Estrogen In Postmenopausal Women Research Articles

Comparison of the Efficacy of Vaginal Hyaluronic Acid to Estrogen for the Treatment of Vaginal Atrophy in Postmenopausal Women: A Systematic Review.

Topical estrogen is effective for treating postmenopausal vaginal atrophy. However, there is a potential risk of estrogen-related adverse effects. There is a need for finding effective non-hormonal treatment for vaginal atrophy. The topical application of moisturising agents, such as hyaluronic acid (HA), represents a promising non-hormonal treatment for the relief of vaginal atrophy. This study aimed to summarize the evidence regarding the efficacy of topical HA compared to topical estrogen in postmenopausal women with vaginal atrophy. The literature search covered English-published studies from database inception till February 2023. The search included the electronic databases of MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, and Scopus, using the terms "Hyaluronic Acid" AND "Postmenopause" AND "Vagina" AND "Atrophy". Due to the diversity in reporting outcomes, meta-analysis was not feasible. A narrative synthesis with a systematic approach was conducted by vote counting of studies that included a direct comparison between topical HA and topical estrogen. Six studies were included. Intra-group comparisons showed that both interventions were significantly effective in alleviating the symptoms of vaginal atrophy and dyspareunia as well as improving vaginal pH and cell maturation index. However, inter-group comparisons in most studies showed that estrogen was superior to HA in relieving vaginal symptoms and improving vaginal pH, dyspareunia, and the cell maturation index. There is no evidence to show the superiority of HA to estrogen in the treatment of postmenopausal vaginal atrophy. However, the therapeutic efficacy of HA seems to be comparable to estrogen and considering its safety, HA can be used as an alternative to estrogen in patients who do not want to use estrogen. The available studies have several limitations, and the reporting of outcomes was considerably heterogeneous.

Preliminary Study on Effect of Lactiplantibacillus plantarum on Osteoporosis in the Ovariectomized Rat.

Osteoporosis is a growing global health concern primarily associated with decreased estrogen in postmenopausal women. Recently, some strains of probiotics were examined for potential anti-osteoporotic effects. This study intended to evaluate the impacts of Lactiplantibacillus plantarum MGE 3038 strain (MGE 3038) in ovariectomized rats. For this purpose, twelve weeks old female Wistar rats (n=21; 250-300 g) were divided into 3 groups; ovariectomy (OVX) group, OVX/MGE 3038 group and Sham group (control). In these groups; two went through respective OVX and one had daily MGE 3038 administration through oral gavage. Prior to 16 weeks after OVX, we collected blood samples and extracted the tibiae. We scanned the extracted tibiae by in-vivo micro-computed tomography (micro-CT) and evaluated pathology by hematoxylin and eosin (H&E) and Masson's trichrome staining. The serum levels of C-telopeptide of type I collagen (CTX), osteocalcin (OC), and the receptor activator of nuclear factor-ĸB ligand (RANKL) were examined. The OVX/MGE 3038 group showed increases in bone mineral density, trabecular bone volume, trabecular number, and trabecular thickness (Tb.Th), and a decrease in trabecular spacing than the OVX group. However, OVX/MGE 3038 group and control group were measurably comparable in Tb.Th. Micro-CT, H&E, and Masson's trichrome findings exhibited increased preservation and maintenance of trabecular bone structure in the OVX/MGE 3038 group in comparison to the OVX group. In serum, the levels of CTX, OC and RANKL were significantly different between the OVX and OVX/MGE 3038 groups. Taken together, L. plantarum MGE 3038 could be helpful for the treatment of osteoporosis.

Urodynamic assessment in patients suffering concomitant overactive bladder syndrome (OAB-S) and vulvo-vaginal atrophy (VVA) treated with ospemifene

Introduction and Aim of the Study: Overactive Bladder Syndrome (OAB-S) is a complex and multifactorial syndrome in which menopausal transition and the ageing process could be contributing factors. Urinary Urgency (UU) is the key symptom reported in the condition of OAB in Post-Menopausal Women (PMW) suffering from Genitourinary Syndrome of Menopause. Even if there are some evidences that the use of hormonal treatments like vaginal estrogens in PMW may be helpful, the evidence on the possible role of others hormonal treatments in improving OAB-S in PMW is scant. Ospemifene is a Selective Estrogen Receptor Modulator (SERM) licensed for treatment of Vulvo-Vaginal Atrophy (VVA).

Part I: Interactive case: Menopause

Part I: Interactive case: Menopause

Recurrent Urinary Tract Infection in Adult Patients, Risk Factors, and Efficacy of Low Dose Prophylactic Antibiotics Therapy

BackgroundRecurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy.MethodsA retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018.ResultsA total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. E. coli infections were the most prevalent organism in patients with UTI episodes. Prophylactic antibiotics were given to 55% of patients with UTIs, Nitrofurantoin, Bactrim or amoxicillin clavulanic acid. Post renal transplant is the most frequent reason to prophylaxis antibiotics (44%). Bactrim was more prescribed in younger patients (P < 0.001), in post-renal transplantation (P < 0.001) and after urological procedures (P < 0.001), while Nitrofurantoin was more prescribed in immobilized patients (P = 0.002) and in patients with neurogenic bladder (P < 0.001). Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P < 0.001), emergency room visits and hospital admissions due to urinary tract infections (P < 0.001).ConclusionDespite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. There was a lack of use of other interventions such as topical estrogen in postmenopausal women and documentation of education on non-pharmacological methods to decrease urinary tract infections.

(014) Impact of Vaginal Prasterone on the Rate of Urinary Tract Infections in GSM Patients and those on Aromatase Inhibitors: A Retrospective Cohort Analysis

Abstract Introduction The Genitourinary Syndrome of Menopause (GSM) is attributed to a decline in the levels of circulating sexual steroids which often results in increased vaginal pH, atrophic urogenital changes, elevated amount of post-void residual urine, and changes in the vaginal microbiome with a shift towards a predominance of fecal gram-negative bacteria rather than lactobacilli, which is believed to create a potential reservoir for recurrent urinary tract infections (UTIs). Current guidelines to prevent recurrent UTIs include vaginal estrogens. Intravaginal prasterone is converted locally in the vaginal tissue into androgens which are subsequently aromatised into estrogens. It is indicated to treat moderate to severe dyspareunia in postmenopausal women in the US. Objective The objective of this study was to assess, through real world evidence data, the potential of vaginal prasterone to be used in postmenopausal GSM women with recurrent UTIs as prophylaxis to reduce the future UTI risk. As a sensitivity analysis, women using aromatase inhibitors, medications that stop the production of estrogen in postmenopausal women typically prescribed to women with a history of breast cancer, were analyzed. Methods This retrospective matched-cohort study was conducted using the Integrated Dataverse (IDV®) - an open-source claims database from Symphony Health Solutions with data from February 2015 through January 2020. 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Within each of these two groups, 286 matched patients were taking aromatase inhibitors. Results Across all age groups, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% and 12.3%, respectively; p˂0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% and 16.2% respectively; p˂0.0001). Consistent with the above, among aromatase inhibitor users, women treated with prasterone have a significantly lower UTI prevalence (4.90% vs. 9.79%; p=0.008). Conclusions This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with recurrent UTIs to reduce future UTI risk, including for patients taking aromatase inhibitors and having contraindications for estrogen-based therapies. This study is however based on real-world evidence and warrants further investigation in a prospective clinical setting. Disclosure Yes, this is sponsored by industry/sponsor: Endoceutics Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Endoceutics

