Subject: Journal Watch Women's Health Alert for April 9, 2007

From: [email-masked]
Date: Mon, 9 Apr 2007 09:57:52 -0700

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WOMEN'S HEALTH for April 9, 2007

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Uterine Effects of Unopposed Estrogen Therapy in Menopausal Women
[Summary and Comment | Free]

Estrogen-only HT was associated with increased incidences of uterine 
bleeding, endometrial hyperplasia, and endometrial biopsies.
   By Andrew M. Kaunitz, MD
   April 5, 2007
   Covering: Steiner AZ et al. Obstet Gynecol 2007 Mar 109:581-7
   http://womens-health.jwatch.org/cgi/content/full/2007/405/1?q=etoc

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Menopausal Hormone Therapy and Blood Clots: Is It All in the Delivery?
[Summary and Comment | Subscription Required]

Differences in routes of administration and formulations of HT may affect 
risk for VTE.
   By Marian C. Limacher, MD
   April 5, 2007
   Covering: Canonico M et al. Circulation 2007 Feb 20; 115:840-5
   http://womens-health.jwatch.org/cgi/content/full/2007/405/2?q=etoc

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HPV Infection in U.S. Women: Who Has the Highest Prevalence?
[Summary and Comment | Subscription Required]

Among sexually active women aged 20&#150;24 years, the prevalence of HPV 
infection was almost 50%.
   By Wendy S. Biggs, MD
   April 5, 2007
   Covering: Dunne EF et al. JAMA 2007 Feb 28; 297:813-9
   Weller SC and Stanberry LR. JAMA 2007 Feb 28; 297:876-8
   http://womens-health.jwatch.org/cgi/content/full/2007/405/3?q=etoc

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HSV-Suppressive Therapy Might Improve HIV Status in Dually Infected Women
[Summary and Comment | Subscription Required]

The antiviral valacyclovir reduced genital and plasma HIV RNA levels.
   By Anna Wald, MD, MPH
   April 5, 2007
   Covering: Nagot N et al. N Engl J Med 2007 Feb 22; 356:790-9
   Corey L. N Engl J Med 2007 Feb 22; 356:854-6
   http://womens-health.jwatch.org/cgi/content/full/2007/405/4?q=etoc

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EDITOR'S PICKS from across Journal Watch
Vaginal Douching Before Pregnancy May Protect Against Preterm Birth
[General Medicine | Summary and Comment | Subscription Required]

However, women who douched during pregnancy were more likely to deliver 
preterm.
   By Robert W. Rebar, MD
   March 27, 2007
   Covering: Misra DP and Trabert B. Am J Obstet Gynecol 2007 Feb 
   196:140.e1-8
   http://general-medicine.jwatch.org/cgi/content/full/2007/327/5?q=etoc

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Menstrual Migraine: The Estrogen Paradox
[Neurology | Summary and Comment | Subscription Required]

New research confirms that estrogen withdrawal is a trigger for menstrual 
migraine, but treatment results with perimenstrual estrogen supplementation
are disappointing.
   By Elizabeth Loder, MD
   March 13, 2007
   Covering: MacGregor EA et al. Neurology 2006 Dec 26; 67:2154-8
   MacGregor EA et al. Neurology 2006 Dec 26; 67:2159-63
   http://neurology.jwatch.org/cgi/content/full/2007/313/2?q=etoc

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FREE FULL-TEXT ARTICLE

Summary and Comment

Uterine Effects of Unopposed Estrogen Therapy in Menopausal Women
Estrogen-only HT was associated with increased incidences of uterine 
bleeding, endometrial hyperplasia, and endometrial biopsies.

Unlike estrogen-progestin menopausal hormone therapy, estrogen-only therapy
is associated with little, if any, increase in breast cancer risk (Journal 
Watch Women's Health Jan 22 2003 and Feb 22 2007). These observations have 
prompted increased interest in using estrogen-only HT to alleviate 
menopausal symptoms. To examine the effects of estrogen-only HT on 
endometrial thickness and uterine bleeding, investigators performed a 
combined analysis of two clinical trials involving 218 women with intact 
uteri who were randomized to receive oral micronized estradiol (1 mg/day) 
or placebo for 2 or 3 years. After baseline assessment of endometrial 
thickness, women kept records of uterine bleeding and underwent annual 
transvaginal ultrasound examinations; endometrial biopsy was performed if 
the endometrial thickness exceeded 5 mm. 

Among women randomized to estradiol, the cumulative incidence of vaginal 
bleeding was 49% and 67% at 1 year and 3 years of treatment, respectively; 
by comparison, the 3-year cumulative bleeding incidence was 11% in the 
placebo group. Among estrogen users, those who were obese were more likely 
to experience bleeding than those who were not. During the study period, 
44% of women in the estradiol group versus 14% in the placebo group had at 
least one endometrial thickness measurement that exceeded 5 mm. Estradiol 
recipients also were more likely than placebo recipients to require at 
least one endometrial biopsy (20.5% vs. 1.5% at 1 year; 48.2% vs. 4.3% at 3
years). Hyperplasia was diagnosed in 9.4% of women in the estradiol group 
and in none in the placebo group. Some women were diagnosed with 
hyperplasia after the conclusion of the studies; thus, the rate of 
hyperplasia after 3 years of estradiol therapy was 20%. 

Comment: No participant was diagnosed with endometrial cancer during either
study. Progestin use has been associated with increased risk for breast 
cancer and, in some women, mood changes; thus, symptomatic menopausal women
with intact uteri might be particularly motivated to use unopposed estrogen
therapy if they have a higher-than-average baseline risk for breast cancer 
or a history of dysphoria associated with progestin use. However, women 
with intact uteri who are considering estrogen-only therapy should be made 
aware of the increased risks for uterine bleeding, for needing one or more 
endometrial biopsies, and for being diagnosed with endometrial hyperplasia.

-- Andrew M. Kaunitz, MD 

Published in Journal Watch Women's Health April 5, 2007 

Citation(s):

Steiner AZ et al. Unopposed estradiol therapy in postmenopausal women: 
Results from two randomized trials. Obstet Gynecol 2007 Mar; 109:581-7. 
(Subscription may be required) (Free)

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