MANY NEW REASONS FOR PERMANENT BALANCED PARENTERAL HUMAN HRT, (NOT ORAL ESTROGEN PLUS PROGESTIN HT)

For over 50 years busy menopause clinics (Masters & Grody USA ; Schleyer-Saunders London ; Gelfand Canada; Greenblatt, Gambrell, Notelovitz, Schiff, Buster, Vliet, Shippen USA; Whitehead & Studd London; Burger & Davis Australia ; Davey et al Cape Town) have seen that  lifelong parenteral  balanced  human sex hormones as old as evolution  – testosterone, progesterone and estradiol-  in longterm replacement  give without any risks the  essential  multisystem benefits of HRT,  including relief of classic menopause (and sexual) symptoms but, far more important, at least one-third reduction in cardiovascular disease, fractures, depression, cancers, and most important of all, dementia and premature deaths.

 

This was confirmed even in the  young women on oral HT OHT for a mean of > 6 years in the Womens’ Health Initiative, and  for 9 years in the  recent Oulu trial.(Heikkinen ea) .

 

Masters and Grody already  by 1953 in the first RCT of HRT in women aged a mean of 73yrs  showed that balanced testosterone: estradiol  20:1  injection  for at least 13 months suppresses both breast and endometrial proliferation and restores multisystem health provided degenerative disease was not already too advanced.  We have confirmed this for the past decade using a quarter of the dose they used, as longer-acting depot injection eg Mixogen, Primodian Depot.   

 

 Moller and Tvedegard Denmark, and Jaffe USA, have shown the protective role of testosterone in cardiovascular disease  in  men and women;  Von Shultz ea at the Karolinska  have recently confirmed the protective role of testosterone on the endometrium; 

 while Clarkson’s group at Wake Forest Univ,  and Zhou and Dimitrikakis in Australia,  have shown testosterone’s  protective role  on breast in both primates and women.

 

Below are many more  reasons why it is negligence both  to go on prescribing oral HT pills to postmenopausal women, and negligence  to deny both men and women lifelong physiological balanced parenteral sex hormone replacement if they have demonstrable sex hormone deficiency/ imbalance  on blood levels- irrespective  of sexual  dysfunction since this is multifactorial  (often culture-specific) and often the last thing complained of.

 

So why encourage women to take even low-dose oral (hepatic first-pass) estrogen plus progestin  HT  if only for the first 10 years, when  permanent parenteral physiological dose testosterone plus estradiol  HRT ( arguably with a little progesterone for it’s unique benefits)  does only good? (by whatever method the woman chooses and can afford- cream, patch, spray, implant, subcutaneous injection- even as lowdose combined oral micronised T+E+P – Lee Vliet).

 

It is common cause that no plant – phyto- hormones  have been proven to give any of the longterm multisystem benefits of appropriate HRT- and concern remains that, as with kava and black cohosh, there may be rare but deadly adverse liver if not cancer effects.

 

Since the post-gonadopausal half of life is crucial to every person  let alone society, and early and permanent  appropriate HRT can make huge difference to dying well,  lay counsellors, nurses and the like  must be banned from  advising, scaring  people  to the contrary.

 

In ethical health systems, only qualified  and registered health practitioners  are allowed to advise and treat serious conditions – and no condition is as serious for aging  humans as sex hormone deficiency/ imbalance, since the deficiency is so safely, cheaply (about $5/month in RSA), easily and effectively replaced with human hormones.

 

It is unethical to neglect to recommend long-proven optimal therapy, especially that which is low-cost and safe.  It is farcical to argue,  after a million years of evolution and >50 years of safe effective use, that any human hormone replacement in physiological  balance  for demonstrable deficiency is unproven unless tested in long-term RCTs, when no designer drug (except metformin- 1922) has been proven in RCTS lasting even 5 years to be  as safe and effective as appropriate HRT, minerals, vitamins, fish oil and scores of  other natural supplements in the chronic prevention of  all  the major degenerative diseases of aging.  

 

The world leaders in menopause management, the International Menopause Society, have summed up the conservative consensus favouring early permanent approriate HRT : Summary of the First IMS Global Summit on menopause-related issues – March 29–30, 2008 http://www.imsociety.org/pdf_files/comments_and_press_statements/ims_press_statement_13_05_08.pdf?SESSID=krplkcvf8f2u5ov4079v6l6k86. But as Peter Collins, Guiseppe Rosano  ea say in in the 2007  European Concensus statements,

“Menopause compounds many traditional CVD risk factors, including changes in body fat distribution from  gynoid to android pattern, worsens  glucose tolerance, plasma lipids, and  increased blood pressure,  sympathetic tone, endothelial dysfunction and vascular inflammation.

