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PAPERS: Michael Wells, David W Sturdee, David H Barlow, Lian G Ulrich, Karen O'Brien, Michael J Campbell, Martin P Vessey, and Anthony J Bragg Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow up study BMJ 2002; 325: 239 [Abstract] [Full text]

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Combined oestrogen/progestogen replacement therapy and the endometrium.

Ellen C G Grant   (17 August 2002)

Combined oestrogen/progestogen replacement therapy and the endometrium. 17 August 2002
Ellen C G Grant, Physician and Medical Gynaecologist 20 Coombe Ridings, kingston-upon-Thames, Surrey, KT2 7JU Send response to journal: Re: Combined oestrogen/progestogen replacement therapy and the endometrium.	The study by Michael Wells et al proves that continuous combined oestrogen/progestogen hormone replacement therapy (HRT) has the same effect as most oral contraceptives because most endometrial samples were secretory, atrophic, or unassessable.1, 2 It is wrong to claim this type of HRT prevents disease. The Women’s Health Initiative blinded randomised control study of combined HRT has been halted prematurely because of unacceptable increases in breast cancer, strokes, heart attacks and venous thromboembolic disease. 3 Although progestogen dominance shrivels the endometrium, there can be disproportionate development of arterioles and sinusoids, which can lead to heavy irregular bleeding. This is most obvious in women with vascular side effects. 4 The Walnut Creek Study found three times more fibroids among women users of progestagenic oral contraceptives than for never users or for oestrogenic HRT users. 5 It is nonsense to ignore or standardise for use of either oral contraceptives or combined oestrogen/progestogen HRT in epidemiological studies when they both have the same effects including increases in many diseases and cancers. Ellen C G Grant physician and medical gynaecologist 20 Coombe Ridings Kingston-upon-Thames Surrey KT2 7JU ellencggrant@onetel.net.uk Tel/Fax 02085469482 1 Wells M, Sturdee DW, Barlow DH, Ulrich LG, et al. Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow-up study. BMJ 2002;325;239-42. 2 Grant ECG. Hormone balance of oral contraceptives. J Obst Gynae Brit Commonwealth 1967;74:908-18. 3 Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomised controlled trial. JAMA 2002; 288: 321-33. 4 Grant ECG. Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-16. 5 Ramcharan S, Pellegrin FA, Ray RM, Hsu JP. The Walnut Creek Contraceptive Study. A prospective study of the effects of oral contraceptives, 111. Centre for Population Research Monograph, NIH, Bethesda 1981.