FDA removed black box warning for HRT

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don’t trust anything RFK jr or trump says. This FDA is currently SUS so I’m seeing this as a red flag. If they promote it, I should not consider it.
If it was legitimately safe, Melania should have made the announcement. Woman to women.
I’ll wait until we have actual medical experts back in the FDA before I trust their advice.

Wow - you would have given it more credence out of Melania’s mouth? That’s moronic.

HRT has enabled me to sleep through the night regularly for the first time in a year. Game changer.

And has increased your risk of stroke and cancer.

Well, my thyroid stopped working in my 20s and I need thyroid replacement hormone for the rest of my life to function because my body doesn’t make thyroid hormone anymore. Does that raise my risk of stroke and cancer? I don’t know, maybe. But I’d rather die than live half dead. I don’t see how it’s different with progesterone and estrogen.

Having had hormone positive breast cancer and a double mastectomy, I beg to differ.

Then you are not a good candidate for HRT. Just like anyone who has had cancer or has a family risk for cancers.

But for many people, it's a viable solution to the problem and the benefits outweigh the risks

The risk is cancer. So, no.

And NOT taking HRT raises your risk of colorectal cancer.

Like it or not, there is no risk-free path. I wish there were.

I wish you peace, which is what I suspect you are seeking.

I don’t think she’s seeking peace. I think she’s searching for fights and is at unusually high risk for being beaten to death with a bag of satsumas in a Whole Foods parking lot.

Obviously you’ve never had a satsuma. No one would dare to bruise them in a fight.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the people who think hormone replacement therapy is just a grift from the wellness industry why aren’t you looking at the other side of the grift? It’s not as if women who don’t choose hormone replacement theory are aging naturally, lol

I’m a healthcare policy walk who can answer any question on Medicare spend and is deep on the data of what happens to aging women in America. Anyone who says women are aging naturally are either deeply delusional or deeply denial and throw in a dose of deeply ignorant.

Do you have any idea of the number of postmenopausal women who are on antidepressants, anti-anxiety meds, prescriptions sleep aids, hypertension drugs, statins, osteoporosis medications, treatments for UTI, treatments for sexual dysfunction, and the list goes on. Not to mention the care that we spend on frailty from hip fractures, chronic pain meds from bone breaks, hospitalizations caused from UTIs in older women and again the list goes on.

Do you know a lot of dentists will not treat women who are on osteoporosis meds beyond basic cleanings because the mortality rate for any kind of dental surgery for women on these meds is so high? Have you thought about what might happen if you need to go on osteoporosis meds, and something happens to your dental health. You probably should.

While I agree that the evidence does not seem to be there to just put every woman on HRT for primary prevention - if women are having symptoms there does seem to be good evidence that it does help prevent the need for some of these other medical conditions.

I’d be very wary of anyone trying to stop any kind of discourse on HRT. It’s just a grift on the other side and frankly, the spend is a lot higher than what we would spend on HRT. Again, I will stress that I do not think every woman should be on HRT, but to not even entertain the need for research and do not even question The bad advice women got 25 years ago from a deeply flawed that has been retracted, there’s something really disturbing going on there.

There’s zero evidence that HRT’s “prevent” all the things you listed. HRTs are very effective for one thing - hot flashes. There is good evidence for osteoporosis. But women are still going to need statins, SSRIs, therapy, blood pressure meds, even when HRT.

Wait. Didn’t you know that HRT is the cure all for anything that happens after you turn 40?

You’re quick with the one liners. That probably feels very satisfying.

One-liners aside, there’s actually ample evidence that HRT helps with the things mentioned. You, too, can look up the studies and meta analyses; some have even been posted in this thread.

But you don’t have to read them! It is absolutely your choice to ignore them and go straight to the next one-liner. Wishing you a good night either way,

DP. There is some evidence HRT may help, to some degree, but not a cure, and in some cases (like muscle pain) the effect is small and possibly outweighed by risks. Not to mention that there are so many different formulations of HRT that the dosages and combinations people are on have not been fully studied.

