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Controversies concerning the safety of estrogen replacement therapy
338
Citations from the literature
Mortality among oral contraceptive users
Porter JB; Jick H; Walker AM Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Wolthom, MA, USA OBSTET. GYNECOL.; 70/l (29-32) 1987 The occurrence of fatal conditions was substantially similar in a large population of recent, healthy oral contraceptive users and comparable nonusers at Group Health Cooperative at Puget Sound during the years 1977-1981. There were no deaths from cardiovascular disease among those who were oral contraceptive users at the onset of their cardiovascular illness; there was one death from liver cancer, probably attributable to oral contraceptive use; and there were no deaths from complications of pregnancy among either users or nonusers. Newer formulations of oral contraceptives and greater care in prescribing oral contraceptives to the healthiest younger women may have substantially lessened the risks identified with earlier preparations and prescription practices. Controversies therapy
concerning the safety of estrogen replacement
Whitehead MI; Fraser D Academic Deportment of Obstetrics and Gynecology, King’s College School of Medicine and Dentistry, London SE5 8RX, UK AM. J. OBSTET. GYNECOL.; 156/5 (1313-1322) 1987 Unopposed estrogen replacement is known to cause endometrial carcinoma in a small percentage of postmenopausal women, but the effects on ovarian and breast tissue remain uncertain. The increased risk of endometrial carcinoma seems to be related to both the dosage and duration of unoppsoed estrogen treatment. Until very recently, the morbidity and costs that result from the need for endometrial biopsy because of abnormal bleeding and from the need for hysterectomy due to hyperplasia have been ignored, but recent data suggest that they are likely to be considerable. Progestogens are known to protect against endometrial hyperstimulation, but the optimal duration of therapy each month and the maximally protective agent and dose remain to be determined. Estrogen replacement therapy may reduce the risk of arterial disease; however, the comparative effects of the various preparations, as well as their respective mechanisms of action, must be subjected to further study. Overview of the efficacy of hormonal replacement therapy
Ettinger B Kaiser Permonente Medico1 Center, Son Francisco, CA 94115, USA AM. J. OBSTET. GYNECOL.; 156/.5 (1298-1303) 1987 The most widely recognized reason for prescribing estrogen for menopausal women is for control of symptoms. Estrogen effectively reduces the vasomotor, somatic, and associated psychologic components of the menopausal syndrome. Recently, however, the role of oestrogen in the prevention of disease, particularly osteoporosis, urogenital atrophy, and atherosclerotic cardiovascular disease, has prompted consideration of this treatment for a more long-term goal. Int J Gynecol Obstet 26
Bone loss occurring after menopause can be prevented by the use of estrogen; this significantly reduces the morbidity and mortality of associated fractures. Atrophic changes, which can occur earlier in the menopause then previously recognized, also respond to estrogen treatment. Atherosclerotic risk profiles are improved by estrogen replacement: blood pressure is lowered, total cholesterol and low-density lipoprotein cholesterol are reduced, and high-density lipoprotein cholesterol is increased. Most studies have found that the incidence of angina or myocardial infarction is lower in estrogen users than in nonusers, and overall mortality rates from cardiovascular disease appear to be reduced as well.
VARIA Factors that correlate with injury sustained sexual assault
by survivors
of
Cartwright PS Deportment of Obstetrics and Gynecology, Vanderbilt Medical School, Nashville, TN, USA OBSTET. GYNECOL.; 70/l (44-46) 1987 A retrospective study of 440 cases of reported sexual assault was undertaken in order to identify factors that correlated with which victims sustained physical injury. Overall, 40% sustained nongenital and 16% genital injury, but most injuries were not severe. Which victim was injured strongly correlated with her age and race, the race of her assailant, and whether he had a weapon. White victims sustained both genital and nongenital injury almost twice as often as black victims. Whether she knew her assailant was less important, unless the victim was a child. Survivors attacked by a single assailant were injured as often as survivors of ‘gang rape’. Conclusions drawn from these data must take into account that these victims choose to report the event to the authorities, and self-reporting bias might explain some of the findings. Approximately half the victims seen sustained no injury. Apparently, physical injury is not an inevitable consequence of being raped. Unemployment
and child abuse
Taitz LS; King JM; Nicholson J; Kessel M University Deportment of Paediatrics, Children’s Hospital, Sheffield SIO 2TH, UK BR. MED. J.; 294/6579 (1074-1076) 1987 The employment state of men living in the homes of children at the time that child abuse was diagnosed was determined. The series included a wide range of abuse, including non-accidental injury, failure to thrive, neglect, and emotional deprivation. Two cohorts of children seen during 1974-9 and 1980-5 were compared; these periods were chosen because a large increase in unemployment began in Sheffield in 1980. Although the proportion of the men without work was significantly increased during the second period, this increase could not be ascribed to the rise in either long term or short term unemployment among those who had previously been in regular employment. It was accounted for by a rise in the proportions of single parent families and families in which the resident man had never had regular employment. This may
