HRT: Attention Women

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califpacific

Wed Oct 24, 2001 8:13 am

hrt - attention women

 

 

 

Each year, doctors prescribe hormone replacement therapy (HRT) to millions =

of women entering

menopause. They tell their patients how HRT offsets a woman's de=

creased ovarian hormone

production and how it thereby relieves the distress of hot flashe=

s, sweats, disturbed sleep and vaginal

dryness, while preventing cardio-vascular disease and osteoporosi=

s. According to a recent survey,

health care providers have reached ¾ of the postmenopausal female=

population with their counseling

on supplementation with exogenous hormones (1).

 

As physicians, the drug industry and the media continue to convin=

ce women that the benefits of

ingesting hormones outweigh any potential risk, the use of HRT st=

eadily rises. During the period from

1982 to 1992, the use of hormone therapy in the U.S. more than do=

ubled (2) and today about a third

of women aged 45 to 65 rely on it (3,4). Such widespread promoti=

on of this treatment implies that

credible science has proven it safe and effective, but unfortunat=

ely this is not so.

 

As early as 1994, a study in the British Medical Journal revealed=

that 3 meta-analyses showing a

reduced risk of cardiovascular diseases in HRT users were flawed =

because their results were due to

the selection of healthy sample populations, rather than to a pro=

tective effect of HRT.(5) The

authors concluded that routine prescription of HRT for the preven=

tion of cardiovascular disease was

not warranted. Unfortunately they were ignored, as were research=

ers who, 25 years earlier, had

reported increased heart attacks and death in men given high dose=

s of estrogens, compared to the

control group.(6)

 

In 1997, the British Medical Journal again published a study that=

debunked the theory that HRT

protects the cardiovascular system. This time, analysis of the re=

sults of 22 trials involving more than

4,000 post-menopausal women showed that women given exogenous hor=

mones had a 40% greater

incidence of cardiovascular events other than pulmonary embolism =

and deep venous thrombosis, and

a 64% increased incidence of cardiovascular events including veno=

us thrombembolism, compared to

those not taking hormones.(7)

 

Current reports confirm that, not only does HRT not avert cardiov=

ascular disease, but it may play a

causative role in a wide range of adverse effects, including hear=

t attacks. A study in the February

2000 issue of The Lancet, for instance, examined the results of t=

rials submitted to the Finnish Drug

Agency by drug companies seeking licensing approval of HRT drugs.=

They judged the quality of the

trials and their reporting of adverse events to be inadequate, bu=

t analysis of the 6 that met the criteria

to be included in the study, revealed that users of HRT had a two=

-fold increased incidence of

cardiovascular and thromboembolic events, compared to nonusers.(8=

)

 

In 1998, the Journal of the American Medical Association publishe=

d the results of the double-blind,

placebo-controlled HERS trial which examined the effect of HRT on=

over 2700 post- menopausal

women with coronary heart disease. Women on HRT had a 50% increa=

sed risk of coronary heart

disease events in the first year of treatment, and fewer events i=

n the 4th and 5th year, compared to

women on placebo. In addition, women on HRT had an almost 3-fold =

increased incidence of deep

venous thrombosis and pulmonary embolism, compared to those takin=

g placebos, and a 40%

increased rate of gallbladder disease. The two groups had similar=

rates of fractures (9)

 

Recently, the preliminary results of a trial by the NIH's Nationa=

l Heart, Lung, and Blood Institute

showed that women on hormone therapy had experienced more heart a=

ttacks, strokes, deep venous

thrombosis and pulmonary embolism, compared to those on a placebo=

..(10) This ongoing trial, which

will last up to 11 years, is being conducted on 27,000 women aged=

50-79, who had been randomly

assigned to receive estrogen, estrogen plus a progestin, or a pla=

cebo.

