A fundamental lesson in methodology, a cautionary tale about primum non nocere, and the ready-made push back against the hubris of biological plausibility, all rolled into one. And WHI is the gift that keeps on giving. Recent evidence from the estrogen-only RCT portion shows a real (albeit small) increase in ovarian cancer risk.
And yes, WHI doesn’t answer everything. Perhaps the women started HRT too late. Perhaps they took HRT for too long. Perhaps modern estrogens rather than CEE might have different results. All perfectly fine speculation. And if there’s one thing to take away from WHI, it’s STFU with the speculation, and for any proponents to go out and prove it.
Seatbelts, sober driving , not smoking anything , being at ideal body weight, walking or exercising a bit and laughing probably the best you can do . That and an ldl under 70
This is so timely for me. I had a heart attack at 55 with one risk factor, high ldl. I am a woman. I was never overweight. I weight the same as I did in high school. all lab values were text book except my LDL which was 180. HDL was 60 triglycerides 57, and my fasting sugar was 85. I exercised and ate well. I did have a family history at an older age around 70. I wasn't even through menopause when I had the heart attack. I have two stents now. I have been pushed and pushed to take HRT by urgent care doctors and nurse practitioners. I have had symptoms like hotflashes now at 59. I do use topical cream for atrophy. I have been cajoled and it's almost like a cult where this HRT is going to fix everything. It won't. I see women that take HRT and they still have some symptoms. I finally hit menopause at 56. I have refused hormones. I also have soured on prevention tests. I think some of these tests work depending on the person and their history.
Don't pay any attention to the so called risk factors. The entire risk factor paradigm for the causation of coronary heart disease is scientifically bankrupt. It has led to nothing but blind alleys that have dominated the research of cardiovascular disease. No one can realistically tell you why you had a heart attack when you did and anyone who tells you they know how to prevent one is just blowing smoke.
I think there are risk factors that they don't yet know about. In my case, my generation is WORSE than the one before. Women are actually getting heart attacks too and catching up to the men. I think it's air quality and environmental. Inhaling ozone is like smoking cigarettes. They always fall back on it's your heredity. That explains nothing. Why is it going backwards? I guess we are going to wait until everyone is getting it and then do something about it.
Hard to believe that anyone continued to push the estrogen protective theory in the 1990s. The Coronary Drug Project in the 1970s demonstrated that estrogen therapy for men was not only useless but caused so much harm that the trial had to be aborted before the time that it was planned to end. That should have been the end of the simple minded concept that hormones explained the difference in the incidence of coronary heart disease in men and women.
Dr. Mandrola has spoken and written extensively on this. I imagine a Google search would turn up stuff.
The problem is confounding. And even after “adjustments”, you still have residual confounding. Basically, you can’t tell why a clinician chose to offer a treatment to one pt, and not to another. And those unknown and unmeasured factors may contribute to any disparity in observed outcomes greater than any effect of the treatment itself.
I think you should be clearer that it isn’t the hormones causing harm but the synthetic progestins, in particular, which are no longer used for HRT. The newer forms of hormones used in the same way would have done just fine for preventative purposes and should still be used that way.
the fact still remains, the BODY shut it off. IT's not a disease like thyroid disease. When the body shuts something off, maybe it's not a good idea to put it back. Just my nothing opinion.
My go to book prior to menopause was and still is. ‘What Your Doctor May Not Tell You About Menopause’. It’s the breakthrough book on Natural Progesterone by John R. Lee, M. D.
In short, the term progestin is synthetic and derived from the yam in the pharmaceutical sector. They can’t patent a natural substance(per laws passed in late 1880’s that naturally occurring substances could not be patented)! Thus big Pharma had to make synthetic drugs by changing the molecular structure. With that as in progestin (synthetic) comes side effects not seen in the natural substance.
For more get the book.
Note I used the appropriate progesterone cream as recommended by Dr Lee as I entered menopause. I had no problems and made a smooth transition.
Your notion of harm does not consider risk-benefit tradeoffs. Perhaps a majority of women use HRT to alleviate symptoms. The tiny increases in absolute risk probably do not offset the perceived benefits of the therapy. Isn’t it odd that we don’t have analyses based on women’s actual utilities for the various outcomes (from a time-tradeoff study for example)?
What's missing is a large mental component. I see people still having symptoms. Just throwing in a few hormones doesn't seem to fix the problem. Some women have relief. I want to know why. Is there a huge placebo effect? Why do some women continue to have the symptoms and some say HRT fixed everything. Some women say HRT makes their hair fall out and makes them have other symptoms.
A fundamental lesson in methodology, a cautionary tale about primum non nocere, and the ready-made push back against the hubris of biological plausibility, all rolled into one. And WHI is the gift that keeps on giving. Recent evidence from the estrogen-only RCT portion shows a real (albeit small) increase in ovarian cancer risk.
