THS: some molecules have positive effects , others do not, the important thing is to know the reasons

Some estrogens and progestins used in hormone replacement therapy (HRT) for menopause have positive effects , while others result in deleterious effects highlighted by studies in populations of specific women ( obese , elderly and / or hypertensive ) , it is important to know that women and prescribers may have recourse to this type of treatment with a little more serenity in a dispassionate climate.
This was attempted to develop and Dr. Christian Jamin, gynecologist at the Bichat Hospital in Paris , during a press conference.

" At the bone level , estrogens reduce the loss, regardless of the molecule and its route of administration , with a dose effect (that is to say, the more you increase it , the more women respond to treatment) and a threshold effect beyond which increasing the dosage is accompanied hardly an increase in profits, " says Dr. Jamin .

According to him, estrogen treatments should be introduced as soon as possible , as early menopause , bone microarchitecture deteriorates irreversibly . " If HRT is initiated at the beginning of hormonal deficiency , then this micro -architecture, essential for bone strength , is found preserved ."

The cardiovascular system , he says , it is clear that the endogenous estrogen secretion has a beneficial effect on the arteries. " If the plaque begins to develop in humans from the age of 20-25 years in women, this phenomenon began after menopause (due to hormonal protection). Many arguments therefore allowed to hope that estrogen would decrease atherosclerotic plaque or at least prevent its proliferation , "said the specialist.

However, in the WHI , HRT use ( combination of oral equine estrogen and a synthetic progestin , medroxyprogesterone acetate , a non-prescribed combination in France ) , not only did not show any effect cardiovascular protection , but on the contrary, a deleterious effect right from the first year of treatment . " The fact of taking hormones orally active coagulation, this route of administration multiplying the risk of phlebitis by 4, the maximum risk is also the first year. Moreover , age and obesity lead an excess risk in this area (remember that the WHI population was aged on average 63 years old and overweight in most cases, a different profile of our country ) , "says the gynecologist .

As for the increased risk of myocardial infarction on HRT, it is not linked to atherosclerosis but phenomena of thrombosis which the culprit is the type of progestin this time , since some of they cause insulin resistance ( in the case of medroxyprogesterone acetate , that is to say, a synthetic progestin and not natural progesterone ) . Insulin resistance is itself responsible for abnormal fibrinolysis natural mechanism preventing blood clot ( from obstructing a coronary artery ) to expand. Diabetics are thus more vulnerable to the risk of heart attack, reports the passage Dr. Jamin .

In addition , estrogens administered orally increase the production of enzymes that stimulate cracking existing atherosclerotic plaques , unlike estrogen produced by the ovaries that protect such a phenomenon .

In risk of stroke , he adds , are estrogen orally that increase blood pressure and may be harmful to a hypertensive patient , hypertension represents a major risk factor for cerebrovascular events .

Finally, regarding breast cancer is estrogen - progestin synthesis that can be ( and not create , says Dr. Jamin ) cancer by stimulating tissue growth . "The risk disappears two years after stopping treatment," he notes , adding with natural progesterone , there is little or no tumor growth .

As suggested , therefore, called the French E3N study , conducted among some 54,000 postmenopausal women adherent to the MGEN , combined estrogen through natural skin - micronized progesterone should protect candidates for HRT against cardiovascular and tumor risk provided to prescribe in a patient who has been through menopause , without either obesity or hypertension, or diabetes, disorders of the climacteric annoying and possibly increased risk of osteoporosis .

Any prescription drug and is common sense and a doctor / patient including on the benefits and risks of treatment dialogue , particularly on a hormone replacement . The key in this case is to get as close as possible to a natural alternative , said Dr. Jamin .