NIH Cautions on Hormone Therapy for women.

[archive_Ulter]

The other day I posted that someone should ask their doctor about Hormone Therapy for their gf. It appears that was not a good idea according to the NIH who has reversed their position on it.


NIH Cautions on Hormone Therapy
Tue Jul 9,11:28 AM ET
By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON (AP) - Government scientists abruptly ended the nation's biggest study of a type of hormone replacement therapy, saying long-term use of estrogen and progestin significantly increase women's risk of breast cancer, strokes and heart attacks.


Six million American women use this hormone combination, either for short-term relief of hot flashes and other menopausal symptoms or because of doctors' long-standing assumptions that long-term use would prevent heart disease and brittle bones and generally keep women healthier longer.

In fact, there are serious risks to using the hormones for years, risks that far outweigh the few benefits, the National Institutes of Health announced Tuesday.

The hormones harm, not protect, the heart — they actually increase previously healthy women's risk of a heart attack by 29 percent and a stroke by a stunning 41 percent. They also increase women's chances of breast cancer by 26 percent.

On the good side, the hormones cut by a third the risk of colon cancer and hip fractures — but there are other, safer ways to fend off those illnesses, doctors noted.

So the NIH stopped the 16,600-woman study three years early, and is advising other women who use the estrogen-progestin combination to ask their doctors if they, too, should quit.

"We want to get the word out to women and their doctors that long-term use of this therapy could be harmful," said Dr. Jacques Rossouw, acting director of the NIH's Women's Health Initiative, which sponsored the study.

Women may still want to use the hormones for a short period to treat menopause symptoms such as hot flashes, he said. But for how long?

"There is no really safe period," he acknowledged, noting that the heart attack risk hit during women's first year taking the hormones. "As short a period as you can get away with in order to manage the menopausal transition."

Other researchers were even more negative.

"We recommend that clinicians stop prescribing this combination for long-term use," wrote Dr. Suzanne Fletcher of Harvard Medical School in an editorial accompanying the study results posted on the Web site of the Journal of the American Medical Association. "Risks from the drug add up over time."

The study's leaders stressed that women shouldn't panic because personal risk is pretty small.

In one year, for every 10,000 women who take the estrogen-progestin combination there will be eight more breast cancers, eight more strokes and seven more heart attacks — and six fewer colon cancers and five fewer hip fractures — compared with 10,000 women who didn't take the pills.

However, because millions take the hormones, those numbers can add up to thousands of illnesses, Rossouw noted.

To use estrogen or not has long been a vexing question for women entering menopause. While the study seems definitive, it doesn't settle all the questions:

_What about women who use estrogen alone? The NIH is letting a second, smaller study of those women continue for now, saying so far the balance of risks and benefits remains uncertain. Only women who have had hysterectomies can use estrogen alone, because it causes uterine cancer unless balanced by progestin.

_How do the risks stack up for short-term use? In the latest study, the cardiovascular risk actually jumped within the first year of use while the cancer risk didn't appear until around year four.

"The message still goes back to treat your individual needs," said study co-author Jennifer Hays of the Baylor College of Medicine. "If you can't sleep for three weeks (because of night sweats) and short-term therapy at a low dose helps you with that, quality of life is an important thing."

_This study used Prempro, the most popular estrogen-progestin combination. But what about lower-dose pills or even skin patches?

Without testing each, "you can get wrong answers," cautioned study co-author Dr. Norman Lasser of the University of Medicine and Dentistry of New Jersey, who wants drug companies to do such testing. "It's going to be a while 'til we know what's safe."

Wyeth Pharmaceuticals, which makes Prempro and other estrogen supplements, said the main reason women start hormone therapy is to relieve hot flashes, night sweats or vaginal problems.

"It is important to recognize the critical role" the hormones play for those women, said Wyeth vice president Dr. Victoria Kusiak.

[This message was edited by Ulter on 07-09-2002 at 12:55 PM.]

[Twiggy]

I assume these are the same progestins used in birth control pills... Is that right? Should this be a concern for women on the pill as well?

[archive_Bjaarki]

Major props, bro.

I'd heard this was coming down the pike. Details are still to emerge, and the whole picture is not in yet. Caution is wise when data are inconsistent or surprising, as here.

Bjaarki

[tidefan00]

So basically Wyeth and their lobbyist didnt pony up enough dough to keep the results in thier favor...cool

"I ain't nothin but a winner"
-Paul "Bear" Bryant

[archive_Ulter]

<BLOCKQUOTE class="**-ubbcode-quote"><font size="-1">quote:</font><HR>Originally posted by Twiggy:
I assume these are the same progestins used in birth control pills... Is that right? Should this be a concern for women on the pill as well?<HR></BLOCKQUOTE>

I would assume so.

testosterone good. estrogen bad.

