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Lupus

HORMONE REPLACEMENT THERAPY AND LUPUS

02/25/2000

Question:

WOULD LIKE INFO ON HORMONE REPLACEMENT THERAPY AND LUPUS

Answer:

The issue of hormone replacement therapy and lupus is not quite settled yet. A recent American study showed that menopausal nurses treated with hormone replacement therapy are at increased risk for development of SLE compared with nurses who did not receive such therapy. A similar observation has been recently reported from the UK - long-term estrogen users were 3-times more likely to develop SLE than nonusers. The women who used progesterone with estrogen were also at risk for developing SLE, but the risk was reduced to 2-fold. On the other hand, HRT has several potential benefits which assume particular importance in SLE where the risks of osteoporosis, exacerbated by menopause (natural or drug-induced) and steroid treatment are substantial. Moreover, HRT is associated with a 30-40% reduction in the risk of coronary artery disease, increase in the `good` cholesterol (HDL), and decrease in the `bad` cholesterol (LDL), benefits that should be especially applicable to post-menopausal women with SLE. Moreover, two small prospective and a few retrospective studies from Canada, Hong Kong and England suggest that estrogen treatment is well-tolerated by women with SLE: there was no increase in symptoms of SLE when HRT was given for 6 months to one year. In a 1999 Hong Kong study, HRT was more effective than calcitriol in decreasing osteoporosis that was induced by steroid treatment in women with SLE. A large prospective double-blind controlled study on the Safety of Estrogen in Lupus Erythematosus-National Assessment (SELENA) is ongoing at several major medical centers in the US. This study should provide the basis for definitive recommendation on the use of HRT in women with SLE. I anticipate that the study would identify subsets of SLE patients where HRT would be well-tolerated and be beneficial, whereas in other subsets of patients it might flare disease.

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Response by:

Ram Raj   Singh, MD Ram Raj Singh, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati