Continuous Hormone Therapy Research Articles

Efficacy of chemotherapy after hormone therapy for hormone receptor-positive metastatic breast cancer.

Objective:According to the guidelines for metastatic breast cancer, hormone therapy for hormone receptor–positive metastatic breast cancer without life-threatening metastasis should be received prior to chemotherapy. Previous trials have investigated the sensitivity of chemotherapy for preoperative breast cancer based on the efficacy of neoadjuvant hormone therapy. In this retrospective study, we investigated the efficacy of chemotherapy for metastatic breast cancer in hormone therapy–effective and hormone therapy–ineffective cases.Methods:Patients who received chemotherapy after hormone therapy for metastatic breast cancer between 2006 and 2013 at our institution were investigated.Results:A total of 32 patients received chemotherapy after hormone therapy for metastatic breast cancer. The median patient age was 59 years, and most of the primary tumors exhibited a T2 status. A total of 26 patients had an N(+) status, while 7 patients had human epidermal growth factor receptor 2–positive tumors. A total of 13 patients received clinical benefits from hormone therapy, with a rate of clinical benefit of subsequent chemotherapy of 30.8%, which was not significantly different from that observed in the hormone therapy–ineffective patients (52.6%). A total of 13 patients were able to continue the hormone therapy for more than 1 year, with a rate of clinical benefit of chemotherapy of 38.5%, which was not significantly different from that observed in the short-term hormone therapy patients (47.4%). The luminal A patients were able to continue hormone therapy for a significantly longer period than the non-luminal A patients (median survival time: 17.8 months vs 6.35 months, p = 0.0085). However, there were no significant differences in the response to or duration of chemotherapy.Conclusion:The efficacy of chemotherapy for metastatic breast cancer cannot be predicted based on the efficacy of prior hormone therapy or tumor subtype, and clinicians should administer chemotherapy in all cases of hormone receptor–positive metastatic breast cancer, if needed.

Study changes how physicians treat metastatic prostate cancer

Study changes how physicians treat metastatic prostate cancer

Nonlinear system identification for prostate cancer and optimality of intermittent androgen suppression therapy

These days prostate cancer is one of the most common types of malignant neoplasm in men. Androgen ablation therapy (hormone therapy) has been shown to be effective for advanced prostate cancer. However, continuous hormone therapy often causes recurrence. This results from the progression of androgen-dependent cancer cells to androgen-independent cancer cells during the continuous hormone therapy. One possible method to prevent the progression to the androgen-independent state is intermittent androgen suppression (IAS) therapy, which ceases dosing intermittently. In this paper, we propose two methods to estimate the dynamics of prostate cancer, and investigate the IAS therapy from the viewpoint of optimality. The two methods that we propose for dynamics estimation are a variational Bayesian method for a piecewise affine (PWA) system and a Gaussian process regression method. We apply the proposed methods to real clinical data and compare their predictive performances. Then, using the estimated dynamics of prostate cancer, we observe how prostate cancer behaves for various dosing schedules. It can be seen that the conventional IAS therapy is a way of imposing high cost for dosing while keeping the prostate cancer in a safe state. We would like to dedicate this paper to the memory of Professor Luigi M. Ricciardi.

Efficacy and safety of DT56a compared to hormone therapy in Greek post-menopausal women.