And yes, WHI doesn’t answer everything. Perhaps the women started HRT too late. Perhaps they took HRT for too long. Perhaps modern estrogens rather than CEE might have different results. All perfectly fine speculation. And if there’s one thing to take away from WHI, it’s STFU with the speculation, and for any proponents to go out and prove it.
Seatbelts, sober driving , not smoking anything , being at ideal body weight, walking or exercising a bit and laughing probably the best you can do . That and an ldl under 70
This is so timely for me. I had a heart attack at 55 with one risk factor, high ldl. I am a woman. I was never overweight. I weight the same as I did in high school. all lab values were text book except my LDL which was 180. HDL was 60 triglycerides 57, and my fasting sugar was 85. I exercised and ate well. I did have a family history at an older age around 70. I wasn't even through menopause when I had the heart attack. I have two stents now. I have been pushed and pushed to take HRT by urgent care doctors and nurse practitioners. I have had symptoms like hotflashes now at 59. I do use topical cream for atrophy. I have been cajoled and it's almost like a cult where this HRT is going to fix everything. It won't. I see women that take HRT and they still have some symptoms. I finally hit menopause at 56. I have refused hormones. I also have soured on prevention tests. I think some of these tests work depending on the person and their history.
Don't pay any attention to the so called risk factors. The entire risk factor paradigm for the causation of coronary heart disease is scientifically bankrupt. It has led to nothing but blind alleys that have dominated the research of cardiovascular disease. No one can realistically tell you why you had a heart attack when you did and anyone who tells you they know how to prevent one is just blowing smoke.
I think there are risk factors that they don't yet know about. In my case, my generation is WORSE than the one before. Women are actually getting heart attacks too and catching up to the men. I think it's air quality and environmental. Inhaling ozone is like smoking cigarettes. They always fall back on it's your heredity. That explains nothing. Why is it going backwards? I guess we are going to wait until everyone is getting it and then do something about it.
Hard to believe that anyone continued to push the estrogen protective theory in the 1990s. The Coronary Drug Project in the 1970s demonstrated that estrogen therapy for men was not only useless but caused so much harm that the trial had to be aborted before the time that it was planned to end. That should have been the end of the simple minded concept that hormones explained the difference in the incidence of coronary heart disease in men and women.
I am still being told that it's all estrogen and estrogen is protective. smh
Don't take advice from anyone who tells you that. They are seriously misinformed.
Can you explain the nature of the bias in the observational reports?
The bias: Women who took estrogen are more health conscious, exercice more and eat « healthier « diet
Dr. Mandrola has spoken and written extensively on this. I imagine a Google search would turn up stuff.
The problem is confounding. And even after “adjustments”, you still have residual confounding. Basically, you can’t tell why a clinician chose to offer a treatment to one pt, and not to another. And those unknown and unmeasured factors may contribute to any disparity in observed outcomes greater than any effect of the treatment itself.
Makes sense. Thanks.
I think you should be clearer that it isn’t the hormones causing harm but the synthetic progestins, in particular, which are no longer used for HRT. The newer forms of hormones used in the same way would have done just fine for preventative purposes and should still be used that way.
the fact still remains, the BODY shut it off. IT's not a disease like thyroid disease. When the body shuts something off, maybe it's not a good idea to put it back. Just my nothing opinion.
My go to book prior to menopause was and still is. ‘What Your Doctor May Not Tell You About Menopause’. It’s the breakthrough book on Natural Progesterone by John R. Lee, M. D.
In short, the term progestin is synthetic and derived from the yam in the pharmaceutical sector. They can’t patent a natural substance(per laws passed in late 1880’s that naturally occurring substances could not be patented)! Thus big Pharma had to make synthetic drugs by changing the molecular structure. With that as in progestin (synthetic) comes side effects not seen in the natural substance.
For more get the book.
Note I used the appropriate progesterone cream as recommended by Dr Lee as I entered menopause. I had no problems and made a smooth transition.
Unrelated but related: can your team review recent approval of Kisunla ?
Your notion of harm does not consider risk-benefit tradeoffs. Perhaps a majority of women use HRT to alleviate symptoms. The tiny increases in absolute risk probably do not offset the perceived benefits of the therapy. Isn’t it odd that we don’t have analyses based on women’s actual utilities for the various outcomes (from a time-tradeoff study for example)?
What's missing is a large mental component. I see people still having symptoms. Just throwing in a few hormones doesn't seem to fix the problem. Some women have relief. I want to know why. Is there a huge placebo effect? Why do some women continue to have the symptoms and some say HRT fixed everything. Some women say HRT makes their hair fall out and makes them have other symptoms.