Effects of long-term estrogen replacement therapy

Menopause is a normal aging phenomenon in women and consists of the gradual transition from the reproductive to the non-reproductive phase of life. The median age at the menopause is currently around 50 years. As a result of the increasing life expectancy in the first and second worlds, many women will be postmenopausal for over one-third of their lives. The influence of menopause per se on blood pressure remains

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“…Neverthe-less, there is some suggestion that oestrogen replacement treatment may reduce the incidence of stroke. 56 …”

Section: Discussionmentioning

confidence: 99%

The epidemiology of the association between hypertension and menopause

1998

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“…The largest of these by far, the Nurses' Health Study (422,991 person-years of follow-up), reported a reduced incidence in those on HRT [25]. Three smaller studies (3428-9752 person-years of follow-up) found a reduction in incidence [26][27][28], lost after adjustment for confounding variables-primarily weight or BMI. This suggests that any apparent protective effect of HRT was secondary to less adiposity in HRT users.…”

Section: Effects Of Oestrogens On Insulin Secretion In Humansmentioning

confidence: 99%

Oestrogens and insulin secretion

2005

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There is a persistent perception that oestrogens have an adverse effect on carbohydrate metabolism. It might therefore be expected that their use would result in a corresponding increase in the incidence of diabetes. Recent evidence from clinical trials suggesting that women on postmenopausal oestrogen hormone replacement therapy (HRT) have a reduced incidence of type 2 diabetes therefore appears paradoxical. Short-term supraphysiological oestrogen administration has an adverse effect on glucose tolerance, resulting from suppression of first-phase insulin secretion and increased insulin resistance. Oestrogen-induced increases in glucocorticoid activity could account for these effects. Oestrogen-induced deterioration in glucose tolerance is, however, accompanied by a reduction in fasting glucose, an effect that could be accounted for by glucagon antagonism. These short-term effects contrast with long-term preservation of insulin secretion and glucose homeostasis by oestrogens. In animal studies, ovariectomy is associated with decreased insulin secretion and increased risk of diabetes, whereas oestrogen administration protects against diabetes and increases the insulin response to glucose. The mechanism is uncertain, but direct effects on the pancreas via steroid receptors or indirect effects via oestrogen-induced glucagon antagonism and subclinical increases in glucocorticoids and growth hormone could all contribute. Recent evidence that HRT increases the risk of cardiovascular disease suggests that it should not be used for the prevention of diabetes, but the mechanism responsible for this benefit merits further investigation and might lead to new therapies.

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“…Early epidemiological studies failed to show an increased risk of venous thromboembolism among users of hormone replacement therapy. [1][2][3][4][5] However, methodological limitations, including small sample size and lack of adequate control of confounding, did not allow a lack of association to be established. Some of these limitations have been addressed in three recent observational studies, which consistently showed that the risk of venous thromboembolism among current users of hormone replacement therapy is 2-3.5 times higher than among women not using postmenopausal oestrogens.…”

Section: Introductionmentioning

confidence: 99%