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Menstruation, Menopause, and Hormone Replacement Therapy for Women — Whalespan

Content›Video›Menstruation, Menopause, and…

Menstruation, Menopause, and Hormone Replacement Therapy for Women

Peter Attia23m · 2022-08-20

Claims Made

32

Claims Supported

18

Support Rate

56%

Support rate

18 of 32 claims supported

18 supported14 partial / not

Claims from this content

29

◐Partially SupportedEstrogen alone in the WHI study showed a non-statistically significant 21% risk increase for breast cancer (p-value of 0.07).✓Well SupportedTaking oral progesterone for seven days can ameliorate PMS symptoms.✕Not SupportedWomen with an intact uterus taking estrogen alone have a high risk of endometrial cancer and increased vaginal bleeding.✓Well SupportedThe rapid reduction of progesterone in the last seven days of a woman's menstrual cycle can cause PMS symptoms.✕Not Supported

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A. Volkovreader

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Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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The original conclusions of the Women's Health Initiative regarding hormone replacement therapy have largely been overturned.

✓Well SupportedThe menstrual cycle consists of a follicular phase followed by a luteal phase.

✓Well SupportedFree testosterone levels in women (e.g., 1 ng/dL) are significantly lower than in men (e.g., 14 ng/dL), but still represent a dominant hormone relative to estrogen.

✓Well SupportedA progesterone-coated IUD can be used for local protection in the uterus while maintaining systemic estrogen therapy if oral progesterone is not tolerated.

✓Well SupportedAnnual endometrial ultrasounds are recommended for women on HRT with a uterus to monitor endometrial lining thickness.

✓Well SupportedBio-identical hormones are recommended for menopause therapy, weighing benefits against the absolute risk of breast cancer.

◐Partially SupportedThe Women's Health Initiative study correctly randomized women with a uterus into groups receiving conjugated equine estrogen plus MPA or placebo, and women without a uterus into groups receiving conjugated equine estrogen or placebo.

✕Not SupportedReporting on health risks can be misleading if absolute risk and the study period are not also considered.

✓Well SupportedLong-term complications of menopause include vaginal atrophy, vaginal dryness, osteopenia/osteoporosis, and brain fog.

✓Well SupportedMenopause is characterized by a decline in estrogen, leading to symptoms such as night sweats and hot flashes.

✓Well SupportedRecent data shows that topical estrogen (estradiol) use does not increase the risk of heart disease and may even decrease it.

◐Partially SupportedCombining estrogen with progesterone effectively counteracts the risk of endometrial hyperplasia and cancer associated with estrogen-only therapy.

◐Partially SupportedNot all women can tolerate oral progesterone, and for some, it can cause significant adverse psychological effects.

✓Well SupportedTestosterone therapy in women, when dosed to physiologically normal levels, does not typically cause acne, body hair growth, or clitoral enlargement.

◐Partially SupportedTopical testosterone may be considered for women with very low testosterone levels to aim for physiologically normal levels and improve muscle mass and libido.

✕Not SupportedThe use of synthetic progesterone (MPA) in hormone replacement therapy may have been a significant factor in the negative findings of the Women's Health Initiative (WHI) study.

✕Not SupportedThe Women's Health Initiative study used conjugated equine estrogen and medroxyprogesterone acetate, instead of bio-identical estradiol and micronized progesterone.

◐Partially SupportedOral estrogen increases blood coagulability, unlike topical or patch forms.

◐Partially SupportedEstrogen-only therapy in women without a uterus showed a trend towards a 24% risk reduction in breast cancer.

✕Not SupportedThe Women's Health Initiative (WHI) study disproportionately selected an unhealthy patient population more than 10 years post-menopause.

◐Partially SupportedOral contraceptives are sometimes used for symptomatic control in pre-menopausal women, often low-dose formulations like Loryna.

◐Partially SupportedThe WHI study enrolled women significantly post-menopause and included a disproportionately high number of unhealthy participants.

◐Partially SupportedThe WHI study excluded symptomatic patients.

◐Partially SupportedThe significant reduction of progesterone in the late luteal phase can cause PMS symptoms by impacting brain function.

◐Partially SupportedTestosterone therapy is sometimes prescribed to women with caution due to limited supporting data.