FDA removed black box warning for HRT

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

You asserted that the studies can be used to make conclusions for the whole range of different HRT dosages and delivery methods and combinations. Also that they are “gold standard” (do you mean RCT?). And I don’t see where the 30% reduction in mortality study is (maybe I missed it).

Basically you are posting a ton of studies and making very big claims based on them. meanwhile no medical society says that HRT should be used for anything other than to address hot flashes and prevent osteoporosis *in those at risk.*

[Anonymous]

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.

This is why the right is talking about with "Trump Derangement Syndrome."

It's like the seinfeld episode where George does the opposite of his instincts.

Use your brain and make decisions one at a time.

My PCP recommends starting HRT when you start feeling hot flashes -- that's the sign.

Then your PCP is an idiot. Menopause not an emergency. Just because you feel hot flashes doesn’t mean you need to run and get HRT.

Sounds like this is more about shaming women who choose to use HRT than anything else honestly.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

This PP doesn't understand statistics. She doesn't know the difference between absolute difference and relative risk, so her post is seriously misleading.

Here's an example: Using seatbelts lowers your risk of death in a serious car crash by 50%. If you don't use a seatbelt and you get in a serious crash, your risk of dying is 43%. If you use a seatbelt, the risk drops to 21%. So by using a seatbelt, you cut your risk in half! Pretty good, right?

But the chances of anyone dying in a serious car crash isn't especially high. So the *absolute* difference between seat belt users and non-users -- 0.0005% -- looks absolutely tiny. That tiny-seeming number = cutting your chance of death in half.

So when PP says, 0.7% (absolute difference) is "hardly a stunning number on an individual level," she's completely misunderstanding what the appropriate "individual" number is. The "individual" number is the decrease in the relative risk an individual might have. That number is 21%, and that is the effect of HRT.

Whether you think a 21% reduction is a compelling number or not is up to you.

Great now do the breast cancer and stroke risk.

These were done upthread, but here are the numbers in one place:

Breast cancer (combined HRT): risks increase
Absolute increase: 0.5% over 5 years
Relative risk increase: 20% to 30% over 5 years
This is the equivalent of going from 23 per 1000 (non-HRT baseline) to ~28 per 1000 (with HRT) over 5 years.
Net effect: 5 extra cases per 1000 over 5 years.

Breast cancer (estrogen only HRT)
No increased risk, and WHI actually showed a small reduction of risk. But estrogen-only applies only to women without a uterus.
Net effect: 0 or possibly protective.

Type 2 diabetes: risks decrease
Absolute decrease: ~1% to 3% over 5 years
Relative risk reduction: ~20% to 30%
This is the equivalent of going from 50 cases per 1000 (non-HRT baseline for healthy women) to 35-40 per 1000 (with HRT) over 5 years.
Net effect: 10 to 15 fewer cases over 5 years

Cardiovascular disease: risks decrease*:
Absolute decrease: 0.6% to 2% over 5 years
Relative risk reduction: 30 to 50%
This is the equivalent of going from ~20–40 per 1000 (non-HRT baseline) to ~10–20 events per 1000 over 5 years
Net effect: 10-20 fewer serious coronary heart disease events (heart attacks and cardiac death) per 1,000 over 5 years
*in women who start HRT <60 or are within 10 years of menopause, the "early initiation" window. HRT is generally not recommended to initiate in older women.

But even this doesn't tell the whole story. Cardiovascular disease is the #1 killer of women -- far more common than breast cancer (35% of deaths vs. <3% ). So a risk relative reduction of 30-50% in coronary heart disease among early starters translates into vast population benefits. This is why trials show all-cause mortality falls by ~30-40% in early starters.

Stroke: data show no increased risk for women who begin HRT (transdermal estrogen, micronized progesterone) under 60 years of age or within 10 years of menopause. (There was a small increased stroke risk with the older formulations, and risks increased with age).

