Research Article| Volume 10, ISSUE 4, P271-282, December 1988

Gynecologic consequences of long-term, unopposed estrogen replacement therapy

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      We evaluated the gynecologic risks of unopposed, long-term estrogen use in postmenopausal women. Our medical record review showed that unopposed estrogen users (mean dose, 0.9 mg of conjugated estrogens) had a significantly higher (P < 0.001) incidence of abnormal vaginal bleeding, curettage, hysterectomy, and endometrial cancer. The ratios of occurrence of these events among users compared with non-users were 7.8, 4.9, 6.6 and 7.7. The prevalence of hysterectomy reached 28.2% of users compared with 5.3% of non-users, and endometrial carcinoma developed in 9.9% of users compared with 1.4% of non-users.


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        • Smith DC
        • Prentice R
        • Thompson DJ
        • Herrmann WL
        Association of exogenous estrogen and endometrial carcinoma.
        N Engl J Med. 1975; 293: 1164-1167
        • Ziel HK
        • Finkle WD
        Increased risk of endometrial carcinoma among users of conjugated estrogens.
        N Engl J Med. 1975; 293: 1167-1170
        • Mack TM
        • Pike MC
        • Henderson BE
        • et al.
        Estrogens and endometrial cancer in a retirement community.
        N Engl J Med. 1976; 294: 1262-1267
        • Gray Sr, LA
        • Christopherson WM
        • Hoover RN
        Estrogens and endometrial carcinoma.
        Obstet Gynecol. 1977; 49: 385-389
        • McDonald TW
        • Annegers JF
        • O'Fallon WM
        • Dockerty MB
        • Malkasian GD
        • Kurland LT
        Exogenous estrogen and endometrial carcinoma: case-control and incidence study.
        Am J Obstet Gynecol. 1977; 127: 572-580
        • Antunes CMF
        • Stolley PD
        • Rosenshein NB
        • et al.
        Endometrial cancer and estrogen use.
        N Engl J Med. 1979; 300: 9-13
        • Hammond CB
        • Jelovsek FR
        • Lee KL
        • Creasman WT
        • Parker RT
        Effects of long-term estrogen replacement therapy: II. neoplasia.
        Am J Obstet Gynecol. 1979; 133: 537-547
        • Hollingshead AB
        • Redlich FC
        Social class and mental illness: a community study.
        Wiley, New York1958
        • Cornfield J
        A statistical problem arising from retrospective studies.
        in: Proceedings, 3rd Berkeley symposium on mathematical statistics and probability. Vol. 3. University of California Press, Berkeley, California1956: 135-148 (No. 4)
        • Kleinman DG
        • Kuppler LL
        • Morgenstern H
        Epidemiologic research: principles and quantitative methods.
        Lifetime Learning Publications, Belmont, California1982
        • Horwitz RI
        • Feinstein AR
        Alternative analytic methods for case-control studies of estrogens and endometrial cancer.
        N Engl J Med. 1978; 299: 1089-1094
        • Weiss NS
        Clinical epidemiology: the study of the outcome of illness.
        in: Monographs in epidemiology and biostatistics. Vol. 11. Oxford University Press, New York1986
        • Hulka BS
        • Fowler Jr, WC
        • Kaufman DG
        • et al.
        Estrogen and endometrial cancer: cases and two control groups from North Carolina.
        Am J Obstet Gynecol. 1980; 137: 92-101
        • Gambrell Jr, RD
        The menopause: benefits and risks of estrogen-progestogen replacement therapy.
        Fertil Steril. 1982; 37: 457-474
        • Hillner BE
        • Hollenberg JP
        • Pauker SG
        Postmenopausal estrogens in prevention of osteoporosis: benefit virtually without risk if cardiovascular effects are considered.
        Am J Med. 1986; 80: 1115-1127
        • Kennedy DL
        • Baum C
        • Forbes MB
        Non-contraceptive estrogens and progestins: use patterns over time.
        Obstet Gynceol. 1985; 65: 441-446
        • Bunker JP
        • McPherson K
        • Henneman PL
        Elective hysterectomy.
        in: Bunker JP Barnes BA Mosteller F Costs, risks, and benefits of surgery. Oxford University Press, New York1977: 262-276
        • Grimes DA
        Diagnostic dilation and curettage: a reappraisal.
        Am J Obstet Gynecol. 1982; 142: 1-6
        • Easterday CL
        • Grimes DA
        • Riggs JA
        Hysterectomy in the United States.
        Obstet Gynecol. 1983; 62: 203-212