 

Even in the face of extensive research documenting the downside o=

f HRT, the scientific community

is reluctant to change its practices. As of August 2000, the Nati=

onal Women's Health Information

Center still stated that: " most scientists think that for most wo=

men, the benefits of hormone

replacement therapy (for example, a reduction in the risk of oste=

oporosis and possibly of

cardiovascular disease) clearly outweigh the possible cancer risk=

s " (11) In fact, the AMA's

" Complete Guide to Women's Health " (available online) recommends =

that to reduce their risk of heart

disease women should " consider hormone replacement therapy (HRT).=

" (12) The American

Academy of Family Physicians' brochure " Menopause: What to Expect=

When Your Body is

Changing, " reassures women that HRT " reduces the risk of osteopor=

osis (a problem with the bones)

and heart disease (such as heart attacks) " (13) The US Food and D=

rug Administration also reports in

its online document, " Help for Menopause, " that " besides protecti=

ng against osteoporosis, researchers

think that estrogen also lowers the risk of heart disease. " (14)

 

We are struck by the number of so-called experts who choose to ig=

nore the mounting evidence of

heart attack risk associated with HRT. Why do they release state=

ments to the media calling results

" inconclusive " and warning women against making decisions about i=

nterrupting treatment? How can

they ignore studies like the one in the May 2000 Annals of Intern=

al Medicine that showed that

women on HRT experienced a three-fold higher rate of deep venous =

thrombosis and pulmonary

embolism compared to those on placebos (15), as well as numerous =

other studies (16-19) that reach

similar conclusions? We wonder whether they are ignorant of thes=

e findings or is it that they are

swept up by vested personal and industry interests?

 

As if the evidence of increased cardiovascular risk were not dam=

ning enough, there are also credible

studies that link synthetic hormones with breast cancer, showing =

increased risk with duration and

dosage. In 2000, J.A.M.A. published a study conducted on more tha=

n 46,000 women that showed

that estrogen replacement therapy increased breast cancer risk by=

20% and even more when a

progestin was added. Women who took an estrogen-progestin combin=

ation in the previous 4 years

were found to have a 40% increased risk of breast cancer, compare=

d to nonusers. The authors

concluded that each year of use of combination therapy increased =

the risk of breast cancer by

8%.(20)

 

Another article, in the February 2000 issue of the Journal of the=

National Cancer Institute, confirmed

that HRT with estrogen and progestin increases the risk of breast=

cancer more than HRT with

estrogen alone. For every five years of treatment, the study demo=

nstrated a 6% increased incidence

of breast cancer in women using estrogen only, and a 24% increase=

in those using an

estrogen-progestin combination, compared to nonusers.(21) In fac=

t, 3 years earlier, researchers had

reported that women using HRT for more than 10 years had a twofol=

d increased incidence of breast

cancer, compared to nonusers. The incidence was significantly hig=

her in women who used an

estrogen-progestin combination (2.4-fold increase) compared to un=

opposed estrogen (30%

increase).(22)

 

It is noteworthy that the above studies conclude that the estroge=

n-progestin combination is more

dangerous than estrogen alone. Ironically progestins had been in=

troduced because unopposed

estrogens had increased the incidence of uterine cancer. The solu=

tion, merely substituted problems,

as HRT has been conservatively estimated to cause an excess of 2,=

6, and 12 breast cancers for

every 1,000 women who use it for 5, 10, and 15 years, respectivel=

y.(23) Considering that a third of

U.S. women aged 45 to 65 years use some form of HRT, the implicat=

ions of its breast cancer

promoting effect on the population (some 16 million women) are en=

ormous.

 

Unfortunately, the dangers of HRT reach beyond the cardiovascular=

system and the breast. Use of

HRT has also been associated with a 30% to 2-fold increased risk =

of ovarian cancer(24-27) and, for

users of unopposed estrogens, with a 3- to 5-fold increased risk =

of uterine cancer.(28-31)

Additionally, women who use HRT have a two-fold increased risk of=

undergoing gallbladder

removal(32-33) and of developing systemic lupus erythematosus.(34=

,35) In both instances, the risk

increases with the duration of hormone intake.

 

In light of the above, we invite readers to carefully review the =

following studies which document the

effects of HRT on multiple systems.

