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The use of hormone replacement therapy for peri- and post-menopausal women has been a topic that has been of great interest to me personally.
It all started in 2001 for me, when I experienced a rather large regression in my LASIK vision correction. Over a period of about 8 months, my correction slowly regressed nearly 2 diopters. Because [at that time] this was not common, the doctors I saw offered theories and educated guesses for this regression. But no definitive diagnosis was made.
Forced to search out answers my own, I speculated that the hormone replacement therapy that my ob-gyn had prescribed [and I automatically starting taking—no questions asked] was causing the regression. I had also experienced severe dry eye during this time, even worse than the severe dry eye that I had experienced during first few months after LASIK. Because of the severe discomfort of dry eye and the regression in correction that I had speculated was caused by the HRT, I stopped the hormone replacement. The dry eye gradually improved and the regression slowed. It was enough for me to believe there was a connection, but there was no medical information at the time to back up my theories.
A few months later, the first results were released by the Women’s Health Initiative Study and suddenly, the conventional medical wisdom about hormone replacement therapy for menopausal women was turned upside down. Hormone replacement therapy, especially long-term use, was found not to be the positive medical treatment for menopause that doctors had assumed it to be, but in fact was found to cause serious health consequences for women taking it.
The first data from the study on women’s health was published in 2002. Read it here.
If you haven’t already, spend some time reading all of the many published studies from the Women’s Health Initiative Study results here.
The first relevant article specific to dry eye syndrome was published in 2001. Read it here.
Here is a more recent study of hormone replacement therapy and dry eye. Read it here.
Discussed often on this forum is the role androgens play in dry eye syndrome, particularly for women. Increase androgen levels, then dry eye syndrome improves, right? DHEA cream, androgen eye drops and use of estrogen/testosterone replacement therapy have all been suggested and tried by people seeking relief from dry eye syndrome. But is it that simple? Can adding androgens help women with dry eye without causing harm?
The most recent published warning to doctors and patients earlier this year [analyzing results from the WHI study] found that women taking combination estrogen and testosterone [Estratest] had double the risk of breast cancer. Read it here.
And another study of combined estrogen/testosterone found that women taking it were at higher risk for elevated IOP. Read it here.
One of the newer portions of the WHI study discusses data collected on the women who discontinued hormone replacement therapy because a large portion of the participants stopped taking HRT due to the health risks.
What the study found was that most of the women who discontinued HRT, no matter how long they had taken it, experienced the same menopausal symptoms that they had experienced prior to taking HRT and at the same intensity.
Link to article: http://jama.ama-assn.org/cgi/content/full/294/2/183
Hormone replacement therapy does not treat menopause, it provides symptom relief and delays the process.
One option for women is “bio-identical” hormones or natural forms of herbs and substances that mimic hormones. Because they are natural, they are safe, right? Well, maybe.
This recent study examined the safety of bio-identicals. Read about it here.
Use of complementary and alternative medicine (CAM) by the women in the WHI study as well as non-pharmalogical interventions (NPI) was documented in this recent study. Read it here.
Just to add a few other recent studies that have listed adverse effects of long-term use of HRT, read about:
Increased risk of ovarian cancer:
here.
Increase in urinary incontinence:
here.
This is not an exhaustive list of studies, but I hope there is enough here for women who are seeking relief for their dry eye symptoms to make an informed decision about taking hormones for symptom relief.
Please weigh the risks and the benefits and consult your trusted physician to help you make the right decision for you.
Scout
Oh, and about that LASIK correction regression?
Read about it here.
It all started in 2001 for me, when I experienced a rather large regression in my LASIK vision correction. Over a period of about 8 months, my correction slowly regressed nearly 2 diopters. Because [at that time] this was not common, the doctors I saw offered theories and educated guesses for this regression. But no definitive diagnosis was made.
Forced to search out answers my own, I speculated that the hormone replacement therapy that my ob-gyn had prescribed [and I automatically starting taking—no questions asked] was causing the regression. I had also experienced severe dry eye during this time, even worse than the severe dry eye that I had experienced during first few months after LASIK. Because of the severe discomfort of dry eye and the regression in correction that I had speculated was caused by the HRT, I stopped the hormone replacement. The dry eye gradually improved and the regression slowed. It was enough for me to believe there was a connection, but there was no medical information at the time to back up my theories.
A few months later, the first results were released by the Women’s Health Initiative Study and suddenly, the conventional medical wisdom about hormone replacement therapy for menopausal women was turned upside down. Hormone replacement therapy, especially long-term use, was found not to be the positive medical treatment for menopause that doctors had assumed it to be, but in fact was found to cause serious health consequences for women taking it.
The first data from the study on women’s health was published in 2002. Read it here.
Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10 000 person-years.
Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.
Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.
The first relevant article specific to dry eye syndrome was published in 2001. Read it here.
Each 3-year increase in the duration of HRT use was associated with a significant 15% (95% CI, 11%-19%) elevation in risk of clinically diagnosed dry eye syndrome or severe symptoms. Results were similar for the combined end point of clinically diagnosed dry eye syndrome and severe symptoms.
Conclusions These data suggest that women who use HRT, particularly estrogen alone, are at increased risk of dry eye syndrome. Physicians caring for women who are taking or considering HRT should be apprised of this potential complication.
Conclusions These data suggest that women who use HRT, particularly estrogen alone, are at increased risk of dry eye syndrome. Physicians caring for women who are taking or considering HRT should be apprised of this potential complication.
