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Dx Estrogen Replacement Treatment Increases Her Survival: Read More...


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Summary: "How To" Use Hormone Replacement Therapy (HRT) in Women
Consider Replacing the natural estradiol,progesterone and testosterone:
  a). Estrace©/Estradiol 1mg tablet. The tablet can be taken once or twice daily (ideally every 12 hours) and will dissolve if inserted into the vagina. Alternatively, Estrace©/ estradiol vaginal cream .0015% is available for vaginal insertion. Alternatively, Vivelle© or Minivelle© patch stabilizes estradiol levels for 3-4 days.
  b). Prometrium©/Progesterone 100mg capsule. The capsule is taken at bedtime. It may improve her sleep. The progesterone may be taken every night or cycled off 5 days per month at which time a withdrawal menstrual bleed may occur. The purpose of the progesterone is to reduce the risk of a hyperplasia (thickening) of the uterine lining.
  c). Natural testosterone replacement may begin with EstraTest© HS (half strength). Since EstraTest© contains a synthetic estrogen, it need be taken just one time daily. The small amount of testosterone may help relieve symptoms such as depression, increase libido and maintain bone and muscle integrity. The natural form of testosterone is the 2% compounded cream. This may be applied to the vaginal opening to reduce pain with intercourse.
  d). There are testosterone pellets and estradiol pellets that relieve symptoms for 6-8 weeks. I typically use one-half of the 75mg testosterone pellet with 2 or 3 of the 25mg estradiol pellets for longer symptom relief. Women may take spirolactone up to 100 mg twice daily to reduce signs of hirsuitism (facial hair, acne, deepening voice) that may occur with higher doses of testosterone.

Observation: Published in OBG Management October 2013 25(10)56-7; by
Phillip Sarrel M.D. who states:
"Estrogen Increases Survival in young Hysterectomized Women"

Medications Used in Treatment:
1. Estrogens: Estrace®/estradiol tablet and vaginal cream, Depo-Estradiol®/estradiol injection, Delestrogen®/estradiol valerate injection, Premarin®/conjugated equine estrogen, Vagifem®/estradiol, Minivelle®/estradiol skin patch, Climara®/estradiol skin patch
2. Androgens: Covaryx®/estrogen-methyl testosterone, testosterone topical cream, testosterone cypionate injections
3. Mini-dose topical estradiol: Divigel®/estradiol, etc.
4.
Progestins/Progesterone:

"Between 2002 and 2011, a minimum of 18,601 and as many as 91,610 excessive deaths occurred among hysterectomized US women aged 50 to 59 years, according to this analysis. These deaths were attributed to the avoidance of estrogen therapy (ET) in the years following publication of the initial findings of the Women's Health Initiative (W.H.I.)". From Sarrel PM, et.al. The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years Am J Public Health 2013;103(9):1583-9.

During the 1990's, more than 90% of hysterectomized women aged 50 to 59 years used ET following the procedure. When the initial findings of the WHI were published in 2002, they prompted many women to refuse or discontinue E--despite the fact that the initial findings concerned the use of [non-biological] estrogen and progestin in combination [Prempro®] in women with an intact uterus. Today, only some 30% of women use ET after hysterectomy.

When findings from the W.H.I. estrogen-only arm were eventually published, they revealed that ET reduced mortality among women 50 to 59 years old, compared with placebo. Although mot of the reduction in mortality relates to fewer deaths from coronary heart disease, a decline in deaths from breast cancer also was seen.

Sarrel and colleagues calculated the excess mortality among US women aged 50 to 59 that could have been prevented by ET during the decade from 2002 through 2011. Their estimates ranged from approximately 19,000 deaths to as many as 92,000 deaths.

By calling attention to the negative health consequences of estrogen avoidance in young hysterectomized women, Sarrel and colleagues have performed a valuable public service.

The Phlethora of W.H.I. data may have contributed to the Confusion:
The W.H.I. clinical trials have produced numerous analyses in various subsets of women. The sheer volume of data may be daunting in some cases, and likely has led to a failure to distinguish between estrogen-only and estrogen-progestin therapy, which have very different safety profiles.
Further, some clinicians and many patients have overlooked the fact that the risk-benefit profile of hormone therapy (both estrogen-only and estrogen-progestin therapy) is more favorable in younger, recently menopausal women than it is in older women.
I encounter evidence of this unwarranted fear of ET in my practice, with highly symptomatic, recently menopausal women who are appropriate candidates for hormone therapy electing to refuse the most effective treatment for menopausal symptoms.
Of course, hormone therapy, like all medications, has risks as well as benefits. For example, oral ET increases the risk of venous thrombosis and stroke, and long-term use of estrogen-progestin therapy increases the risk of breast cancer However, the overblown fears of estrogen therapy have caused many appropriate candidates to miss out on symptom relief, prevention of osteoporosis, and treatment of symptomatic genital atrophy".

PODCAST
Hormone Replacement - The First Line in the Treatment of Diseases and Aging

Suggested Links
* N.H.S. Choice
* Medscape on Risk Factors

*[Editor]The OB-GYN News January 2015 p. 16 reported that Dr. Howard N. Hodis at the American Heart Association confirmed in the ELITE study that "women who start hormone therapy within 6 years of menopause show a significant slowing of sub-clinical carotid-artery atherosclerosis, whereas women who are more than 20 years postmenopausal show no difference from placebo" [no benefit].
Furthermore, he use 1mg of oral micronized 17-Beta estradiol and (for women with an intact uterus) micronized progesterone gel on 12 days per cycle.

*[Editor] In the practice of gynecology for more than 40 years, my professors and I have never shied away from replacing natural estrogen (estradiol) and testosterone. As Phillip Sarrel, M.D. made clear, all this misinformation is driving women to rely on treatments of their symptoms, while the direct, cheap effective estradiol-testosterone is vilified. Make no mistake: estradiol is available as oral and vaginal tablets, vaginal creams, patches, pellets and as injections. Testosterone is available as a tablet (combined with estrogen: Esstratest(TM), as topical creams, as a patch (only outside the U.S.) and in injections. As the two arms of the W.H.I. proved, medroxyprogesterone acetate is linked directly to breast cancer not the estrogen component. That is why I use exclusively natural progesterone as a compounded oral product or topical noted below.

*[Editor] Compounded products:
1. Testosterone cream: male 10-20%; women 1-2% [mg/cc] dispensed 30cc syringe
2. Progesterone cream: female 4-8% [40-80mg/cc] dispenses 30cc syringe
3. Bi-Est: 50:50 E2/E3 .5%/.5% dispensed 30cc syringe
4. Estriol (E3): 0.5mg/gm 30grm syringe dispensed

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