“Window of Opportunity” Data Leads to New Understanding Regarding Benefits of Estrogen Replacement Therapy
Unequivocal evidence from both the Women’s Health Initiative (WHI) and several large clinical trials now provide indisputable evidence that there is a “window of opportunity” to begin peri/post-menopausal hormone therapy. This “window” stretches between menopause (around the time of the final menstrual period) and the next two years— probably up to five years in some cases. If hormone therapy is started within this “window,” all evidence points to a reduction of coronary artery disease/cardiovascular disease of 30%, as well as a 30% reduction of late-life cognitive impairment, and a reduction of osteoporotic fractures of well over 50%!
The WHI’s premature termination of recommended hormone therapy was due to a small increase in breast cancer in the group of patients (averaging age 63 at inclusion—an average of 13 years post-menopause) taking a relatively high dose oral estrogen (Premarin™) plus the relatively strong synthetic progesterone, Provera™. This WHI recommendation was hyped to the extreme by the press. Unfortunately, both most physicians and media pundits got their “news” from the non- menopausal medicine media. In the resulting panic, more than 60% of women then taking hormone therapy quit, frequently with the advice of their not-very-knowledgeable-physicians.
Interestingly, the only physician group not to recommend mass discontinuance was menopause practitioners, which was the only group to carefully read the study and realize that its conclusions were faulty as they applied to the long-term safety and risk: benefit ratio of estrogen therapy. This group waited to see complete data, which has since been forthcoming.
Further analysis of the vast amount of data generated by the WHI has shown:
- The real culprit in the increased incidence of breast cancer in the “Prem-Pro™” group was the “Pro” (Provera™) part. A second group of women took estrogens (Premarin™) only (no Provera™). After 11 years of follow- up, there is no increase in breast cancer in this group. In fact, the latest data to emerge from the WHI study group is showing a statistically significant decrease in cancer rate (LaCroix et. al. for the WHI Investigators: “Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy.” JAMA April, 2011). Remember, women who took the PremPro™ had a not-statistically significant increase in breast cancer rate, which was reported in 2002, with a follow- up showing the same findings in 2008.
- Premarin™ is a potent oral estrogen. The dose studied (0.625 mg) gave a blood serum level of 87pg/ml. Average blood levels of all low-dose FDA-approved bioidentical transdermal estrogens is 15 to 35 pg/ml. It is known that the incidence of breast cancer increases with increased blood estrogen concentration.
- There is a real “window of opportunity” in which to start menopausal hormone therapy. Although hormone therapy initiated in older, high-risk (obese, diabetic, poor lipids, smokers, etc.) individuals has cardiovascular (CV) benefit long-term, short term there is a definite increase in CV problems. The WHI study group had many women in this category. However, re-analyzing the group of women who were near to menopause (within two years and probably within five years of their final menses) showed significant cardio-protection, with rates of cardiovascular disease and cognitive problems falling 30% long-term in the group of women starting early and staying on therapy for 10 years or more.
Your health and well-being are worth digging a little deeper to get the real story on hormone replacement therapy. Learn more about menopausal symptoms, menopausal medicine and bio identical hormone replacement therapy at https://www.drmichaelgoodman.com/.