by Philippe Koninckx | Oct 23, 2020 | menopauza |
Individual hormone replacement therapy Every woman is different One size does not fit all Pro and Cons: EBM The advantages and disadvantages of hormone replacement therapy (HRT) are well known. Besides the treatment of symptoms, the prevention of wrinkles and bone loss and brain function, and the prevention of cardiovascular accident, of bowel cancer and of the mortality of ovarian cancer and of breast cancer are well documented. (read recent review) HRT does not cause a clear increase in breast cancers if all cofounding factors are taken into account. The disadvantages of hrt are a minimal increase in the risk of deep vein thrombosis and of premenstrual tension in women who experienced this before menopause. In women with a uterus menstrual or irregular blood loss can be a problem. Notwithstanding these important advantages, are not that many women using hormones. For us, the most important reason is the lack of individualization of hormone replacement therapy, which requires the right products in the right dose with focus on the mental tonic effect and well-being. Brain effects, well-being Estrogens, progestagens and androgens have brain effects . That brain effects and well-being are the key drivers for the patient, is not recognized sufficiently since Individual variability does not fit with EBM and since brain effects are more difficult to measure. Individualisation does not fit with EBM Evidence based medicine is the evidence that a treatment is effective and safe. Although the randomised controlled trial (RCT) is mathematically correct it is often forgotten that this is only true if the investigated population is homogeneous. We therefore have to be careful whne extrapolating conclusions...
