Hormone replacement therapy

:This article is about the treatment with sex steroids. For hormone replacement therapy in general, and for other instances in which hormones might be prescribed, see hormone therapy.

Results of the WHI hormone replacement therapy studies

Much of the controversy regarding hormone replacement therapy (HRT) result from a study by the Women's Health Initiative, which came out in 2002 http://jama.ama-assn.org/cgi/content/abstract/288/3/321%20. It followed 16,608 women, aged 50 to 79 (average age = 63 at study intake), for 5.2 years who were either on a combination of progestins and equine estrogens (8506 women) or a placebo (8102 women). The WHI study found that the measured risks of this combination outweighed its measured benefits (see the table, below). Regrettably, the results were almost universally mis-reported as risks and problems associated with HRT in general, rather than with the specific proprietary combination of progestins and equine estrogens that was actually studied.

Related Topics:
Women's Health Initiative - Placebo

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Adverse event

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Relative risk

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(95% CI)

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Change in number of eventsper 10,000 women in one year

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Breast cancer

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1.26 (1.00-1.59)

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8 more

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Heart disease

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1.29 (1.02-1.63)

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7 more

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Stroke

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1.41 (1.07-1.85)

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8 more

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Pulmonary embolism

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2.13 (1.39-3.25)

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8 more

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Colorectal cancer

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0.63 (0.43-0.92)

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6 fewer

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Hip fracture

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0.66 (0.45-0.98)

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5 fewer

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It is not clear to what extent the results of the "Progestin plus Estrogen" study (above) should be applied to women who begin HRT at a young age. For the women age 50-59 in this study, there was an observed trend towards a reduced risk of cardiovascular disease (relative risk = 0.56, 95% CI 0.30-1.03) and a statistically significant increase in blood clotting was not observed (relative risk for stroke = 1.08, 95% CI 0.57-2.04). Absent research with bioidentical estrogen and progesterone, there is no sure basis assessing whether the results of this study are relevant to other forms of estrogen replacement therapy such as topically administered estradiol and estriol. Results from other studies suggest that when equine estrogens are administered orally, liver function is altered and the risk of blood clots is increased http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12927428. The results of the WHI ?Estrogen Alone? clinical trial suggest that the synthetic progestin used in the "Estrogen-plus-Progestin" study was the cause of the increased risk of breast cancer, rather than the equine estrogens. In the "Estrogen Alone" clinical trial http://jama.ama-assn.org/cgi/content/full/291/14/1701 there was an observed trend towards a reduced risk of breast cancer (relative risk = 0.77, 95% CI 0.59-1.01)

Related Topics:
Topically - Estradiol - Estriol

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