[Dragon]

I wonder exactly how accurate these test are? Do they take into consideration every one of the 20,000 peoples diet over the years, along with lifestyles, and a buttload of other things that cause cancer, and heart problems these people may have done. I just read a study that cancer rates alone are increasing because we are living longer, and a multitude of other causes. I don;t know about women, but when my hormones are very low when I get old, you can bet I'll be on test theropy even if it gives me cancer or what ever.



[This message was edited by Dragon on 07-10-2002 at 03:56 PM.]

[archive_Bjaarki]

Dragon, you can get a nice little summary of the study here:

http://www.nhlbi.nih.gov/whi/hrtupd/upd2002.htm

Bottom line of the study is:

<BLOCKQUOTE class="**-ubbcode-quote"><font size="-1">quote:</font><HR> Only 2.5% of women in the estrogen plus progestin study had these [negative] health events. These results tell us that during one year, for every 10,000 women taking estrogen plus progestin, we would expect:

7 more women with heart attacks. In other words, 37 women taking estrogen plus progestin would have heart attacks compared to 30 women taking placebo.

8 more women with strokes.

8 more women with breast cancer.

18 more women with blood clots.

These results also suggest that for every 10,000 women taking estrogen plus progestin, we would expect:

6 fewer colorectal cancers.

5 fewer hip fractures.

Fewer fractures in other bones.

In summary, then, more women taking estrogen plus progestin had a serious health event than did women taking placebo. We conclude that estrogen plus progestin does not prevent heart disease and is not beneficial overall.
<HR></BLOCKQUOTE>

You'll see a lot more about this, and as Ulter alludes to in his threadstarter, there will probably be some policy and practice guideline changes in HRT for women. It will be interesting to see if there is any fall-out for HRT with men. Stay tuned.

Bjaarki

[Dragon]

But it makes them feel better overall, just like any hormone replacement.That is the major beneift I thought. I know what my mother-in-law was like in menopause and she is a lot easier to be around now that she is on hormones!



[This message was edited by Dragon on 07-10-2002 at 06:18 PM.]

[archive_Bjaarki]

That is a very good point, Dragon, which is important to not overlook. HRT does have very important quality-of-life (QOL) advantages for women who are experiencing difficulty with menopause.

The problem with HRT is that it was oversold as a "cure for whatever ails you." It was expected, strongly suspected at the time the Women's Health Initiative was funded, that HRT would have positive effects on a host of morbidity/mortality domains, like heart disease, stroke, cancers, etc.. Those did not pan out. They failed to show in some initial data runs a couple of years back, and there was hope that the extended followups and larger sample sizes in the 2002 reports would, finally, prove out that HRT has those positive effects I mentioned. Instead, it looks like HRT has negative implications for cardiovascular disease and cancers, which is a real bummer for life-extention medicine (LEM), which really depends on improvements in health, not just QOL. So, that's down the drain for HRT, at least on the basis of this study.

We should remember, though, that the subjects in the WHI study were older (mean age of 67 or something like that), and most had already had some signs of cardiovascular disease. So, this was not exactly a young, well group having problems going through The Change. It doesn't look to me like the results of WHI even speak to the kind of case you raise here, Dragon. But I think you'll see a lot of downscaling of the interest in HRT for women - and perhaps for men, just because the logic of it is the same, even if the hormones are different.

Bjaarki

[retropump]

Combination HRT has never been recommended for long term prophylactic treatment of postmenopausal women. It is only intended to help women through the symptoms of transition to menopause. There has never been any evidence that long term therapy would be beneficial for anything other than prevention of osteoporosis and maybe some dementias. It is also hard to tell if the problem these women experienced was due to HRT in general, or because of the pharmaceutical industry's push to prescribe synthetic progestins and conjugated estrogens rather than natural hormonal alternatives such as transdermal HUMAN hormones or prohormones such as pregnenolone, androstendione, testosterone or DHEA. Thank goodness this has finally come into the limelight (better late than never) so that more GPs can get this message!!!!!

For my body, I hope to have access to very specific SERMs that will prevent osteoporosis and brain atrophy without all the negative side effects of HRT…….that's a few years off yet for me [img]/infopop/emoticons/icon_smile.gif[/img]

As a female, I've spent all of my BB life trying to minimize the drawbacks to my physique that are caused by excess estrogen toxicity. I can't fathom why anyone would want to have more than the bare necessity of this hormone floating around unless they really wanted to get pregnant. I feel sorry for those women [img]/infopop/emoticons/icon_frown.gif[/img]

[archive_Ulter]

That's what Macro just got finished explaining to me. He believes the NIH jumped the gun BTW. Like Retro says... Why aren't these women given REAL estrogen and progesterone instead of Equine estrogen and progestin. The reason Macro the synic explained is simple, you can't patent progesterone. So they give them synthetic Progestin. The holders of the Progestin patents are probably jumping off building after this NIH deal dumping all over their product.
Also, I want to add an addendum to my opener, that there is no relationship between testosterone therapy and any of the things they are claiming here. Testosterone therapy will cause your "natural" E to rise and there is no ill effects, at least not that I have seen, from raising a womans natural E levels if they were low to begin with.
I agree with Macro this will probably blow up in the face of the NIH for taking an alarmist reaction without more study into what they were using for HRT.

