Not all oestrogens the same – Bioidentical safer.
I very frequently am told by patients that their GPs and or specialists tell them that all hormones are the same, and the synthetic is the same as the natural. Here is another article (from the Journal of the American Association no less) disproving this. How much more evidence do we need? Premarin in Australia is also known as Premia.
Pfizer’s Premarin for Menopause Linked to Blood Clot Risk
Bloomberg News, 10/01/2013
Pfizer’s Inc. (PFE)’s Premarin for menopause may be tied to a higher risk of blood clots than another common estrogen treatment called estradiol, a study found. Women taking Premarin, also known as conjugated equine estrogens, had double the risk of a blood clot in the veins than women taking estradiol, a synthetic form of estrogen, according to research in JAMA Internal Medicine. No difference between the treatments was seen in the risk of stroke. The findings don’t mean women should stop taking Premarin, an estrogen gathered from the urine of pregnant horses, to ease their menopausal symptoms such as hot flashes, night sweats, mood swings and vaginal dryness, said Nicholas Smith, the lead study author. More research is needed to replicate the results so doctors can say for sure that different types of estrogen drugs carry varied levels of heart risks, he said. “The assumption has held that all oral estrogens have similar safety profiles. This may not be the case,” Smith, a professor of epidemiology at the University of Washington School of Public Health in Seattle, said in an e–mail. “More comparative safety studies of commonly used treatments are needed.”
Here is the full study, if you want more information.
Lower Risk of Cardiovascular Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens ONLINE FIRST
2Group Health Research Institute, Group Health Cooperative, Seattle, Washington
3Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington
4Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
5Department of Medicine, University of Washington, Seattle
6Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
7Department of Biostatistics, University of Washington, Seattle
8Department of Statistics, University of Auckland, Auckland, New Zealand
9Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
10Department of Health Services, University of Washington, Seattle
Importance Little is known about the comparative cardiovascular safety of oral hormone therapy products, which impedes women from making informed safety decisions about hormone therapy to treat menopausal symptoms.
Objective To compare the relative clinical cardiovascular safety of 2 commonly used oral estrogen drugs—conjugated equine estrogens (CEEs) and estradiol.
Design, Setting, and Participants Population-based, case-control study from January 1, 2003, to December 31, 2009, comparing cardiovascular event risk associated with current CEEs and estradiol use in a large health maintenance organization in which the preferred formulary estrogen changed from CEEs to estradiol during the course of data collection. Participants were 384 postmenopausal women aged 30 to 79 years using oral hormone therapy.
Main Outcomes and Measures Incident venous thrombosis was the primary clinical outcome, and incident myocardial infarction and ischemic stroke were secondary outcomes. As validation, an intermediate clotting phenotype, the endogenous thrombin potential–based normalized activated protein C sensitivity ratio, was measured in plasma of controls.
Results We studied 68 venous thrombosis, 67 myocardial infarction, and 48 ischemic stroke cases, with 201 matched controls; all participants were current users of oral CEEs or estradiol. In adjusted analyses, current oral CEEs use compared with current oral estradiol use was associated with an increased venous thrombosis risk (odds ratio, 2.08; 95% CI, 1.02-4.27; P = .045) and an increased myocardial infarction risk that did not reach statistical significance (odds ratio, 1.87; 95% CI, 0.91-3.84; P = .09) and was not associated with ischemic stroke risk (odds ratio, 1.13; 95% CI, 0.55-2.31; P = .74). Among 140 controls, CEEs users compared with estradiol users had higher endogenous thrombin potential–based normalized activated protein C sensitivity ratios (P < .001), indicating a stronger clotting propensity.
Conclusions and Relevance In an observational study of oral hormone therapy users, CEEs use was associated with a higher risk of incident venous thrombosis and possibly myocardial infarction than estradiol use. This risk differential was supported by biologic data. These findings need replication and suggest that various oral estrogen drugs may be associated with different levels of cardiovascular risk.