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LETTERS: J Michael Dixon Message about hormone replacement therapy is unclear BMJ 2002; 325: 1036 [Full text]

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HRT yo-yo

dr.manan vasenwala   (2 November 2002)

Conflicts

Mary Grace Kovar   (5 November 2002)

Re: HRT yo-yo

Kevin J McLaughlin   (13 November 2002)

HRT yo-yo 2 November 2002
dr.manan vasenwala, consultant-cardiologist (non-invasive) aligarh-202002. india Send response to journal: Re: HRT yo-yo	it is time this dilemma is resolved. to give HRT or not. more and more women are having pre-mature menopause, increasing longevity, severe osteoposis, often crippling. hrt was a good option with added cardio-vascular benefits. the controversy was whether only oestrogen was to be given or along with progesterone. low doses were recommended and that was wise. now the picture keeps changing like a yo-yo. the message is not only muddy but also alarmist. Competing interests:   None declared
Conflicts 5 November 2002
Mary Grace Kovar, Consultant Washington DC 20036 Send response to journal: Re: Conflicts	It might help your understanding if you noticed that the authors of the article in the BMJ described themselves as conducting clinical trials on breast cancer. It is not difficult to imagine that the authors want to promote trials, espcially if they believe in and love their work. mgk Competing interests:   None declared
Re: HRT yo-yo 13 November 2002
Kevin J McLaughlin, Integrative Medicine PhD candidate NFL Center For Integrative medicine A2H-1C4 50 Main st. suite 11CornerBrook Send response to journal: Re: Re: HRT yo-yo	As I have previously mentioned to Dr. Dixon, the issue of the current HRT dilemma is not the appropriateness of the regimen itself but the manner and nature of its delivery. We cannot expect synthetic hormone analogues to replace or replicate the intricate,endogenous hormonal cascade of the female. The Premarin-Porvera combination does not replicate human physiology only tries to roughly mimic it.When we compare apples to apples we will have a truer picture of HRT. This can only occur when bioidentical HRT is utilized in these studies because it will attempt to closely reflect the actual physiological process by which these complex structures function.(Structure governs function)Comparing drug toxicity data to endogenous human physiological processes is not valid. Since most of these studies are utilizing synthetic derivatives (Premarin-Provera), the data is going to be misleading to say the least. The PEPI trial utilized bioidentical progesterone (progestins are quite different and should not be referred to in a synominous manner)with excellent results. Those who have an understanding of progesterone were not surprised at the result. Competing interests:   None declared