 

 

 

HRT REFERENCES

 

 

 

Ref 1. The North American Menopause Society 1998 Menopause Survey=

: Part II. Counseling About

Hormone Replacement Therapy: Association With Socioeconomic Statu=

s and Access to Medical

Care. Ettinger B, Fugate Woods N, Barrett-Connor E, Pressman A. M=

enopause: The Journal of The

North American Menopause Society. Vol. 7, No. 3, pp. 143 - 148.

 

Ref 2. Use of menopausal estrogens and medroxyprogesterone in the=

United States, 1982-1992.

Wysowski DK, Golden L, Burke L. Obstet Gynecol 1995 Jan;85(1):6-1=

0.

 

Ref 3. Use of hormone replacement therapy by postmenopausal women=

in the United States.

Keating NL, Cleary PD, Rossi AS, Zaslavsky AM, Ayanian JZ.

Ann Intern Med 1999 Apr 6;130(7):545-53.

 

Ref 4. Use of postmenopausal hormone replacement therapy: estimat=

es from a nationally

representative cohort study. Brett KM, Madans JH. Am J Epidemiol.=

1997 Mar 15;145(6):536-45.

 

Ref 5. Cardioprotective effect of hormone replacement therapy in =

postmenopausal women: is the

evidence biased? Posthuma WF, Westendorp RG, Vandenbroucke JP.

BMJ 1994 May 14;308(6939):1268-9.

 

Ref 6. Early risk of Hormone Therapy in Patients With Coronary He=

art Disease. Wenger NK,

Knatterud GL, and Canner PL. JAMA, Vol. 284 No. 1, July 5, 2000. =

 

 

Ref 7. Impact of postmenopausal hormone therapy on cardiovascular=

events and cancer: pooled data

from clinical trials. Hemminki E, et al. BMJ 1997;315:149-153 (19=

July).

 

Ref 8. Value of drug-licensing documents in studying the effect o=

f postmenopausal hormone therapy

on cardiovascular disease. Hemminki R, McPherson K. Lancet 2000 F=

eb 12;355(9203):566-9.

 

Ref 9. Randomized trial of estrogen plus progestin for secondary =

prevention of coronary heart

disease in postmenopausal women. Heart and Estrogen/progestin Rep=

lacement Study (HERS)

Research Group. Hulley S, et al. JAMA 1998 Aug 19;280(7):605-13. =

 

 

Ref 10. Hormone Replacement Therapy Study Fact Sheet and WHI HRT =

Update.

www.mhlbi.nih.gov/whi/hrt.htm and www.mhlbi.nih.gov/whi/hrt-en.ht=

m

 

Ref 11. http://www.4woman.gov/menopaus.htm

 

Ref 12. From the AMA Complete Guide to Women's Health.

http://www.ama-assn.org/insight/h_focus/wom_hlth/menopaus/menopau=

s.htm

 

Ref 13. Menopause: what to expect when your body is changing " AAF=

P Family Health Facts " series.

http://www.nlm.nih.gov/cgi/medlineplus/leavemedplus.pl?theURL=htt=

p%3A%2F%2Ffamilydoctor%2Eorg%2Fhealthfacts%2F125%2Findex%2Ehtml

 

Ref 14. http://www.fda.gov/opacom/lowlit/menopause.html

 

Ref 15. Postmenopausal hormone therapy increases risk for venous =

thromboembolic disease. The

Heart and Estrogen/progestin Replacement Study. Grady D, et al. A=

nn Intern Med 2000 May

2;132(9):689-96.

 

Ref 16. Hormone replacement therapy and risk of venous thromboemb=

olism: population based

case-control study. Perez Gutthann S, Garcia Rodriguez LA, Castel=

lsague J, Duque Oliart A.BMJ

1997 Mar 15;314(7083):796-800.

 

Ref 17. Risk of hospital admission for idiopathic venous thromboe=

mbolism among users of

postmenopausal oestrogens. Jick H; Derby LE; Myers MW; Vasilakis =

C; Newton KM. Lancet,

348(9033):981-3 1996 Oct 12.