MP15-17 IMPACT OF VAGINAL PRASTERONE ON THE RATE OF URINARY TRACT INFECTIONS IN GSM PATIENTS AND THOSE WITH A HISTORY OF BREAST CANCER: A RETROSPECTIVE COHORT ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP15-17 IMPACT OF VAGINAL PRASTERONE ON THE RATE OF URINARY TRACT INFECTIONS IN GSM PATIENTS AND THOSE WITH A HISTORY OF BREAST CANCER: A RETROSPECTIVE COHORT ANALYSIS Rachel Rubin, Erick Moyneur, Katherine Dea, Fernand Labrie, and Alain Dury Rachel RubinRachel Rubin More articles by this author , Erick MoyneurErick Moyneur More articles by this author , Katherine DeaKatherine Dea More articles by this author , Fernand LabrieFernand Labrie More articles by this author , and Alain DuryAlain Dury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Genitourinary Syndrome of Menopause (GSM) is attributed to a decline in the levels of circulating sexual steroids which often results in increased vaginal pH, atrophic urogenital changes, elevated amount of post-void residual urine, and changes in the vaginal microbiome with a shift towards a predominance of fecal gram-negative bacteria rather than lactobacilli, which is believed to create a potential reservoir for recurrent urinary tract infections (UTIs). Current guidelines to prevent recurrent UTIs include vaginal estrogens. Intravaginal prasterone is converted locally in the vaginal tissue into androgens which are subsequently aromatised into estrogens. It is indicated to treat moderate to severe dyspareunia in postmenopausal women in the US. The objective of this study was to assess, through real world evidence data, the potential of vaginal prasterone to be used in postmenopausal GSM women with recurrent UTIs as prophylaxis to reduce the future UTI risk. As a sensitivity analysis, women using aromatase inhibitors, medications that stop the production of estrogen in postmenopausal women typically prescribed to women with a history of breast cancer, were analyzed. METHODS: This retrospective matched-cohort study was conducted using the Integrated Dataverse (IDV®) - an open-source claims database from Symphony Health Solutions with data from February 2015 through January 2020. RESULTS: 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Within each of these two groups, 286 matched patients were taking aromatase inhibitors. Across all age groups, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% and 12.3%, respectively; p˂0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% and 16.2% respectively; p˂0.0001). Consistent with the above, among aromatase inhibitor users, women treated with prasterone have a significantly lower UTI prevalence (4.90% vs. 9.79%; p=0.008). CONCLUSIONS: This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with recurrent UTIs to reduce future UTI risk, including for patients taking aromatase inhibitors and having contraindications for estrogen-based therapies. This study is however based on real-world evidence and warrants further investigation in a clinical setting. Source of Funding: Endoceutics © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e199 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Rubin More articles by this author Erick Moyneur More articles by this author Katherine Dea More articles by this author Fernand Labrie More articles by this author Alain Dury More articles by this author Expand All Advertisement PDF downloadLoading ...

Diosgenin Attenuates Myocardial Cell Apoptosis Triggered by Oxidative Stress through Estrogen Receptor to Activate the PI3K/Akt and ERK Axes.

Cardiovascular diseases in post-menopausal women are on a rise. Oxidative stress is the main contributing factor to the etiology and pathogenesis of cardiovascular diseases. Diosgenin, a member of steroidal sapogenin, is structurally similar to estrogen and has been shown to have antioxidant effects. Therefore, we aimed to investigate the effects of diosgenin in preventing oxidation-induced cardiomyocyte apoptosis and assessed its potential as a substitute substance for estrogen in post-menopausal women. Apoptotic pathways and mitochondrial membrane potential were measured in H9c2 cardiomyoblast cells and neonatal cardiomyocytes treated with diosgenin for 1[Formula: see text]h prior to hydrogen peroxide (H2O2) stimulation. H2O2-stimulated H9c2 cardiomyoblast cells displayed cytotoxicity and apoptosis via the activation of both Fas-dependent and mitochondria-dependent pathways. Additionally, it led to the instability of the mitochondrial membrane potential. However, the H2O2-induced H9c2 cell apoptosis was rescued by diosgenin through IGF1 survival pathway activation. This led to the recovery of the mitochondrial membrane potential by suppressing the Fas-dependent and mitochondria-dependent apoptosis. Diosgenin also inhibited H2O2-induced cytotoxicity and apoptosis through the estrogen receptor interaction with PI3K/Akt and extracellular regulated protein kinases 1/2 activation in myocardial cells. In this study, we confirmed that diosgenin attenuated H2O2-induced cytotoxicity and apoptosis through estrogen receptors-activated phosphorylation of PI3K/Akt and ERK signaling pathways in myocardial cells via estrogen receptor interaction. All results suggest that H2O2-induced myocardial damage is reduced by diosgenin due to its interaction with estrogen receptors to decrease the damage. Herein, we conclude that diosgenin might be a potential substitute substance for estrogen in post-menopausal women to prevent heart diseases.

