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In addition, mammography examinations should be scheduled based on patient age and risk factors. b. Endometrial cancer. The reported endometrial cancer risk among unopposed estrogen users is about 2-to 12-fold greater than in nonusers, and appears dependent on duration of treatment and on estrogen dose. Most studies show no significant increased risk associated with the use of estrogens for less than one year. The greatest risk appears associated with prolonged use, with increased risks of 15-to 24-fold for five to ten years or more, and this risk has been shown to persist for at least 8 to 15 years after estrogen therapy is discontinued. Text Continues Below
Clinical surveillance of all women taking estrogen/ progestin combinations is important. Adequate diagnostic measures, including endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal vaginal bleeding. There is no evidence that the use of natural estrogens results in a different endometrial risk profile than synthetic estrogens of equivalent estrogen dose. Endometrial hyperplasia (a possible precursor of endometrial cancer) has been reported to occur at a rate of approximately 1% or less with PREMPRO or PREMPHASE in two large clinical trials. In the two large clinical trials described above, two cases of endometrial cancer were reported to occur among women taking combination Premarin/ medroxyprogesterone acetate therapy. 3. Dementia. In a study of women 65 years of age and older (a randomized controlled sub-study of the Women's Health Initiative, the Women's Health Initiative Memory Study; n= 4,532, 54% older than 70), those treated with PREMPRO (0.625 mg, conjugated equine estrogen, plus 2.5 mg medroxyprogesterone acetate) were reported to have a two-fold increase in the risk of developing probable dementia. After an average follow-up of 4 years, the absolute risk of probable dementia was 45 per 10,000 woman-years in the PREMPRO group and 22 per 10,000 woman-years in the placebo group. It is unknown whether these findings apply to younger postmenopausal women. Page: << Prev | 1 | 2 | 3 | 4 | 5 | Next >>
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