Why are physicians reluctant to use estrogens for anything - or do they prefer 'PROFOX'?
Studd J.
London PMS & Menopause Clinic, 46 Wimpole Street, London W1G8SD, UK. harley@studd.co.uk.
The reluctance of physicians to use estrogens in women with hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to estrogen therapy antedated these studies, the flawed data is now used as justification for the denial of estrogens for treatment of low bone density and various types of hormone responsive depression in women. Estrogens should be first choice therapy for osteoporosis in women under the age of 60 years, but in practice bisphosphonates, with its increasing number of long-term side-effects, has become first-line therapy for physicians. These side-effects include osteonecrosis of the jaw, mid-shaft femoral fractures and the need for proton pump inhibitors, which further reduce bone density and add to the fracture risk. Pyschiatrists fail to use transdermal estradiol for postnatal depression, premenstrual depression and perimenopausal depression in spite of randomized trials demonstrating their efficacy. Selective serotonin reuptake inhibitor therapy for depression independently decreases bone density and is also responsible for loss of libido, loss of mental acuity and dependence. Thus postmenopausal women with vasomotor symptoms, depression, loss of libido, vaginal dryness or low bone density are frequently denied effective estrogen therapy and given a combination of low-cost generic prozac and fosamax, which is in danger of becoming a post-WHI nightmare drug PROFOX (PROzacFOsamaX). This can only be avoided if advisory bodies review the reassuring evidence concerning estrogen therapy in women under the age of 60 years and advise accordingly.
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- 1 HRT help me with the psychological difficulties that I am experiencing around?
- 2 HRT help my mental ability?
- 3 Can HRT reduce my chance of developing heart disease?
- 4 How does HRT protect against coronary heart disease?
- 5 If I am at particular risk of heart disease, can HRT still help?
- 6 Do progestogens taken in combination with oestrogen replacement therapy have an adverse effect on heart protection?
- 7 How long should HRT be taken to reduce the risk of heart disease?
- 8 Is there any evidence that HRT will protect my bones?
- 9 Would the dose (strength) of my HRT influence its ability to protect my bones?
- 10 Are there other treatments apart from HRT for osteoporosis?
- 11 Would HRT help my skin?
- 12 Can hormone replacement therapy cure all my menopausal symptoms?
- 13 How prevalent is cancer of the breast?
- 14 What factors influence the chance of breast cancer developing?
- 15 What is the relationship between HRT and breast cancer?
- 16 I have benign breast disease. Can I take HRT?
- 17 Does a history of breast cancer mean that HRT is absolutely contraindicated?
- 18 If I started HRT early (aged 30 to 45), does this influence my chance of developing breast cancer?
- 19 Does hormone replacement therapy increase the risks of cancer of the womb?
- 20 I have had endometrial cancer and now have menopausal problems. Can I take HRT?
- 21 Does HRT have a relationship to ovarian cancer?
- 22 How does HRT relate to a blood clot (DVT - deep venous thrombosis or pulmonary embolism)?
- 23 I have varicose veins. Can I take HRT?
- 24 Should HRT be discontinued before I have a major operation or leg surgery?
- 25 Does HRT increase life-expectancy?
- 26 I am still seeing periods. Could HRT have any benefits for me?
- 27 I have been told that I have fibroids. Can I take HRT?
- 28 What happens if I decide not to take HRT?
- 29 Doctors seem to promote HRT but the media cause me anxiety. Who is right?
- 30 Support Groups.