 

Ref 18. HRT and the risk of deep vein thrombosis. Barlow DH. Int =

J Gynaecol Obstet, 59 Suppl

1():S29-33 1997 Oct.

 

Ref 19. Prospective study of exogenous hormones and risk of pulmo=

nary embolism in women.

Grodstein F, et al. Lancet, 348(9033):983-7 1996 Oct 12.

 

Ref 20. Menopausal Estrogen and Estrogen-Progestin Replacement Th=

erapy and Breast Cancer

Risk. Schairer C, et al. JAMA 2000;283:485-491.

 

Ref 21. Effect of Hormone Replacement Therapy on Breast Cancer Ri=

sk: Estrogen

Versus Estrogen Plus Progestin. Ross, RK et al. J Natl Cancer Ins=

t. 2000 Feb 16;92(4):328-332.

 

Ref 22. Hormone replacement therapy and the risk of breast cancer=

.. Nested case-control study in a

cohort of Swedish women attending mammography screening.

Persson I, Thurfjell E, Bergstrom R, Holmberg L. Int J Cancer 199=

7 Sep 4;72(5):758-61.

 

Ref 23. The adverse effects of hormone replacement therapy. Tavan=

i A, La Vecchia C. Drugs

Aging 1999 May;14(5):347-57.

 

Ref 24. Hormone replacement therapy and the risk of epithelial ov=

arian carcinoma: a meta-analysis.

Garg PP, Kerlikowske K, Subak L, Grady D. Obstet Gynecol 1998 Sep=

;92(3):472-9.

 

Ref 25. Hormonal therapy for menopause and ovarian cancer in a co=

llaborative re-analysis of

European studies. Negri E, et al. Int J Cancer 1999 Mar 15;80(6):=

848-51.

 

Ref 26. Estrogen replacement therapy and risk of epithelial ovari=

an cancer.

Risch HA.Gynecol Oncol 1996 Nov;63(2):254-7.

 

Ref 27. Hormone replacement therapy and risk of epithelial ovaria=

n cancer.

Purdie DM, et al. Br J Cancer 1999 Oct;81(3):559-63.

 

Ref 28. Risk of endometrial cancer following estrogen replacement=

with and without

progestins.Weiderpass E, et al. J Natl Cancer Inst 1999 Jul 7;91(=

13):1131-7.

 

Ref 29. Risks of breast and endometrial cancer after estrogen and=

estrogen-progestin replacement.

Persson I, Weiderpass E, Bergkvist L, Bergstrom R, Schairer C. Ca=

ncer Causes Control 1999

Aug;10(4):253-60.

 

Ref 30. Menopausal hormone use and endometrial cancer, by tumor g=

rade and invasion. Shapiro JA,

Weiss NS, Beresford SA, Voigt LF. Epidemiology 1998 Jan;9 (1): 99=

-101.

 

Ref 31. Long-term surveillance of mortality and cancer incidence =

in women receiving hormone

replacement therapy. Hunt K, Vessey M, McPherson K, Coleman M. Br=

J Obstet Gynaecol 1987

Jul;94(7):620-35.

 

Ref 32. Postmenopausal hormone use and cholecystectomy in a large=

prospective study. Grodstein F,

Colditz GA, Stampfer MJ. Obstet Gynecol 1994 Jan;83(1):5-11.

 

Ref 33. Increased risk of cholecystectomy in users of supplementa=

l estrogen.

Petitti DB, Sidney S, Perlman JA. Gastroenterology 1988 Jan;94(1)=

:91-5.

 

Ref 34. Postmenopausal estrogen replacement therapy and the risk =

of developing systemic lupus

erythematosus or discoid lupus. Meier CR; Sturkenboom MC; Cohen A=

S; Jick H. J Rheumatol,

25(:1515-9 1998 Aug.

 

Ref 35. Postmenopausal estrogen therapy and the risk for developi=

ng systemic lupus erythematosus.

