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What a Great Week For Midlife Women And Menopausal Hormone Therapy – Keeps And Dops!


Ten years ago the bottom dropped out of the use
of estrogens and progestogens (EPT) for menopausal hot flashes and prevention
of chronic disease. Gross exaggeration and misrepresentation of
breast cancer findings in the WHI terrified women and sent them searching for


Fortunately good research continued, and this
week 2 major studies were reported. Both presented findings that should be
truly reassuring to women, and highlight the need for major professional
organizations to once again revisit their recommendations for use of hormones
after menopause.


Let me first describe the studies and their
findings, and then give you my read of where we now stand.


 727 women average age 52.7, within 3 years of

 Randomized prospective placebo-controlled study

 Duration 4 years

 Study medications: cyclic estradiol patch or conjugated
equine estrogens (CEE) and micronized progesterone

 Primary endpoints – intima media thickness (IMT) and
coronary artery calcium (CAC). Additional outcomes include quality of life (QOL)
and cognition

At this time we only have the preliminary
reports presented to the media and at the October Annual Scientific Meeting of
NAMS. The following is a brief summary of the study:

symptoms on both hormone types

bone mineral density

improvement in sexual function (lubrication, decreased pain)

markers favorable for oral except triglycerides

and CAC – no differences

statistical differences in breast cancer, endometrial cancer, MI, TIA, stroke
or VTE but #’s small

– no adverse or beneficial effects

– improvement on the Utian global QOL scale



Published in the
British Medical Journal last week, this is a significant study because of its
duration and that women, unlike in the WHI, were entered into the study on
average at age 50 and around 3 months after menopause:

women average age 50, recently postmenopause

prospective controlled open-label study

11 years with a further 6 years follow up

medications: cyclic estradiol and norethisterone acetate

endpoints – mortality, heart failure, myocardial infarction


The results of 10 years continuous therapy
showed the following results:

reduction in mortality, heart failure, and myocardial infarction

apparent increase in risk of cancer, venous thromboembolism, or stroke

Previously this group had reported the major
benefit of bone sparing and reduction in all fractures.




The combination of the WHI results in women
under age 60 and the KEEPS and DOPS study now present a uniform message. For
women starting estrogen or estrogen-progestogen combinations within 10 years of
menopause and having a clear indication for therapy, reassurance is the key
word. The safety profile is good and the efficacy side is excellent.


In future columns I will address potential
benefits and potential risks in detail.


In the interim, enjoy good news for once, and
have a great week!



Wulf Utian MD PhD




Author; CHANGE YOUR MENOPAUSE – Why one size does not fit all. http://www.amazon.com/Change-Your-Menopause-size-does/dp/0982845723/


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