MOST IMPORTANT CAVEAT: we do NOT all have the same risks of diseases. Family history, BMI, BP, lifestyle, personal medical history, etc., all matter here. This is why the decision to take or not take HRT should never be one-size-fits all. So even with all the available data on risks and benefits, you really must discuss the decision with a health care provider who knows you, and understands your specific risk profile.

Hope this is helpful to anyone still reading. I'm going to bow out of this thread now, hoping that most readers can discern best-available data from strong opinions. Wishing you all well as we navigate our respective choices.

Right - so the absolute risks AND absolute benefits are small. And we won’t get into how you are cherry picking studies, the limits of observational studies, and the fact that there are so many possible combinations of dosages and types of hormones administered that are not studied in detail.

How is 30% drop in all cause mortality a small absolute benefit? What is your background to take this tack?

Where are you getting that from? Also yes, it is likely small in absolute terms (because it’s not like 50% of women between 50-60 die).

Do you not understand how percentages work?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

This PP doesn't understand statistics. She doesn't know the difference between absolute difference and relative risk, so her post is seriously misleading.

Here's an example: Using seatbelts lowers your risk of death in a serious car crash by 50%. If you don't use a seatbelt and you get in a serious crash, your risk of dying is 43%. If you use a seatbelt, the risk drops to 21%. So by using a seatbelt, you cut your risk in half! Pretty good, right?

But the chances of anyone dying in a serious car crash isn't especially high. So the *absolute* difference between seat belt users and non-users -- 0.0005% -- looks absolutely tiny. That tiny-seeming number = cutting your chance of death in half.

So when PP says, 0.7% (absolute difference) is "hardly a stunning number on an individual level," she's completely misunderstanding what the appropriate "individual" number is. The "individual" number is the decrease in the relative risk an individual might have. That number is 21%, and that is the effect of HRT.

Whether you think a 21% reduction is a compelling number or not is up to you.

Great now do the breast cancer and stroke risk.

These were done upthread, but here are the numbers in one place:

Breast cancer (combined HRT): risks increase
Absolute increase: 0.5% over 5 years
Relative risk increase: 20% to 30% over 5 years
This is the equivalent of going from 23 per 1000 (non-HRT baseline) to ~28 per 1000 (with HRT) over 5 years.
Net effect: 5 extra cases per 1000 over 5 years.

Breast cancer (estrogen only HRT)
No increased risk, and WHI actually showed a small reduction of risk. But estrogen-only applies only to women without a uterus.
Net effect: 0 or possibly protective.

Type 2 diabetes: risks decrease
Absolute decrease: ~1% to 3% over 5 years
Relative risk reduction: ~20% to 30%
This is the equivalent of going from 50 cases per 1000 (non-HRT baseline for healthy women) to 35-40 per 1000 (with HRT) over 5 years.
Net effect: 10 to 15 fewer cases over 5 years

Cardiovascular disease: risks decrease*:
Absolute decrease: 0.6% to 2% over 5 years
Relative risk reduction: 30 to 50%
This is the equivalent of going from ~20–40 per 1000 (non-HRT baseline) to ~10–20 events per 1000 over 5 years
Net effect: 10-20 fewer serious coronary heart disease events (heart attacks and cardiac death) per 1,000 over 5 years
*in women who start HRT <60 or are within 10 years of menopause, the "early initiation" window. HRT is generally not recommended to initiate in older women.

But even this doesn't tell the whole story. Cardiovascular disease is the #1 killer of women -- far more common than breast cancer (35% of deaths vs. <3% ). So a risk relative reduction of 30-50% in coronary heart disease among early starters translates into vast population benefits. This is why trials show all-cause mortality falls by ~30-40% in early starters.

Stroke: data show no increased risk for women who begin HRT (transdermal estrogen, micronized progesterone) under 60 years of age or within 10 years of menopause. (There was a small increased stroke risk with the older formulations, and risks increased with age).

MOST IMPORTANT CAVEAT: we do NOT all have the same risks of diseases. Family history, BMI, BP, lifestyle, personal medical history, etc., all matter here. This is why the decision to take or not take HRT should never be one-size-fits all. So even with all the available data on risks and benefits, you really must discuss the decision with a health care provider who knows you, and understands your specific risk profile.