I will consider HRT if my hot flashes start to disrupt sleep badly (but I will also look into the other new meds). I will ask my doctor about whether they recommend a DEXA scan to see if taking HRT to prevent osteoporosis makes sense. Otherwise, all the rest of the benefits are so far from being proven or as significant as those two that there’s no reason to even consider them in the calculus.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don’t trust anything RFK jr or trump says. This FDA is currently SUS so I’m seeing this as a red flag. If they promote it, I should not consider it.
If it was legitimately safe, Melania should have made the announcement. Woman to women.
I’ll wait until we have actual medical experts back in the FDA before I trust their advice.

Wow - you would have given it more credence out of Melania’s mouth? That’s moronic.

HRT has enabled me to sleep through the night regularly for the first time in a year. Game changer.

And has increased your risk of stroke and cancer.

Well, my thyroid stopped working in my 20s and I need thyroid replacement hormone for the rest of my life to function because my body doesn’t make thyroid hormone anymore. Does that raise my risk of stroke and cancer? I don’t know, maybe. But I’d rather die than live half dead. I don’t see how it’s different with progesterone and estrogen.

Having had hormone positive breast cancer and a double mastectomy, I beg to differ.

Then it’s not for you. So step off.

I’m not in a breast cancer thread. You’re here for what purpose? Did you take HRT and then have your double mastectomy? No, right? STFU.

Wow. Umm.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the people who think hormone replacement therapy is just a grift from the wellness industry why aren’t you looking at the other side of the grift? It’s not as if women who don’t choose hormone replacement theory are aging naturally, lol

I’m a healthcare policy walk who can answer any question on Medicare spend and is deep on the data of what happens to aging women in America. Anyone who says women are aging naturally are either deeply delusional or deeply denial and throw in a dose of deeply ignorant.

Do you have any idea of the number of postmenopausal women who are on antidepressants, anti-anxiety meds, prescriptions sleep aids, hypertension drugs, statins, osteoporosis medications, treatments for UTI, treatments for sexual dysfunction, and the list goes on. Not to mention the care that we spend on frailty from hip fractures, chronic pain meds from bone breaks, hospitalizations caused from UTIs in older women and again the list goes on.

Do you know a lot of dentists will not treat women who are on osteoporosis meds beyond basic cleanings because the mortality rate for any kind of dental surgery for women on these meds is so high? Have you thought about what might happen if you need to go on osteoporosis meds, and something happens to your dental health. You probably should.

While I agree that the evidence does not seem to be there to just put every woman on HRT for primary prevention - if women are having symptoms there does seem to be good evidence that it does help prevent the need for some of these other medical conditions.

I’d be very wary of anyone trying to stop any kind of discourse on HRT. It’s just a grift on the other side and frankly, the spend is a lot higher than what we would spend on HRT. Again, I will stress that I do not think every woman should be on HRT, but to not even entertain the need for research and do not even question The bad advice women got 25 years ago from a deeply flawed that has been retracted, there’s something really disturbing going on there.

There’s zero evidence that HRT’s “prevent” all the things you listed. HRTs are very effective for one thing - hot flashes. There is good evidence for osteoporosis. But women are still going to need statins, SSRIs, therapy, blood pressure meds, even when HRT.

It's important to pause here to distinguish between indication (what offical approval does the therapy have) and effectiveness, as well as the standards of evidence for treatment vs. prevention.

HRT is indicated for the *treatment* of hot flashes and other vasomotor symptoms, genitourinary symptoms, osteoporosis, and other issues related to estrogen deficiency. It is also indicated for the *prevention* of osteoporosis in at-risk postmenopausal women. It has both treatment and prevention indication for osteoporosis, because the biological mechanism is direct and clear (and has been confirmed in every major study).