Effect of Lactobacillus plantarum on Osteoporosis in the Ovariectomized Rat

Osteoporosis is a growing global health concern primarily associated with decreased estrogen in postmenopausal women. Recently, some strains of probiotics were examined for potential anti-osteoporotic effects. This study intended to evaluate the impacts of Lactobacillus plantarum CJNU 3002 strain (LP) in ovariectomized rats. For this purpose, twelve weeks old female Wistar rats (n=21; 250–300 g) were divided into 3 groups; ovariectomy (OVX) group, OVX/LP group and Sham group (control). In these groups; two went through respective OVX and one had daily LP administration through oral gavage. Prior to 16 weeks after OVX, we collected blood samples and extracted the tibiae. We scanned the extracted tibiae by ex-vivo micro-computed tomography (micro-CT) and evaluated pathology by hematoxylin and eosin (H&amp;E) and Masson’s trichrome staining. The serum levels of C-telopeptide of type I collagen (CTX) and osteocalcin (OC) were examined. The OVX/LP group showed increases in bone mineral density, trabecular bone volume, trabecular number, and trabecular thickness (Tb.Th), and a decrease in trabecular spacing than the OVX group. However, OVX/LP group and control group were measurably comparable in Tb.Th. Micro-CT, H&amp;E, and Masson’s trichrome findings exhibited increased preservation and maintenance of trabecular bone structure in the OVX/LP group in comparison to the OVX group. In serum, the levels of CTX and OC were significantly different among the OVX and OVX/LP groups (p&lt;0.05). Taken together, L. plantarum CJNU 3002 could be helpful for the treatment of osteoporosis.

The Association Between Route of Post-menopausal Estrogen Administration and Blood Pressure and Arterial Stiffness in Community-Dwelling Women.

BackgroundPostmenopausal hormone therapy (HT) is associated with increased cardiovascular risk. Although the route of estrogen administration may play a role in mediating risk, previous studies have not controlled for concomitant progestin use.ObjectiveTo investigate the association between the route of estrogen therapy (oral or non-oral) HT use, without concomitant progestin, and blood pressure and arterial stiffness in postmenopausal women.MethodsSystolic blood pressure [SBP], diastolic blood pressure [DBP]), arterial stiffness (aortic pulse wave velocity [aPWV] and augmentation index at 75 beats per minute [AIx]) were measured using a validated automated brachial cuff-based oscillometric approach (Mobil-O-Graph) in a community-dwelling sample of 328 women.ResultsFifty-five participants (16.8%) were ever users (current and past use) of estrogen-only HT (oral [n = 16], transdermal [n = 20], vaginal [n = 19]), and 223 were never HT users (control). Ever use of oral estrogen was associated with increased SBP and DBP (Oral: SBP: 137 ± 4 mmHg, DBP: 79 ± 2 mmHg) compared to use of non-oral estrogen (transdermal: SBP: 118 ± 2 mmHg, DBP: 73 ± 1 mmHg; p < 0.01 & p = 0.012, respectively; vaginal: SBP: 123 ± 2 mmHg DBP: 73 ± 2 mmHg; p = 0.02 & p = 0.01, respectively.) and controls (SBP: 124 ± 1 mmHg, DBP: 74 ± 1 mmHg, p = 0.03, p = 0.02, respectively) after adjustment for covariates. aPWV was higher in oral estrogen ever users (9.9 ± 1 m/s) compared to non-oral estrogen (transdermal: 8.6 ± 0.3 m/s, p < 0.01; vaginal: 8.8 ± 0.7 m/s, p = 0.03) and controls (8.9 ± 0.5 m/s, p = 0.03) but these associations were no longer significant after adjustment for covariates. AIx was higher in oral estrogen (29 ± 2 %) compared to non-oral estrogen (transdermal: 16 ± 2 %; vaginal: 22 ± 1.7 %) but this association was no longer significant after adjustment for covariates (p = 0.92 vs. non-oral; p = 0.74 vs. control).ConclusionEver use of oral estrogen was associated with increased SBP and DBP compared to non-oral estrogen use and no use. Given the cardiovascular risk associated with both menopause and increased blood pressure, further studies are required exploring the potential benefits of non-oral estrogen in postmenopausal women.

Effective Image Communication of Hormone Replacement Therapy Risks and Benefits.

This article focuses on the value of a unique graphic/image designed to communicate health risks and benefits related to the administration of hormone replacement therapy. It will demonstrate why equations, technical terms, and confusing rhetoric need not be used for communication to patients and others. The use of a "familiar" theater graphic (given the name Benefit/Risk Characterization Theater) will allow physicians and patients to share decision-making by visualizing tradeoffs through the use of a clearer format: example Benefit/Risk Characterization Theaters: breast cancer risks associated with hormone replacement therapy, effectiveness of estrogen in treating menopausal symptoms, and thromboembolic risk of taking estrogen for postmenopausal women. The article describes a practical, simple methodology that can be used in many countries to facilitate doctor-patient communication.

