Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
HRT; remember premature menopause
- Margaret C P Rees (6 September 2008)
-
HRT; premature menopause and past hormone use
- Ellen CG Grant (7 September 2008)
|
|
|||
|
Margaret C P Rees, Reader in reproductive medicine, University of Oxford. Visiting Professor , University of Glasgow Women’s Centre, John Radcliffe Hospital, Oxford OX3 9DU
Send response to journal:
|
I am very concerned about the blanket statement based on the WISDOM study made by Grant that ‘it would be irresponsible to think that any use of HRT is justifiable’.1 The study was undertaken in women with a mean age of 63.8 years at randomisation starting combined HRT many years after the menopause. 2 The conclusion by Grant will cause confusion with those dealing with women with early ovarian failure in their 20s and 30s. Normally these women would be exposed to their own sex steroids. National guidelines recommend the use of HRT until the average age of the natural menopause in the early 50s and the WISDOM study should not be extrapolated to them. 3 1. Grant ECG. Hormone replacement therapy: Irresponsible to modify current guidelines BMJ 2008;337: a1494 2. Welton AJ, Vickers MR, Kim J, Ford D, Lawton BA, MacLennan AH, Meredith SK, Martin J, Meade TW; WISDOM team. Health related quality of life after combined hormone replacement therapy: randomised controlled trial. BMJ 2008; 337:550-553. 3. British Menopause Society Council Consensus Statement. Premature menopause. www.thebms.org.uk/statementcontent.php?id=3 Competing interests: None declared |
|||
|
|
|||
|
Ellen CG Grant, physician and medical gynaecologist Kingston-upon-Thames, KT2 7JU
Send response to journal:
|
Professor Rees highlights the growing problem of premature menopause which she thinks still needs to be treated with HRT. Premature ovarian failure now increases from 1/10,000 in women below age 20 to 1% women below age 40. Causes are generally believed to be unknown in 80% of women.1 Other established causes are chromosome anomalies like Turner’s syndrome, or pelvic surgery, radiotherapy or chemotherapy. About a quarter of breast cancers occur before menopause and most breast cancer types occurring in young women require adjuvant treatments that can partially or definitively affect the reproductive function. The risk of developing breast cancer is greatest for women who have started contraceptive progesterones and oestrogens before age 20 and have had longer use before a first full-time pregnancy. Most women now become menopausal after years of use of hormone use for contraception or infertility treatments, including for well-known post -Pill amenorrhea. Strangely, it is generally believed that more progesterones and oestrogens in the form of HRT are needed to avoid vascular diseases and osteoporosis, especially if these women have developed ovarian failure. This belief received a set back with the results of the WHI study - exogenous progesterones and oestrogens increase the risk of vascular diseases and cancers whatever the reason for such use. In our studies zinc and magnesium deficiencies are increased by exogenous progesterones and oestrogens and these deficiencies are also implicated in the etiology of vascular diseases and osteoporosis.2,3 It is also possible restore ovulation and fertility by repleting proven mineral deficiencies.4 Ovarian concentrations of the toxic metal cadmium increase with age. Cadmium toxicity is associated with failure of progression of oocyte development from primary to secondary stage, and failure to ovulate. Cadmium can replace zinc in reproductive tissues. Thompson and Bannigan suggest that the use of micronutrients should be considered to prevent these problems.5 Selenium supplementation is useful to lower the toxic effects of dental mercury. Nickel sensitivity is also common due to reactions to stainless steel jewellery. It is a pity that caring doctors prefer to keep on giving women more hormones, rather than investigate the need for the use of micronutrients and the avoidance of toxic metals. It is not good science to treat ovarian failure with hormones which may have caused the condition in the first place. 1 Belaisch-Allart J, Mayenga JM, Grefenstete I, Mokdad A, Moumin H. Premature ovarian failure: which approaches? Gynecol Obstet Fertil 2008;36:882-5. 2 Grant ECG. The Pill, hormones replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med. 1998;8:105-116. 3 McLaren-Howard J. Grant ECG, Davies S. Hormone replacement therapy and osteoporosis: bone enzymes and nutrient imbalances. J Nutr Environ Med. 1998;8:129-138. 4 McLaren-Howard J, Davies S, Hunnisett AG. Red cell magnesium and glutathione peroxidase in infertile women – effects of oral supplementation with magnesium and selenium. Mag Res 1994;7:49-57. 5. Thompson J, Bannigan JReprod Toxicol. Cadmium: toxic effects on the reproductive system and the embryo. 2008;25:304-15. Competing interests: None declared |
|||