   In “European”  people CVD kills 20% more women ie 57% vs 43% of men;  whereas cancer kills only 17% of women (BRCA 3% vs PRCA 4% of men).  Metabolic syndrome is now present  in 2/3  of older women; after the menopause, women fatten, get more HBP, lipidemia, IGR, diabetes and thus CVD, so all these risk factors need to be addressed including with appropriate HRT.    The management of the menopause is not the exclusive responsibility of the gynecologist “

 OHT  increases BRCA risk after 12 to 15 years ie total dose about  3 to 5mg estradiol cumulative dose. (Henderson B ea 1980).

 

 Never mind crippling prevalent arthritis, obesity,  and depression,  by 65yrs 80% have raised bloodpressure (>130/85) -which predisposes to heartfailure, hemorrhagic stroke and dementia. In women, use of digoxin is associated with increased all-cause death.

 

         The symptom discomforts of the menopause  – for which women consult their gynaecologists , mothers, grannies, aunts, sisters, pharmacies, journalists , herbalists and everyone else – last for about 5 years, then  usually pass..  But the non-gynaecological consequences of gonadopause –  premature death, or dementia, even major arthritis or hip or spinal or heart failure  or stroke – affect probably 90% after the menopause phase  is over;  and  are a permanent loss or crippling disability to the survivors- of which the family, society,  family practitioner,  internist and orthopaedist, ( not the lay counsellor or  surgeon -gynecologist, breast)have to take care .   

            So the necessity for appropriate  permanent HRT is the major longterm concern of everyone but gynecological and breast surgeons and lay counsellors – who deal only with shortterm issues.  

When will doctors, and regulators, and our medical schemes, begin to follow evidence-based medicine  (instead of dogma – profit) and give women the same appropriate physiologica  lhuman hormone replacement as  men, instead of hypocritically forcing on the most vulnerable – the postmenopausal woman – what profits only  the drug and disease industry? Why should women be forced to take undesirable oral HT that has been known to promote major complications for over 30 years, and to boot produces unnecessary and unwanted menstruation, and suppresses necessary anabolic androgen, and promotes adiposity, fluid retention, hypertension, thrombotic, biliary and breast disease?

 

new  refs

Horwitz & Sartorius JCEM  prepub 22 July 2008   U Colorado http://jcem.endojournals.org/cgi/rapidpdf/jc.2008-0938v1  and Flesch-Janys ea   Univ Hamburg Int J Cancer.2008 Aug 15;123(4):933-41  on the major role of progestins (MPA, progesterone, LNG, NETA)  in initiatingbreast cancer  from the age of forty, where-after estrogen becomes promotitive and cumulative;   .

 

Zervoudis ea  U Athens Gynecol Endocrinol. 2008 May;24:257-60   http://www.informaworld.com/smpp/content~content=a793650333~db=all~jumptype=rss describe  ischemic colitis in a dozen women mean age  56.8 years (range 43 to 70, mean duration of HRT (combined diverse estrogens + progestins)  only 5.7 months (range 3 to 14 months).

 

Gotmar ea U Linkoping Climacteric.2008 Aug;11(4):304-14.Symptoms in peri- and postmenopausal women in relation to testosterone concentrations: data from The Women’s Health in the Lund Area (WHILA) study) Lower testosterone concentrations were associated with lower quality of life in perimenopausalwomen but not to sexual well-being.

  

Lin ea London BMJ.2008 Jul 10;337:a386.  Gallbladder disease and use of transdermal versus oralhormone replacement therapy in postmenopausalwomen: prospective cohort study.  Gallbladder disease is common in postmenopausal women and use of hormone replacement therapy increases the risk. Use of transdermal therapy rather than oral therapy over a five year period could avoid one cholecystectomy in every 140 users

 

Meyer ea Univ Auckland Osteoporos Int.2008 Jun 19.  Change in the use of hormone replacement therapy and the incidence of fracture in Oslo. The reduction in fracture incidence in postmenopausalwomen in Oslo occurred in a period with a substantial increase in the use of HRT

 

Heikkinen Menopause Int.2008 Jun;14(2):70-7. A 10-year follow-up of the effect of continuous-combined hormone replacement therapy and its discontinuation on bone in postmenopausal women. Low-dose  oral  ccHRT in postmenopausal women is associated with increases in lumbar spine BMD for at least nine years. These gains are not sustained after cessation of therapy but the rate of BMD loss varies between individuals.

Canonica ea Inserm France BMJ.2008 May 31;336(7655):1227-31. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. Oral oestrogen increases the risk of venous thromboembolism, especially during the first year of treatment. Transdermal oestrogen may be safer with respect to thrombotic ris

Ramnath ea,  NY  Oncology. 2007;73(5-6):305-10. Hormone replacement therapy as a risk factor for non-small cell lung cancer: results of a case-control study.   hormone use was associated with a significant reduction in risk of lung cancer (adjusted odds ratio = 0.67).

 

 

 

 

 

 

 

 

 

 

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