Think Twice, Ladies

If humans knew everything, a whole lot of people would be out of a job right about now. The basis for research, experiments, and trial and error are what makes science an evolving field. In an editorial “What We Think and What We Know,” conveyed by John Buse, MD, PhD, CDE and Laura Raftery, this ongoing idea of hopeful treatments but not quite consistent results is embodied through hormone replacement therapy (HRT) for postmenopausal women, particularly those diagnosed with diabetes. Menopause occurs when a woman stops menstruating which is accompanied by hormonal, physical, and psychological changes. Basically, not everything works for everyone, and the newest treatments are so experimental and so dependent on different variables and situations that not everyone can expect them to work consistently with every case. However, we as consumers and patients don’t always realize that simply because something is out there, that doesn’t mean it will automatically cater to our individual needs. Buse and Raftery state is perfectly: “We hope it serves as a reminder that there is actually very little that we ‘know’ in medicine, whereas there is a great deal that we ‘think’ that we know,” (Buse 1877).

The trials covered by this editorial only tested conjugated equine estrogen and medroxyprogesterone acetate. Conjugated equine estrogen in HRT is derived from a pregnant mare’s urine to work as a substitute and takes over where estrogen levels drop after menopause. Estrogen is the primary group of female sex hormones which promotes female organ, tissue, and bone well-being throughout a woman’s life. When estrogen levels fall off during menopause, women can experience hot flashes and vaginal dryness, itching, or burning. Medroxyprogesterone acetate, on the other hand, is a progestin synthetic progesterone) used to strengthen the lining of the uterine wall. It has also been found to help maintain skin elasticity and bone strength. Dosages for this experiment were limited to 0.625 mg/day of conjugated equine estrogen and 2.5 mg/day of medroxyprogesterone acetate, but it is to be reminded that lower dosages of these same HRT drugs may not be applicable to results found. At these levels of intake, HRT may still be a good short-term option for menopause symptoms like hot flashes, night sweats, disrupted sleep patterns, and mood swings, but probably not for longer than a year or two (Buse 1876). Other options for postmenopausal women mentioned include raloxifene or bisphosphonates to reduce possible fractures in the hips and spine primarily. Raloxifene seems desirable because it could presumably be connected to a reduction of probability of breast cancer and/or cardiovascular disease (CVD) (Buse 1876-7).

Everyone can tell the difference between recommended and required, but what happens when the recommended course of action is uncertain as it regularly is in the medical industry? For instance, physicians recommend to their postmenopausal diabetic patients to consider HRT because there are implications of HRT to decrease CVD risk, prevent osteoporosis, preserve memory, slow dementia, maintain skin elasticity, and promote sexual well-being, vitality, and overall health (Buse 1876). BUT at the same time, there are increased risks for any woman on HRT including stroke, coronary heart disease, pulmonary embolism, and breast cancer (Buse 1876). For a woman to continue on HRT for the benefits to carry on, she would also have to go on other regiments to counteract the side effects. This creates what seems to be an endless cycle of pumping a body with every drug imaginable. So many of you would ask: what is too much and what is too little?

I’m no doctor, but that is the first place to start: go to the doctor. Take care of yourself, exercise, and eat healthy according to your lifestyle’s needs. Be conscious to stress and avoid unnecessary complications in all aspects of your life. You’ve been hearing these same comments since you were a child, but it is still good, reliable advice. John Buse, unlike me, is a doctor here at UNC-Chapel Hill School of Medicine, Divisions of Endocrinology and of General Medicine and Clinical Epidemiology. Buse is a collaborator for the UNC Diabetes Interest Group. He wants it to be clear that everyone is “vulnerable to bias,” (Buse 1877). In the editorial, Buse goes on to describe some of the satisfying reports in advancements in diabetic treatments, ending with a metaphorical poem by John Godfrey Saxe. In short, the poem describes how every man can look at a single aspect of a greater being and make a connection to another being, when really, there could be no connection at all. Therefore, the title fits for we think we know, but perhaps we only know how to think. Most importantly, from the editorial, is not necessarily the information about HRT presented but rather to remember: there will always be stipulations and every case is different. Just because one treatment works for someone presumably identical to you doesn’t mean that it will react in the same manner toward your body.

Buse (MD, PhD, CDE), John, and Laura Raftery "What We Think and What We Know."
Diabetes Care 25.10 (2002): 1876-1878. American Diabetes Association. 31 Jan.
2007 <http://http://care.diabetesjournals.org/cgi/content/full/25/10/1876?maxtoshow=&HITS=&hits=&RESULTFORMAT=&author1=Buse%2C+John&title=What+We+Think+and+What+We+Know&andorexacttitle=phrase&searchid=1&FIRSTINDEX=0&volume=25&firstpage=1876&resourcetype=HWCIT>.