A Western Diet Influences Ventilation in a Sex‐Specific Manner and Prevents Expression of Respiratory Neuroplasticity in Adult Rats

Estrogen impacts neuroplasticity in multiple areas of the central nervous system including within respiratory neural networks. Previous research from our group established that estrogen is necessary to permit expression of phrenic long‐term facilitation (pLTF), a form of respiratory neuroplasticity induced by acute, intermittent hypoxia (AIH). Many factors influence circulating estrogen levels such as age, gender, and diet. Specifically, the Western Diet is associated with increased levels of circulating estrogen in post‐menopausal women. Common to cultures of the Western Hemisphere, the Western Diet is characterized by high intakes of red and processed meats, sweets, fried foods, and refined grains with the addition of a high intakes of sugar, salt, omega 6 fatty acids, and a reduction of omega 3 fatty acids. Since the Western Diet is associated with high estrogen levels, and estrogen appears to play a critical role in expression of respiratory neuroplasticity, we assessed whether rats fed a Western Diet would have altered respiratory function and expression of AIH‐induced pLTF. Experimental rats of both sexes were fed a Western Diet in pellet form for 12 weeks and compared to rats consuming standard pellet chow. Weekly whole body plethysmography was used to measure ventilation and changes in ventilatory responses over time. At the conclusion of 12 weeks, AIH‐induced phrenic LTF was measured in anesthetized, vagotomized, and mechanically ventilated rats. Surprisingly, neither sex exhibited a change in body weight in response to the 12‐wk Western Diet, nor was baseline ventilation different between experimental groups within the same sex. However, with hypoxic challenge, male rats on the Western Diet showed lower breathing frequency and higher tidal volumes, while females on the Western Diet exhibited the opposite effects. Also, AIH‐induced pLTF was abolished in male and female Western Diet rats despite an increase in circulating estrogen levels in Western Diet Rats as measured by ELISA assay. These preliminary data suggest that the Western Diet may induce progressive changes in ventilation and loss of respiratory neuroplasticity independent of increased circulating estrogen levels.

Unstimulated Salivary Estrogen in Postmenopausal Women With and Without Oral Dryness: A Prospective Study

Objective: This study aimed to compare the unstimulated salivary estrogen levels in postmenopausal women with and without oral dryness. Methodology: A study was carried out on 70 selected postmenopausal women, out of which 35 were in the case group and 35 were in the control group. A questionnaire related to oral dryness was given to all the patients to evaluate their response to oral dryness. Patients were asked to spit in a plastic container, and their unstimulated saliva samples were obtained and analyzed for estimation of salivary estrogen levels by ELISA technique. After analyzing the results of salivary estrogen levels, the patients in the case group with low levels of estrogen were subjected to HRT under the guidance of a gynecologist. The patients were followed after 3 months of therapy for their response to oral dryness by the questionnaire, and salivary estrogen levels were again reevaluated after the therapy. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc, Chicago, IL, version 15.0 for windows). The Pearson’s correlation and Student’s unpaired t-test were used for comparisons. Results: Before hormone replacement therapy, the mean estrogen level of the case group was 1.0031, and the mean estrogen level of the control group was 4.0080 pg/ml. This suggested that the reduced levels of estrogen hormone after menopause were associated with the complaint of oral dryness in these females. The mean salivary estrogen levels in the case group after HRT were more than the levels before HRT. Conclusion: Estrogen levels were reduced in patients with oral dryness. Further, the patients receiving HRT showed significant improvement in symptoms of oral dryness.

Vaginal estrogen: An option to be considered for postmenopausal women

The author reviews the use of vaginal estrogen for postmenopausal women affected by the genitourinary syndrome of menopause, explaining that it is safe and effective for most and that women’s health nurse practitioners are well positioned to recognize the need for vaginal estrogen, educate the patient on safety concerns, and prescribe it when indicated.

Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: a cohort study

ObjectiveDetermine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19.DesignNationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals...

