Tuesday, November 12, 2013

Hormone Therapy for Women

The latest report from the Women’s Health Initiative from Harvard is confusing to say the least. They looked at a fixed dose of conjugated estrogen (Premarin, from horse urine) with or without a synthetic progestin (Provera) to see if the benefits outweighed the risks. The end points included heart attacks, strokes, blood clots, gall bladder disease, onset of diabetes, hip fractures, cancers, and urinary incontinence. Some of these improved a little and others got worse. Neither regimen affected all-cause mortality, and symptom improvement was not predictable. My conclusion from this is that they used lousy medical treatment. Provera is the most dangerous hormone to give and should be avoided. Natural progesterone and Estriol (bio-identical) are the safest hormones to use, and they were excluded from the study. If you can get by with just natural progesterone, that is the best choice. Finally, if you want to relieve symptoms, you have to give the correct dose for each individual patient, not the same dose for everyone. Come on, Harvard, we deserve better than that. See JoAnn Manson, et.al. JAMA 2013; 310:1353-1368. Celebration of Health Association website

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