CONCLUSION: Duration of menopause and use of HRT may increase the incidence of dry eye in post-menopausal woman.
The most recent published warning to doctors and patients earlier this year [analyzing results from the WHI study] found that women taking combination estrogen and testosterone [Estratest] had double the risk of breast cancer. Read it here.
Among women with a natural menopause, the risk of breast cancer was nearly 2.5-fold greater among current users of estrogen plus testosterone therapies (multivariate relative risk, 2.48; 95% confidence interval, 1.53-4.04) than among never users of PMHs. This analysis showed that risk of breast cancer associated with current use of estrogen and testosterone therapy was significantly greater compared with estrogen-only therapy (P for heterogeneity, .007) and marginally greater than estrogen and progesterone therapy (P for heterogeneity, .11). Women receiving PMHs with testosterone had a 17.2% (95% confidence interval, 6.7%-28.7%) increased risk of breast cancer per year of use.
Conclusion Consistent with the elevation in risk for endogenous testosterone levels, women using estrogen and testosterone therapies have a significantly increased risk of invasive breast cancer.
Conclusion Consistent with the elevation in risk for endogenous testosterone levels, women using estrogen and testosterone therapies have a significantly increased risk of invasive breast cancer.
The increase in IOP was statistically significant at the 0.05 level of significance within three months and continued over 12 months. Two patients whose pressures increased (>4 mm Hg) returned to baseline levels after EECM was discontinued. CONCLUSIONS: Esterified estrogens combined with methyltestosterone produce a clinically significant increase in IOP in postmenopausal women with dry eye syndrome.
What the study found was that most of the women who discontinued HRT, no matter how long they had taken it, experienced the same menopausal symptoms that they had experienced prior to taking HRT and at the same intensity.
Link to article: http://jama.ama-assn.org/cgi/content/full/294/2/183
Symptoms reported by more than 10% of respondents after discontinuing use of CEE + MPA included (in descending frequency) pain or stiffness, feeling tired, vasomotor symptoms, difficulty sleeping, and bloating or gas. Symptoms reported by more than 10% of respondents after stopping placebo were pain or stiffness and feeling tired. The percentage of respondents with scores on the Center for Epidemiologic Studies Depression Scale above the cut point for depression was greater for women after discontinuing use of CEE + MPA (10.5%) than placebo (7.2%) (P<.001). Younger women reported more frequent emotional or neurological symptoms, headaches, breast tenderness, vaginal symptoms, and vasomotor symptoms.
Table 3 shows moderate or severe symptoms in participants after discontinuing study pill use stratified by whether or not women had these symptoms at baseline. Women who reported having moderate or severe symptoms at baseline were more likely to report these symptoms after discontinuing study pill use regardless of treatment group. Overall, 91.1% of women in the former CEE + MPA group who reported vasomotor symptoms after discontinuing MHT had also experienced them in the past.
Table 3 shows moderate or severe symptoms in participants after discontinuing study pill use stratified by whether or not women had these symptoms at baseline. Women who reported having moderate or severe symptoms at baseline were more likely to report these symptoms after discontinuing study pill use regardless of treatment group. Overall, 91.1% of women in the former CEE + MPA group who reported vasomotor symptoms after discontinuing MHT had also experienced them in the past.
One option for women is “bio-identical” hormones or natural forms of herbs and substances that mimic hormones. Because they are natural, they are safe, right? Well, maybe.
This recent study examined the safety of bio-identicals. Read about it here.
The clinical trials that have examined cardiovascular outcomes associated with estriol therapy are limited, and there is evidence to demonstrate variable effects on markers associated with cardiovascular risk. Based on the current evidence, the same cardiovascular risks that have recently been found to be associated with oral HRT may also be associated with the administration of oral estriol in BHRT. The use of oral bio-identical hormones cannot be promoted until further evidence is available to demonstrate its safety.
Of 1,206 women who responded, 563 (47%) were symptomatic. The most commonly used CAM/NPI for symptom management were diet/nutrition (44.3%), exercise/yoga (41.5%), relaxation/stress management (27.4%) and homeopathic/naturopathic remedies (25.4%). Of women who used these interventions, large proportions reported them to be helpful. The characteristics that were independently associated with use of CAM/NPI were White ethnicity, being physically active, and not smoking. CONCLUSIONS: Many menopausal symptomatic women are using a wide range of CAM/NPI and report these to be effective, particularly those who are white, physically active and do not smoke.
Increased risk of ovarian cancer:
here.
Long durations of use of unopposed estrogen and of estrogen plus progestin, especially sequential regimens, are associated with increased ovarian cancer risk. These data expand the range of possible risks associated with menopausal hormone therapy.
here.
Among women who were already incontinent, the relative risk of aggravation with hormone replacement therapy compared with placebo was about 1.40. (2) The results of another trial involving nearly 3000 women were similar. (3) Other, smaller trials failed to show any positive impact of oestrogen-progestin therapy on urinary incontinence in postmenopausal women. (4) In practice, postmenopausal hormone replacement therapy does not protect against urinary incontinence; on the contrary, it may trigger or worsen urinary incontinence.
Please weigh the risks and the benefits and consult your trusted physician to help you make the right decision for you.
Scout
Oh, and about that LASIK correction regression?
Read about it here.
Women on HRT are at an increased risk of refractive regression after LASIK.
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