PS - School Assignment Part 2

(PS added)

So the second (and third) parts of my school assignment are to respond to 2 other posts and to any replies on my own (under our Pharmacology class discussion page).

Of course I'm not posting anyone else's posts or replies, but here is my reply to a reply under my post, which is important, because it actually contains the links/and gives more information on the 2002 Women's Health Initiative Study and the pushback that ensued, leading to further confusion regarding birth control and HRT treatments:

Hey XXX!

Thanks for replying and the backup on this subject, you write like a pro, by the way, very clear and concise - and yes, that was my goal, asking that people learn from my mistakes and not fearing advocating for yourself as women (I'm speaking to myself as much as anyone else, learning when to be assertive and when not to and how to.)

IMO, it just seems like the emphasis (and value) is still too focused on the female ability to have children, and to heck with women of a certain age, despite the fact that what you choose now can affect later, and even what you do during and postmenopause is important. 

It's often finding a balance between symptom relief  and/or contraception VS. possible long-term effects.

On that note, our book mentioned that 2002 WHI study that revealed what we believed previously - throwing a bunch of estrogen at problems and hoping it'd stick, despite lack of evidence either way - was problematic at the very least.

https://pubmed.ncbi.nlm.nih.gov/12117397/

And what the book doesn't mention is  that there was pushback, it was controversial, and there was a critique of that study in 2006 and others since.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1630688/

(Nothing against the book, I'm grateful they even mentioned it.)

Essentially, the pushback is with regard to reproductive cancer and estrogen therapy, that it's been misread and misinterpreted that birth control and HRT actually cause breast cancer, when that's not what it said -  it only said there was a correlation between the two and a slightly higher risk.

In other words, "correlation" does not mean "caused."

(I personally never read it that way anyway, but apparently some did.)

After reading both studies, here's what I'm left with, the balance between the two ...

It's complicated - and there is an important balance that needs to be had and that balance may even need to be individualized further for each woman, rather than trying to blanket all of us.

Further, I think at some point, we're going to need more research on what the mechanisms actually are that account for these differences and address those - if we can stop focusing  our research JUST on women of childbearing age (though like I said, what you do now may affect later) -  but for now, everything in moderation, just like everything else.

And you are absolutely correct - smoking is likely THE biggest risk factor for DVT/PE.

(I know you weren't scolding or anything, just following the discussion guidelines, I'm just  also taking it as a personal reminder because I'm going to try to quit again on Spring Break lol)

My smoking is not logical, it's a poor coping skill with anxiety versus taking something that dulls mentation. Thus, I've just received a prescription for bupropion (Wellbutrin) to help with quitting AND anxiety, which I play to try again on Spring Break! (Wish me luck trying again.) :) 

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PS - Interestingly and coincidentally, I'm doing a job for my contract work today about a completely unrelated drug coming to market, completely different medical area (and I can't tell you what and whom), but the economic pharmacologist respondent used this analogy:

"Let's pick something that’s been in the news recently, without (crosstalk) peri/post menopause, what is it, 25 years ago, someone said there was 35% higher chance of them developing breast cancer taking hormone therapy? Well, that turned out to be 4 out of 1,000 versus 5 out of 1,000, and so we scared women out of getting treated with hormones for 35 fricking years, which is criminal, so I’m thinking the same thing here."

He is referring to that 2002 WHI study we are talking about and the pushback controversy over it.

I see his point, and yet still, whether it's 4 out of 1,000 or 5 out of 1,000, we still don't yet understand WHY those 4 or 5 patients developed breast cancer or responded the way they did to hormonal therapy, and that may be important to know before blanket-generalizing treatment for all women.

Is it genetic variant we aren't aware of yet?

Is there some immunology involved? 

Is there some inhibition or overexpression going on?  

Why ARE some women more sensitive to estrogen than others (like me), and what other effects on the body does that have?

Do we really have to choose between bone-bending/bone breaking osteoporosis and heightened risk for breast cancer in such absolute  either/or terms?

The truth is ... we don't know. 

Like I said, taking in both sides of this argument, for me, taking hormones in an individual cocktail like I'm doing, in moderation, perhaps even cyclical treatment with tapering, may be best for now until we know more.

(Like I said *IF* we can get more research focused on women lifelong instead of just childbearing years, though what you take/do then will affect you later, because there is definitely a correlation - arguably percentage-wise - about taking estrogen and reproductive cancers and also prevention of osteoporosis.)