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GAPS IN KNOWLEDGE: A PROBLEM WITH MUCH OF THE EVIDENCE ABOUT THE BENEFITS AND RISKS OF HRT

by admin - April 21st, 2009.
Filed under: Hormonal. Tagged as: .

A problem with much of the evidence about the benefits and risks of HRT is that the early research was into oestrogens alone, not the combination with progestogen. For women who don’t have a uterus, and who therefore do not take a progestogen, this is not important. But the concern for the much larger number of women who take a combination of hormones is that the long-term effects on heart disease, blood vessel disorders needed before we can tell women which progestogens are least disadvantageous, in what dose, and combined with what oestrogen.

Many studies show that women with a uterus who use oestrogen on its own for longer than six months experience an increased risk of cancer of the endometrium (lining of the uterus). By adding an adequate amount of progestogen for ten to fourteen days a month, we can make sure that the endometrium is protected.

Other concerns relevant to all women include the following.

The apparent benefit of oestrogen in reducing the risk of heart disease may be due, partly at least, to bias in the selection of the women studied. All the studies of the risks and benefits of HRT are overshadowed by a big question mark. Are women who use it somehow different from the remainder of the female population, and if so might this skew the results? Are they healthier and at less risk of heart disease to start with, for example? Are they more health-conscious at the outset? Are they careful about eating nutritious foods, not smoking, exercising regularly? And are they more likely to follow their doctor’s suggestions? To be sure that HRT really benefits the heart it would be necessary to give HRT to one group of women selected from the general population and a placebo (a harmless and inert substitute) to a comparable group. The results of three such trials, which are at an early stage in the US, will be of interest.

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