Hormone therapy (HT) is the treatment of choice for the alleviation of menopausal symptoms; concerns, however, about its concomitant long-term health risks have limited its use. DT56a is a unique enzymatic isolate of soybeans. The purpose of our study was to evaluate the efficacy and safety of DT56a, compared to HT, in symptomatic post-menopausal women. Eighty-nine post-menopausal women were studied prospectively. Women with climacteric symptoms were randomly assigned to receive eitherDT56a (no.=27) or oral low dose continuous combined HT (no.=26). Symptomatic women not wishing to receive any treatment served as controls (no.=36). Menopausal symptoms as assessed through the Kupperman index, serum lipids and lipoproteins, calcium, as well as bone mineral density (BMD), endometrial thickness, and mammography were assessed at baseline and at 12 months. Patients receiving HT and DT56a showed a significant and independent decrease in menopausal symptoms (mean difference in Kupperman score, DT56a group: -3.98, HT group -5.601, no treatment group +1.76, p-value <0.001). Lumbar spine BMD T-score was significantly lower in women receiving no treatment, as opposed to the two treatment arms which showed no significant change (No treatment, baseline: -0.60, final: -0.85, p=0.001; HT, baseline: -84, final -0.99, p=0.79; DT56a, baseline -0.51, final: -0.76, p=0.75). No differences in femoral bone density, ET or mammography classification were detected in any of the treatment arms. Likewise, serum lipids or lipoproteins did not differ between the three groups. DT56a decreased menopausal symptoms significantly and in the same degree as HT.

Current evidence about intermittent androgenic deprivation in prostate cancer

ObjectivesTo identify clinical application of intermittent hormonotherapy in prostatic carcinoma. Material and methodsWe conducted a systematic review in the MEDLINE database and COCHRANE Library using the words MeSH “prostate cancer, androgenic deprivation and intermittent”. Those with the best level of evidence and published in the last 10 years were included. ResultsIntermittent hormone therapy is one of the tools we use in urological armamentarium for special circumstances. This analysis highlights: possibility to regain sexual function during the period of suspension of treatment (time off) due to the recovery of testosterone levels also demonstrating an improvement in symptoms, decreased costs while preserving the same oncological control as compared to complete androgenic deprivation. ConclusionsThere is still controversy about the benefits in quality of life and the emergence of long-term side effects typical of continuous hormonal therapy. Therefore and until now, we should only propose intermittent therapy in selected patients.

Evidencia actual acerca de bloqueo hormonal intermitente en cáncer de próstata

ObjectivesTo identify clinical application of intermittent hormonotherapy in prostatic carcinoma. Material and methodsWe conducted a systematic review in MEDLINE database and COCHRANE Library using the words MeSH “prostate cancer, androgenic deprivation and intermittent”. There were included those with the best level of evidence and published in the last 10 years. ResultsIntermittent hormone therapy is one of the tools we use in urological armamentarium for special circumstances. This analysis highlights: possibility to regain sexual function during the period of suspension of treatment (time off) due to the recovery of testosterone levels also demonstrating an improvement in symptoms, decreased costs preserving the same oncological control compared to complete androgenic deprivation. ConclusionsThere is still controversy about the benefits in quality of life and the emergence of long-term side effects typical of continuous hormonal therapy. Therefore and until now, we should only propose intermittent therapy in selected patients

Continuous versus Cyclic Progesterone Exposure Differentially Regulates Hippocampal Gene Expression and Functional Profiles

This study investigated the impact of chronic exposure to continuous (CoP4) versus cyclic progesterone (CyP4) alone or in combination with 17β-estradiol (E2) on gene expression profiles targeting bioenergetics, metabolism and inflammation in the adult female rat hippocampus. High-throughput qRT-PCR analyses revealed that ovarian hormonal depletion induced by ovariectomy (OVX) led to multiple significant gene expression alterations, which were to a great extent reversed by co-administration of E2 and CyP4. In contrast, co-administration of E2 and CoP4 induced a pattern highly resembling OVX. Bioinformatics analyses further revealed clear disparities in functional profiles associated with E2+CoP4 and E2+CyP4. Genes involved in mitochondrial energy (ATP synthase α subunit; Atp5a1), redox homeostasis (peroxiredoxin 5; Prdx5), insulin signaling (insulin-like growth factor I; Igf1), and cholesterol trafficking (liver X receptor α subtype; Nr1h3), differed in direction of regulation by E2+CoP4 (down-regulation relative to OVX) and E2+CyP4 (up-regulation relative to OVX). In contrast, genes involved in amyloid metabolism (β-secretase; Bace1) differed only in degree of regulation, as both E2+CoP4 and E2+CyP4 induced down-regulation at different efficacy. E2+CyP4-induced changes could be associated with regulation of progesterone receptor membrane component 1(Pgrmc1). In summary, results from this study provide evidence at the molecular level that differing regimens of hormone therapy (HT) can induce disparate gene expression profiles in brain. From a translational perspective, confirmation of these results in a model of natural menopause, would imply that the common regimen of continuous combined HT may have adverse consequences whereas a cyclic combined regimen, which is more physiological, could be an effective strategy to maintain neurological health and function throughout menopausal aging.

