Thank you for the very objective and detailed report. You seem to be one of the few menopausal experts that leads with caution and is completely honest with the studies limitations.
Thank you for tackling this study. As usual, your talent for distilling complexities to digestible explanations is a big help. Now if only I could convince my CRNP…At least I am better armed now. Thank you.
I am anxiously awaiting your impressions from the estrogen/progesterone results. How can progesterone and E2 alone be protective of breast but combine increase the risk??
Dear Dr. Gunther, thank you for your in-depth report. I so appreciate all your research and info for us!! I am still confused though: Due to family history of ovarian cancer and several cysts, I have had a profilactic BSO nine years ago at the age of 51, but kept my uterus. I was advised not to take HRT. Due to vaginal dryness and pain, I have now been put on Premarin vaginal cream 0,625 mg, which I use 2 x weekly, very sparingly and it has helped a lot. Is Premarin Vaginal Cream included in these findings, or in other words: does "low dose vaginal" mean "cream"? Is there an expiration date on safely using Premarin vaginal cream? And does it provide the same percentage health benefits as discussed in your report?
Good breakdown and explanations, thank you! I was wondering about the effects of having been on hormonal contraception prior to MHT, presumably not something this study could capture?
As someone who has been on either the combined or mini pill all my adult life, I am a little concerned about what will happen when I stop....
I was diagnosed last year (39 years old) with POI and told that I had gone through an early menopause. I’m just a half a standard deviation away from osteoporosis In lumbar spine and I already had both of my hips replaced at 38 due to end stage osteoarthritis. I started HRT immediately and I’ve gone from the patch to oral and now the creams. My mood has spiraled into dangerous levels and I’ve also had withdrawal bleeding. I was treated for IDA in Feb (ferritin was a 6). My new gyno is recommending I come off HRT and just go back on the pill in order to stabilize mood and anemia. All I do is research. I’m on a timeline with my bone health. Can I really afford to be put on synthetic estrogen and progesterone(or whatever P is in BC)? I’m going to have to be on hormones for at least 2 decades. My mom had breast cancer. I’ve already had thyroid cancer. I need help making these decisions
Thank you for this excellent analysis and summary. What about absolute length of time on MHT? Say, for someone who started taking it in their early 40s for vasomotor symptoms and thus may have many more years on it than someone starting in their 50s.
Such an informative read. I feel scared and like a failure for not being able to take mht at 53. I’m still having light symptoms and some nightsweats 4 years post menopause. I feel like I amsending myself to an early grave with all the mht push. I get so many side effects from it. Debilitating progesterone intolerance. I feel defeated but appreciate everything you share with us. I feel like you are the only logical source anymore.
I took the time to read the recent study. The one issue that is not presented however is the impact all forms of estrogen (including vaginal delivery) has on women who are on a thyroid replacement. You have stated,"In the main analysis, the investigators grouped low-dose transdermal and low-dose vaginal therapies together, meaning a 25 mcg estradiol patch was in the low-dose category, but so were vaginal estrogen tablets and rings. However, one of these delivers estrogen into the blood (patch), and the other does not". Since vaginal estrogen does to a small degree enter the bloodstream (which I have proven by using it TSH does increase) why is the Menopause Society not addressing this issue since more women are impacted by thyroid issues especially during midlife? The study does recognize through statistics that vaginal estrogen impacts bone health (to a lesser degree than transdermal patches) lung cancer et al which suggests that the impact of this form of therapy is systemic. The product monograph as well as the information from the manufacturer of vagifem (and yes I did reach out to them) can impact TBG proteins in women who are on a suppressive or replacement of levothyroxine. I have accessed JAMA, the Journals from the Endocrine and OB/GYN societies as well as PubMed and cross referenced all of the information with the product monographs (and was told by the pharmaceutical companies they are published for medical doctors to access for additional information) and all support that any form of estrogen will impact TBG proteins (increase). How many doctors are up to date on this? The information in the latest study means women who have been waiting for help should be able to access it. Some women on a replacement of levothyroxine require two specialists, one for menopause issues as well as one to assist with adjustments in doses.
This has been a tremendously helpful review with great discussion points of your interpretation as I often have this question posed to me—“is there a reason to preventatively be on hormones?” I look forward to more studies. Thank you!!!
Thank you for the very objective and detailed report. You seem to be one of the few menopausal experts that leads with caution and is completely honest with the studies limitations.
Huge thanks for this information, I read this avidly. They didn’t look at bone health?
