Hormone Therapy and Long Term Mortality

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Exciting new article on Hormone Replacement Therapy (HRT) in The Journal of the American Medical Association.

JAMA, the Journal of the American Medical Association is one of the major pieces of literature that doctors read to obtain new information about the knowledge and practice of medicine. For years JAMA has been publishing articles challenging the use of Hormone Replacement Treatment, particularly for women.

In the 1980s HRT took off as a miracle treatment for women who were aging and post -menopausal. Many doctors and their female patients were getting into this treatment it was an exciting time for women who wanted to live long and healthy lives. Then, in order to validate this movement in modern medicine, the Women’s Health Initiative put together a research program to check out the legitimacy of hormone replacement treatment. This research program was checking the replacement of estrogen and provera. In just a little time they obtained data that caused them to believe that women receiving this treatment were at an increased risk for breast cancer and death.

The news media got on board and rushed to publish warnings to women and their doctors to say stop killing women! They did not really verify the research they just accepted the warning and rushed out to say the sky is falling.

Dr. Maupin had been watching this issue unfold. After twenty five years as a gynecologist treating women who became postmenopausal she did not see an increase in breast cancer or death in women who received HRT. So she continued to practice medicine the way she knew and used the data and the research she had obtained from Europe to bolster her argument that the treatment was safe and efficacious.

Many doctors in our community ran scared and scared their patients and said “ I won’t practice this way and I don’t think you should go to her to obtain HRT.”

This week, eighteen years after the controversy over the WHI study which was fatally flawed a study has been released that tracked over 27000 women who had received HRT for between five and seven years or more. This is considered long term treatment. The result is exciting: there is no supporting data that shows any increase in risk of death from all cause mortality among these women based on whether or not they have received hormone replacement therapy.

There is no data that says HRT will increase your risk of death from any cause of death, particularly heart disease and cancers of all types. They are not saying it will keep you alive, but they are saying it won’t kill you.

Now that we do not have to look at the risk of death with anxiety and fear, we can look at research that will talk about the quality of life and the health and improved quality of life that can happen when people obtain hormone replacement therapies when they need them.

Not only can you safely consider the replacement of estrogen, you should also look at other hormones that our bodies make and use which decline as we age.

Talk to your doctor about whether or not they are aware of this exciting new article in the most recent issue of JAMA and whether or not they are willing to recommend and provide HRT treatments for aging people.


September 12, 2017 Issue of The Journal of the American Medical Association

Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality The Women’s Health Initiative Randomized Trials

JoAnn E. Manson, MD, DrPH, et al

JAMA. 2017;318(10):927-938. doi:10.1001/jama.2017.11217

Abstract

Importance  Health outcomes from the Women’s Health Initiative Estrogen Plus Progestin and Estrogen-Alone Trials have been reported, but previous publications have generally not focused on all-cause and cause-specific mortality.

Objective  To examine total and cause-specific cumulative mortality, including during the intervention and extended postintervention follow-up, of the 2 Women’s Health Initiative hormone therapy trials.

Design, Setting, and Participants  Observational follow-up of US multiethnic postmenopausal women aged 50 to 79 years enrolled in 2 randomized clinical trials between 1993 and 1998 and followed up through December 31, 2014.

Interventions  Conjugated equine estrogens (CEE, 0.625 mg/d) plus medroxyprogesterone acetate (MPA, 2.5 mg/d) (n = 8506) vs placebo (n = 8102) for 5.6 years (median) or CEE alone (n = 5310) vs placebo (n = 5429) for 7.2 years (median).

Main Outcomes and Measures  All-cause mortality (primary outcome) and cause-specific mortality (cardiovascular disease mortality, cancer mortality, and other major causes of mortality) in the 2 trials pooled and in each trial individually, with prespecified analyses by 10-year age group based on age at time of randomization.

Results  Among 27 347 women who were randomized (baseline mean [SD] age, 63.4 [7.2] years; 80.6% white), mortality follow-up was available for more than 98%. During the cumulative 18-year follow-up, 7489 deaths occurred (1088 deaths during the intervention phase and 6401 deaths during postintervention follow-up). All-cause mortality was 27.1% in the hormone therapy group vs 27.6% in the placebo group (hazard ratio [HR], 0.99 [95% CI, 0.94-1.03]) in the overall pooled cohort; with CEE plus MPA, the HR was 1.02 (95% CI, 0.96-1.08); and with CEE alone, the HR was 0.94 (95% CI, 0.88-1.01). In the pooled cohort for cardiovascular mortality, the HR was 1.00 (95% CI, 0.92-1.08 [8.9 % with hormone therapy vs 9.0% with placebo]); for total cancer mortality, the HR was 1.03 (95% CI, 0.95-1.12 [8.2 % with hormone therapy vs 8.0% with placebo]); and for other causes, the HR was 0.95 (95% CI, 0.88-1.02 [10.0% with hormone therapy vs 10.7% with placebo]), and results did not differ significantly between trials. When examined by 10-year age groups comparing younger women (aged 50-59 years) to older women (aged 70-79 years) in the pooled cohort, the ratio of nominal HRs for all-cause mortality was 0.61 (95% CI, 0.43-0.87) during the intervention phase and the ratio was 0.87 (95% CI, 0.76-1.00) during cumulative 18-year follow-up, without significant heterogeneity between trials.

Conclusions and Relevance  Among postmenopausal women, hormone therapy with CEE plus MPA for a median of 5.6 years or with CEE alone for a median of 7.2 years was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.

Trial Registration  clinicaltrials.gov Identifier: NCT00000611

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.  

 

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