The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting On With Your Life by Rita Baron-Faust, Jill Buyon Page B
Authors: Rita Baron-Faust, Jill Buyon
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decreased risk of more severe anti–cyclic citrullinated peptide antibody (ACPA) positive RA among current users of hormones ages 50 to 70, but not for ACPA-negative RA. 37
Many rheumatologists focus on treating RA and leave the management of menopausal symptoms up to a woman and her gynecologist.
The ACR says hormone therapy (HT, or hormone replacement therapy, HRT) may be considered for postmenopausal women with severe hot flashes and other symptoms in whom there are no contraindications.
Estrogen therapy is generally considered safe for women with RA, and there have been some hints over the years that ET can even make RA a little better. However, given the increased risk of cardiovascular disease in RA, postmenopausal hormones should be approached cautiously.
Women, including those with RA, who are candidates for and wish to take postmenopausal hormones should take the lowest possible dose for the shortest possible period, advises the North American Menopause Society (NAMS). 38
Hormone therapy needs to be individualized, depending on the drugs you’re taking. For example, it’s known that corticosteroids interact with estrogen. They may lessen the effectiveness of estrogen and often cause bleeding. This is because drugs like prednisone may interfere with estrogen receptors and can cause fluctuations in estrogen. So instead of the steady effects of your regular daily dose you get ups and downs that may cause you to bleed or spot.
Short-term estrogen replacement therapy (less than five years) has not been shown to increase the risk of breast cancer. Women with an intact uterus need to take progestin along with the estrogen to prevent precancerous overgrowth of the uterine lining ( endometrium ), such as micronized progesterone (Prometrium) .
Use of postmenopausal hormones has declined since 2002, when results first emerged from the Women’s Health Initiative (WHI). The WHI, a major prevention trial of a combined estrogen/progestin drug ( Prempro ) among 16,608 healthy women aged 50 to 79, was stopped after five years because of an increased rate of heart attacks, strokes, deep vein clots, and invasive breast cancer among women taking this drug. There were fewer cases of colorectal cancer and bone fractures among women on HT, but the WHI Data Safety and Monitoring Board (DSMB) concluded that the health risks of HT outweighed the benefits and stopped the study. However, the actual risks were small. According to the WHI data, over one year, 10,000 women taking Prempro might experience seven more coronary heart disease events, eight more breast cancers, eight more strokes, and eight more pulmonary emboli (but six fewer colorectal cancers and five fewer hip fractures), compared to women not taking hormones. 39
The estrogen-only arm of the WHI was continued, with no increased risk of breast cancer seen among that group (all of whom had had hysterectomies).
On the strength of the WHI and other recent studies, the U.S. Preventive Services Task Force recommends that estrogen or estrogen/progestin not be used to prevent heart disease and other chronic conditions, and women should explore other therapies to prevent bone loss. 40 Experts stress that the main indication for hormone therapy is to ease menopausal symptoms.
Menopausal symptoms like hot flashes may get better, but there may be absolutely no difference in your RA. “Physicians do say that in their experience estrogen is helpful. But you can never be sure that it’s really doing something for the disease, or whether it’s improving a woman’s sense of well-being, helping her mood, or lessening her pain perception, and so on,” comments Duke University’s Dr. Pisetsky.
If you can’t (or don’t want to) take systemic oral estrogens, estrogen is available in patches (such as Climara ) that are changed once or twice a week. Estrogen from transdermal patches is believed to have less cardiovascular risk. Local estrogen treatments include creams ( Estrace ) and
Many rheumatologists focus on treating RA and leave the management of menopausal symptoms up to a woman and her gynecologist.
The ACR says hormone therapy (HT, or hormone replacement therapy, HRT) may be considered for postmenopausal women with severe hot flashes and other symptoms in whom there are no contraindications.
Estrogen therapy is generally considered safe for women with RA, and there have been some hints over the years that ET can even make RA a little better. However, given the increased risk of cardiovascular disease in RA, postmenopausal hormones should be approached cautiously.
Women, including those with RA, who are candidates for and wish to take postmenopausal hormones should take the lowest possible dose for the shortest possible period, advises the North American Menopause Society (NAMS). 38
Hormone therapy needs to be individualized, depending on the drugs you’re taking. For example, it’s known that corticosteroids interact with estrogen. They may lessen the effectiveness of estrogen and often cause bleeding. This is because drugs like prednisone may interfere with estrogen receptors and can cause fluctuations in estrogen. So instead of the steady effects of your regular daily dose you get ups and downs that may cause you to bleed or spot.
Short-term estrogen replacement therapy (less than five years) has not been shown to increase the risk of breast cancer. Women with an intact uterus need to take progestin along with the estrogen to prevent precancerous overgrowth of the uterine lining ( endometrium ), such as micronized progesterone (Prometrium) .
Use of postmenopausal hormones has declined since 2002, when results first emerged from the Women’s Health Initiative (WHI). The WHI, a major prevention trial of a combined estrogen/progestin drug ( Prempro ) among 16,608 healthy women aged 50 to 79, was stopped after five years because of an increased rate of heart attacks, strokes, deep vein clots, and invasive breast cancer among women taking this drug. There were fewer cases of colorectal cancer and bone fractures among women on HT, but the WHI Data Safety and Monitoring Board (DSMB) concluded that the health risks of HT outweighed the benefits and stopped the study. However, the actual risks were small. According to the WHI data, over one year, 10,000 women taking Prempro might experience seven more coronary heart disease events, eight more breast cancers, eight more strokes, and eight more pulmonary emboli (but six fewer colorectal cancers and five fewer hip fractures), compared to women not taking hormones. 39
The estrogen-only arm of the WHI was continued, with no increased risk of breast cancer seen among that group (all of whom had had hysterectomies).
On the strength of the WHI and other recent studies, the U.S. Preventive Services Task Force recommends that estrogen or estrogen/progestin not be used to prevent heart disease and other chronic conditions, and women should explore other therapies to prevent bone loss. 40 Experts stress that the main indication for hormone therapy is to ease menopausal symptoms.
Menopausal symptoms like hot flashes may get better, but there may be absolutely no difference in your RA. “Physicians do say that in their experience estrogen is helpful. But you can never be sure that it’s really doing something for the disease, or whether it’s improving a woman’s sense of well-being, helping her mood, or lessening her pain perception, and so on,” comments Duke University’s Dr. Pisetsky.
If you can’t (or don’t want to) take systemic oral estrogens, estrogen is available in patches (such as Climara ) that are changed once or twice a week. Estrogen from transdermal patches is believed to have less cardiovascular risk. Local estrogen treatments include creams ( Estrace ) and
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