Sanchez-Guerrero J, Liang MH, Karlson EW, Hunter DJ, Colditz GA. =

Ann Intern Med 1995 Mar

15;122(6):430-3.

 

 

 

HRT & CARDIOVASCULAR DISEASE.

 

 

 

Hormone Replacement Therapy Study Fact Sheet & WHI HRT Update

www.mhlbi.nih.gov/whi/hrt.htm and www.mhlbi.nih.gov/whi/hrt=

-en.htm

 

This online document reports on the preliminary results of a tria=

l conducted by the NIH' National

Heart, Lung, and Blood Institute, indicating that hormone replace=

ment therapy increases the risks of

heart attack, stroke and venous thromboembolism in post-menopausa=

l women. The trial, designed to

last up to 11 years, is being conducted on 27,000 women aged 50-7=

9, who had been randomly

assigned to receive estrogen, estrogen plus a progestin, or place=

bo. Up to this point, women on

hormone therapy experienced more heart attacks, strokes, deep ven=

ous thrombosis and pulmonary

embolism, compared to those on placebo. These findings add to the=

results of several recent studies

indicating that post-menopausal hormone replacement therapy, rath=

er than exerting protective effects,

may in fact be associated with an excess risk of fatal and nonfat=

al cardiovascular events.

 

 

 

Study Throws Doubt On Protective Effects Of HRT For Heart Disease=

..

Gottlieb S.

BMJ 2000;320:826 ( 25 March).

 

This article reports on the results of the Estrogen Replacement a=

nd Atherosclerosis (ERA) Trial,

presented at the American College of Cardiology's 49th annual sci=

entific meeting held in California,

showing that hormone replacement therapy has no beneficial effect=

s on the cardiovascular system.

The study was conducted on 309 post-menopausal women with coronar=

y heart disease who were

randomly assigned to receive one of three treatments: estrogen, e=

strogen plus progestin, or placebo.

Women were followed-up for 3.5 years and disease progression was =

assessed through coronary

angiography, a test used to detect the blockages caused by harden=

ing in the arteries. No differences

in disease progression were observed between the three groups, su=

ggesting that neither estrogen

alone nor estrogen combined with a progestin, offer protection to=

women from heart disease.

 

 

 

Impact Of Postmenopausal Hormone Therapy On Cardiovascular Events=

And

Cancer: Pooled Data From Clinical Trials.

Elina Hemminki, et al.

BMJ 1997;315:149-153 (19 July).

 

This study reviewed the results of 22 trials conducted on 4,124 p=

ost-menopausal women comparing

the effects of hormone replacement therapy, placebo, no therapy, =

or vitamins on the incidence of

cardiovascular diseases. The results of the analysis indicated th=

at, overall, women who took

hormones had a 40% increased risk of cardiovascular events other =

than pulmonary embolism and

deep vein thrombosis, and a 64% increased risk of cardiovascular =

events including venous

thrombembolism, compared to women who did not take hormones. Thes=

e results are in contrast with

the commonly held assumption that hormone replacement therapy pre=

vents cardiovascular diseases.

 

 

 

Value Of Drug-licensing Documents In Studying The Effect Of Postm=

enopausal

Hormone Therapy On Cardiovascular Disease.

Hemminki R, McPherson K.

Lancet 2000 Feb 12;355(9203):566-9.

 

The results of this study indicate that use of hormone replacemen=

t therapy (HRT) is associated with

a 2-fold increased risk of cardiovascular and thromboembolic dise=

ase in postmenopausal women.

These findings come from the analysis of the results of trials su=

bmitted to the Finnish Drug Agency

by drug companies seeking licensing approval of HRT drugs. The qu=

ality of the trials and their

reporting of adverse events experienced by participants were foun=

d to be mostly inadequate. In

addition, analysis of the 6 trials that met the criteria to be en=

tered in the study revealed that users of

HRT had a 2-fold increased incidence of cardiovascular and thromb=

oembolic events, compared to

nonusers.

 

 

 

Randomized Trial Of Estrogen Plus Progestin For Secondary Prevent=

ion Of

Coronary Heart Disease In Postmenopausal Women

Heart and Estrogen/progestin Replacement Study (HERS) Research Gr=

oup.

