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estrogen replacement therapy
Over the past 20 years Lila E. Nachtigall, M.D. has been involved in three areas of investigation. These include: 1) evaluating whether estrogen replacement therapy (ERT) reduces the risk of coronary heart disease and other cardiovascular in women; 2) determining whether estrogen replacement alone or estrogen progesterone replacement reduces the incidence of osteoporosis-related fractures and hip fractures; and 3) whether ERT increases the risk of endometrial cancer and whether progestin and estrogen replacement therapies (PERT) increase breast cancer risk.
Studies in these specific areas have been ongoing at NYU Medical Center since 1967. Dr. Nachtigall conducted a comprehensive ten year prospective double blind placebo controlled study of estrogen replacement therapy and the relationship to carcinoma, cardiovascular disease, and osteoporosis in a sample of hospitalized women. From the 300 women recruited, 168 were followed as matched pairs. This study was the first to demonstrate the increased survival of patients on ERT, of lipid patterns as a significant risk factor, and of a reduction in breast cancer incidence in treated patients as compared to the controls. Moreover, a ten year follow-up with single photon densitometer measurements found continued increase in bone density in treated women who had their last menstrual period within three years or less, while those on placebo continued to lose bone. In addition, treated women who had their last menstrual period more than three years previously, kept their bone at a steady level, while their placebo controlled matched pairs continued to lose bone. Dr. Nachtigall subsequently conducted a 22 year follow-up on these studies, losing only five patients to follow-up or breast cancer.
Studies are continuing to address such issues as the efficacy of transdermal versus oral estrogen, the use of progesterone in prevention of endometrial cancer, the ability to decrease the side effects of progesterone therapy and on cardiovascular disease in older women, with and without hormones.
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