[archive_MR. BMJ]

At the end of this article, it also states that JAMA will be coming out with more on this topic in its July 17, 2002 journal release.

I just read this in today's paper as well...and at the end of it it mentioned the JAMA study.

I knew RETRO would be all over this...perfect timing [img]/infopop/emoticons/icon_smile.gif[/img]

BMJ

Human estrogen is 10% estrone, 10% estradiol and 80% estriol. Premarin is essentially all estradiol and it is a slightly different form so that it is 5 times harder to break down.

This study was weighted so smoking was eliminated as a factor.

As far as women "feeling good" or "feeling better", this could easily be placebo since they are told by the doctors "this should make you feel better".

[retropump]

Yes, I also beleive as macro does about the lack of patentability of naturally occuring hormones as the main culprit. No money in it. However I think you will soon find there is a huge upsurge in 'patentable' transdermal and depot delivery systems for natural estrogens and progesterone.

I'm undecided about test alone to increase E levels. Many Postmenopausal women have adequate T levels and already suffer masculinizing effects from having nearly normal T with unopposing E. Also, in the peripheral circulation (which is where the androgens get converted to E in post menopausal women), androstenedione is a better substrate for peripheral aromatase in women. Of course androstendione can also convert to T so a women gets the best of both worlds this way [img]/infopop/emoticons/icon_smile.gif[/img], and T converts to the more protective/beneficial estriol. Flip a coin....

Other androstendione precursors also work well for many women. I think the most important 'treatment' for women suffering negative symptoms of menopause is the most over looked one. Good diet and lifestyle, including regular weight bearing exercise, plenty of EFAs, and healthy weight maintenence starting well before menopause would be my prescription.

Strange topic for an anabolic discussion boar

[This message was edited by retropump on 07-11-2002 at 04:55 PM.]

[supergirl]

strange topic yes LOL

however.. as far as HRT... my mother went through her changes and used soy supplimentation along with 7-Keto Dhea... it got rid of her hot flashes and mood swings.. with out the hassle of the estrogen/prog bullshit...

all i know is that i have tried birth control twice and it does not work for me... i was QUEEN BITCH lol with weight gain and break through bleeding.. so i decided that playing with those particular hormones did not work for me... yet i take roids LOL go figure [img]/infopop/emoticons/icon_wink.gif[/img]

i wonder though, now that i have taken roids if i were to try to get back on birth control how it would be..

www.anasci.com

keepin it real

"I'm doin' a hundred on the highway
So if you do the speed limit, get the FUCK outta my way"

Retro, out of curiousity how do you know that about womens testo levels?

I have seen quite a few post-menopausalo women's hormone panels over the last few years. Of the many I have seen that have had complete hysterectomies but were not on HRT, the majority had high estro levels, low testo and low progesterone levels. I cannot think of one that I have seen that had normal or low estro levels, even though there may be a couple.

[retropump]

Yes, Got Wood, a full hysterectomy will do that every time. It's not really the same as normal menopause because the ovaries will still churn out test after menopause, though often at a reduced level. Removal of the ovaries=no ovarian test at all=guaranteed low test levels. So we need to distinguish between normal menopause and surgical menoupause when we talk about test. Also, women given HRT for 'normal' menopause will have low free test levels because of the increase in SHBG that the estrogen provokes, so we also need to distinguish between non-HRT women and HRT women when we talk about test levels

[Cocktails]

I find my maintainence dose of Deca every 10 days helps me alot, but I'm not exactly sure why.
The hot flashes I have without it are unbearable.
Plus it really helps me maintain my muscle!
I'd like something more to take the rest of the edge off but don't want to go the HRT route.
Any suggestions Retro?
(As I almost burst into flames here!).

[retropump]

Almost certainly the Deca is helping because it antagonizes the estrogen both via hypothalamic/pituitary feedback, as well as direct binding of DHN to the estrogen recptor. Wildly fluctuating estrogen levels during the transition to menopause are the main culprit for hot flashes. If Deca is making life bearable without too many sides, then the best bet is to continue with the deca. What dose are you taking?

[Cocktails]

It helps but not like it used to............
Right now I was thinking I may have to increase my dose. Just worried that the sides wouldn't be good.
GP says all my levels are just fine. Yah.....right!!
I felt real good and sure looked better when I added a little T3 into the mix. Body fat went down and I wasn't as tired. Doc says Thyroid is fine but I think I wil