Hope this is helpful to anyone still reading. I'm going to bow out of this thread now, hoping that most readers can discern best-available data from strong opinions. Wishing you all well as we navigate our respective choices.

Right - so the absolute risks AND absolute benefits are small. And we won’t get into how you are cherry picking studies, the limits of observational studies, and the fact that there are so many possible combinations of dosages and types of hormones administered that are not studied in detail.

How is 30% drop in all cause mortality a small absolute benefit? What is your background to take this tack?

Where are you getting that from? Also yes, it is likely small in absolute terms (because it’s not like 50% of women between 50-60 die).

Do you not understand how percentages work?

^sorry, that was directed at the prior poster

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

The women who are passionate about opposing HRT use have cited nothing. It’s just bizarre. Why not let other women use in peace.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

This PP doesn't understand statistics. She doesn't know the difference between absolute difference and relative risk, so her post is seriously misleading.

Here's an example: Using seatbelts lowers your risk of death in a serious car crash by 50%. If you don't use a seatbelt and you get in a serious crash, your risk of dying is 43%. If you use a seatbelt, the risk drops to 21%. So by using a seatbelt, you cut your risk in half! Pretty good, right?

But the chances of anyone dying in a serious car crash isn't especially high. So the *absolute* difference between seat belt users and non-users -- 0.0005% -- looks absolutely tiny. That tiny-seeming number = cutting your chance of death in half.

So when PP says, 0.7% (absolute difference) is "hardly a stunning number on an individual level," she's completely misunderstanding what the appropriate "individual" number is. The "individual" number is the decrease in the relative risk an individual might have. That number is 21%, and that is the effect of HRT.

Whether you think a 21% reduction is a compelling number or not is up to you.

Great now do the breast cancer and stroke risk.

These were done upthread, but here are the numbers in one place:

Breast cancer (combined HRT): risks increase
Absolute increase: 0.5% over 5 years
Relative risk increase: 20% to 30% over 5 years
This is the equivalent of going from 23 per 1000 (non-HRT baseline) to ~28 per 1000 (with HRT) over 5 years.
Net effect: 5 extra cases per 1000 over 5 years.

Breast cancer (estrogen only HRT)
No increased risk, and WHI actually showed a small reduction of risk. But estrogen-only applies only to women without a uterus.
Net effect: 0 or possibly protective.

Type 2 diabetes: risks decrease
Absolute decrease: ~1% to 3% over 5 years
Relative risk reduction: ~20% to 30%
This is the equivalent of going from 50 cases per 1000 (non-HRT baseline for healthy women) to 35-40 per 1000 (with HRT) over 5 years.
Net effect: 10 to 15 fewer cases over 5 years

Cardiovascular disease: risks decrease*:
Absolute decrease: 0.6% to 2% over 5 years
Relative risk reduction: 30 to 50%
This is the equivalent of going from ~20–40 per 1000 (non-HRT baseline) to ~10–20 events per 1000 over 5 years
Net effect: 10-20 fewer serious coronary heart disease events (heart attacks and cardiac death) per 1,000 over 5 years
*in women who start HRT <60 or are within 10 years of menopause, the "early initiation" window. HRT is generally not recommended to initiate in older women.

But even this doesn't tell the whole story. Cardiovascular disease is the #1 killer of women -- far more common than breast cancer (35% of deaths vs. <3% ). So a risk relative reduction of 30-50% in coronary heart disease among early starters translates into vast population benefits. This is why trials show all-cause mortality falls by ~30-40% in early starters.

Stroke: data show no increased risk for women who begin HRT (transdermal estrogen, micronized progesterone) under 60 years of age or within 10 years of menopause. (There was a small increased stroke risk with the older formulations, and risks increased with age).

MOST IMPORTANT CAVEAT: we do NOT all have the same risks of diseases. Family history, BMI, BP, lifestyle, personal medical history, etc., all matter here. This is why the decision to take or not take HRT should never be one-size-fits all. So even with all the available data on risks and benefits, you really must discuss the decision with a health care provider who knows you, and understands your specific risk profile.

