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Menopausal Estrogen: Good or Bad?

Posted Apr 12 2011 8:30am
As I noted back towards the end of January , hormone replacement has received quite a bad rap since the Women's Health Initiative study was first released.  It's unfortunate, however, that the lumpers put conjugated equine estrogen (CEE) in the same group as bio-identical estradiol.  Likewise, they did the same with medroxyprogesterone acetate (MPA) and bio-identical progesterone, which is chemically distinct.  Ironically, traditional medicine and the press downplayed any benefit from the use of CEE alone in those women who had been hysterectomized.  But those of you who paid close attention theorized that perhaps the bad news was due to MPA rather than CEE.

So here it is nearly a decade later and a study was released last week in JAMA concluding that almost 6 years use of CEE alone did not change (increase or decrease) heart disease, stroke risk, venous thromboembolism risk, colorectal cancer or total (all-cause) mortality.  Interestingly, those who took CEE alone did demonstrate a lower risk of breast cancer as noted in the initial study.

What does this mean for our female patients?  If your peri-menopausal symptoms are bothering you enough, take the lowest dose for the shortest period of time without any fear of negative outcomes over the ensuing 10 years.  But don't take it because you're trying to improve or prevent some health outcome.  And while you're at it, consider a bio-identical transdermal estradiol, rather than conjugated equine estrogen.  Studies demonstrate safer physiologic responses and better outcomes w/bio-identical transdermal estradiol products.
But what do you do if your patient doesn't believe in Big Pharma products (and you don't believe in compounded estradiol)?  Consider branded bio-identical transdermal estradiol products such as Vivelle-Dot or Climara (not Climara Pro which contains non-bio-identical levonorgestrel).  That way you and your patient can have the best of both worlds.


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