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The International Hormone Society

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Consensus # 2 Estrogen And Progesterone Treatment of Pre- and Postmenopausal Women

December 11, 2005

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After a literature review and discussions with physicians from all over the world who are well-versed in treating patients with endocrine abnormalities, we, the members of the Consensus Group of Experts of the International Hormone Society, think the time is ripe to reconsider current concepts on correction of female hormone deficiency.

We acknowledge the present controversy on the use of female hormone replacement since the American Woman's Health initiative (WHI) study published in 2002 and the British One Million Women study published in 2003. In both of these studies, the use of female hormone supplementation was associated with an increased breast cancer incidence compared to placebo or nonusers. In the WHI study the use of female hormones was correlated with an increased risk of cardio- and cerebrovascular diseases.

For the members of the consensus group of the International Hormone Society, the main bias of these studies is that none of the participants took progesterone. Of the women who did take a progestogen, it was a synthetic that is structurally different from the body's endogenous progesterone. Similarly, the estrogen administered in the WHI study was not bio-identical and structurally different from the body's endogenous estradiol. This is also true for the majority of women in the One Million Women study who took a non bio-identical estrogen. We have reviewed the literature on the use of non bio-identical estrogens and found other studies that confirm the potential toxicity and increase in risk of these compounds for the female body. Therefore, In accordance with the recommendations of an increasingly growing number of medical societies, we do not recommend the use of non bio-identical estrogens and progestogens for treatment of ovarian deficiencies, except when no other possibility exists such as for the use in birth-control where contraceptive pills with synthetically modified female hormones are often the only alternative. This is also true for the treatment of menorraghia where synthetic progestogens may have a better effect.

If the use of the compounds that are structurally different from the body's own hormones is not recommended, then what is the alternative? In contrast to recommendations of some other societies not to use female hormones in postmenopausal women, or to use them for a limited time (a maximum of five years after menopause), we recommend the use of female hormones before and after menopause for as long as necessary, as long as the patients remain deficient in these hormones and no new events occur that would contraindicate their use.

However, we recommend the use of bio-identical hormones, estrogens, in particular estradiol and estriol, and of bio-identical progesterone for the correction of ovarian deficiencies, except for specific cases as those mentioned above, where for limited periods the use of non bio-identical hormones may work better. The scientific literature we reviewed on bio-identical hormones is clearly more reassuring than that on non bio-identical ones. The route of administration is also of considerable importance. The transdermal route is safer for estradiol administration than the oral route. No increase of the incidence of breast cancer has to our knowledge be found with the use of transdermal gel of estradiol, while the addition of bio-identical progesterone may reduce the incidence as reported in at least two studies. In the One Million Women study the use of transdermal estradiol nonsignificantly increased the incidence of breast cancer, but the increase concerned only a very small subgroup (about 300 women out of a total of more than one million participants). Moreover, nearly all these women were using transdermal patches of estradiol, a delivery system that may be far from optimal as it provides fluctuating serum levels of estradiol levels that make it difficult to correctly balance the estradiol with progesterone.
In one Australian study the increased risk of breast cancer found in women who used non bio-identical hormones such as those in the WHI and One Million Women study disappeared in women who received testosterone combined to estrogen-progestogen preparations. The observation needs confirmation, but it does give some support to physicians who opt to correct ay androgen deficiency in female patients who take female hormone replacement therapy.

May women who have had breast cancer, take estrogens and progesterone? The general trend nowadays is to avoid administering female hormones to women who have had breast cancer. The recommendation may not be justified for women with total surgical removal of the cancer. In all studies, except one, we reviewed on breast cancer patients treated with female hormones, no increase in risk was reported. On the contrary, female hormone replacement generally was associated with a considerable reduction of the risk of breast cancer recurrence and mortality in most studies or with no significant difference in some studies. However, it is still too soon to recommend the intake of female hormones by all women with breast cancer and ovarian deficiency. It is perhaps too soon yet to recommend the treatment for women who had their tumor surgically and totally removed and who seem to be cured. We recommend that large-scaled controlled studies should be urgently undertaken, in order to check safety and find for which women who had breast cancer, sex hormone therapy is best indicated.

Whatever the choice of female hormones, we recommend the physicians to carefully and regularly follow-up all female patients undergoing female hormone therapy, including submitting them to regular cancer screening.

In conclusion, we recommend pohysicians to correct any female hormone deficiency in female patients with preferably transdermal estradiol and oral, or even better vaginal, progesterone under the condition the female patient is carefully and regularly followed, including cancer screening.


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23 signatures for this petition
1 to 10

Marina Ussai
(no comment)
Jaime Cegielski
United States
(no comment)
Carole Hughes
United Kingdom
(no comment)
Giselle Wildman, D.O.
United States
There is an epidemic of need both with patients who suffer greatly and well trained physicians who are able to diagnose and treat this properly.
Ida Hardy
United States
(no comment)
Dustin Leonard
United States
(no comment)
Kathy Evans
United Kingdom
(no comment)
Isabel Wilson
United Kingdom
(no comment)
Alenka Radelj
(no comment)
Diane Richard
United States
My life has changed thanks to this therapy.



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