Hope this is helpful to anyone still reading. I'm going to bow out of this thread now, hoping that most readers can discern best-available data from strong opinions. Wishing you all well as we navigate our respective choices.

Right - so the absolute risks AND absolute benefits are small. And we won’t get into how you are cherry picking studies, the limits of observational studies, and the fact that there are so many possible combinations of dosages and types of hormones administered that are not studied in detail.

How is 30% drop in all cause mortality a small absolute benefit? What is your background to take this tack?

Where are you getting that from? Also yes, it is likely small in absolute terms (because it’s not like 50% of women between 50-60 die).

Do you not understand how percentages work?

Yes … do you understand that a 30% reduction in mortality does not mean that 30% of all women would have lived longer?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

The women who are passionate about opposing HRT use have cited nothing. It’s just bizarre. Why not let other women use in peace.

As long as you mischaracterize the discussion as “opposing HRT,” you have zero credibility. Pointing out the limits of what we know is not opposing HRT. I don’t think there is any argument that HRT is effective for reducing hot flashes. Beyond that the risk benefit calculation for most women is very very complex and far from clear.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

You asserted that the studies can be used to make conclusions for the whole range of different HRT dosages and delivery methods and combinations. Also that they are “gold standard” (do you mean RCT?). And I don’t see where the 30% reduction in mortality study is (maybe I missed it).

Basically you are posting a ton of studies and making very big claims based on them. meanwhile no medical society says that HRT should be used for anything other than to address hot flashes and prevent osteoporosis *in those at risk.*

This.

[Anonymous]

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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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

You asserted that the studies can be used to make conclusions for the whole range of different HRT dosages and delivery methods and combinations. Also that they are “gold standard” (do you mean RCT?). And I don’t see where the 30% reduction in mortality study is (maybe I missed it).

Basically you are posting a ton of studies and making very big claims based on them. meanwhile no medical society says that HRT should be used for anything other than to address hot flashes and prevent osteoporosis *in those at risk.*

You missed it because you apparently didn't read the posted studies. It's all in Hodis & Mack, which summarizes a bunch data and meta analyses from a variety of sources, all of which all show consistent drops in all cause mortality if HRT is initiated within 10 years of menopause or age <60...and yes, many of these are based on randomized controlled studies, and yes, there are different therapies and doses studied. It's all in there.

You are correct that the absolute numbers are small.

You are also correct that the medical societies don't recommend HRT for primary prevention of heart disease, diabetes, etc. That co-exists with their simultaneously stating that these benefits do exist.

It's fine not to be convinced by the existing data. But any "big claims" are being made by the data itself, not by me. I would never tell a woman to take (or not take) HRT. That really is a discussion for her and her doctor.

[Anonymous]

What is so weird about this thread is that it is not reflective of what any of the medical experts are saying.

While there are doctors out there screaming that most women should consider HRT, I don’t know of any that are saying it’s not safe and we should go back to 25 years ago. People like Jen Gunter are annoyed that the benefits are overstated, but she has come out and said she thinks FDA black box removal is correct. I’ve read her book The Menopause Manifesto and she clearly supports HRT. What she doesn’t like is the wellness people who also trying to sell supplements and overstate the benefits. But I haven’t seen any credible doctor Say that we need to go back to 25 years ago when there was a chilling effect on HRT.

There are clearly individual doctors who are not comfortable prescribing it to their patients but the researchers and ones on the panels and making the rounds are not saying this so it’s really curious to me why a group of women on the thread really seems so anti-HRT when the medical experts while they may disagree on overall risk and benefits, are not anti-HRT. Some of you seem angry than any women would consider it or being offered it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

The variability issue definitely affects FDA approval (a preventive indication requires a specific therapy, in a single dose/range, in a well-defined population). And it's likely why NAMS is so cautious about their language, even as they acknowledge the preventive benefits of HRT. But to your specific question, the studies linked to here -- which are the current gold standard (I hope we get more!) -- have included a range of HRT therapies, doses, and populations. The results are consistent across this variability, which actually strengthens rather than diminishes the case for HRT impact on prevention of these conditions.