Predictors of Breast Density Change After Hormone Therapy Cessation: Results from a Randomized Trial

Postmenopausal hormone therapy cessation is associated with a decrease in mammographic density (MD), but it is unknown whether this effect is modified by woman-level characteristics. We investigated whether we could identify characteristics of women who were most likely to experience a decrease in MD due to hormone therapy cessation. Postmenopausal hormone therapy users with a prior screening mammogram (n = 1,168) were randomized to continue hormone therapy or to suspend hormone therapy for 1 month or 2 months before their next screening mammogram. We estimated relative risks (RR) and attributable risks with 95% CIs of a ≥7.5% decrease in percentage MD (%MD) versus no change associated with hormone therapy cessation, stratified by age, body mass index (BMI), parity, and other factors. Hormone therapy cessation increased a woman's likelihood of experiencing a ≥7.5% decrease in %MD by 30% (95% CI = 1.03-1.7), but we found little evidence of effect modification by age, race, BMI, change in BMI, baseline %MD, parity, family history of breast cancer, hormone therapy type, or duration of hormone therapy use. Woman-level factors do not appear to explain why some women experience a decrease in %MD following hormone therapy cessation and others do not. We were unable to identify subgroups of women who are more likely to experience a decrease in MD due to hormone therapy cessation; other factors, such as genetic factors, may be important determinants of hormone therapy-related changes in MD.

Ghrelin, leptin, adiponectin, and insulin levels and concurrent and future weight change in overweight, postmenopausal women

Weight loss and maintenance can be particularly challenging for postmenopausal women given the changes in body composition, metabolism, and lifestyle that can accompany the menopausal transition. Peptides mediating energy homeostasis (ghrelin, leptin, adiponectin, and insulin) may play an important role in the weight and body composition changes of postmenopausal women and may in turn be affected by hormone therapy (HT) use. This study examines how success with weight loss may be related to peptides mediating energy homeostasis and HT use. The present analysis involves 200 women from a lifestyle intervention trial in overweight, postmenopausal women for whom data on the peptides ghrelin, leptin, adiponectin, and insulin were collected at 0 and 18 months. Peptide levels were compared with changes in weight from 0 to 18 and from 18 to 30 months. Baseline peptide levels were not significantly related to future weight change. From 0 to 18 months, ghrelin (P = 0.0005) and adiponectin (P ≤ 0.0001) levels increased, whereas leptin (P ≤ 0.0001) and insulin (P = 0.0003) levels decreased with increasing amount of weight loss. However, only leptin change was related to 18-30-month weight change. Women who were on HT at 0 months but discontinued by 18 months had a greater increase in ghrelin level from 0 to 18 months compared with women with continuous HT use or nonuse. In overweight, postmenopausal women, changes in energy homeostasis peptides relate to both concurrent and future weight change. Future studies should continue to address how ghrelin, leptin, insulin, and adiponectin contribute to body composition changes and weight loss maintenance after menopause.

