Combination Estrogen/Continuous Progestin Reduces Postmenopausal Risk of Endometrial Cancer
Adding continuous progestin to estrogen lowers the risk of endometrial cancer in postmenopausal women, according to a study recently published in the Journal of the National Cancer Institute.
Adding continuous progestin to estrogen lowers the risk of endometrial cancer in postmenopausal women, according to a study recently published in the JNCI: Journal of the National Cancer Institute(doi:10.1093/jnci/djv350). The addition of progestin to an estrogen regimen is known to lower the risk of endometrial cancers, which are associated with estrogen alone use; but just how much the addition of progestin lowers that risk has remained unclear.
To determine the effects that continuous estrogen plus progestin use has on the risk of endometrial cancer, Rowan T. Chlebowski, MD, PhD, at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, and colleagues reviewed data from a Women's Health Initiative (WHI) randomized clinical trial assessed 16 608 postmenopausal women age 50 to 79 years with intact uteri. All participants had normal findings on endometrial biopsy on entry. In the double-blind placebo-controlled trial, participants were randomly assigned to daily estrogen plus progestin given as one pill or placebo. The participants were followed for 13 years.
Study findings demonstrated a statistically significant reduction in endometrial cancer incidence in the intervention group (33 cases, 0.06% yearly) compared with the placebo group (95 cases, 0.10% yearly) after 5.6 years' median intervention and 13 years' cumulative follow-up.
"Continuous combined estrogen plus progestin use for 5.6 years in postmenopausal women with normal endometrial biopsy at therapy initiation resulted in a statistically significant reduction in endometrial cancer incidence, with the difference becoming statistically significant during longer-term post intervention follow-up," the authors reported, adding that, "In postmenopausal women, continuous combined estrogen plus progestin use reduces endometrial cancer incidence by 35%."
For Women - Hormone therapy: Is it right for you?
Early menopause typically lowers the risk of most types of breast cancer. For women who reach menopause prematurely, the protective benifits of hormone therapy usually outweigh the risks.
Hormone therapy was once routinely used to treat menopausal symptoms and protect long-term health. Then large clinical trials showed health risks. What does this mean to you? By Mayo Clinic Staff
Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it's now called) was also thought to have the long-term benefits of preventing heart disease and possibly dementia.
Use of hormone therapy changed abruptly when a large clinical trial found that the treatment actually posed more health risks than benefits for one type of hormone therapy, particularly when given to older postmenopausal women. As the concern about health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it.
Hormone therapy is no longer recommended for disease prevention, such as heart disease or memory loss. However, further review of clinical trials and new evidence show that hormone therapy may be a good choice for certain women, depending on their risk factors. What are the benefits of hormone therapy?
The benefits of hormone therapy depend, in part, on whether you take systemic hormone therapy or low-dose vaginal preparations of estrogen.
Systemic hormone therapy. Systemic estrogen — which comes in pill, skin patch, gel, cream or spray form — remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. Estrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
Although the Food and Drug Administration (FDA) still approves estrogen for the prevention of the bone-thinning disease called osteoporosis, doctors usually recommend medications called bisphosphonates to treat osteoporosis. Low-dose vaginal products. Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form — can effectively treat vaginal symptoms and some urinary symptoms, while minimizing absorption into the body. Low-dose vaginal preparations do not help with hot flashes, night sweats or protection against osteoporosis. Long-term systemic hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But some data suggest that estrogen can decrease the risk of heart disease when taken early in postmenopausal years.
A recent, randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — explored estrogen use and heart disease in younger postmenopausal women. The study found no significant association between hormone therapy and heart disease.
For women who haven't had their uterus removed, estrogen is typically prescribed along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer. Women who have had their uterus removed (hysterectomy) don't need to take progestin. What are the risks of hormone therapy?