Role of nitric oxide in prevention diabetic nephropathy in females after menopause

Background: Type 2 diabetes mellitus (T2DM) is a complex disease, which affects many organs besides the pancreas such as the liver, brain, eye, stomach, and kidney. Purpose: The current study aimed to evaluate role of nitric oxide in prevention diabetic nephropathy in females after menopause. Methods: Our study was carried out on 90 females and 90 males with T2DM aged over 45 years, randomly selected from the outpatient clinic of the National Institute for Diabetes and Endocrinology (NIDE). T2DM patients were divided into 3 subgroups; subgroup 1: patients without any complications, subgroup 2: patients with nephropathy complications (DN), and subgroup 3: patients with cardiovascular compactions (CVD). Results: Result showed that dyslipidemia and oxidative stress was more pronounced in females rather than in male. While, kidney function markers was worse in male than female. Conclusion: The current study shows that diabetic females are more susceptible to cardiovascular disease than males due to the depletion of estrogen in postmenopausal women, causing oxidative stress. On the other hand, diabetic males are more susceptible to diabetic nephropathy than females due to a decrease in nitric oxide level, which is considered a kidney protective factor.

Associations of established breast cancer risk factors with urinary estrogens in postmenopausal women.

Circulating estrogens are an established risk factor for postmenopausal breast cancer (BCa). We describe the distribution of urinary estrogens, their metabolites, and relevant metabolic pathway ratios among healthy postmenopausal women and examine associations of several known BCa factors with these estrogen measures. Eligible postmenopausal women (n = 167) had no history of hormone use (previous 6months) and cancer/metabolic disorders and had a body mass index (BMI) ≤ 35kg/m2. Estrogens were quantified in spot urine samples with liquid chromatography-high-resolution mass spectrometry and corrected for creatinine. We assessed overall distributions of estrogens and associations of age, BMI, race/ethnicity, parity/age at first birth, age at menarche, alcohol, and smoking with log-transformed estrogen measures using multivariate regression. BMI was positively associated with estrone (β per unit = 0.04, 95% Confidence Interval [CI] 0.00; 0.07), combined parent estrogens (β = 0.04, 95% CI 0.01; 0.07), and E2:total estrogens (β = 0.04, 95% CI 0.02; 0.06), and inversely associated with 4-MeOE1 (β = -0.17, 95% CI -0.33; -0.02), E3:parent estrogens (β = -0.04, 95% CI -0.07; -0.00), and 16-pathway:parent (β = -0.04, 95% CI -0.07; -0.01). Being African American vs. white was associated with higher levels of 4-MeOE1 (β = 3.41, 95% CI 0.74; 6.08), 17-epiE3 (β = 1.19, 95% CI 0.07; 2.31), 2-pathway:parent (β = 0.54, 95% CI 0.04; 1.04), and lower levels of E2:total estrogens (β = -0.48, 95% CI -0.83; -0.13). Having < 7 alcohol drinks/week vs. none was associated with higher levels of 16-ketoE2 (β = 1.32, 95% CI 0.36; 2.27), 16-epiE3 (β = 1.02, 95% CI 0.24; 1.79), and 17-epiE3 (β = 0.55, 95% CI 0.02; 1.08). Smoking was positively associated with E3:parent (β = 0.29, 95% CI 0.01; 0.57), 16-pathway:parent (β = 0.25, 95% CI 0.01; 0.49), and inversely associated with estradiol (β = -0.52, 95% CI -0.93; -0.10). As compared to nulliparous, parous women with age at first birth ≥ 25years had lower levels of estrone, combined parent estrogens, 2-OHE1, and 2-OHE2. Our findings suggest that BMI, race/ethnicity, and some reproductive and lifestyle factors may contribute to postmenopausal BCa through their effects on circulating estrogens.

