Jen Gunter Instagram – I have finished my review of the new study that looks at use of MHT beyond age 65. Here is a summary, and for the full piece please head to TheVajenda.com. Remember, this is an observational study, so not definitive.
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Estradiol and either progesterone or a progestin continued after age 65 was not associated with an increased risk of mortality, colon cancer, cardiovascular disease, or dementia. These are important takeaways.
This study doesn’t support combined MHT reducing the risk of dementia or the progesterone-based regimens protecting the heart. The data for the progestin-based regimens protecting the heart was a bit all over the place.
Overall, progestin regimens tended to perform better in several domains, which is surprising given the findings of other observational studies.
There was, as expected, an increased risk of breast cancer, more so with progesterone vs progestin regimens, which has not been shown in other observational data. Until now, the data suggested progesterone has a lower risk of breast cancer. The lowest dose of transdermal estradiol wasn’t linked with an increased risk of breast cancer, but whether that is a true effect or not isn’t possible to know.
Progestins were more protective than progesterone for endometrial cancer, and I think this is one of the more important findings. I think this needs further study and might be something for someone at high risk for endometrial cancer to consider when thinking about MHT.
The authors concluded that estrogen plus progestin “exhibited risk reductions in endometrial and ovarian cancers, ischemic heart disease, congestive heart failure, and venous thromboembolism.” In contrast, estrogen plus progesterone “exhibited risk reduction only in congestive heart failure.”
For those who want to continue MHT past age 65, as long as they are aware of the increased risk of breast cancer and aware that there may be some unanswered questions about progestin vs. progesterone, there is no reason to say they shouldn’t, given the mortality data is neutral and that they understand this is based on observational data. | Posted on 30/Apr/2024 12:27:06