Effect on endometrium of long term treatment with continuous combined oestrogen-progestogen replacement therapy: follow up studyBMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7358.239 (Published 03 August 2002) Cite this as: BMJ 2002;325:239
All rapid responses
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
Surrey KT2 7JU
1 Wells M, Sturdee DW, Barlow DH, Ulrich LG, et al. Effect on
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
3 Writing Group for the Women’s Health Initiative Investigators.
benefits of estrogen plus progestin in healthy postmenopausal women:
principal results from the Women’s Health Initiative randomised
trial. JAMA 2002; 288: 321-33.
4 Grant ECG. Grant ECG. The pill, hormone replacement therapy,
mood over-reactivity, and mineral imbalance. J Nutr Environ Med
5 Ramcharan S, Pellegrin FA, Ray RM, Hsu JP. The Walnut Creek
Study. A prospective study of the effects of oral contraceptives,
111. Centre for
Population Research Monograph, NIH, Bethesda 1981.
Competing interests: No competing interests