Long-Term Hormone Treatment Significantly Lowers Mortality Risk
Postmenopausal women who have taken long-term estrogen replacement therapy (ERT) have an overall lower risk of death from all causes than women who have not taken ERT, according to a study in the January 1996 issue of Obstetrics and Gynecology.
The primary apparent effect of long-term ERT use was a reduction in coronary heart disease and other cardiovascular disease, the leading cause of death for women.
Bruce Ettinger, M.D., and colleagues at the Division of Research, Kaiser Permanente Medical Care Program in Oakland, California USA, with a grant from the National Cancer Institute, studied data from the medical records and death certificates of 454 postmenopausal women born between 1900 and 1915. They compared 232 women who had taken ERT within three years of starting menopause for a period of five or more years to 222 age-matched women who had not taken ERT (or had taken ERT for less than one year). Women with a history of heart attack, stroke and most forms of cancer were excluded from the study).
Long-term ERT use was associated with a 46 percent reduction in the overall mortality rate from all causes of death, but apparently estrogen appeared to offer the most protection against cardiovascular disease. The lower death rate among estrogen users was related to both the recency and duration of ERT use, according to the study. Those who had taken ERT for longer than 15 years had a risk of death 30 percent lower than those who had used estrogen for a shorter time.
Overall cancer deaths were similar for both groups. Estrogen users did have a higher risk of death from breast cancer than non-users, but the total number of deaths was small and lacked statistical significance. A surprising finding: lung cancer was less common among estrogen users even though cigarette smoking was found in both groups of women.
Source: The American College of Obstetricians and Gynecologists, 409 12th Street, S.W., Washington, D.C. 20024-2188 USA, Telephone: 202-484-3321; FAX: 202-479-6826). Website: http://www.acog.org
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If you are approaching the menopause, discuss the risks and benefits of estrogen replacement therapy with your doctor. Administered over a period of years, estrogen can relieve unpleasant symptoms related to reduced estrogen levels. For women at high risk of osteoporosis, long-term therapy substantially reduces the chances of bone fracture. In addition, some studies show that estrogen lowers the risk of cardiovascular disease, and some evidence suggests that women taking estrogen suffer from depression less often.
Recent studies show that hormonal replacement therapy, which was abandoned by the women in the age finding that could lead to breast cancer, reduces substantially the risk of a colo-rectal cancer.
The most remarkable reduction in the risk-48 percent-was observed in women who received hormonal therapy with combined estrogen and progestin for a period of 2 to 5 years, researchers reported in the latest edition of Cancer Epidemiology, Biomarkers and Prevention, published by the American Association for Cancer Research.
Coronary heart disease remains unusual in women before menopause, particularly in the absence of known risk factors like diabetes, hypertension etc. Menopause (permanent cessation of menstruation) usually occurs between 47 to 50 years. Premenopausal women seem to be protected against coronary heart disease morbidity and motality in comparison with men of similar age or postmenopausal women. The difference is most pronounced between ages 35 and 44 years.
The Heart Estrogen-progestin Replacement Study (HERS) conducted by Dr. Joel A. Simon and colleagues at the VA Medical Centre in San Francisco found that HRT does not reduce the risk of stroke among postmenopausal women with coronary artery disease.
According to Dr. Simon this is the first large randomised clinical trial to examine the effect of HRT on risk of strokes in women already compromised by Coronary Artery Disease. HERS is a secondary Coronary Heart Disease prevention study among postmenopausal women i.e. in those with pre-existing Coronary Artery Disease.
Aspirin is the standard treatment for patients suffering from coronary heart disease. The breakthrough treatment consists of a daily dose of aspirin and an anti-clotting drug - clopidogrel. The combination has been shown to significantly reduce the risk of a patient dying from heart disease, having a repeat heart attack or suffering from a stroke.
Given the reduced risk of AD for persons with at least 8 years of education, it is reasonable to recommend active, regular use of thinking skills such as reading, writing and arithmetic. For example, research in the area of use-dependent plasticity has shown that persons who use language skills have larger, more elaborate connections in the areas of the brain related to language function. Also, we routinely see, clinically, patients with AD who have particular talents that are well preserved until moderately demented.
More than 150 symptoms have been reported in association with PMS. There are five basic categories:
- Anxiety (includes nervousness, mood swings, irritability & impatience)
- Depression (includes crying, confusion, social withdrawal & insomnia)
- Pain (includes backache, cramps and breast pain)
- Water retention (includes abdominal bloating, weight gain & swelling)
- Hypoglycemia (includes headache, craving sweets, increased appetite & fatigue)
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