Citations from the literature
Mortality among oral contraceptive users
Porter JB; Jick H; Walker AM Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Wolthom, MA, USA OBSTET. GYNECOL.; 70/l (29-32) 1987 The occurrence of fatal conditions was substantially similar in a large population of recent, healthy oral contraceptive users and comparable nonusers at Group Health Cooperative at Puget Sound during the years 1977-1981. There were no deaths from cardiovascular disease among those who were oral contraceptive users at the onset of their cardiovascular illness; there was one death from liver cancer, probably attributable to oral contraceptive use; and there were no deaths from complications of pregnancy among either users or nonusers. Newer formulations of oral contraceptives and greater care in prescribing oral contraceptives to the healthiest younger women may have substantially lessened the risks identified with earlier preparations and prescription practices. Controversies therapy
concerning the safety of estrogen replacement
Whitehead MI; Fraser D Academic Deportment of Obstetrics and Gynecology, King’s College School of Medicine and Dentistry, London SE5 8RX, UK AM. J. OBSTET. GYNECOL.; 156/5 (1313-1322) 1987 Unopposed estrogen replacement is known to cause endometrial carcinoma in a small percentage of postmenopausal women, but the effects on ovarian and breast tissue remain uncertain. The increased risk of endometrial carcinoma seems to be related to both the dosage and duration of unoppsoed estrogen treatment. Until very recently, the morbidity and costs that result from the need for endometrial biopsy because of abnormal bleeding and from the need for hysterectomy due to hyperplasia have been ignored, but recent data suggest that they are likely to be considerable. Progestogens are known to protect against endometrial hyperstimulation, but the optimal duration of therapy each month and the maximally protective agent and dose remain to be determined. Estrogen replacement therapy may reduce the risk of arterial disease; however, the comparative effects of the various preparations, as well as their respective mechanisms of action, must be subjected to further study. Overview of the efficacy of hormonal replacement therapy
Ettinger B Kaiser Permonente Medico1 Center, Son Francisco, CA 94115, USA AM. J. OBSTET. GYNECOL.; 156/.5 (1298-1303) 1987 The most widely recognized reason for prescribing estrogen for menopausal women is for control of symptoms. Estrogen effectively reduces the vasomotor, somatic, and associated psychologic components of the menopausal syndrome. Recently, however, the role of oestrogen in the prevention of disease, particularly osteoporosis, urogenital atrophy, and atherosclerotic cardiovascular disease, has prompted consideration of this treatment for a more long-term goal. Int J Gynecol Obstet 26
Bone loss occurring after menopause can be prevented by the use of estrogen; this significantly reduces the morbidity and mortality of associated fractures. Atrophic changes, which can occur earlier in the menopause then previously recognized, also respond to estrogen treatment. Atherosclerotic risk profiles are improved by estrogen replacement: blood pressure is lowered, total cholesterol and low-density lipoprotein cholesterol are reduced, and high-density lipoprotein cholesterol is increased. Most studies have found that the incidence of angina or myocardial infarction is lower in estrogen users than in nonusers, and overall mortality rates from cardiovascular disease appear to be reduced as well.
VARIA Factors that correlate with injury sustained sexual assault
by survivors
of
Cartwright PS Deportment of Obstetrics and Gynecology, Vanderbilt Medical School, Nashville, TN, USA OBSTET. GYNECOL.; 70/l (44-46) 1987 A retrospective study of 440 cases of reported sexual assault was undertaken in order to identify factors that correlated with which victims sustained physical injury. Overall, 40% sustained nongenital and 16% genital injury, but most injuries were not severe. Which victim was injured strongly correlated with her age and race, the race of her assailant, and whether he had a weapon. White victims sustained both genital and nongenital injury almost twice as often as black victims. Whether she knew her assailant was less important, unless the victim was a child. Survivors attacked by a single assailant were injured as often as survivors of ‘gang rape’. Conclusions drawn from these data must take into account that these victims choose to report the event to the authorities, and self-reporting bias might explain some of the findings. Approximately half the victims seen sustained no injury. Apparently, physical injury is not an inevitable consequence of being raped. Unemployment
and child abuse
Taitz LS; King JM; Nicholson J; Kessel M University Deportment of Paediatrics, Children’s Hospital, Sheffield SIO 2TH, UK BR. MED. J.; 294/6579 (1074-1076) 1987 The employment state of men living in the homes of children at the time that child abuse was diagnosed was determined. The series included a wide range of abuse, including non-accidental injury, failure to thrive, neglect, and emotional deprivation. Two cohorts of children seen during 1974-9 and 1980-5 were compared; these periods were chosen because a large increase in unemployment began in Sheffield in 1980. Although the proportion of the men without work was significantly increased during the second period, this increase could not be ascribed to the rise in either long term or short term unemployment among those who had previously been in regular employment. It was accounted for by a rise in the proportions of single parent families and families in which the resident man had never had regular employment. This may