But it's much harder to get preventive indications when biological mechanisms aren't direct, and/or don't apply equally to all populations-- for example, cardiovascular disease and type 2 diabetes. These diseases are complex, and they involve multiple pathways. So it's much, much harder to meet a blanket indication standard. That said, multiple randomized trials and meta analyses do suggest quite strongly that HRT helps prevent type 2 diabetes. And newer trials and re-analysis of the women's health initiative (removing women who had already developed heart disease, for example) offer evidence that women who begin HRT before 60 have lower rates of heart-disease and all-cause mortality. But because the data are more complex and more nuanced, the FDA can’t write a blanket approval for prevention the way it can for treating hot flashes or preserving bone.

TLDR: Evidence is not the same thing as approval. I think that's partly what makes this discussion so challenging.

I don’t disagree with what you wrote. I was responding to the PP who seemed to be trying to claim that HRT can replace the medications/therapies/lifestyle interventions for basically all chronic diseases. No. Even if HRT has some protective effect on heart disease, depression, diabetes, joint pain, etc, women will still need to take statins, GLPs, SSRIs, get therapy, etc. it doesn’t cure any of those things, even in the most positive of trials.

But no one wrote that. You’ve misinterpreted that post, per your apparent usual.

Are you a researcher or a physician?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I was all for HRT. I started taking it last year and this year I got diagnosed with hormone positive breast cancer with no family or genetic history. I’m not anti HRT even now but I do wonder if the timing was suspicious? I’m pretty bummed that not only can I never use it again but now I have to be on a hormone blocker for at least 5 years.

Hm.
Really.

I don't know why it's necessary to question this. It's clear that there is a small absolute increase in the risk of breast cancer from taking combined (not estrogen-only, but if you have a uterus, you need combined, i.e. estrogen + progestin) HRT -- an annual increase in risk of about 0.1% per year. Over five years, that means the risk rises from roughly 23 in 1000 women (without HRT) to 28 in 1000 women (with HRT). That's real. The question really isn't whether that risk exists, it's about the risk-benefit ratio for each individual.

[Anonymous]

For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the people who think hormone replacement therapy is just a grift from the wellness industry why aren’t you looking at the other side of the grift? It’s not as if women who don’t choose hormone replacement theory are aging naturally, lol

I’m a healthcare policy walk who can answer any question on Medicare spend and is deep on the data of what happens to aging women in America. Anyone who says women are aging naturally are either deeply delusional or deeply denial and throw in a dose of deeply ignorant.

Do you have any idea of the number of postmenopausal women who are on antidepressants, anti-anxiety meds, prescriptions sleep aids, hypertension drugs, statins, osteoporosis medications, treatments for UTI, treatments for sexual dysfunction, and the list goes on. Not to mention the care that we spend on frailty from hip fractures, chronic pain meds from bone breaks, hospitalizations caused from UTIs in older women and again the list goes on.

Do you know a lot of dentists will not treat women who are on osteoporosis meds beyond basic cleanings because the mortality rate for any kind of dental surgery for women on these meds is so high? Have you thought about what might happen if you need to go on osteoporosis meds, and something happens to your dental health. You probably should.

While I agree that the evidence does not seem to be there to just put every woman on HRT for primary prevention - if women are having symptoms there does seem to be good evidence that it does help prevent the need for some of these other medical conditions.

I’d be very wary of anyone trying to stop any kind of discourse on HRT. It’s just a grift on the other side and frankly, the spend is a lot higher than what we would spend on HRT. Again, I will stress that I do not think every woman should be on HRT, but to not even entertain the need for research and do not even question The bad advice women got 25 years ago from a deeply flawed that has been retracted, there’s something really disturbing going on there.

There’s zero evidence that HRT’s “prevent” all the things you listed. HRTs are very effective for one thing - hot flashes. There is good evidence for osteoporosis. But women are still going to need statins, SSRIs, therapy, blood pressure meds, even when HRT.

