Hormone replacement therapy in general practice: a survey of doctors in the MRC's general practice research framework.

Wilkes, H; Meade, T. W.

doi:10.1136/bmj.302.6788.1317

Cited by 87 publications

(30 citation statements)

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“…[109][110][111] This apparent protective effect was considered by many to be biologically plausible because of the marked differences in coronary heart disease rates between men and women before the menopause, as well as the known effects of oestrogens on lipid profiles. [111][112][113] As a result, hormone replacement therapy was widely prescribed to prevent coronary disease (even though it was not licensed for that purpose), 114 becoming one of the most commonly used medications in industrialized countries.…”

Section: Biases Due To Differences In Underlying Risks Of Health Outcmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms SummaryThis review is intended to help clinicians, patients and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomized controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures ("major vascular events") by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per

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Section: Biases Due To Differences In Underlying Risks Of Health Outcmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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“…This information was not available in the present study, so that we had to use the average age of the menopause (50 years [19]) as a proxy for the onset of estrogen deficiency. The present uptake of hormone replacement therapy in the UK and elsewhere in Europe is probably less than 15% of women aged 40-65 [20,21], with as many as 40% of women failing to complete 12 months of treatment even when there is a clear reason to do so [22]. The use of estrogen replacement in our study population is therefore unlikely to have had a significant effect on the results.…”

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confidence: 60%

Does the Menopause Influence the Risk of Bacteriuria?

et al. 2001

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The objective of this study was to test the hypothesis that the risk of bacteriuria is increased as a result of estrogen deprivation following the menopause. All midstream urine samples (MSU) sent to the King's College Hospital department of microbiology by general practitioners in 1997 were assessed. Bacteriuria was diagnosed when the bacterial count was >10(5) organisms/ml. Logistic regression analysis was performed to investigate the effects of age and sex on the likelihood of having a positive result. Non-linear effects of age were investigated, with interest focusing in particlar on the time around the menopause. There were 15,392 MSU samples analyzed; 11,811 (77%) were from women and 3581 (23%) from men. In both sexes the proportion of positive results increased with increasing age (P<0.0001). The specimens taken from women were significantly more likely to be positive than those taken from a man of the same age (P<0.0001). In women there was no evidence of any non-linear relationship between age and the log odds of a positive result. A plot of the proportion of positive results versus age did not suggest any departure from a linear relationship at or following the menopause. In conclusion, the increased risk of bacteriuria which occurs as women get older appears to happen gradually as a result of the aging process, rather than as the result of pathophysiological changes in the urogenital tract that take place at or following the menopause.

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“…The proportion of women using hormone replacement therapy at any one time in Britain has increased considerably over the past 15 years23 24 to nearly 20% in 1993-4 (MRC Epidemiology and Medical Care Unit, unpublished). By the end of the decade some 30% or more of postmenopausal women may be taking hormone replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy

Meade¹

1996

BMJ

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Objective: To compare the acceptability and symptomatic and metabolic effects of two regimens of hormone replacement therapy in women with hysterectomy. Design: Randomised, double blind comparison. Setting: Seven group practices in the Medical Research Council's general practice research framework. Subjects: 321 women with hysterectomy aged 35-59. Interventions: Hormone replacement therapy with (a) conjugated equine oestrogen 625 µg daily alone or (b) conjugated equine oestrogen 625 µg daily plus the progestogen norgestrel 150 µg daily for the last 12 days of the “cycle.” Main outcome measures: Changes in blood pressure, weight, symptoms, and haemostatic and lipid values. Results: After two years 36% (57/158) of women randomly allocated to take oestrogen alone had discontinued treatment as compared with 30% (49/163) of women allocated to take oestrogen plus progestogen. Smokers were more likely to withdraw than non-smokers. There were no clear differences between the two groups in symptoms often attributed to hormone replacement therapy or in blood pressure or weight. At one year low density lipoprotein cholesterol concentrations had fallen substantially in both groups. High density lipoprotein cholesterol concentrations rose to significantly higher values in women taking oestrogen alone compared with those taking oestrogen plus progestogen, though triglyceride concentrations and factor VII activity were also significantly higher in this group. Fibrinogen concentration tended to fall, though not significantly, in both groups, possibly more in women taking oestrogen alone. Conclusions: Oestrogen plus progestogen was no less well tolerated than oestrogen alone. There was a fairly even balance between possibly beneficial and adverse effects of the two regimens on lipid concentrations and coagulability. Concern that the combined regimen may not have the cardioprotective effects ascribed to oestrogen alone can to some extent be allayed, with reassurance for the growing numbers of women with intact uteri using the combined regimen. Misgivings about the combined regimen in women with hysterectomy on the grounds of its acceptability and its effects on lipid values may also be unfounded. Key messages Key messages In fact, in hysterectomised women norgestrel containing hormone replacement preparations may be as well tolerated as unopposed oestrogen There may be little difference between norgestrel containing hormone replacement therapy and oestrogen only preparations in their lipid and haemostatic effects Pending the results of clinical end point trials, anxieties about the metabolic effects of norgestrel in hormone replacement therapy can largely be allayed

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Hormone replacement therapy in general practice: a survey of doctors in the MRC's general practice research framework.

Abstract: Objectives-To survey current prescribing

Cited by 87 publications

References 4 publications

Interpretation of the evidence for the efficacy and safety of statin therapy

Interpretation of the evidence for the efficacy and safety of statin therapy

Does the Menopause Influence the Risk of Bacteriuria?

Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy

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