Limitation of cytology and the impacton reduction of cervical cancer

Introduction: Cervical cancer is the third most common malignant tumor in the female population and the fourth cause of death from cancer in women in Brazil. The squamocolumnar junction and the transformation zone concentrate 90% of pre-invasive and invasive cervical lesions. Objective: To evaluate the prevalence of cytology without cells of the squamocolumnar junction and feasibility of active search. Methods: Cross-sectional study at a university hospital between 2017 and 2018. The prevalence of cytology without squamocolumnar junction cells was calculated. A convenience sample was obtained and mean age and relationship with presence of transformation zone cells were calculated. An active search was performed and cytology collected, with estrogen preparation if indicated. Medical records of the other women were analyzed. Results: Squamocolumnar junction cells were not found in 28.84% of samples. Mean age was 53 years, without association with presence of squamocolumnar junction cells (p=0.409). Seventy-six women returned, 36 of which (47.37%) used estrogen. Level 2 or 3 cervical intraepithelial neoplasia, microinvasive carcinoma or cancer was not identified. A total of 134 medical records were analyzed; only 36 women (26.87%) completed screening. Conclusions: The presence of squamocolumnar junction cells indicates quality of cytology; the use of estrogen in postmenopausal women favors its collection. There were difficulties in active search. An immediate repetition of cytology should be considered.

Cost-Effectiveness of perioperative Vaginally Administered estrogen in postmenopausal women undergoing prolapse surgery (EVA trial): study protocol for a multicenter double-blind randomized placebo-controlled trial

BackgroundSurgery for pelvic organ prolapse (POP) is associated with high recurrence rates. The costs associated with the treatment of recurrent POP are huge, and the burden from women who encounter recurrent POP, negatively impacts their quality of life. Estrogen therapy might improve surgical outcome for POP due to its potential beneficial effects. It is thought that vaginal estrogen therapy improves healing and long-term maintenance of connective tissue integrity. Hence, this study aims to evaluate the cost-effectiveness of perioperative vaginal estrogen therapy in postmenopausal women undergoing POP surgery.MethodsThe EVA trial is a multi-center double-blind randomized placebo-controlled trial conducted in the Netherlands comparing the effectiveness and costs-effectiveness of vaginal estrogen therapy. This will be studied in 300 postmenopausal women undergoing primary POP surgery, with a POP-Q stage of ≥ 2. After randomization, participants administer vaginal estrogen cream or placebo cream from 4 to 6 weeks preoperative until 12 months postoperative. The primary outcome is subjective improvement of POP symptoms at 1 year follow-up, measured with the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes are POP-Q anatomy in all compartments, re-interventions, surgery related complications, general and disease specific quality of life, sexual function, signs and complaints of vaginal atrophy, vaginal pH, adverse events, costs, and adherence to treatment. Follow up is scheduled at 6 weeks, 6 months and 12 months postoperative. Data will be collected using validated questionnaires and out-patient visits including gynecological examination performed by an independent gynecologist.DiscussionThis study investigates whether perioperative vaginal estrogen will be cost-effective in the surgical treatment of POP in postmenopausal women. It is hypothesized that estrogen therapy will show a reduction in recurrent POP symptoms and a reduction in reoperations for POP, with subsequent improved quality of life among women and cost savings.Trial registrationNetherlands Trial Registry: NL6853; registered 19-02-2018, https://www.trialregister.nl/trial/6853. EudraCT: 2017-003144-21; registered: 24-07-2017.

Elevated level of the soluble receptor for advanced glycation end-products involved in sarcopenia: an observational study

BackgroundThe soluble receptor for advanced glycation end products (sRAGE) has been proposed to serve as a marker for disease severity, but its role in sarcopenia, an age-related progressive loss of muscle mass and function, remains elusive. This study examines the association between sRAGE and sarcopenia.MethodsA total of 314 community-dwelling elderly adults who had their health examination at Tri-Service General Hospital from 2017 to 2019 underwent protein analysis with enzyme-linked immunosorbent assay. The relationship with sarcopenia and its detailed information, including components and diagnosis status, were examined using linear and logistic regressions.ResultsAs for sarcopenia components, low muscle mass (β = 162.8, p = 0.012) and strength (β = 181.31, p = 0.011) were significantly correlated with sRAGE, but not low gait speed (p = 0.066). With regard to disease status, confirmed sarcopenia (β = 436.93, p < 0.001), but not probable (p = 0.448) or severe sarcopenia (p = 0.488), was significantly correlated with sRAGE. In addition, females revealed a stronger association with sRAGE level by showing significant correlations with low muscle mass (β = 221.72, p = 0.014) and low muscle strength (β = 208.68, p = 0.043).ConclusionssRAGE level showed a positive association with sarcopenia, illustrating its involvement in the evolution of sarcopenia. This association is more evident in female groups, which may be attributed to the loss of protection from estrogen in postmenopausal women. Utilizing sRAGE level as a prospective marker for sarcopenia deserves further investigation in future studies.