It's important to pause here to distinguish between indication (what offical approval does the therapy have) and effectiveness, as well as the standards of evidence for treatment vs. prevention.

HRT is indicated for the *treatment* of hot flashes and other vasomotor symptoms, genitourinary symptoms, osteoporosis, and other issues related to estrogen deficiency. It is also indicated for the *prevention* of osteoporosis in at-risk postmenopausal women. It has both treatment and prevention indication for osteoporosis, because the biological mechanism is direct and clear (and has been confirmed in every major study).

But it's much harder to get preventive indications when biological mechanisms aren't direct, and/or don't apply equally to all populations-- for example, cardiovascular disease and type 2 diabetes. These diseases are complex, and they involve multiple pathways. So it's much, much harder to meet a blanket indication standard. That said, multiple randomized trials and meta analyses do suggest quite strongly that HRT helps prevent type 2 diabetes. And newer trials and re-analysis of the women's health initiative (removing women who had already developed heart disease, for example) offer evidence that women who begin HRT before 60 have lower rates of heart-disease and all-cause mortality. But because the data are more complex and more nuanced, the FDA can’t write a blanket approval for prevention the way it can for treating hot flashes or preserving bone.

TLDR: Evidence is not the same thing as approval. I think that's partly what makes this discussion so challenging.

I don’t disagree with what you wrote. I was responding to the PP who seemed to be trying to claim that HRT can replace the medications/therapies/lifestyle interventions for basically all chronic diseases. No. Even if HRT has some protective effect on heart disease, depression, diabetes, joint pain, etc, women will still need to take statins, GLPs, SSRIs, get therapy, etc. it doesn’t cure any of those things, even in the most positive of trials.

But no one wrote that. You’ve misinterpreted that post, per your apparent usual.

Are you a researcher or a physician?

Many people on this thread have implied or stated that HRT is more beneficial than it is. That particular PP seemed to be implying that HRT is so beneficial that it will meaningfully reduce the number of women who need diabetes meds, SSRIs, and osteoporosis meds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To the people who think hormone replacement therapy is just a grift from the wellness industry why aren’t you looking at the other side of the grift? It’s not as if women who don’t choose hormone replacement theory are aging naturally, lol

I’m a healthcare policy walk who can answer any question on Medicare spend and is deep on the data of what happens to aging women in America. Anyone who says women are aging naturally are either deeply delusional or deeply denial and throw in a dose of deeply ignorant.

Do you have any idea of the number of postmenopausal women who are on antidepressants, anti-anxiety meds, prescriptions sleep aids, hypertension drugs, statins, osteoporosis medications, treatments for UTI, treatments for sexual dysfunction, and the list goes on. Not to mention the care that we spend on frailty from hip fractures, chronic pain meds from bone breaks, hospitalizations caused from UTIs in older women and again the list goes on.

Do you know a lot of dentists will not treat women who are on osteoporosis meds beyond basic cleanings because the mortality rate for any kind of dental surgery for women on these meds is so high? Have you thought about what might happen if you need to go on osteoporosis meds, and something happens to your dental health. You probably should.

While I agree that the evidence does not seem to be there to just put every woman on HRT for primary prevention - if women are having symptoms there does seem to be good evidence that it does help prevent the need for some of these other medical conditions.

I’d be very wary of anyone trying to stop any kind of discourse on HRT. It’s just a grift on the other side and frankly, the spend is a lot higher than what we would spend on HRT. Again, I will stress that I do not think every woman should be on HRT, but to not even entertain the need for research and do not even question The bad advice women got 25 years ago from a deeply flawed that has been retracted, there’s something really disturbing going on there.

There’s zero evidence that HRT’s “prevent” all the things you listed. HRTs are very effective for one thing - hot flashes. There is good evidence for osteoporosis. But women are still going to need statins, SSRIs, therapy, blood pressure meds, even when HRT.

It's important to pause here to distinguish between indication (what offical approval does the therapy have) and effectiveness, as well as the standards of evidence for treatment vs. prevention.

