Hormone Therapy Has More Benefits than Risks

The reproductive years of a woman’s life are regulated by production of the hormones estrogen and progesterone by the ovaries. Estrogen regulates a woman’s monthly menstrual cycle and secondary sexual characteristics. In addition, it prepares the body for fertilization and reproduction. Progesterone concentrations rise in a cyclical fashion to prepare the uterus for possible pregnancy and to prepare the breasts for lactation.

Toward the end of her reproductive years when a woman reaches menopause, circulating levels of estrogen and progesterone decrease because of reduced synthesis in the ovary. Hypoestrogenism during menopause can lead to several symptoms, the severity of which can vary widely.

Menopause is the time in a woman’s life when menstruation ceases, signaling the end of her reproductive ability. The timing of menopause varies widely, but this event often occurs naturally in women in the fourth or fifth decades of life, at a mean age of 51 years. 

Menopause symptoms

Common presenting symptoms may include the following : irregular menstruation cycles, sweating, hot flushes, palpitations, vaginal dryness, soreness , dyspareunia, urinary urgency and frequency , mood changes, insomnia, depression, anxiety, among others.

Some cardiovascular risks on bone metabolism and cardiovascular system may be increased, such as osteoporosis and heart attack, this becauses of the increase of insulin resistance, hyperlipemia and endothelial function. 

Management 

Hormone therapy (HT) involves the administration of synthetic estrogen and progestogen. HT is designed to replace a woman’s depleting hormone levels and thus alleviate her symptoms of menopause. However, HT has been linked to various risks, and debate regarding its risk-benefit ratio continues.

In 2002, negative news about the Women’s Health Initiative (WHI) estrogen+progestin therapy (EPT) results created lasting fears about hormone therapy (HT), despite later statistical corrections to the negative outcomes and another, less-publicized, WHI study in 2004 identifying several benefits for estrogen monotherapy

New perspective of benefits of the Hormonal Therapy

Researchers at the National Library of Medicine, National Institutes of Health, Bethesda and Maryland, did a retrospective study on women 65 years old and older. 

The researchers analyzed data from 2007-2019 records of more than 7 million women with Medicare coverage aged 65 and older, of whom 15% used some type of HT at least once during the study period.

The researchers classified HT into estradiol alone; conjugated estrogen alone; progestin alone; estradiol and progestin combined; conjugated estrogen and progestin combined; and ethinyl estradiol progestin combined. 

The study reviewed three dose strengths as well as routes including oral, transdermal, vaginal, and injectable.

Rates of death occurred less often in women using hormone therapy, 6.08/1000 patient years, compared with a rate of 12.93/1000 patient years among those not using hormone therapy. 

After adjustment for potential confounders the hazard ratio (HR) for mortality on hormone therapy was 0.80 compared with women not on hormone therapy, this means a 20% less risk of mortality.

Mortality risk reductions were significant compared with no hormone therapy for both estradiol 22% (HR 0.78) and conjugated estrogen 14% (HR, 0.86).

Route administration shows  significant mortality reductions also,  occurring with vaginal (HR, 0.69), oral (HR, 0.89), and transdermal (HR, 0.78) formulations.

In the incidence of all cancers, treatment with estrogen without progestin linked with significant reductions compared with no hormone therapy, including breast (HR, 0.82), lung (HR, 0.87), endometrial (HR, 0.65), colorectal (HR, 0.86) and ovarian (HR, 0.83).

High-dose, but not low-dose, estrogen was associated with a slightly but significantly increased risk for ischemic heart disease (HR, 1.03 and 0.98, respectively).

Both estrogen+progestin therapy and progestin monotherapy each significantly associated with an increased breast cancer risk (HR, 1.11 and 1.09, respectively).

Conclusions

These findings shows a lot of benefits of the hormonal therapy when is indicated in menopause condition. The route and doses differentiate the reduction of mortality risk, anyways the estrogen based hormone therapy have shown more beneficial effects compared with those HT with conjugated and combined therapies. Another important finding is the reduction of the risk of presenting some types of cancers, this is important to focus because with adequate start of HT may prolong our women’s life.

SOURCE:

Seo H. Baik , Fitsum Baye, Clement J. McDonald (May 26, 2022). Effects of Hormone Therapy on survival, cancer, cardiovascular and dementia risks in 7 million  menopausal women over age 65: a retrospective observational study. Preprint study: BJM Yale. Retrived from: https://www.medrxiv.org/content/10.1101/2022.05.25.22275595v1 

https://emedicine.medscape.com/article/276104-overview#a1

IMAGE:Photo by Ravi Patel on Unsplash.