Hulley S, et al.

JAMA 1998 Aug 19;280(7):605-13.

 

This double-blind placebo controlled trial investigated the effec=

ts of hormone replacement therapy

(HRT) on the prevention of recurrent coronary heart disease. The =

study was conducted on 2763

postmenopausal women with a history of coronary artery disease wh=

o were randomly assigned to

receive either an estrogen-progestin combination, or placebo. Rat=

es of myocardial infarction, cardiac

arrest, angina, congestive heart failure, stroke, transient ische=

mic attack, peripheral artery disease,

cardiovascular mortality and overall mortality did not differ bet=

ween patients taking HRT or placebo.

Women on HRT had a 50% increased risk of coronary heart disease e=

vents in the first year of

treatment, and fewer events in the 4th and 5th year, compared to =

women on placebo. In addition,

women on HRT had an almost 3-fold increased incidence of deep ven=

ous thrombosis and pulmonary

embolism than those taking placebo, and a 40% increased rate of g=

allbladder disease. Rates of

fractures were similar in the two groups. These data indicate tha=

t hormone therapy in

postmenopausal women is not protective towards coronary heart dis=

ease and is instead associated

with an early increase in coronary death and nonfatal myocardial =

infarction.

 

 

 

Early Risk Of Hormone Therapy In Patients With Coronary Heart Dis=

ease.

Wenger NK, Knatterud GL, and Canner PL.

JAMA, Vol. 284 No. 1, July 5, 2000.

 

This article emphasizes that the early increase in fatal and nonf=

atal coronary events documented in

the HERS trial (described in the above article) in women with cor=

onary heart disease (CHD) taking

hormone replacement therapy, has been documented 30 years ago in =

a large study conducted on men

with CHD randomized to receive different doses of estrogens or pl=

acebo. The trial arm that tested

the effects of 5.0 mg/d of estrogen was interrupted after a media=

n 1.5 years of follow-up, because of

an increase in rates of mortality and nonfatal myocardial infarct=

ion in men taking estrogens,

compared to those taking placebo. The trial harm that tested the =

effects of 2.5 mg/d of estrogen was

discontinued after a median of almost 5 years of follow-up becaus=

e of treatment-related adverse

effects such as thromboembolic events and gallbladder disease in =

men taking estrogen, and no benefit

on overall mortality. The authors conclude that postmenopausal ho=

rmone therapy for the prevention

of coronary heart disease is not advisable, and is associated wit=

h an early increased risk of fatal and

nonfatal coronary events. The finding that the same pattern of ad=

verse effects and early excess in

coronary death and nonfatal myocardial infarction found in women =

was also demonstrated 3 decades

earlier in men is striking, and points to a precise biological ef=

fect of this class of hormones.

 

 

 

Cardioprotective Effect Of Hormone Replacement Therapy In Postmen=

opausal

Women: Is The Evidence Biased?

Posthuma WF, Westendorp RG, Vandenbroucke JP.

BMJ 1994 May 14;308(6939):1268-9.

 

The results of this study show that data gathered from 3 meta-ana=

lysis indicating that hormone

replacement therapy (HRT) reduces the risk of cardiovascular dise=

ase in postmenopausal women,

are due to bias originated from the selection of a relatively hea=

lthy sample population, rather than to a

protective effect of HRT. The authors conclude that, based on the=

available data, routine prescription

of HRT for the prevention of cardiovascular disease is not indica=

ted.

 

 

 

Postmenopausal Hormone Therapy Increases Risk For Venous Thromboe=

mbolic

Disease

The Heart and Estrogen/progestin Replacement Study.

Grady D, et al.

Ann Intern Med 2000 May 2;132(9):689-96.

