THS: rehabilitation confirmed by studying Mission

The Anglo-Saxon WHI (Women 's Health Initiative ) and MWS ( Million Women Study) studies, which have caused a stir respectively in 2002 and 2003 , by objectifying increased coronary risk of breast cancer in postmenopausal women on HRT have since been called into question and the subject of much controversy because of their questionable methodology and the lack of opportunity to translate their findings to the French situation, since real bombshell , a study French this faith and Mission called , attempts to rehabilitate the THS with reassuring results for the health of postmenopausal women treated .
Complications taking HRT
This topic has been widely discussed at a press conference organized in Paris by the Theramex laboratory, which helps fund the study mission , and under the leadership of the National Federation of Gynecology Medical Colleges ( FNCGM ) in presence of Dr Christian Jamin, Paris gynecologist , Dr Marc Espié , senologist at St. Louis hospital in Paris , Dr. Pia de Reilhac gynecologist Nantes and coordinator of the study mission , and Dr. Brigitte Méot gynecologist Nancy .

In 2002, a storm warning was sent to the media brutally through WHI results conducted among 16,000 U.S. patients showing an increased risk of developing breast cancer and cardiovascular disease , resulting as a consequence stop equally brutal HRT in a majority of French women so treated . It is the turn of the MWS , driving a million postmenopausal women, confirm the increased risk of breast cancer, with higher associations of estrogens and progestins with an estrogen treatment alone. WHI also provided negative results on Alzheimer's disease with an increased risk of this disease in women over 65 years on HRT .

Only a French study named Esther highlighted that natural estrogens administered subcutaneously ( gel or patch) , as is mostly the case in France , did not cause an increased risk of venous thromboembolism.

Since 2005 , however, appear the first controversy over the Anglo- Saxon studies , thanks to the results of a second French E3N study ( study of 100,000 postmenopausal women with 54,584 Mutual General of National Education ) , revealing that the risk of breast cancer depends primarily on the type of HRT used : indeed, as estrogen in combination with natural progesterone , this risk did not appear increased. " In addition, says Dr. Jamin , experts realize that the Anglo-Saxon data can not be extrapolated to the French people , because on the one hand , the study population was much older (over 60 years) than in women treated France and characterized by a higher percentage of comorbidities (hypertension, obesity) on the other hand , the molecules used in the United States are not the same as those prescribed in France . "

In fact, since 2006 , reanalysis of the WHI study and the Nurses 's Health Study (a large epidemiological study following decades tens of thousands of nurses from the city of Boston ) are more comforting , revealing that HRT administered during first ten years of menopause does not increase coronary risk . " Hence the importance of starting HRT as soon as possible , destabilization or cracking of atherosclerotic plaques in the blood vessels is observed when HRT is initiated more than 5 years after menopause. Similarly, has been shown to reduce by two the risk of dementia ( including Alzheimer's disease) , "says Dr. Jamin .

In 2008 , the data show that HRT prescribed in French ( with transdermal estrogen and natural progesterone , both administered at the lowest effective dose) in women with climacteric symptoms associated with menopause , n ' produces no significant excess risk of breast cancer , says Dr. Espié .

The true effect of HRT on carcinogenesis involves " a promoting effect in cancer cells with estrogen / progestin combination artificial ," says Dr. Jamin . According to him, a cancer that develops in the hormone has also a better prognosis with half the risk of metastasis . " The hormones do not cause the appearance of breast cancer but change the composition of it , making it a better prognosis ," he says .

In addition, says Dr. Jamin, " the establishment of early menopause of HRT ( about 50 years) is beneficial vis-à -vis osteoporosis and may also reduce the risk of myocardial infarction " .

The study assignment : additional positive light
Conducted by the National Federation of Gynecology Medical Colleges , Mission study conducted among 6,600 women followed by a gynecologist and recruited by a lot by 800 volunteers gynecologists to compare the risk of breast cancer in women , aims to French menopausal or not using HRT.

" The results of the first follow-up , who received the Award for 'New Investigator at 18th annual meeting of the North American Menopause Society, in October 2007, should both strengthen the French doctors in their practice and reassure women about the choice of HRT , "said Dr. Reilhac .

In France , the power of hormone replacement therapy usually ranges from age 48 to 53 years. In Mission, treated women received estrogen oral , dermal and either natural progesterone or a progestin pregnane derivative or normal pregnane ( were excluded medroxyprogesterone acetate and derivatives of 19 nor-testosterone ) .

Women journals consultation in the study had 62 years and were postmenopausal and 50 years on average. Their body mass index (BMI : weight ratio of the square of height ) was between 24 and 25.2 kg / m² ( overweight from a BMI of 25 and obesity as a BMI greater than 30 ), the proportion of obese women was higher in the untreated group . "Similarly, women were excluded at greater risk of developing breast cancer ," said Dr. Espié .

" We Mission with a mean of 8.3 years for the duration of HRT treatment , even over 10 years for 31% of enrolled patients ," said Dr. Reilhac .

"Among the evaluable patients , 2,693 are found in the treated group and 2256 in the untreated group. Incidence of breast cancer (number of new cases per year) , after two years of follow up , only revealed not statistically different in both groups ( 0.6 % in the HRT group versus 0.7% for the other group ) . Moreover, in the treated group , the incidence did not vary either by route of administration estrogen ( oral or dermal ) or the type of progestin used (natural progesterone assimilated product pregnane derivative or normal pregnane ) , " says Dr. Espié while recalling the particularity of HRT in France , requires the card and how customized according to the patient.

Finally, in the study which is ongoing Mission ( second stage in June 2008) , no excess risk of breast cancer was observed among women who received progestin therapy before menopause (between 40 and 50 years , usually prescribed in cases of benign breast disease ) , compared to women who do have not taken .

Seen with these results, said Dr. Jamin , rehabilitation of HRT in France must consolidate , respecting the rule of starting treatment as early as possible after menopause.

For Dr. Méot , a woman can be treated if it shows no indication - cons and if it indicates significantly bothersome symptoms : hot flashes ( important during the first 5 years of menopause ) , night sweats that disrupt significantly sleep , fatigue and sleep disturbances even in the absence of the first two symptoms, vaginal dryness and urinary disorders with frequent cravings.

" If menopause is not a disease , it nevertheless represents a more or less difficult passage . For my part, I ask my patients why they want to take HRT or not , and decides with them according to their health , their history and their activities : some , indeed, prefer to be treated during their working life and stop all treatment plans, because they believe the symptoms interfere less , even to rebuke the result otherwise . Others older , who wish to continue , I suggest them to smaller doses. the key is to continue to be well attended , " the expert concludes .

The improvement in symptoms HRT must feel after 15 days to three weeks , if it is necessary to increase the doses , she said. Usually , treatment is started at the lowest effective dose , however, knowing that the dosage of 50 micrograms of estradiol per day is one that has demonstrated its efficacy on fracture risk .