Wednesday, October 3, 2012

To "e" or not to "e..."

is estrogen right for you?

Looks like another case study for participatory medicine.

New information  has called attention to flaws in the formerly-considered-definitive Women's Health Initiative study (WHI). After WHI was published in 2002, a once commonplace practice -- the prescription of estrogen, or "e" to women entering menopause -- fell out of favor and many women discontinued its use.

The WHI provided plenty of evidence that supplemental estrogen, aka "hormone therapy" (HT) or "hormone replacement therapy" (HRT), does more harm than good to women. For example, HT has been linked to higher rates of hormone-receptor positive breast cancer.

But today we have an announcement from a privately funded study called KEEPS - the Kronos Early Estrogen Prevention Study. It seems the participants' age and the type of therapy they received made a significant difference in their health outcomes. I haven't yet seen the data, but according to Medscape
There were some differences between the Women's Health Initiative and the KEEPS trial that may lead to real differences in outcome...The KEEPS trial included 727 healthy women ages 42 to 58 who were all within three years of the onset of menopause at baseline.
In keeping with the trend toward personalized medicine, we are beginning to get more nuanced messages emerging about HT.

JoAnn Manson, MD is highly regarded among women's health clinical researchers. In a recent paper she wrote "An emerging body of evidence suggests that it may be possible to identify women who are more likely to have favorable outcomes and less likely to have adverse events on HT."

Even the North American Menopause Society guideline now says:
In the decade since the first publication of results from the WHI..., much has been learned. There is a growing body of evidence that HT formulation, route of administration, and the timing of therapy produce different effects. Constructing an individual benefit-risk profile is essential for every woman (emphasis mine) considering any HT regimen. A woman's interest in using HT will vary depending on her individual situation, particularly the severity of her menopausal symptoms and their effect on her quality of life. The absolute risks known to date for use of HT in healthy women ages 50 to 59 years are low. In contrast, long-term HT or HT initiation in older women is associated with greater risks.
If you're perimenopausal and suffering, educate yourself and discuss HT with your doctor. Then decide together, based on your values as well as your individual clinical indications.

1 comment:

Eve Harris said...

Update! A Danish study gives us more evidence to ponder...