August 25, 2001
Other Medications
Question from the USA:
I have a question that is both of a personal nature (since this affects me) and also I have been in contact with several women around my age (that is, perimenopausal) who are concerned with the following: What about hormone replacement therapy for women with type�1 diabetes?
I am a 49 year old who has type 1 diabetes, normal lipids, normal blood pressure, no heart disease (although my dad had a heart attack at about age 75), and my hemoglobin A1c is 6.8-7.0%. I have been on estrogen/progesterone for about two years because of severe hot flashes and sweating.The gynecologists and my endocrinologist do not seem too interested, so, until the last news report on HRT (hormone replacement therapy), I did not press the issue of their use in women with type 1 diabetes.
The news of concern lately is that if one has heart disease, HRT is not recommended. I have no heart problems and my friends are healthy folks who have type 1, but we know we are at high risk for heart problems. None of us can find any studies of type 1 women hitting menopause without having so many other problems that those problems preclude the menopause issue. I know there is one study that suggests that menopause hits women with type 1 earlier, but what about HRT?
Answer:
I feel rather strongly that the recommendation by the American Heart Association was overblown. First, it is true that the only prospective study to evaluate estrogen in the postmenopausal state did not show a cardioprotective effect. It even suggested that the initial time after starting the estrogen may be associated with increased cardiac events, presumably to activation of the clotting cascade. However, it should be kept in mind that this study did not aggressively control for cholesterol. It is also a secondary prevention trial. That means women who already had cardiac disease were studied. They already had the disease! Maybe estrogen is better at primary prevention of cardiac disease. There is a lot of data, although not obtained in a prospective randomized control trial, which favors a cardioprotective effect of estrogen. It is too early to pull the plug on estrogen use. Finally, I would add that the other beneficial effects of estrogen, especially bone effects, are not trivial.
My opinion is that women on estrogen, especially if they have been on estrogen, should stay on it while receiving follow-up from their physicians with appropriate exams and mammography.
JTL