Yeah I’m going to need to see more than that.

What specifically?

Basically every assertion you made there is unsupported

They’re…supported by the studies that have been linked to?

This is getting weird.

You asserted that the studies can be used to make conclusions for the whole range of different HRT dosages and delivery methods and combinations. Also that they are “gold standard” (do you mean RCT?). And I don’t see where the 30% reduction in mortality study is (maybe I missed it).

Basically you are posting a ton of studies and making very big claims based on them. meanwhile no medical society says that HRT should be used for anything other than to address hot flashes and prevent osteoporosis *in those at risk.*

You missed it because you apparently didn't read the posted studies. It's all in Hodis & Mack, which summarizes a bunch data and meta analyses from a variety of sources, all of which all show consistent drops in all cause mortality if HRT is initiated within 10 years of menopause or age <60...and yes, many of these are based on randomized controlled studies, and yes, there are different therapies and doses studied. It's all in there.

You are correct that the absolute numbers are small.

You are also correct that the medical societies don't recommend HRT for primary prevention of heart disease, diabetes, etc. That co-exists with their simultaneously stating that these benefits do exist.

It's fine not to be convinced by the existing data. But any "big claims" are being made by the data itself, not by me. I would never tell a woman to take (or not take) HRT. That really is a discussion for her and her doctor.

That article is a literature review. Please post the exact studies you are relying on.

[Anonymous]

Anonymous wrote:What is so weird about this thread is that it is not reflective of what any of the medical experts are saying.

While there are doctors out there screaming that most women should consider HRT, I don’t know of any that are saying it’s not safe and we should go back to 25 years ago. People like Jen Gunter are annoyed that the benefits are overstated, but she has come out and said she thinks FDA black box removal is correct. I’ve read her book The Menopause Manifesto and she clearly supports HRT. What she doesn’t like is the wellness people who also trying to sell supplements and overstate the benefits. But I haven’t seen any credible doctor Say that we need to go back to 25 years ago when there was a chilling effect on HRT.

There are clearly individual doctors who are not comfortable prescribing it to their patients but the researchers and ones on the panels and making the rounds are not saying this so it’s really curious to me why a group of women on the thread really seems so anti-HRT when the medical experts while they may disagree on overall risk and benefits, are not anti-HRT. Some of you seem angry than any women would consider it or being offered it.

Seems like you misread this thread. I don't recall any comments being anti-HRT, just anti-misinformation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What is so weird about this thread is that it is not reflective of what any of the medical experts are saying.

While there are doctors out there screaming that most women should consider HRT, I don’t know of any that are saying it’s not safe and we should go back to 25 years ago. People like Jen Gunter are annoyed that the benefits are overstated, but she has come out and said she thinks FDA black box removal is correct. I’ve read her book The Menopause Manifesto and she clearly supports HRT. What she doesn’t like is the wellness people who also trying to sell supplements and overstate the benefits. But I haven’t seen any credible doctor Say that we need to go back to 25 years ago when there was a chilling effect on HRT.

There are clearly individual doctors who are not comfortable prescribing it to their patients but the researchers and ones on the panels and making the rounds are not saying this so it’s really curious to me why a group of women on the thread really seems so anti-HRT when the medical experts while they may disagree on overall risk and benefits, are not anti-HRT. Some of you seem angry than any women would consider it or being offered it.

Seems like you misread this thread. I don't recall any comments being anti-HRT, just anti-misinformation.

There are currently two threads on HRT and both of them get nasty. One person asks oh haven’t you heard any ailment past 40 has to be treated with hormones? I’m sure there are well intended posters here who are against misinformation but there’s a ton of Snark on this thread and the other one.

Give me a break that people are calling out misinformation. People are being rude and they’re definitely seems to be a lot of hostility whenever this topic comes up if women are choosing hormones. There’s also another thread that women are avoiding this topic with their friends because it’s so heated.