HRT is indicated for the *treatment* of hot flashes and other vasomotor symptoms, genitourinary symptoms, osteoporosis, and other issues related to estrogen deficiency. It is also indicated for the *prevention* of osteoporosis in at-risk postmenopausal women. It has both treatment and prevention indication for osteoporosis, because the biological mechanism is direct and clear (and has been confirmed in every major study).

But it's much harder to get preventive indications when biological mechanisms aren't direct, and/or don't apply equally to all populations-- for example, cardiovascular disease and type 2 diabetes. These diseases are complex, and they involve multiple pathways. So it's much, much harder to meet a blanket indication standard. That said, multiple randomized trials and meta analyses do suggest quite strongly that HRT helps prevent type 2 diabetes. And newer trials and re-analysis of the women's health initiative (removing women who had already developed heart disease, for example) offer evidence that women who begin HRT before 60 have lower rates of heart-disease and all-cause mortality. But because the data are more complex and more nuanced, the FDA can’t write a blanket approval for prevention the way it can for treating hot flashes or preserving bone.

TLDR: Evidence is not the same thing as approval. I think that's partly what makes this discussion so challenging.

I don’t disagree with what you wrote. I was responding to the PP who seemed to be trying to claim that HRT can replace the medications/therapies/lifestyle interventions for basically all chronic diseases. No. Even if HRT has some protective effect on heart disease, depression, diabetes, joint pain, etc, women will still need to take statins, GLPs, SSRIs, get therapy, etc. it doesn’t cure any of those things, even in the most positive of trials.

But no one wrote that. You’ve misinterpreted that post, per your apparent usual.

Are you a researcher or a physician?

Lol, "researcher".

[Anonymous]

Anonymous wrote:For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/

Sure. But since we are being so detailed about the absolute of HRT it is also important to be detailed about the absolute benefits: “The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2%”

So there was 0.7% fewer diabetes cases in the HRT group. Hardly a stunning number on an individual level. These findings are probably most important to conclude that a woman with diabetes or at risk of it can take HRT without a negative impact on diabetes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/

Sure. But since we are being so detailed about the absolute of HRT it is also important to be detailed about the absolute benefits: “The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2%”

So there was 0.7% fewer diabetes cases in the HRT group. Hardly a stunning number on an individual level. These findings are probably most important to conclude that a woman with diabetes or at risk of it can take HRT without a negative impact on diabetes.

Oh! Oh! Now do breast cancer risk!!!!! Let’s see those research skillz that clearly pay the bills. That is, if you’re not busy getting a lube-free fk from your devoted DH right now as you stalk this thread all day.

[Anonymous]

Re heart disease, the most important study is proably Hodis & Mack 2022, because it pulls together data from previous randomized trials, meta-analyses, and observational studies. This paper shows that timing is everything. When initiated in women <60 or <10 years since menopause, HRT reduces coronary heart disease events and all-cause mortality by roughly 30–50%, with no increase in stroke in this age/timing group. When started later, though, HRT shows no benefit and may be associated with increased risks. https://pmc.ncbi.nlm.nih.gov/articles/PMC9178928

There are plenty of other papers on the topic, but Hodis & Mack incorporate and synthesize them.

As with type 2 diabetes, HRT does not have FDA approval for prevention of heart disease.

And, similar to type 2 diabetes, The NAMS 2022 statement does not recommend starting HRT primarily to prevent cardiovascular disease, but they acknowledge that randomized trials, meta-analyses, and observational data suggest fewer cardiovascular events in *appropriately selected* (i.e. younger women who initiate HRT near menopause), and that overall benefits outweigh risks for most healthy symptomatic women <60 or within 10 years of menopause.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/

Sure. But since we are being so detailed about the absolute of HRT it is also important to be detailed about the absolute benefits: “The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2%”

So there was 0.7% fewer diabetes cases in the HRT group. Hardly a stunning number on an individual level. These findings are probably most important to conclude that a woman with diabetes or at risk of it can take HRT without a negative impact on diabetes.

