Risk actors Associated with Womens Compliance with Estrogen Replacement Therapy - Essay Example

Table of Contents Introduction …………………………………………………………………….. 2 Advantages ………………………………………………………………………2 Disadvantages …………………………………………………………………...6 Critical Appraisal of the Three Studies ………………………………………….7 Conclusion ……………………………………………………………………….10 Reference ………………………………………………………………………..11 Abstract Menopause and post-menopause are conditions most women do not look forward to. Nevertheless, it continues to be an important issue as physicians and patients alike try to find better ways to alleviate unwanted symptoms associated with these stages. Hormone replacement therapy is one of the solutions to this problem. In this paper, three clinical articles that have been published in acclaimed medical journals were presented to understand the advantages and disadvantages of hormone replacement therapy. Cardiovascular diseases and osteoporosis are the top illnesses that are said to be prevented by HRT. On the contrary, an association with increased risk of breast cancer has been discovered. HRT could still be used for post-menopause syndromes. Nevertheless, it should not be used as primary prevention for CVDs and bone density diseases. Introduction Women’s health is considered to be one of the most crucial medical topics today. Such is why treatments of post menopausal conditions of women continue to be a topic largely investigated. Hormone replacement therapy (HRT) is noted to be widely used among the more developed countries (Nelson, 2008). In the United States, about one third of their population of women report to be users of HRT (Sharma, 2003). In this paper, the author aims to present the advantages and disadvantages of HRT. A review of 3 scientific medical journals will be presented and thoroughly appraised for its validity and reliability. The author hopes that by doing such, a clearer understanding of the benefits and risks of HRT will be achieved. Advantages According to Sharma (2003), hormone replacement therapy is widely used by women today because of its ability to treat symptoms of menopause and the chronic conditions associated with it. In his paper, Hormone Replacement Therapy in Menopause: Current concerns and considerations (Sharma, 2003), he launched into an in-depth critical analysis of past studies concerning HRT. His methodology involved a highly specific Medline research for papers written and submitted in the years 1997 to 2003. Only those written in the English language and have an abstract readily available were included in his study (Sharma, 2003). The specific key words used for his study involved hormone replacement therapy, estrogen replacement therapy, menopause and hormone replacement. He was also very thorough and set a criterion in which he would only include materials that are original. According to Sharma (2003) the use of HRT has a strong correlated effect on vasomotor symptoms. All the material he included in his study showed a positive strong correlation with such symptoms. However, he also reported that on psychological or social behavior, HRT has no effect based on the studies tackled. Reports showed that HRT did not significantly affect mood swings or psychological affect of women who are taking it (Sharma, 2003). Cognition and dementia were another aspect that was studied. Unfortunately, the articles that were used showed little information regarding cognitive functioning of women in menopause. One study, did say however that recall and memory seemed to improve for women who were using HRT. Sharma (2003) additionally noted that though such finding existed, it could have been confounded by the improved sleep the women under HRT were experiencing. The skin, genital tract and lower urinary tract were also discussed. Although estrogens and androgens may possess beneficial components for the skin, neither proved to help in preventing skin aging (Sharma, 2003). One disadvantage was seen concerning the genital tract and urinary tract (Samsioe, 2007). A study involving a 4 year period use of HRT showed that women who have been using HRT for the number of years mentioned experienced a worsening of incontinence (Sharma, 2003). An important advantage of HRT that was noted was its preventive properties for coronary heart disease. This may be associated with the effect of HRT to the ratio of High-density lipoprotein (HDL) and Low-density Lipoprotein (LDL) (Roussel, et al, (2002). Estrogen was found to cause vasodilation by increasing the release of vaso active peptide and at the same time increasing bloodflow (Berman, Epstein and Lydick, 1997). There was an observed difference in HRT used. For natural estrogens like estradiol or estrone, effects such as increased clotting factors or insulin resistance were not noted. It was only with the use of synthetic estrogen that such effects could occur (Sharma, 2003). In addition, the method of taking in estrogen appeared to have a significant influence on effects as well. Oral estrogen therapy is found to be more effective in lowering LDLs. Orally taking estrogen like conjugated equine estrogens produce a reaction wherein hepatic synthesis of apolipoprotein B100 is induced. As a consequence, fasting serum triglyceride levels increase. On the other hand, taking in estrogen transdermally was reported to the opposite—greatly lowering fasting serum triglyceride levels (Sharma, 2003). One interesting study to note was the effect of using combined HRT. It was found that estrogen used with progestin could in