Perimenopausal use of hormone therapy is associated with enhanced memory and hippocampal function later in life

Evidence suggests that initiation of some forms of hormone therapy (HT) early in the perimenopausal or postmenopausal stage might confer benefit to verbal memory and the neural systems underlying memory, whereas late-life initiation confers no benefit or harm. This “critical window hypothesis” remains a topic of debate. Using functional magnetic resonance imaging (fMRI), we examined the long-term impact of perimenopausal HT use on brain function during performance of verbal and figural memory tasks. Participants were 34 postmenopausal women (mean age 60 years) from the Melbourne Women's Midlife Health Project and included 17 early (perimenopausal) and continuous users of HT and 17 never users matched on age, education, and verbal knowledge. Continuous HT use from the perimenopausal stage versus no use was validated with prospective daily diary records and study visit data. The primary outcome was patterns of brain activation in an a priori region of interest in the medial temporal lobe during verbal encoding and recognition of words. Results indicated that perimenopausal HT users performed better than nonusers on the imaging verbal memory task (p < .05). During verbal recognition, perimenopausal HT users showed increased activation in the left hippocampus and decreased activation in the parahippocampal gyrus bilaterally compared with never users. Each of these patterns of activation was associated with better memory performance on the imaging memory task. These results suggest that perimenopausal use of HT might confer long-term benefits to verbal memory and the brain systems underlying verbal memory. More generally, the results support the critical window hypothesis.

Efficacy of hormone therapy for osteoporosis in adolescent girls after hematopoietic stem cell transplantation: a longitudinal study

To assess changes in bone mineral density of adolescent girls diagnosed with hypogonadism after hematopoietic stem cell transplantation (HSCT) during continuous hormone therapy (HT). Retrospective study. Department of Obstetrics and Gynecology, Osaka Medical Center and Research Institute for Maternal and Child Health. Twenty-eight adolescent girls with hormone deficiency after HSCT. All patients were treated with HT. Bone mineral density and markers of bone metabolism were evaluated. Twenty-eight patients were enrolled. The girls underwent HSCT at 10.2 ± 4.0 years of age (median ± SD).The first evaluation was performed at 15.1 ± 1.9 years of age, 3.8 ± 3.4 years after HSCT. Bone mineral density increased significantly from -2.7 ± 1.1 (Z-score) to -2.3 ± 1.2 during HT administration for 5.7 ± 2.5 years. Twenty-four of 28 patients (86%) showed a good response to HT. The levels of urinary N-telopeptides of type 1 collagen and serum osteocalcin were high at the first evaluation in 76% and 53% of patients and at the last in 76% and 18%, respectively, thereafter. Significant effects on bone metabolism resulting from HSCT were observed; however, HT increased bone mineral density of the hypogonadal patients.

Comparative effects of continuous combined hormone therapy and tibolone on body composition in postmenopausal women

ObjectiveTo compare the effects of tibolone with those of continuous combined hormone replacement therapy (HT) on body composition in postmenopausal women.MethodsOne hundred and fifty postmenopausal women were enrolled in a randomized, controlled trial to compare the effects of tibolone with continuous combined HT on body composition. Patients were randomly allocated into three groups and followed for 9 months. Of the subjects included, 50 women received 2.5 mg tibolone plus one Cal+D tablet (500 mg calcium and 200 IU vitamin D) daily, 50 women received 0.625 mg conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate (CEE/MPA) plus one Cal+D tablet daily, and the rest (50 women) received only one Cal+D tablet and served as a control group. Body composition was evaluated with measurements of body mass index (BMI), weight, waist-to-hip ratio (WHR), fat mass and fat-free mass (FFM) before and after the intervention. Measurements of body fat mass percentage, fat mass, body fat-free mass percentage and fat-free mass (FFM) were assessed by measurement of skin-fold thickness.Results Tibolone significantly increased weight, BMI and FFM and decreased WHR after the treatment in comparison with baseline (p < 0.05). However, only weight and BMI increased significantly in the CEE/MPA group after the treatment (p < 0.05). There were significant increases in weight, BMI and fat mass in the control group after 9 months. In the comparison of the parameters after the treatment between the three groups, tibolone significantly increased FFM compared with the control and CEE/MPA groups (p < 0.01).Conclusions The effect of tibolone on body composition is favorable and therefore tibolone may be regarded as an alternative to continuous combined hormone therapy in postmenopausal women.

