DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
The combination pill (E and P) has an increased risk of heart attacks and stroke (increased blood clotting) where as the mini pill (progestin only) doesn't have any effects on thrombosis.
But when we look at Hormone therapy for post-menopausal women:
HT which is E and P causes an increased risk of heart attacks, whereas ET (estrogen only) doesn't.
Please explain why this is.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| fudoc_20
Forum Junior
Topics: 4
Posts: 48
|
yeah ..u are right in what u said but in postmenapousal female she is already at risk of endometrial carcinoma ..due to unopposed weak effect of estrone due to periperal conversion of androstendione .ok so u cannot give estrogen replacement therapy alone becuse it will act unopposed .increasing the risk of endometrial carcinoma. while regarding .combined pills .it dont have that effet on the end and yes it increases cvs risks .but we are affraid more from enodometrial carinoma that is why ..if afemale after hysterctomy we dont give her .combined pills but only estrogen alone to avoid the effect of prog on cvs .
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
I don't think you understood my question.
-I am asking:
-------WHY does estrogen have an INCREASED CV risk when given in premenopausal women?
-------And WHY does estrogen have a DECREASED CV rick when given in postmenopausal women?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| fudoc_20
Forum Junior
Topics: 4
Posts: 48
|
yeah i got your question now but sorry ..i am not sure of the answer .
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Dear DrVirgo..
The estrogen used in OC pills is of HIGH dose---Potential to cause CV effects
The estrogen used in HRT is of LOW dose----Not significant enough to cause CV effects but potential to cause Endometrial cancer!
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Thanks sprint. I'm beginning to see it now.
However I still have a question.
OK, we know that estrogen promotes blood clotting.
so high doses in the OCPs would lead to risk of thrombotic events.
HT is low dose estrogen so it doesn't do this.
But research on HT states that Estrogen actually has a PROTECTIVE effect on the heart, and decreases CV risk factors, and it is this point which I was wondering about.
"Most women in the observational trials such as the Nurses' Health Study, which suggested a protective effect of estrogen, started HT during the perimenopausal transition...."
http://www.medscape.com/viewarticle/528595_9
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Well.It is a controversial topic still...It is a still continuing argument of these studies showing risks of estrogen on heart----But, as far as I know, in these studies.. the so-called estrogen benefit came not from taking the hormone but from the fact that women who took it were initially healthier and had a higher socioeconomic status than nonusers.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Thanks again sprint,
So for the purpose of Step 2 CK, what are we required to know about Estrogen and it's effect on CV risk and other things?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Ok..Let us see OCP's and HRT separately
OCP's :
1.Both estrogen and progesterone in high doses with progesterone even higher than estrogen.
2. Progesterone---> causes unhealthy lipid profile and hence OCP users are increased risk for DVT.
3.Predominant hormone is progesterone---> So women are protected from EM cancer, Ovarian ca, benign breast disease.
Long term use might cause an slightly increased risk of breast cancer.
HRT :
*Best HRT is ONLY estrogen a ----But it can cause EM ca so we add progesterone.....that is why--In hysterectomised patients---Still,estrogen ONLY is the best treatment
Bottom line : In a post-menopausal woman with uterus -----> Treatment is Estrogen + Progesterone.
Since we are adding progesterone. patients will have thrombotic effects like heart attack,stroke and DVT and also increased incidence of breast cancer.
I am not sure of Why there is NOT increases DVT effects in progesterone only pills? Dr.Virgo as per kaplan explanation----progesterone causes unhealthy lipid profile.Can you tell me the source of this information?
Hope I have confused everyone
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
sprint123 wrote:
I am not sure of Why there is NOT
increases DVT effects in progesterone only pills? Dr.Virgo as per
kaplan explanation----progesterone causes unhealthy lipid profile.Can
you tell me the source of this information?
Hope I have confused everyone
It has to do with dose. The mini pill contains about a third of the progestin found in the combination pills (which have HIGH doses, like you mentioned), so the effect is little to none.
From an article:
Progestin-only pills, also called the 'minipill', are used in a manner similar to combined OCs. The progestin-only minipill has a dose of progestin that is very close to the threshold of contraceptive efficacy.
A recent WHO case-control study of cardiovascular disease and progestin-only pill use found no significant increase in the risk of acute myocardial infarction (RR=1.0, 95%CI, 0.2-6.0), stroke (RR=1.1, 95%CI, 0.6-1.9), or venous thromboembolism (RR=1.8, 95%CI, 0.8-4.2) (91). Thus far, progestin-only pills appear to have little or no effect on lipid metabolism, carbohydrate metabolism, hypertension, and coagulation factors (88).
http://www.endotext.org/female/female8/ch01s05.ht...
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
Thanx Drvirgo! Makes sense!
|
|
| |
| | | | | | | | | | | |
