch Intern Med 162:665–672CrossRefPubMedGoogle Scholar
- Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Patterson RE, Ara-gaki AK, Shumaker SA, Brzyski RG, LaCroix AZ, Granek IA, Valanis BG, The Women’s Health Initiative Investigators (2003) Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 348:1839–1854Google Scholar
- Scarabin PY, Oger E, Plu-Bureau G, and the Estrogen and Thromboembolism Risk (ESTHER) Study group (2003) Oral but not transdermal Estrogen Replacement Therapy is associated with venous thromboembolism. Lancet (in press)Google Scholar
- Shumaker SA, Legault C, Rapp SR, Thai L, Wallace RB, Ockene JK, Hen-drix SL, Jones III BN, Assaf AR, Jackson RD, Kotchen JM, Wassertheil-Smoller S, Watctawski-Wende J, for the WHIMS Investigators (2003) Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA 287:2651–2662CrossRefGoogle Scholar