fact lower the rate of cardiovascular diseases (Hyman and Kelner, 2007). A specific study called Heart and estrogen study was conducted in a span of 4 years using control placebo groups to measure the effect of estrogen with progestin on the risks of women who are taking such drugs in developing stroke, angina, MI, etc (Sharma, 2003). The results showed that such therapy was actually effective in preventing such diseases. However, follow up after the 4 year study period reported that after 6 years of use of such therapy, risk of cardiovascular diseases could no longer be further decreased (Sharma, 2003). Also noted was that hormone replacement therapy should not be used to treat patients with CVD. Another important aspect where HRT seem to have a crucial impact on is osteoporosis (Huntingford, 2004). From different studies, scientists and physicians alike recognize that osteoporosis is more common in women than in men. This may be attributed to the fact that during menopause, bone loss occurs (Sharma, 2003). In relation to HRT, studies show that administration of estrogen orally, via transdermal patches or even percutaneous implants could increase the mineral density of bones (Sharma, 2003). Different studies also report that by engaging in HRT, occurrence of hip and spine fractures are significantly reduced. Sharma (2003) concluded by saying that HRT outweighs the harms because of the important preventive measures it offers. Nevertheless, he recommended that more studies and experiments be conducted to further strengthen the literature pertaining to HRT. Disadvantages Moving on, a different study involving HRT focused on its negative effect on breast cancer will be discussed. Chen (2008) explored the mechanism behind the increased risk of breast cancer associated with exposure to exogenous and endogenous hormones. Risk of breast cancer was said to be strongly influenced by hormonal factors (Cuzick, 2008). Decades ago, it was believed that other factors such as alcohol consumption and weight gain are key contributors to this disease as well (Jacobsen, 2007). However, after years of study, it was found that these two factors are only secondary as they are closely affected by hormones (Chen, 2008). Hormone replacement therapy in women in menopause has been widely used, especially to prevent cardiovascular diseases and bone ailments, as discussed earlier. In 2002, a study by Women’s Health Initiative (WHI) in the United States released a trial reports exposing the adverse effects of HRT to breast cancer development. Due to this, many physicians started recommending HRT for a short-term use only (Kendall, Folkerd and Dowsett, 2007). As a consequence, use of HRT dramatically went down (Chen, 2008). Before the phenomenal release of the study of WHI, breast cancer risk was attributed to estrogen because the types of HRT were not thoroughly investigated. In subsequent years, they found out that progesterone could actually be the cause for such an increased risk (Cuzick, 2008). Progesterone was found to be highly influential in causing cell division which would lead to DNA damage (Chen, 2008). Experiments done in vivo and in vitro have been consistent in reporting that breast tissue proliferation occurs in the presence of exogenous progesterone. In a similar study by Cuzick (2008), it was reported that this effect of progesterone could be reversible. His paper cited a study done in 1996 involving women in the United Kingdom whose age fell in the range of 50-64 years. These women participated in a breast screening that was done nationally and use of HRT was also collected (Cuzick, 2008). After about two and a half years, a follow up was made on the women. Results showed that risk of breast cancer was highly dependent on the length of time a woman has been using HRT. For women who have used HRT for a year, the relative increase of risk was about 45%. For those who have used HRT for 10 years or more, on the other hand, 131% relative increase in risk was reported (Cuzick, 2008). From Cuzick’s (2008) study, it was noted how important the role of the duration of HRT is. Combined use of progesterone and estrogen also significantly increased the risk of breast cancer. Without progesterone, reduced risk may be observed although not significantly (Gambacciani, et al, 2007). Nevertheless, the author concluded by saying that HRT should not be all together avoided. It could still be beneficial in alleviating unwanted symptoms of menopause. In terms of using it for a long time as primary prevention for cardiovascular diseases and maintenance of bone density, HRT would be highly discouraged (Cuzick, 2008). Critical Appraisal of the Three Studies These three studies were chosen by the author of this paper for their highly reliable data and information. To begin with, Sharma’s (2003) study was presented in a very organized manner. He divided his paper into categories of diseases that a woman in menopause is at risk and discussed how HRT could benefit or worsen her situation. In the beginning of his text, he was able to clearly define what he was aiming for in the paper. His goals were set and the paper had clear direction. As for his methodology, it was well written and conducted. He ran a thorough search using Medline—a competent database for medical journals, and closely adhered to the criteria he set. Although no tables and graphs were included, a great deal of statistical information and figures depicting the population concerned were included in his paper. Since this paper involved