Hormone therapy in Brazilian postmenopausal women with chronic hepatitis C: a pilot study

Objective To evaluate liver function and hemostatic parameters in postmenopausal women who have chronic infection with the hepatitis C virus and climacteric symptoms and are undergoing hormone therapy (HT) (standard dose of transdermal continuous combined hormone therapy).Design Fifty out of 336 postmenopausal patients with chronic infection with the hepatitis C virus were selected. The non-inclusion criteria were other chronic or systemic liver diseases, severe vascular diseases, autoimmune diseases or malignant tumors. The patients were randomized into two groups: the HT group with 25 patients to be given transdermal hormone therapy (50 μg estradiol plus 170 μg norethisterone/day) and the control group with the other 25 patients (no medication). Hepatic tests (alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, total alkaline phosphatase, albumin, serum bilirubin) and hemostatic parameters (prothrombin time, factor V, fibrinogen) were evaluated at baseline and at 1, 4, 7 and 9 months of treatment.Results No significant changes in parameters were found in the comparison between the treated group and the controls, except for a decrease in total alkaline phosphatase (p = 0.002), presumably due to changes in bone remodelling.Conclusions There were no changes in liver function after a 9-month treatment with transdermal estradiol plus norethisterone in symptomatic postmenopausal patients with hepatitis C.

Effects of menopausal hormone therapy on hemostatic parameters, blood pressure, and body weight: Open-label comparison of randomized treatment with estradiol plus drospirenone versus estradiol plus norethisterone acetate

Objectives Clinical studies have reported changes in hemostatic parameters in women taking menopausal hormone therapy (HT) and a small increased risk of venous thromboembolism. We compared the effects of two different HTs on hemostatic parameters in postmenopausal women. Study design An open-label, randomized study conducted at two centers in Germany compared continuous 28-week combined HT with 17β-estradiol 1 mg plus drospirenone 2 mg (E2/DRSP) daily versus E2 1 mg plus norethisterone acetate 0.5 mg (E2/NETA) daily in healthy postmenopausal women. Changes in D-dimer levels from baseline to the end of treatment, as well as effects on further parameters of coagulation, fibrinolysis, and global hemostasis, and effects on bleeding pattern, blood pressure, and body weight were evaluated. Results D-dimer levels increased by 9.1% (median change) with E2/DRSP ( n = 29) and by 15.1% with E2/NETA ( n = 30). Other hemostatic parameters showed <10% median change from baseline in both treatment groups, except for tissue plasminogen activator antigen (E2/DRSP, −1.9%; E2/NETA, −24.2%). Systolic blood pressure decreased from baseline by 6.4 mmHg in the E2/DRSP group compared with 0.1 mmHg in the E2/NETA group at final examination. Body weight remained stable in the E2/DRSP group (+0.18 kg) compared with a slight increase (+1.00 kg) in the E2/NETA group. In nonhysterectomized women, the mean number of bleeding/spotting days was 5.2 (2.0 bleeding/3.2 spotting) in the E2/DRSP and 8.2 (4.4 bleeding/3.8 spotting) in the E2/NETA group. Most nonhysterectomized women, however, remained amenorrheic during the study period (E2/DRSP, 68%; E2/NETA, 62%). Conclusion Both E2/DRSP and E2/NETA were associated with a minor increase in fibrinolytic activity and a slight change in the concentration of some coagulation factors. Both HTs were well tolerated. The decrease in systolic blood pressure and stable body weight in the E2/DRSP group are consistent with DRSP's anti-aldosterone properties.

