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[Sage 🍃]

Very interesting!

https://www.bmj.com/content/381/bmj.p1364

[Hurdity]

Looks interesting but it lasts 2 hours - if you have that time to spare then I'm sure would be illuminating!!! Perhaps you can summarise for us Sage if you've watched it?

Hurdity x

[margherita]

If people don’t have time to listen to the video, the first response from a GP gives a handy list of all the problems with this talk and the distortedly selective evidence that is cited (sort of the opposite of cherry picking) – a problem that extends to many interventions that fail to specify that any reported adverse effects of HRT refer to non body identical oestrogen (eg oral or equine) and/or progesterone, ie not transdermal oestradiol or micronized progesterone. I was also surprised to see that the totally discredited WHI study still being referred to.

Some of the problems the GP lists are (emphases are mine):

“the increased risk of endometrial cancer with oestrogen-only therapy was highlighted however we do not prescribe oestrogen only therapy for women who have an endometrium. Not raised was the significantly decreased risk of endometrial cancer for combined therapy. Also not discussed was the decreased risk of colorectal cancer for those taking HRT.

As highlighted, the WHI study showed a null effect for CHD in HRT users. However, most of the study participants were in their 60s and 70s (and the vast majority overweight and obese) and this was not the typical age to start HRT. Could this explain why this null effect was found (in contrast to the observational studies which showed a protective effect)?

For oestrogen only HRT taken by women in their 50s, a significant reduction in CHD was found in the WHI study. In suggesting that this was most likely a chance finding in a sub-group analysis, another important point was missed: In the WHI study, combined HRT consisted of oestrogen with medroxyprogesterone acetate, a synthetic progestogen. When you look at oestrogen alone or oestrogen with micronised progesterone, the picture may look quite different.

After stating that HRT increases stroke risk, Professor Reeve also mentioned that this finding has not been replicated for transdermal body identical oestrogens. So, As well as micronised progesterone, we need to be looking at transdermal body identical oestrogens. When considering the safety and effectiveness of SSRIs, we do not look at data pertaining to MAO-Inhibitors and TCAs.

Mortality was not considered in the webinar either. When Finnish mortality data was analysed, a significant reduction in mortality from CHD, stroke, and all cause mortality was found in women using HRT compared to non-users.”

There’s also an excellent summary by this GP of the proven benefits of HRT not only for heart disease as discussed here but also for osteoporosis, type 2 diabetes and Alzheimer’s disease https://bjgplife.com/theres-something-about-menopause/[/url]

[Penguin]

Thanks margarita, this is really helpful

[laszla]

Very helpful reminder, even if takes many of us a while to settle on the right regime in the here-and-now, of the proven benefits of body identical HRT for the serious conditions that affect so many women later in life - though as you say Margherita it's the first gp's response that is the really helpful part.

[Sage 🍃]

Marguerita, have you listened to the whole video?