a review, it was expected that the author would just present previous data and conclusions. What was note-worthy about the paper, nonetheless was that the author drew out his own conclusions and made further analyses. All clinical outcomes were also considered. As his paper suggested, both harms and risks of HRT was presented, although the paper was leaning more towards the benefits it could actually bring about. Scholarly journals were properly cited and he included relevant information and proposed rational recommendations for future studies. Similarly, Chen (2008) also planned out a well constructed paper. The author was able to clearly state her focus and subject matter. Clearly stated, the Chen (2008) divided the paper into two distinct parts: one discussed exogenous hormones and how it influenced breast cancer and the other discussed endogenous hormones and its consequence on breast cancer. The author did not anymore put headings for the paper so the flow was not very easily understood. The methodology for her study was not defined, for example. From the flow of the paper, one would see that she included several studies in the past. No inclusion criteria were provided. Due to this, one cannot say if the study of Chen (2008) could be worth expanding on. Nonetheless, content-wise it had a lot of information of the effect of HRT on breast cancer. Results of the included studies were combined and this was necessary to strengthen the argument that progesterone hormones do increase the risk of breast cancer. The author was very successful in pointing this out because she was able to tie up different studies from different regions that support one statement and that are how progesterone increases the risk of breast cancer. The results were presented in a manner wherein additional statistical information backed the figures up. Although, this paper did not present tables and graphs to clearly illustrate the data. She did, on the one hand, present a systematic diagram depicting the relationships of estrogen to different other factors such as cholesterol. Such illustrations were very helpful in understanding the subject matter. The author believes that the results of this paper could be effectively applied to the population—which is women. There was no confounding of race or region in the study and it was clear that this could be applicable for women who fall in the same category as the study population. All important outcomes were considered. Moreover, Chen (2008) was able to make her own conclusions and suggestions, separate from the literature she was presenting. The third and final paper presented was also reliable and valid like the two. In fact, the author would like to commend this third paper for its note-worthy organization and better illustration of findings through presentation of tables and graphs. Similar to the study of Chen (2008), Cuzick (2008) presented relevant literature although inclusion criteria were not included in the study. He was also able to draw conclusions from the study on top of the ones he expounded from the studies. The author believes that this study by Cuzick (2008) may be further continued for he was able to give sound recommendations. Like the other two studies that were already discussed, this study by Cuzick (2008) explored all possible outcomes and such are applicable to the study population. The results were also statistically derived and analyzed thoroughly. Conclusion In conclusion, the author would like to say that all information included in this paper have reliable sources that could support the conclusions. HRT equally has benefits and risks attached to it. Nevertheless, the patient should go through this information and analyze if she could indeed benefit more from HRT than experience its disadvantages. References Berman, R.S., Epstein, R.S., and Lydick, E. (1997). Risk factors associated with women’s compliance with estrogen replacement therapy. Journal of Women’s Health. 6(2), 219-226 Chen, W.Y. (2008). Exogenous and endogenous hormones and breast cancer. Best Practice and Research Clinical Endocrinology and Metabolism. 22(4), 573-585 Cuzick, J.(2008). Hormone replacement therapy and the risk of breast cancer. European Journal of Cancer. 44(2008), 2344-2349 Gambacciani, M., et al. (2007). Ultra low-dose hormone replacement therapy and bone protection in postmenopausal women. Mauritas. 59(1), 2-6 Huntingford, C.A. (2004). Confusion over benefits of hormone replacement therapy. The Lancet. 363(2004), 332 Hyman, P. and Kelner, P. (2007). Pharmacotherapeutic uses of hormones. Nursing Clinics of North America. 42(1), 1-18 Jacobsen, D.E., et al (2007). Postmenopausal HRT and tibolone in relation to muscle strength and body composition. Maturitas. 58(1), 7-18 Kendall, A., Folkerd, E.J. and Dowsett, M. (2007). Influences on circulating oestrogens in postmenopausal women: Relationship with breast cancer. The Journal of Steroid Biochemistry and Molecular Biology. 103(2), 99-109 Nelson, H.D. (2008). Menopause. The Lancet. 371(9614), 760-770 Roussel, A.M., et al (2002). Beneficial effects of hormone replacement therapy on chromium status and glucose and lipid metabolism in postmenopausal women. The European Menopause Journal. 42(2002), 63-69 Samsioe, G. (2007). Urogenital symptoms around the menopause and beyond. Treatment of the Postmenopausal Woman (Third Edition). Sharma, S. (2003). Hormone replacement therapy in menopause: Current concerns and considerations. Kathmandu University Medical Journal. 1(4), 288-293 Read More