Patient-Specific Decisions About Hormone Replacement Therapy in Postmenopausal Women

Col, Nananda F.; Eckman, Mark H.; Karas, Richard H.; Pauker, Stephen G.; Goldberg, Robert J.; Ross, Elizabeth M.; Orr, Richard K.; Wong, John B.

doi:10.1001/jama.1997.03540380054031

Cited by 186 publications

(42 citation statements)

References 90 publications

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“…American women were prescribed and consumed hormone replacement therapy to relieve menopausal symptoms, with the added belief that HRT might also prevent heart disease, osteoporosis, and stroke (e.g., Col et al 1997). In 1999, the popularity of HRT surged once again with the introduction of a new combination pill of estrogen and progesterone (cHRT), which was seen as safer and more effective at controlling menopausal symptoms.…”

Section: Introductionmentioning

confidence: 99%

Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine

Fishman

Flatt

Settersten

2015

Social Science & Medicine

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In 2002, the Women’s Health Initiative, a large-scale study of the safety of hormone replacement therapy (HRT) for women conducted in the United States, released results suggesting that use of postmenopausal HRT increased women’s risks of stroke and breast cancer. In the years that followed, as rates of HRT prescription fell, another hormonal therapy rose in its wake: bioidentical hormone replacement therapy (BHRT). Anti-aging clinicians, the primary prescribers of BHRT, tout it as a safe and effective alternative to treat menopausal symptoms and, moreover, as a preventative therapy for age-related diseases and ailments. Through in-depth interviews with 31 U.S.-based anti-aging clinicians and 25 female anti-aging patients, we analyze attitudes towards BHRT. We illustrate how these attitudes reveal broader contemporary values, discourses, and discomforts with menopause, aging, and biomedicine. The attraction to and promise of BHRT is rooted in the idea that it is a “natural” therapy. BHRT is given both biomedical and embodied legitimacy by clinicians and patients because of its purported ability to become part of the body’s “natural” processes. The normative assumption that “natural” is inherently “good” not only places BHRT beyond reproach, but transforms its use into a health benefit. The clinical approach of anti-aging providers also plays a role by validating patients’ embodied experiences and offering a “holistic” solution to their symptoms, which anti-aging patients see as a striking contrast to their experiences with conventional biomedical health care. The perceived virtues of BHRT shed light on the rhetoric of anti-aging medicine and a deeply complicated relationship between conventional biomedicine, hormonal technologies, and women’s bodies.

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Section: Introductionmentioning

confidence: 99%

Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine

Fishman

Flatt

Settersten

2015

Social Science & Medicine

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“…In 1997, a mathematical model of several epidemiological studies concluded that the benefit from CVD provided by hormone therapy far outweighed the potential risks and recommended a broader use of hormone therapy in postmenopausal women (Col et al, 1997). Scarcely a decade later, the Women's Health Initiative (WHI) study yielded just the opposite recommendation, namely that hormone therapy should be given in the smallest dose possible for the shortest amount of time and should not be prescribed for cardiovascular protection (FDA statement posted 8/13/2002).…”

mentioning

confidence: 99%

Revisiting the timing hypothesis: Biomarkers that define the therapeutic window of estrogen for stroke

Sohrabji

Selvamani

Balden

2013

Hormones and Behavior

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Significantly extended life expectancy coupled with contemporary sedentary lifestyles and poor nutrition have created a global epidemic of cardiovascular disease and stroke. For women, this issue is complicated by the discrepant outcomes of hormone therapy (HT) for stroke incidence and severity as well as the therapeutic complications for stroke associated with advancing age. Here we propose that the impact of estrogen therapy cannot be considered in isolation, but should include age-related changes in endocrine, immune, and nucleic acid mediators that collaborate with estrogen to produce neuroprotective effects commonly seen in younger, healthier demographics. Due to their role as modulators of ischemic cell death, the post-stroke inflammatory response, and neuronal survival and regeneration, this review proposes that Insulin-like Growth Factor (IGF)-1, Vitamin D, and discrete members of the family of non-coding RNA peptides called microRNAs (miRNAs) may be crucial biochemical markers that help determine the neuroprotective “window” of HT. Specifically, IGF-1 confers neuroprotection in concert with, and independently of, estrogen and failure of the insulin/IGF-1 axis is associated with metabolic disturbances that increase the risk for stroke. Vitamin D and miRNAs regulate and complement IGF-1 mediated function and neuroprotective efficacy via modulation of IGF-1 availability and neural stem cell and immune cell proliferation, differentiaton and secretions. Together, age-related decline of these factors differentially affects stroke risk, severity, and outcome, and may provide a novel therapeutic adjunct to traditional HT practices.

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“…In three cases, the findings of DA and matching SR of RCTs were similar after the sensitivity analysis [14,16,27]. …”

Section: Resultsmentioning

confidence: 92%

Concordance between decision analysis and matching systematic review of randomized controlled trials in assessment of treatment comparisons: a systematic review

Mhaskar

Wao

Mahony

et al. 2014

BMC Med Inform Decis Mak

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BackgroundSystematic review (SR) of randomized controlled trials (RCT) is the gold standard for informing treatment choice. Decision analyses (DA) also play an important role in informing health care decisions. It is unknown how often the results of DA and matching SR of RCTs are in concordance. We assessed whether the results of DA are in concordance with SR of RCTs matched on patient population, intervention, control, and outcomes.MethodsWe searched PubMed up to 2008 for DAs comparing at least two interventions followed by matching SRs of RCTs. Data were extracted on patient population, intervention, control, and outcomes from DAs and matching SRs of RCTs. Data extraction from DAs was done by one reviewer and from SR of RCTs by two independent reviewers.ResultsWe identified 28 DAs representing 37 comparisons for which we found matching SR of RCTs. Results of the DAs and SRs of RCTs were in concordance in 73% (27/37) of cases. The sensitivity analyses conducted in either DA or SR of RCTs did not impact the concordance. Use of single (4/37) versus multiple data source (33/37) in design of DA model was statistically significantly associated with concordance between DA and SR of RCTs.ConclusionsOur findings illustrate the high concordance of current DA models compared with SR of RCTs. It is shown previously that there is 50% concordance between DA and matching single RCT. Our study showing the concordance of 73% between DA and matching SR of RCTs underlines the importance of totality of evidence (i.e. SR of RCTs) in the design of DA models and in general medical decision-making.

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Patient-Specific Decisions About Hormone Replacement Therapy in Postmenopausal Women

Abstract: The benefit of hormone replacement therapy in reducing the likelihood of developing CHD appears to outweigh the risk of breast cancer for nearly all women in whom this treatment might be considered. Our analysis supports the broader use of hormone replacement therapy.

Cited by 186 publications

References 90 publications

Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine

Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine

Revisiting the timing hypothesis: Biomarkers that define the therapeutic window of estrogen for stroke

Concordance between decision analysis and matching systematic review of randomized controlled trials in assessment of treatment comparisons: a systematic review

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