Prostate Cancer: Closing the Gap Between Science and Practice — Introduction and Conclusions

Androgen deprivation therapy (ADT) has become the mainstay treatment in patients with advanced PCa (ie, locally advanced and metastatic PCa). In recent years, ADT has been used in younger patients with earlier disease stages, for instance, as adjuvant treatment with radiotherapy (RT) [3]. ADT, however, is associated with substantial adverse events, such as hot flushes, sexual problems, fatigue, psychological problems, and metabolic syndrome, that may adversely affect a patient’s quality of life (QoL) [3]. Intermittent hormone therapy (IHT) has gained interest as an alternative to continuous hormone therapy for advanced PCa, with the aim of reducing adverse events and improving QoL [3–5]. Generally, physicians should carefully weigh the benefits against the potential risks of ADT in patients with PCa. Additionally, patients should be well informed about the treatment approach and its potential adverse events. During the symposium ‘‘Prostate cancer: Closing the gap between science and practice’’, five experts discussed recent findings related to PCa treatment, particularly hormone therapy. They first discussed recent data on the detection and management of PCa that were retrieved from abstracts presented at urological and oncological congresses in 2008 and were critically selected by urological experts. The current status of neoadjuvant or adjuvant hormone therapy to local treatment in the management of PCa was summarised. Scientific evidence on IHT and recommendations on how to implement IHT in clinical practice were presented. Lastly, they discussed several aspects considered important in the maintenance or improvement of the QoL of PCa patients treated with ADT. This manuscript introduces and summarises the presentations given at a satellite symposium on PCa that was held during the 24th annual congress of the European Association of Urology (EAU) in March 2009 in Stockholm, Sweden.

Physicians' and Women's Views on Hormone Therapy and Breast Cancer Risk After the WHI: A Qualitative Study

Background: The use of menopausal hormone therapy (HT) has significantly declined since the release of the Women's Health Initiative findings, but to what extent physicians' and women's concerns about breast cancer contributed to this change is unknown. Our study explored physicians' and women's beliefs about hormone therapy and breast cancer risk. Methods: We conducted qualitative in-depth interviews with 22 primary care physicians and 45 female patients at two large integrated health care delivery systems in Washington State and Massachusetts. Results: Concerns about breast cancer risk weighed into the decision-making process for physicians and women in initiating and continuing hormone therapy. For women, control of menopausal symptoms was important and possibly outweighed their concerns about the potential risks of breast cancer. Though concerned about its association with increasing breast cancer risk, physicians were willing to consider hormone therapy to manage women's menopausal symptoms but were frustrated about the lack of available non-hormone therapy alternatives. Most physicians and some women were aware of the Women's Health Initiative, and its findings appeared to influence their beliefs about hormone therapy and breast cancer risk, though doubts remained among both groups about the study findings and implications. Conclusions: Our qualitative study suggests that after the Women's Health Initiative, concerns about breast cancer risk weighed into decisions to initiate and continue hormone therapy for both physicians and women, but menopausal symptoms often directed use.

Intermittent Hormone Therapy: What Is Its Place in Clinical Practice?

Abstract Context Intermittent hormone therapy (IHT) for prostate cancer (PCa) has been garnering interest in the urologic community. IHT aims to minimise treatment-related side-effects, to improve overall quality of life (QoL), to reduce the cost of care, and possibly to delay progression to castration-resistant PCa (CRPC). But questions remain as to whether its use is supported by scientific evidence and how it should be applied in clinical practice. Objective To discuss the current scientific evidence on IHT and to offer recommendations on how to implement IHT in clinical practice. Evidence acquisition This paper was based on a presentation given at a satellite symposium on PCa that was held at the 2009 annual meeting of the European Association of Urology (EAU) in Stockholm, Sweden. Data were retrieved from recent review articles, original articles, and abstracts on IHT. Evidence synthesis Several phase 2 and 3 clinical trials have evaluated IHT; however, the phase 2 trials were generally small and used different methodologies, and most of the randomised controlled phase 3 trials are not mature yet. While considering these limitations, it can be concluded that IHT appears to have a beneficial effect on the incidence of side-effects, on QoL, and on cost. Additionally, IHT appears to have no negative impact on overall survival or progression-free survival compared to continuous hormone therapy. It could not yet be demonstrated that IHT prolongs the time to CRPC; therefore, further research is needed, also to provide guidance on how IHT should be applied in clinical practice. Conclusions IHT appears to have a beneficial effect on treatment-related side-effects and QoL and no negative impact on survival. Final data from phase 3 studies, however, are awaited, also to determine selection criteria for patients.

