Avoid hormones in gastrointestinal angiodysplasia

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Humphrey Hodgson (May 11, p 1630)1Hodgson H Hormonal therapy for gastrointestinal angiodysphasia.Lancet. 2002; 359: 1630-1631Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar asks whether there is any reason for exposing patients with gastrointestinal angiodysplasia to the potential morbidities of oestrogen therapy. There are good reasons for not prescribing hormones.In a randomised controlled trial and a cohort study, no benefit was reported from oestradiol and norethisterone use, in contrast to a very small short trial in which patients had lower transfusion requirements.It is unsurprising that giving hormones to patients with bleeding results in confusion. In studies of the vascular changes in endometrial blood vessels caused by a large range of progestagens and oestrogens, I found that commonly used combinations of these two hormones caused abnormalities in arterioles, sinusoids, or both. At the same time, lowered zinc and raised copper concentrations interfere with immune system regulation that can raise the risk of gastrointestinal infections.2Grant EGG The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance.J Nutr Environ Med. 1998; 8: 105-116Crossref Scopus (9) Google ScholarThe large Royal College of General Practitioners’ Oral Contraceptive Study3Anon Further analyses of mortality in oral contraceptive users: Royal College of General Practitioners' Oral Contraception Study.Lancet. 1981; 1: 541-546PubMed Google Scholar shows increases in a wide range of infections and vascular diseases after hormone treatment. The increased relative risk of death from vascular disease among ever users was 4·2, which rose with age and smoking to 7·4. Current users also had a significant 60% increase in diseases of the arteries, arterioles, and capillaries.4Incidence of arterial disease among oral contraceptive users: Royal College of General Practitioners' Oral Contraception Study.J R Coll Gen Pract. 1983; 33: 75-82PubMed Google Scholar Abnormal abdominal, hepatic, pulmonary, and leg blood vessels have been noted in women taking hormones for less than 5 years.5Irey NS Manion WC Taylor HB Vascular lesions in women taking oral contraceptives.Arch Pathol. 1970; 89: 1-9PubMed Google ScholarThe taking of female sex hormones can increase the risk of vascular diseases, thrombosis with possible secondary haemorrhages, and infections, which can also increase the risk of bleeding. Use of such hormones for bleeding disorders, including hereditary haemorrhagic telangiectasia, therefore, does not seem sensible. Humphrey Hodgson (May 11, p 1630)1Hodgson H Hormonal therapy for gastrointestinal angiodysphasia.Lancet. 2002; 359: 1630-1631Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar asks whether there is any reason for exposing patients with gastrointestinal angiodysplasia to the potential morbidities of oestrogen therapy. There are good reasons for not prescribing hormones. In a randomised controlled trial and a cohort study, no benefit was reported from oestradiol and norethisterone use, in contrast to a very small short trial in which patients had lower transfusion requirements. It is unsurprising that giving hormones to patients with bleeding results in confusion. In studies of the vascular changes in endometrial blood vessels caused by a large range of progestagens and oestrogens, I found that commonly used combinations of these two hormones caused abnormalities in arterioles, sinusoids, or both. At the same time, lowered zinc and raised copper concentrations interfere with immune system regulation that can raise the risk of gastrointestinal infections.2Grant EGG The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance.J Nutr Environ Med. 1998; 8: 105-116Crossref Scopus (9) Google Scholar The large Royal College of General Practitioners’ Oral Contraceptive Study3Anon Further analyses of mortality in oral contraceptive users: Royal College of General Practitioners' Oral Contraception Study.Lancet. 1981; 1: 541-546PubMed Google Scholar shows increases in a wide range of infections and vascular diseases after hormone treatment. The increased relative risk of death from vascular disease among ever users was 4·2, which rose with age and smoking to 7·4. Current users also had a significant 60% increase in diseases of the arteries, arterioles, and capillaries.4Incidence of arterial disease among oral contraceptive users: Royal College of General Practitioners' Oral Contraception Study.J R Coll Gen Pract. 1983; 33: 75-82PubMed Google Scholar Abnormal abdominal, hepatic, pulmonary, and leg blood vessels have been noted in women taking hormones for less than 5 years.5Irey NS Manion WC Taylor HB Vascular lesions in women taking oral contraceptives.Arch Pathol. 1970; 89: 1-9PubMed Google Scholar The taking of female sex hormones can increase the risk of vascular diseases, thrombosis with possible secondary haemorrhages, and infections, which can also increase the risk of bleeding. Use of such hormones for bleeding disorders, including hereditary haemorrhagic telangiectasia, therefore, does not seem sensible.