In the largest clinical trial to date, a combination estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including:
- Heart disease
- Stroke
- Blood clots
- Breast cancer
A related clinical trial evaluating estrogen alone (Premarin) in women who previously had a hysterectomy found no increased risk of breast cancer or heart disease. The risks of stroke and blood clots were similar to the combination therapy.
Hormone therapy, particularly estrogen combined with a progestin, can make your breasts look more dense on mammograms, making breast cancer more difficult to detect. Also, especially when taken for more than a few years, hormone therapy increases the risk of breast cancer, a finding confirmed in multiple studies of different hormone therapy combinations, not just limited to a combination estrogen-progestin pill (Prempro).
The risks of hormone therapy may vary depending on whether estrogen is given alone or with a progestin, and depending on your current age and age at menopause, the dose and type of estrogen, and other health risks such as your risks of heart and blood vessel (cardiovascular) disease, cancer risks and family medical history.
All of these risks should be considered in deciding whether hormone therapy might be an option for you. Who should consider hormone therapy?
Despite the health risks, systemic estrogen is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you're healthy and:
Experience moderate to severe hot flashes or other menopausal symptoms Have lost bone mass and either can't tolerate or aren't benefitting from other treatments Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian insufficiency) Women who experience an early menopause, particularly those who had their ovaries removed and don't take estrogen therapy until at least age 45, have a higher risk of:
- Osteoporosis
- Coronary heart disease
- Earlier death
- Parkinsonism (Parkinson's-like symptoms)
- Anxiety or depression
Early menopause typically lowers the risk of most types of breast cancer. For women who reach menopause prematurely, the protective benefits of hormone therapy usually outweigh the risks.
Your age, type of menopause and time since menopause play a significant role in the risks associated with hormone therapy. Talk with your Blueprint Patient Care Coordinator about it.
Research and Markets: Global Hormone Replacement Therapy Market 2015-2019
Research and Markets has announced the addition of the "Global Hormone Replacement Therapy Market 2015-2019" report to their offering.
The report presents the vendor landscape and a corresponding detailed analysis of the top vendors in the market, including F. Hoffmann-La Roche, Merck Serono, Novartis, Novo Nordisk, and Pfizer.
Hormone replacement therapy involves the replacement of the hormones in the body whose levels have become low, in case of women nearing menopause or patient with growth hormone deficiency due to conditions such as dwarfism. At present, the combination of drugs are used to treat the conditions, which are known to have a better safety and efficacy parameter. Unmet medical needs is one of the major drivers influencing the growth of the market. Therefore, the need for new treatment options with better safety results to accommodate the current unmet need is huge.
In 2014, the Americas dominated the market, where the majority of the contribution was from the US, and this trend is expected to continue during the forecast period. However, the market in the APAC region is witnessing a rapid growth, hence, there is a vast opportunity for vendors to venture into this region. Technavio expects the global hormone replacement therapy market to grow at a moderate rate, posting a CAGR of over 2% during the forecast period.
With a market share of more than 60% the estrogen replacement therapy segment dominate the hormone replacement therapy market. Estrogen replacement therapy is a type of therapy in which estrogen hormones are commonly used to treat the symptoms of menopause. It helps in the reduction of short-term changes of menopause such as hot flashes, disturbed sleep, and vaginal dryness.
Segmentation of the hormone replacement therapy market by route of administration
- Oral
- Parenteral
- Transdermal
Key questions answered in the report include
- What will the market size and the growth rate be in 2019?
- What are the key factors driving the global hormone replacement therapy market?
- What are the Key Market trends?impacting the growth of the global hormone replacement therapy market
- What are the challenges to market growth?
- Who are the key vendors in the global hormone replacement therapy market?
- What are the market opportunities and threats faced by the vendors in the global hormone replacement therapy market?
- What are the trending factors influencing the market shares of the Americas, EMEA, and APAC?
- What are the key outcomes of the five forces analysis of the global hormone replacement therapy market?
- For more information visit http://www.researchandmarkets.com/research/tvzh23/global_hormone
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