my obstetric/gynae assignment in Year 5.IUMP

1. Is Hormone Replacement Therapy Safe?
Presented by: Ahmad Abid Abas
07-05-02

2. Is Hormone Replacement Therapy
Safe?
..Estrogen + Progestin as HRT for menopausal
symptoms , ↑ breast cancer risk, but that risk ↘ within
two years after quitting HRT.
(as published in The New England Journal of Medicine)
Key points: Advisable to have HRT only if needed
and at the lowest dose for the shortest time to be
effective.
The longest "shortest time" might be as two years.

3. Two Studies ; (WHI) and (MWS):
The Women's Health Initiative (WHI) oestrogen plus progestogen trial
(1993-2002) :
↑ coronary events, stroke, breast cancer and vein blood clots and ↓
osteoporotic fractures and colon cancer.
The Women's Health Initiative (WHI) oestrogen alone trail (1993-2004) :
↑ in stroke and vein blood clots.↓ in breast cancer and osteoporotic fractures .
The MillionWomen Study (MWS) (1996-2001)
Est. only HRT – small ↑ risk of breast,body and ovary cancer.
Combined HRT - ↑ risk breast cancer > Est. only HRT , < risk of womb cancer
, the longer HRT used , the ↑ risk of breast cancer.

4. New Findings on Hormone Replacement
Therapy
1) The long-term breast cancer risk from estrogen-plus-
progestin therapy is real.
(Rowan Chlebowski, MD, PhD, who worked on The New England Journal of Medicine study)
2) Quitting hormone therapy cuts breast cancer risk.
(The increased breast cancer risk from hormone replacement therapy appears to end about two years after
quitting hormone therapy. In the WHI data, "it looked like the risk starts to go down right away. And after
between one and two years, it looks like pretty much like that risk is gone)
3) Breast cancer risk is greater with estrogen+progestin
than estrogen alone.
(Evidence from the WHI clinical trial that estrogen do not increases breast cancer. It's the combination of
estrogen and progestin)

5. Weighing the Risks and Benefits
1) Every woman is different.
2) Breast cancer risk from hormone therapy is
"almost certainly going to be small for
short-term use.
3) Continuing hormone therapy for five years
roughly doubles breast cancer risk.
4) There are ways to treat hot flashes and
vaginal dryness without hormones.

6. The Transdermal Trend
• Evamist , EstroGel.

7. References
• http://www.myhealthnewsdaily.com/5-experts-hormone-replacement-
therapy-safe-1444/
• http://www.womenandinfants.org/ri/REI/?t=HORMONE-
REPLACEMENT-THERAPY
• http://www.womens-health-
concern.org/help/factsheets/fs_hrtrisksbenefits.html
• http://www.webmd.com/menopause/news/20090204/menopause-hormone-
therapy-safe-time
• http://www.drdonnica.com/guests/00008828.htm