Hormone Therapy for Prostate Cancer: Exploring Current Controversies

Abstract Context Although there is increasing interest in the use of neoadjuvant or adjuvant hormone therapy with local treatment for patients with prostate cancer (PCa), the survival benefit of hormone therapy is still debated. In addition, hormone therapy is associated with adverse events, which can have negative effects on a patient's quality of life (QoL). Intermittent hormone therapy is being investigated as an alternative to continuous hormone therapy for advanced PCa with the aims of delaying progression to hormone-refractory PCa and minimising adverse events. Objective To summarise current controversies on hormone therapy for PCa. Evidence acquisition This manuscript is based on presentations given at a satellite symposium held at the 2nd World Congress on Controversies in Urology (CURy) in Lisbon, Portugal. Recent English-language reports were identified through a search of Medline and abstracts of scientific congresses on hormone therapy for PCa. Data from review papers, original papers, and abstracts were compiled and interpreted. Evidence synthesis Neoadjuvant hormone therapy with radical prostatectomy (RP) does not seem to offer a survival advantage over RP alone in patients with localised and locally advanced PCa. Neoadjuvant hormone therapy with radiotherapy (RT) appears to improve treatment outcomes over RT alone in patients with locally advanced PCa, but the impact on overall survival is still unclear. Adjuvant hormone therapy with RT seems to increase overall survival in high-risk localised and locally advanced PCa. Final results of a phase 3 trial suggest that intermittent hormone therapy improves QoL without a negative effect on overall survival compared with continuous hormone therapy. Furthermore, the patient–physician dialogue should be enhanced and patients' preferences should be taken into consideration in the decision-making process. Conclusions Neoadjuvant or adjuvant hormone therapy with radical treatment may improve survival in carefully selected patients with PCa. Intermittent hormone therapy seems to reduce adverse events and improve QoL without a negative effect on survival. The availability of different formulations of a luteinising hormone-releasing hormone agonist offers patients an individualised treatment approach.

Neuroprotective effects of estrogen therapy for cognitive and neurobiological profiles of monkey models of menopause

Many postmenopausal women question whether to start or continue hormone therapy because of recent clinical trial negative results. However, evidence from other studies of postmenopausal women, and from studies in menopausal monkeys, indicate that estrogen has neurocognitive protective effects, particularly when therapy is initiated close to the time of menopause before neural systems become increasingly compromised with age. In this review, we present studies of menopausal women and female monkeys that support the concept that estrogen therapies protect both cognitive function and neurobiological processes.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome with a single septate uterus: a novel anomaly and description of treatment options

To report a rare Mayer-Rokitansky-Kuster-Hauser (MRKH) anomaly with a septate midline uterus and describe management options. Case report. Major academic medical center. Two adolescent patients presented with pelvic pain and primary amenorrhea. Radiographic imaging showed evidence of a bicornuate uterus with two uterine horns, cervical hypoplasia, and absence of the upper vagina. Owing to pain, both patients planned laparoscopy with bilateral hemihysterectomies, but in each case laparoscopy showed evidence of a single midline uterus. Continuous hormone therapy was used to suppress pain and retrograde menstruation. Uterine preservation and future fertility management. Given the fertility potential, the treatment plan was to continue hormone therapy until adulthood, when the young woman could select a treatment option for herself. After 2 years, one patient elected hysterectomy at age 18.5 due to persistent pain, while the other patient continues uterine preservation. We present two cases of a rare and uniquely described anomaly of MRKH with a single septate midline uterus. We recommend uterine preservation until the age of 18, at which point the patient may select her treatment option. Novel options include septal resection with subsequent assisted reproductive technology (ART) and cesarean delivery or ART and a gestational carrier.