Oh! Oh! Now do breast cancer risk!!!!! Let’s see those research skillz that clearly pay the bills. That is, if you’re not busy getting a lube-free fk from your devoted DH right now as you stalk this thread all day.

Wow. You truly are not making the case that the HRT discourse is impartial.

Take a step back please.

[Anonymous]

Anonymous wrote:Re heart disease, the most important study is proably Hodis & Mack 2022, because it pulls together data from previous randomized trials, meta-analyses, and observational studies. This paper shows that timing is everything. When initiated in women <60 or <10 years since menopause, HRT reduces coronary heart disease events and all-cause mortality by roughly 30–50%, with no increase in stroke in this age/timing group. When started later, though, HRT shows no benefit and may be associated with increased risks. https://pmc.ncbi.nlm.nih.gov/articles/PMC9178928

There are plenty of other papers on the topic, but Hodis & Mack incorporate and synthesize them.

As with type 2 diabetes, HRT does not have FDA approval for prevention of heart disease.

And, similar to type 2 diabetes, The NAMS 2022 statement does not recommend starting HRT primarily to prevent cardiovascular disease, but they acknowledge that randomized trials, meta-analyses, and observational data suggest fewer cardiovascular events in *appropriately selected* (i.e. younger women who initiate HRT near menopause), and that overall benefits outweigh risks for most healthy symptomatic women <60 or within 10 years of menopause.

Thanks. part of my concern with this research is that it uses (I believe) standardized dosages, types and delivery methods of hormones. Whereas there is much more varied in how HRT is actually prescribed in real life.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/

Sure. But since we are being so detailed about the absolute of HRT it is also important to be detailed about the absolute benefits: “The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2%”

So there was 0.7% fewer diabetes cases in the HRT group. Hardly a stunning number on an individual level. These findings are probably most important to conclude that a woman with diabetes or at risk of it can take HRT without a negative impact on diabetes.

Oh! Oh! Now do breast cancer risk!!!!! Let’s see those research skillz that clearly pay the bills. That is, if you’re not busy getting a lube-free fk from your devoted DH right now as you stalk this thread all day.

I did that above.

[Anonymous]

Anonymous wrote:

Anonymous wrote:For those who want data and official medical positions, here's some research on HRT and type 2 diabetes. Summarizing, it shows that across multiple large randomized trials and meta-analyses, HRT with estrogen (with or without progestin) reduces the risk of developing type 2 diabetes on the order of 20–30% and improves insulin resistance and glucose control:

Margolis KL et al., Diabetologia 2004 — 15,641 postmenopausal women randomized and placebo controlled: https://link.springer.com/article/10.1007/s00125-004-1448-x

Mauvais-Jarvis et al. 2017 – Endocrine Reviews
https://academic.oup.com/edrv/article/38/3/173/3063786

Note that HRT does not have an FDA-approved prevention indication.

The North American Menopause Society in their 2022 position statement said that they do NOT recommend starting HRT primarily to prevent diabetes, but that a diabetes-preventive effect is a real, evidence-based benefit in appropriate women (younger, early postmenopause): https://pubmed.ncbi.nlm.nih.gov/35797481/

Sure. But since we are being so detailed about the absolute of HRT it is also important to be detailed about the absolute benefits: “The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2%”

So there was 0.7% fewer diabetes cases in the HRT group. Hardly a stunning number on an individual level. These findings are probably most important to conclude that a woman with diabetes or at risk of it can take HRT without a negative impact on diabetes.

Correct, the absolute difference was 0.7%.
That represents a 21% reduction in diabetes risk relative to the placebo -- that's the real effect.

Note that the data were from the WHI, which had an average age of 63, and enrolled many women who were more than 10 years post menopause. The effect would likely be larger among women <60 but we don't have that data.