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medpundit |
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Tuesday, March 18, 2003"Estrogen plus progestin did not have a clinically meaningful effect on any aspect of health-related quality of life," said the NEJM article. No difference at all was seen between the women on the drug and the placebo group in mental health, depression or sexual satisfaction. A benefit in sleep disturbance and pain was observed, but researchers said it was too small to be "clinically significant" and was restricted to the first year of use. The study looked at several parameters of “well-being”: quality of life and functional ability, depression, sleep disturbance, sexual functioning, cogntive function, and menopausal symptoms. Only rates of menopausal symptoms were significantly different among estrogen users: We examined the effects of estrogen plus progestin on the relief of symptoms among all women who reported moderate-to-severe vasomotor symptoms at base line (1072 women in the estrogen-plus-progestin group and 974 women in the placebo group).At the one year follow-up,76.7 percent of the women in the estrogen-plus-progestin group had improvement in the severity of hot flashes,as compared with 51.7 percent of the women in the placebo group (P<0.001);71.0 percent of the women in the estrogen-plus-progestin group had improvement in the severity of night sweats,as compared with 52.8 percent of the women in the placebo group (P<0.001). To me, that says that for some women, estrogen therapy works, since that's why we prescribe it, to treat menopausal symptoms, not to cure every ailment and dissatisfaction in life. There are so many other factors that can affect one’s overall well-being besides menopause that those other parameters are worthless. Estrogen isn’t a panacea, despite what advertisements may have once claimed. And it was never prescribed that way by the majority of doctors. Another flaw in the study is that they didn’t look at the incidence of vaginal atrophy in users and nonusers, which can be quite painful. They looked, instead, at sexual satisfication, which isn’t at all the same thing. A woman can have no sex life at all and call herself satisfied if she’s come to terms with it. A better question would have been, “Is sex painful?” The shame of this is that the study will be touted by the media as proof that estrogen therapy is completely unwarranted when it’s considered alongside last year’s over-hyped findings (by the same group of researchers, by the way) on estrogen side-effects. And physicians, too busy to scrutinize the study, will by into the hype and discourage more women from using the drug, and perhaps refuse to prescribe it. And all the while, they'll say they're practicing "evidence-based medicine." Yet, in the end, this study is akin to asking the same questions of aspirin users and deciding that aspirin isn’t an effective drug because it doesn’t improve overall well-being. All in all, a very shoddy piece of work. posted by Sydney on 3/18/2003 07:55:00 AM 0 comments 0 Comments: |
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