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"Alternative to estrogen found for menopause"

Vancouver Sun

Source: Vancouver Sun

Published: 26 Jan 2022

Category: Pharmaceutical

Rating: (2 stars)

what they said (Hover the mouse cursor over underlined words for more info)

Newly published research that could affect thousands of menopausal women across Canada says there is a safer, but equally effective alternative to estrogen when it comes to controlling hot flushes and night sweats.
Dr. Jerilynn Prior, professor of endocrinology and medicine at the University of B.C. and Vancouver Hospital, says medroxyprogesterone, a synthetic version of the hormone progesterone, works as well as estrogen in treating extreme menopausal problems. But, unlike estrogen, it does not cause blood clots, breast cancer or increase the likelihood of migraine headaches.
Between 10 and 20 per cent of all menopausal women in Canada suffer serious enough hot flushes to require some form of medication to control them...

The original article can be found at:

how did it rate? (more information)

Criteria Rating
Total Score 4 of 10
Availability of Treatment Satisfactory (?)
Novelty of Treatment Satisfactory (?)
Disease Mongering Satisfactory (?)
Treatment Options Not Satisfactory (?)
Costs of Treatment Not Satisfactory (?)
Evidence Not Satisfactory (?)
Quantification of Benefits of Treatment Satisfactory (?)
Harms of Treatment Not Satisfactory (?)
Sources of Information Not Satisfactory (?)
Relies on Press Release Not Applicable
Quantification of Harms of Treatment Not Satisfactory (?)

what we said (Hover the mouse cursor over underlined words for more info)

This article extrapolates from a small study of 41 women to draw conclusions that medroxyprogesterone is a safe and effective treatment option for menopausal hot flushes. It is unclear from the article whether patients were randomly assigned to one treatment or another, whether they or their doctors knew what drug they were taking, how long the trial was, or how effective the two drugs were.

This is much too small a study to show that medroxyprogesterone is safer than estrogen or than combined estrogen-progestin treatment. Thousands of women were followed up for up to five years in the Women's Health Initiative to examine estrogen and combined estrogen and progestin's effects on risks of heart disease, stroke, cancer, dementia, etc. It is difficult to see these outcomes being assesed in a study of 41 women. The statement that "medroxyprogesterone doesn't pose the same health risks as estrogen" cannot be supported by such a small study.

Additionally, the study participants were all pre-menopausal women who had had their ovaries removed surgically. This is a different situation from natural menopause. The sudden loss of ovarian hormones can cause much more intense symptoms. This is mentioned in the article but the text also implies in a number of places that the study results can be directly applied to post-menopausal women (who didn't have their ovaries removed)

What is problematic is that this study did not include a group of women taking a placebo (or "sugar pill") which makes it impossible to know the extent to which women felt better because they knew they were getting treatment or the extent to which the drugs made a difference. So even in terms of the very limited question such a small study could answer - effects of these drugs on symptoms - the design is potentially fatally flawed.

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