Albeit observational, This new study from one of the world’s leading University hospitals (Copenhagen Denmark) has massive power – 3 million women years over a 6year span; it confirms that it is folly to double the risk of heart attack in postmenopausal women by prescribing them oral HT (estrogen +- synthetic progestin) (or no HRT), when harmless dermal/ vaginal HRT halves their risk. This in an age-group where avoidable cardio/vascular disease kill (or cripple) well over half.
This contrasts with the statins (HMGA inhibitors) for mild-moderate hypercholesterolemia, where in the absense of cardiovascular disease- ie in primary prevention- statins lower CVD by less than a third and have if anything adverse influence on non-CVD morbidity and mortality.
The statistics on parenteral estrogen were based on some 100 000 women years- about the same size as the billion-dollar Women’s Health Initiative trial of oral HT over about the same period in about the same agegroup. By contrast, oral HT (solo premarin) reduced deaths (by 27%) only in the 50-59year cohort of the WHI(2002) – whereas in the combined oral premarin-Provera leg of the WHI(2004), there was (as in the Danish study) no overall benefit. The authors of the Danish study reason against healthy-user bias.
Denial of this long-obvious evidence- that natural (ie balanced human parenteral) HRT is best- cannot be stupidity, so perhaps it comes down to the Disease Industry’s ruthless profiteering: explaining parenteral HRT takes longer, and more effective and safer cheap prevention decreases the needs of aging women for monitoring and interventions.
Illich’s Medical Nemesis, the medicalization of society (1974), described how western medicine promotes sickness by discouraging self-determination (with eg sensible disciplined diet lifestyle and vigorous supplements), labelling many conditions as diseases requiring doctor care (eg overweight, stress, mild hypertension/ mild-moderate lipidemia, or self-induced insomnia ) and prescription perseverance with profitable but adverse prescription patent drugs like oral HT and nonsteroidal antiinflammatories that in the long term cause as much harm as good .
The latest tricks of the consumer (food- entertainment-disease) global industry conglomerate and it’s regulators and lobbyists are failure to stop the sale of the greatest killers – cigarette smoking, raw sugar and commercial fast foods loaded with sugar, aspartamate, corn omega 6 and saturated fats;
discourage people from taking the best prevention there is- appropriate vigorous safe supplements like parenteral human HRT, and vitamins minerals and the other natural biologicals;
and creating imaginary pandemics eg anxiety-panic disorder, mild depression/ hypercholesterrolemia, impotence that need costly new designer drugs. Pfizer and the FDA have for years colluded to deny access – despite the Freedom of Information Act – to their public trials of sildenafil- Viagra in thousands of men , but subsequent other studies and trials confirmed the massive fraud of Viagra marketing- that Viagra works poorly in men with relative androgen deficiency; that all that most men with impotence and suboptimal testosterone levels need is lowcost fortnightly selfinjection sc of human depot testosterone, with only perhaps 20% actually requiring some Viagra equivalent as well longterm.
The Disease Industry thus wants to force people to deteriorate with aging without natural prevention till they become sick, then have to enroll as patients.
Over the generation since Illich, not one patent drug for chronic prevention has reduced all-cause mortality and morbidity in the chronic major degenerative diseases of aging, unlike the natural supplements:
*metformin the plant extract (1922);
*appropriate HRT; and
*the basket of some 50 vitamins, minerals and the other biologicals.
The much safer effect of vaginal estrogen is understandable considering that absorption of low dose vaginally ie transmucosally must be much higher than transdermally, subject to less biotransformation than it is in slower transit through dermis. .
Parenteral human HRT has always been known to be safer than oral HT (at 10-20 times the dose)- since the much higher oral dose required for symptom relief has been known for over 30 years to increase the risk of thrombosis, fluid retention, biliary disease, and, cumulatively, breast cancer.
But despite Masters and Grody showing in the first HRT controlled trial in 1953 how well old women do on parenteral testosterone-estradiol 20:1, most doctors (but not most women) obtusely prefer to follow Masters’ classic Industry-led hypocrisy at the AMCOG meeting in 1957, that the “convenience of the HT pill” (ie Wyeth’s Premarin) takes priority over what was already proven as generally best for postmenopausal women- parenteral testosterone: estradiol, without endometrial need for any progestin since testosterone protects both the breast and endometrium. This has since been amply confirmed in Sweden (von Schoultz ea; Hirschberg ea ), Australia (Zhou Dimitrikakis ea) and North America (the Wake Forest Primate HRT research group- personal communications).
So unless women specifically want cosmetic ie facial cream benefit, one should always advise them to use the cream vaginally – with appropriate co-mix with testosterone / progesterone. .
The ideal may be to let them use the estrogen +- testosterone vaginally, with progesterone facially -especially when ERT is started in the agegroup 60-69yrs, and especially when the ERT is vaginal; since starting conventional oral mega-HT (as in the Womens’ Health Initiative) after the age of 60years has been universally discouraged for the past 5 years.
Or more simply, many women in the pre/perimenopause require initially just testosterone for relative androgen deficiency (aka FADS) – which can most adjustably be taken as cream daily; or most conveniently be taken by tiny selfinjection subcutaneously sc as about 20-50mg depotestosterone every 2 to 4 weeks, or testosterone undecanoate 50-100mg sc every 3 months. Then appropriate parenteral estrogen/ progesterone can be added from menopause.