This week’s material covered topics that I was unfamiliar with—for instance, hormone replacement therapy (HRT), the controversy surrounding HRT, and the web of causation. Chapter 9’s readings centered on the difference between statistical inference and causal inference, the basic concepts of hypothesis formulation and testing, establishing casual associations, and much more. All of the information within this chapter is of great value. Some of the reading was reviewed and gave me a refresher on specific terms and concepts. What I discovered to be most outstanding is the concept of web causation. PH 505 Epidemiology introduced me to the idea of web causation. Web of causation is complex graphics, pictorials, or paradigms that illustrate the relationship between multiple factors contributing to the cause of a disease. Web of causation appears to be a widely accepted model used in public health and epidemiology. The model offers a valuable way of understanding etiology, connecting social determinants and social factors, and biomedical etiological factors.
As an individual who aims to pursue a career as an epidemiologist, I envision myself utilizing the model, the web of causation. Even though the model has potential flaws, it aids the discovery of causation. In the study of public health, causation is vital. If etiological factors reveal, then it allows for the opportunity to develop preventative measures or treatments. Similar concepts such as the advanced epidemiologic triangle and causal pies aspire to embody a more intricate structure in the context of chronic diseases and conditions. The underlining of causality in epidemiology provides a scientific platform for interfering with and managing public health crises.
HRT and chronic postmenopausal diseases have begun the first clinical studies in the USA. According to Nelson, “approximately 38% of postmenopausal women in the United States in 1995 used hormone replacement therapy (HRT), estrogen with or without progestin, to treat symptoms of menopause and prevent chronic conditions such as cardiovascular disease and osteoporosis” (Nelson et al., 2002). Following the publication of the Women’s Health Initiative (WHI) results indicating HRT had more negative than positive effects, the consumption of HRT declined.
The unfavorable results of the research have gained wide-ranging exposure and alarm amongst some consumers. According to NPR, “within months the number of women using HRT dropped by almost half” (NPR, 2013). HRT posed more significant dangers for all women than advantages. In subsequent years, a re-analysis of the WHI study was conducted. It has shown the benefit to the cardiovascular system, decreasing coronary disease and death in younger women or early postmenopausal women. According to NPR, “After that, the pendulum swung away from using hormone therapy for anything more than alleviating menopausal symptoms in the short term. Moreover, as millions of women stopped taking hormone replacement therapy, the breast cancer rate in the U.S. dropped” (NPR, 2016). However, there has been no shift in public opinion on the HRT, which has had significant adverse effects on women’s health and quality of life.
According to Cagnacci and Venier (2019), “in the 20th century, the interest in menopausal disorder had been increasing, but it took a long time to realize the real impact of hormone depletion on women’s health” (602). The hormone-deficiency syndrome was diagnosed clinically as including warm flashes and other chronic illnesses such as osteoporosis, cardiology, Alzheimer’s, and vaginal atrophy. Clinical symptoms linked with menopause had hot flashes.
The feminist movement transformed women’s status and life span and encouraged menopause treatment with the notion of “feminine forever,”, particularly in European nations. Hormone replacement treatment is a therapy that can enable women to get rid of malediction and maintain their femininity; the treatment was introduced. The discovery that non-opposed estrogen supplements were linked to an increased risk of endometrial cancer had a severe influence on the reputation of HRT.
While specialists have been increasingly concerned about the possible influence of progestin on estrogen benefit, especially in the cardiovascular system, the initial recommendations have been set out on the use of HRT as a preventative therapy for chronic postmenopausal women illnesses. However, researchers found lowering the incidence of endometrial cancer and the combination of estrogen and progesterone. For women with an intact uterus, such combination therapy was advised, which increased the excitement of HRT treatment. In addition, other observational studies in the same years have shown that HRT has several advantages, not only in treating menopausal symptoms but also in avoiding chronic illnesses. Thus, the notion has shifted from “feminine eternity” to “healthy eternity.”
The complex history of HRT concerns every postmenopausal disorder with the background of solid pathogenetic treatment. It has effects on the symptoms at first driving fast-growing estrogen usage and were quickly apparent. The lack of understanding of its adverse effects and problems, especially in the endometrium, has had implications that restrict HRT use. A post-progressive association permitted the widespread use of HRT, positively impacting several areas of female health. Unfortunately, with the release of the WHI study poorly conceived, assessed, and reported, the increase in HRT usage and consolidation has been suddenly stopped. The damage has been substantial, essentially without adequate therapy for many symptomatic women. At the same time, the epidemiological evidence is less than sufficiently robust to show specific damage to women’s health. The harm continues to occur worldwide, and modest HRT usage continues to be unwarranted.
Cagnacci, A., & Venier, M. (2019). The controversial history of hormone replacement therapy. Medicina, 55(9), 602.
Nelson, H. D., Humphrey, L. L., Nygren, P., Teutsch, S. M., & Allan, J. D. (2002). Postmenopausal hormone replacement therapy: Scientific review. Jama, 288(7), 872-881.
NPR. (2013). The last word on hormone therapy from the women’s health initiative. Web.
NPR. (2016). Possible heart benefits of taking estrogen get another look. Web.