Ethinylestradiol and Estrogen Replacement Therapy (ERT)
Ethinylestradiol and Estrogen Replacement Therapy – ERT
Menopause is a natural occurrence for women in the mid stage of life but unfortunately many will suffer from agonizing symptoms ranging from mild to wild on the comfort scale. Hormone replacement therapies are used to substitute for these lost hormones that regulate the female cycle. Once a woman’s menses cycles conclude, the ovaries are producing much less of the hormone estrogen so an exogenous replacement is used as a proxy.
The average women will menstruate for the last time around age 51 but it can occur earlier or later depending on the individual. Genetically speaking a woman will enter into menopause roughly about the same time as her mother did. The problem with menopause comes with the chemical change in the system due to less hormone production so many are advised to modify their lifestyles, eating habits etc. This will assist with symptoms in those women who are already healthy or may be experiencing little or no menopausal symptoms.
For those who suffer with severe residual effects of less estrogen production a more aggressive approach to treatment is required. Since the early 1970’s, estrogen replacement therapy has been increasing in popularity and the introduction of synthetic hormones such as ethinylestradiol, that had been around since the late 30’s, was an option for estrogen based treatments for various ailments. Early on as the use of ethinylestradiol and other exogenous hormones continued, it was becoming evident that there were increased risks of endometrial cancer. This caused the inclusion of progesterone into the mix and this combination of hormones has become the hormone replacement therapy of choice.
There were obvious medicinal advantages when ethinylestradiol and other estrogen replacements were used on their own. When the combination therapy was introduced, any evidence of its treatment successes has been cloudy to say the least. There are so many differing and confusing issues with the HRT combination and risks began to become more prevalent over the years since its introduction to mainstream relevance.
Confirmation of the potential hazards of using the estrogen/ progesterone combinations for hormonal replacement showed an increased incidence of breast cancer, heart disease and stroke, and venous thromboembolism. These risks were reported based on a study named The Women’s Health Initiative or WHI that reported in a July 2002 AMA journal.
The study included 16,608 women of which half were given a placebo, who had an average usage time of 5.2 years on the HRT protocol and it was ended prematurely. There was also an estrogen only ERT element to the group, which was approved to carry on with the study with it to ending prematurely but further on into the research. The early-ended HRT study showed an obvious increase in the rate of both breast cancer and coronary heart disease.
The HRT trial results confirmed an increase in the risk of breast cancer by 24% and the risk of a stroke increased by 31%. In 2003, the WHI put into print their HRT trial element results in no less than the New England Journal of Medicine. The WHI found that by and large there was a 24% increase in coronary heart disease [CHD] and a staggering 81% increase in the risk of CHD within the first year of beginning a combined therapy protocol of estrogen and progesterone.
There was a positive result from the study. Taken as a whole, bone breakage amongst participants decreased by 24%, and there was a 33% drop in the incidence of hip fractures. The pace of Endometrial cancer occurrence also dropped by 19%. There is little wonder given the results of this study that the weighing of the risk versus benefit theory needs to be carefully considered before commencing with a hormone replacement therapy regimen. But the jury was still out on the estrogen only ERT element of the WHI research.
Like the HRT study, the ERT research was also ended prematurely after results began to surface showing evidence of health risk. Reported on in 2004 after the study was stopped in February of the same year, the researchers found that estrogen, of which ethinylestradiol is a exogenous proxy, showed no increase of CHD specifically but there was an absolute risk in women who were post menopausal for stroke and deep venous thrombosis, or blood clotting in the legs, was in evidence. There was no increased risk of colorectal cancer or breast cancer but it did decrease the incidence of hip and general bone fractures. The Estrogen Replacement Therapy [ERT] arm of the WHI study was originally slated to end in 2005.
The study concluded that ERT should not be used as a therapy for chronic illness or for treating long-term conditions. It said that ERT should only be used to treat menopause symptoms and only the smallest dosages offering the maximum effect should be administered for the least amount of time possible. Originally slated to research the effect of the ERT on the heart, the study was conclusive that the ERT protocols used did not shield women from the risk of CHD and actually increased the chance of stroke. These finding were in point of fact directed at older women age 60 or more.
Millions of women are currently taking some type of Hormone replacement therapy, the majority taking an estrogen alone therapy. The WHI – ERT study encompassed a mix of women who were postmenopausal and did not have their uterus any longer, different races, aged 50 to 79 with an average age to start the study at 64 and 70 when the study finished. Many of the participants were overweight but in general pretty fair health.
The WHI study of Estrogen alone has also been geared toward the effects on a woman’s cognitive abilities. These included research into their ability to think concerning recall, thought awareness, attention span, language and conceptual ways of thinking as well as number computation. Was there any subtle conscious impairment evident? Was there any sign of dementia, the loss or unexpected lessening of more than one cognitive function that was not a result of medication or personal health but was definitely affecting a person’s daily routine?
The study showed an indication of increase risk of dementia in some older participants over time. Estrogen alone would not offer protection from normal cognitive impairment. Women who were not taking a placebo showed a slender increase in cognitive impairment in yearly specific testing. A higher decline was noticed in women who began the study already in cognitive peril. Interestingly there was a higher incidence of cognitive impairment of women who ingested both estrogen and progesterone.