 

The results of this study show that hormone replacement therapy s=

ignificantly increases the risk of

deep venous thrombosis and pulmonary embolism in post-menopausal =

women. The study was

conducted on 2,763 women postmenopausal women who were randomly a=

ssigned to receive

hormone replacement therapy (1380 women) or placebo (1383 women).=

During a 4-year follow-up

period, 34 women in the hormone group experienced deep venous thr=

ombosis or pulmonary embolism,

compared to 13 in the placebo group. These data indicate that use=

of synthetic hormones almost

triples the risk of venous thromboembolism in post-menopausal wom=

en. The authors conclude that

the potential risks and benefits of hormone therapy must be weigh=

ted before considering initiation of

therapy.

 

 

 

Hormone replacement therapy and risk of venous thromboembolism: p=

opulation

based case-control study.

Perez Gutthann S, Garcia Rodriguez LA, Castellsague J, Duque Olia=

rt A.

BMJ 1997 Mar 15;314(7083):796-800.

 

The results of this study, conducted on 347,253 women aged 50 and=

older, show that users of

hormone replacement therapy have a 2- to 3-fold increased risk of=

developing pulmonary embolism or

deep venous thrombosis, compared to nonusers. The risk is particu=

larly elevated during the first year

of use, as indicated by an over 4-fold increased incidence of ven=

ous thromboembolism documented

during the first six months of treatment.

 

 

 

Risk Of Hospital Admission For Idiopathic Venous Thromboembolism =

Among

Users Of PostmenopausAl Oestrogens.

Jick H; Derby LE; Myers MW; Vasilakis C; Newton KM.

Lancet, 348(9033):981-3 1996 Oct 12.

 

The results of this study show that post-menopausal women on horm=

one replacement therapy have a

3.6-fold increased risk of idiopathic venous thromboembolism (IVT=

), compared to nonusers. The risk

increases with increasing daily doses of estrogen intake, and wom=

en using 0.325 mg, 0.625 mg, and

1.25 mg or more estrogen per day, were shown to have a 2-, 3.3-, =

and 7-fold increased incidence of

IVT, compared to nonusers.

 

 

 

HRT And The Risk Of Deep Vein Thrombosis.

Barlow DH.

Int J Gynaecol Obstet, 59 Suppl 1():S29-33 1997 Oct.

 

This article reports on 4 recent epidemiological studies demonstr=

ating a three-fold increased incidence

of pulmonary embolism and deep venous thrombosis in women using h=

ormone replacement therapy,

compared to nonusers.

 

 

 

Prospective Study Of Exogenous Hormones And Risk Of Pulmonary Emb=

olism

In Women.

Grodstein F, et al.

Lancet, 348(9033):983-7 1996 Oct 12.

 

The results of this study show that users of postmenopausal hormo=

ne replacement therapy have an

over 2-fold increased risk of primary pulmonary embolism secondar=

y to deep venous thrombosis,

compared to nonusers

 

 

 

Thrombosis Of The Straight Sinus Complicating Hormone Replacement=

Therapy.

Strachan R; Hughes D; Cowie R.

Br J Neurosurg, 9(6):805-8 1995.

 

This article reports on the case of a woman who developed venous =

thrombosis of the dura mater (the

outer of the 3 membranes or meninges that cover the brain and the=

spinal cord) while on hormone

replacement therapy (HRT). The authors suggest that this life-thr=

eatening complication, already

documented in women taking oral contraceptives, may also be rarel=

y associated with HRT.

 

 

 

Cerebral Venous Thrombosis In Association With Hormonal Supplemen=

t

Therapy.

Knox AM; Brophy BP; Sage MR.

Clin Radiol, 41(5):355-7 1990 May.

 

This article reports on the case of a woman who developed cerebra=

l venous thrombosis while on

postmenopausal hormone replacement therapy.

 

 

 

HRT & BREAST CANCER

 

 

 

Menopausal Estrogen And Estrogen-Progestin Replacement Therapy An=

d Breast

Cancer Risk.

Schairer C, et al.

JAMA 2000;283:485-491.

 

The results of this study, conducted on a sample population of 46=

,355 postmenopausal women, show

that use of estrogen replacement therapy increases the risk of br=

east cancer by 20%.

 

 

 

 

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