This is the clearest synopsis of a complicated subject and everyone should read it.
Thank you for tackling this study. As usual, your talent for distilling complexities to digestible explanations is a big help. Now if only I could convince my CRNP…At least I am better armed now. Thank you.
Wow! Thanks for this!. Can’t wait for part 2. I really appreciate your work!
I am anxiously awaiting your impressions from the estrogen/progesterone results. How can progesterone and E2 alone be protective of breast but combine increase the risk??
Dear Dr. Gunther, thank you for your in-depth report. I so appreciate all your research and info for us!! I am still confused though: Due to family history of ovarian cancer and several cysts, I have had a profilactic BSO nine years ago at the age of 51, but kept my uterus. I was advised not to take HRT. Due to vaginal dryness and pain, I have now been put on Premarin vaginal cream 0,625 mg, which I use 2 x weekly, very sparingly and it has helped a lot. Is Premarin Vaginal Cream included in these findings, or in other words: does "low dose vaginal" mean "cream"? Is there an expiration date on safely using Premarin vaginal cream? And does it provide the same percentage health benefits as discussed in your report?
Good breakdown and explanations, thank you! I was wondering about the effects of having been on hormonal contraception prior to MHT, presumably not something this study could capture?
As someone who has been on either the combined or mini pill all my adult life, I am a little concerned about what will happen when I stop....
I was diagnosed last year (39 years old) with POI and told that I had gone through an early menopause. I’m just a half a standard deviation away from osteoporosis In lumbar spine and I already had both of my hips replaced at 38 due to end stage osteoarthritis. I started HRT immediately and I’ve gone from the patch to oral and now the creams. My mood has spiraled into dangerous levels and I’ve also had withdrawal bleeding. I was treated for IDA in Feb (ferritin was a 6). My new gyno is recommending I come off HRT and just go back on the pill in order to stabilize mood and anemia. All I do is research. I’m on a timeline with my bone health. Can I really afford to be put on synthetic estrogen and progesterone(or whatever P is in BC)? I’m going to have to be on hormones for at least 2 decades. My mom had breast cancer. I’ve already had thyroid cancer. I need help making these decisions
Thank you for reporting on this research. Looking forward to part 2.
Whenever I have a question about anything related to female health, my search includes your name.
Thank you for this excellent analysis and summary. What about absolute length of time on MHT? Say, for someone who started taking it in their early 40s for vasomotor symptoms and thus may have many more years on it than someone starting in their 50s.
Great analysis. I too, am looking forward to Part 2.
Such an informative read. I feel scared and like a failure for not being able to take mht at 53. I’m still having light symptoms and some nightsweats 4 years post menopause. I feel like I amsending myself to an early grave with all the mht push. I get so many side effects from it. Debilitating progesterone intolerance. I feel defeated but appreciate everything you share with us. I feel like you are the only logical source anymore.
I took the time to read the recent study. The one issue that is not presented however is the impact all forms of estrogen (including vaginal delivery) has on women who are on a thyroid replacement. You have stated,"In the main analysis, the investigators grouped low-dose transdermal and low-dose vaginal therapies together, meaning a 25 mcg estradiol patch was in the low-dose category, but so were vaginal estrogen tablets and rings. However, one of these delivers estrogen into the blood (patch), and the other does not". Since vaginal estrogen does to a small degree enter the bloodstream (which I have proven by using it TSH does increase) why is the Menopause Society not addressing this issue since more women are impacted by thyroid issues especially during midlife? The study does recognize through statistics that vaginal estrogen impacts bone health (to a lesser degree than transdermal patches) lung cancer et al which suggests that the impact of this form of therapy is systemic. The product monograph as well as the information from the manufacturer of vagifem (and yes I did reach out to them) can impact TBG proteins in women who are on a suppressive or replacement of levothyroxine. I have accessed JAMA, the Journals from the Endocrine and OB/GYN societies as well as PubMed and cross referenced all of the information with the product monographs (and was told by the pharmaceutical companies they are published for medical doctors to access for additional information) and all support that any form of estrogen will impact TBG proteins (increase). How many doctors are up to date on this? The information in the latest study means women who have been waiting for help should be able to access it. Some women on a replacement of levothyroxine require two specialists, one for menopause issues as well as one to assist with adjustments in doses.
Thank you for this information. Did the study address MHT and cholesterol levels?
This has been a tremendously helpful review with great discussion points of your interpretation as I often have this question posed to me—“is there a reason to preventatively be on hormones?” I look forward to more studies. Thank you!!!