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Re: hormone replacement and s/p tah bsoFrom: Zach Newton (zbnewton@mindspring.com)Tue Oct 26 20:08:56 1999
Jomyrwhipt@aol.com wrote: > > I was just precepting a Family Practice Resident and the woman presented for another complaint. In the presentation, the resident mentioned that this pt was s/p tah/bso and was taking prem-pro. I was under the impression and teaching that if you didn't have your uterus, then progesterone wasn't indicated. The resident, however, mentioned that the unopposed estrogen would increase the patients risk for breast cancer. I have two questions for the list. > > 1. What does the latest date suggest on unopposed Estrogen in a post-menopausal woman with tah/bso, and no family history of breast ca and no other risk factors, in increasing her risk for breast ca? > 2. Is replacement of progesterone in a woman without a uterus necessary for other reasons, physiologically. > > I appreciate responses and articles to support your feedback would be helpful. The maze to transgress to arrive at the right answer is tortuous and you end up at a wall after all that extraterrestial effort. The final answer is never at hand. The science does have data to offer. Abundant. The faultline of presumption on the part of your resident is obscene. That unopposed estrogen increases risk of endometrial carcinoma by 8X has no implication on pharmocologic impact on breast glandular receptors. The evidence is strong that there is increased risk of breast cancer as a function of length and level of exposure to estrogen, with or without progestin. The life analysis data in aggregate suggests that estrogen confers a positive impact across users that substantially outweighs the risk of death from breast cancer. The misappropriation of protective influence of progestin against breast cancer fostered by Gambrell with his Wilford Hall data has been persuasively put on a garbage barge. The protective effect of progestin against endometrial cancer in appropriate schedules and dosage has been sustained. The paradox of bifurcation in impact of progestin on the breast acinar apparatus (proliferative) and proliferative endometrium (maturative) is the basis for avoiding use of progestins in women without a uterus, in part. Beyond the breast, progestin has generally negative impact metabolically and systemically, except for estrogen-exposed endometrium. You are correct in your position as preceptor. If challenged by cite to the above statements, I will be happy to produce supportive literature. The shoe is on the foot of your resident to support the use of progestin in the patient presented. The literature is flaming with reviews on the general topic.
-- Zach Newton Z. B. Newton, III, M.D. Atlanta/Gyn
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