Female Hormone Use Research Articles

Gynaecological and Reproductive Risk Factors of Vertebral Osteoporosis

Menopause plays an important role in skeletal loss among aging female population. The aim of this study was to determine the role of gynaecological and reproductive risk factors in vertebral osteoporosis.Data on gynaecological and reproductive history were collected, (together with data of other risk factors, as a part of a larger study) using an interviewer administered questionnaire in urban randomised population of women age 50 and above. One hundred and sixty nine women were interviewed. Questions included: age at menarche, use of oral contraceptive pills, age at natural menopause, age at hysterectomy and/or ovariectomy, use of female sex hormones around or after menopause (more than 1 year), number of pregnancies. A lateral radiograph of dorsal and lumbar spine was taken. The films were read in a way that 6 points for each vertebra were placed to denote anterior, middle and posterior heights. The McCloskey and Kanis' morphometric method was used and 3 SD cut-off point was chosen for vertebral deformi...

Antithrombin III: Associations with Age, Race, Sex and Cardiovascular Disease Risk Factors

Antithrombin III (AT III) is a major inhibitor of blood coagulation, and hereditary deficiency is associated with venous thrombotic disease. The Atherosclerosis Risk in Communities (ARIC) Study, a prospective study of 15,800 middle-aged men and women, measured AT III in its baseline examination. AT III levels were significantly higher in women than men, and in blacks than whites. AT III decreased with age in men but increased with age in women. In age- and race-adjusted analyses, AT III was positively associated with smoking, HDL-cholesterol, triglycerides (men only), and in women, with diabetes and lipoprotein(a). AT III was negatively associated with educational level, body mass index in men, and use of female hormones in women. Most of these associations were confirmed in multivariate analysis. These correlations between AT III and other risk factors must be considered when evaluating AT III as a risk factor for venous or arterial thrombosis.

The Impact of Female Hormone Usage on the Lipid Profile

Exogenous female hormone use appears to affect cardiovascular disease risk in both premenopausal and postmenopausal women. The purpose of this study was to evaluate the impact of exogenous female hormone usage on the lipid profile among premenopausal and postmenopausal women. One thousand nine hundred thirty female participants of the Framingham Offspring study comprised the study population. Of the 992 premenopausal subjects, 57 were current oral contraceptive users; among the 938 postmenopausal subjects, 80 were current hormone users. The influence of hormone use on lipid and lipoprotein levels was determined using multivariable linear regression models that adjusted for age, body mass index, smoking, alcohol intake, beta-blocker, and diuretic therapy. Adjusted least-squares means were calculated for each lipid and lipoprotein according to female hormone usage and menopausal status. In the premenopausal analysis, pooled oral contraceptive use was significantly related to increased levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol and apolipoprotein A-I. Increased estrogen content was inversely associated with low-density lipoprotein cholesterol, and apolipoprotein B levels, while increased progestin content was inversely related to high-density lipoprotein cholesterol and apolipoprotein A-I levels. Among postmenopausal women, use of premarin only was significantly associated with increased high-density lipoprotein cholesterol and apolipoprotein A-I levels. Combination use of premarin and provera was significantly associated with increased apolipoprotein A-I levels; less powerful but still significant associations with increased high-density lipoprotein cholesterol and decreased low-density lipoprotein cholesterol were also observed. In this cross-sectional analysis, oral contraceptive use is associated with both favorable and unfavorable lipid alterations with respect to atherogenic risk. Among postmenopausal women, hormone replacement therapy (both premarin only and combined premarin and provera) appears to be associated with favorable effects on the lipid profile.

Osteoporosis risk factors, gynaecological history and fractures in perimenopausal women — the results of the baseline postal enquiry of the Kuopio Osteoporosis Risk Factor and Prevention Study

The Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study examines the risk factors of osteoporosis, the relationship of risk factors to bone density and fractures, as well as the possibility to prevent bone loss by administering certain hormones. The baseline postal enquiry in 1989 was sent to all the 14 220 women aged 47–56 years residing in the Kuopio Province, Finland. The questionnaire included questions about their gynaecological history, physical exercise and smoking habits, calcium intake, body weight and height, history of bone fractures, health disorders, their current and previous use of drugs, as well as their willingness to participate in bone densitometry and in a clinical hormone trial. The response rate was 92.8%. In all, 56% reported some previous use of female hormones. Strong contraindications for oestrogen replacement therapy were found in 9.3% of the women. Almost half of the respondents reported lack of regular physical exercise, 11.9% were smokers, and 17.0% reported a calcium intake from milk products of less than 500 mg daily. The incidence of fractures increased steadily with age. The incidence of premenopausal fractures within the last 10 years was 7.65 per 1000 person/years and that of postmenopausal fractures was 17.40 per 1000 person/years ( P = 0.000). The effect of menopause on fracture incidence was stronger than the effect of a 5-year age increase. Of the respondents, 84.4% were willing to participate in bone densitometry and 68.3% for long-term prevention of osteoporosis with oestrogen.

Female hormone utilisation and risk of hepatocellular carcinoma

The relationship between female hormone use and primary liver cancer was analysed using data from a case-control study conducted between 1984 and 1992 in Milan on 82 female incident cases with histologically or serologically confirmed hepatocellular carcinoma and 368 controls admitted to hospital for acute non-neoplastic, non-hormone-related diseases. An elevated relative risk (RR) or primary liver cancer was observed in oral contraceptive (OC) users (RR 2.6, for ever versus never users, 95% confidence interval, CI 1.0-7.0). The RR was directly related to duration of use (RR 1.5 for < or = 5 years and 3.9 for > 5 years) and persisted for longer than 10 years after stopping use (RR 4.3%, 95% CI 1.0-18.2). The RR were below unity, although not significantly, for women ever using oestrogen replacement therapy (RR 0.2, 95% CI 0.03-1.5) and female hormones for indications other than contraception and menopausal therapy (RR 0.4, 95% CI 0.1-1.5). The long-lasting, association between risk of hepatocellular carcinoma and OC use has potential implications on a public health scale, since primary liver cancer is a relatively rare disease among young women, but much more common at older ages. This study provides limited but reassuring evidence on the possible relationship between oestrogen replacement treatment and subsequent risk of hepatocellular carcinoma.

Clustering of high density lipoprotein cholesterol levels in premenopausal and postmenopausal female twins.

Previous family and twin studies indicate that genetic variation makes an important contribution to individual variation in high density lipoprotein cholesterol (HDL) levels, even after adjustment for covariates (such as obesity and alcohol consumption) that also cluster in families. However, most studies assume that genetic mechanisms affecting variation in HDL level are the same in all subgroups of the population (e.g., men versus women, by age). Using data from the Kaiser-Permanente Women Twins Study, we found different patterns of clustering for monozygotic (MZ) and dizygotic (DZ) twins depending on menopausal status. Premenopausal MZ twins were more similar than postmenopausal MZ twins (r(i) = 0.79 and r(i) = 0.61, respectively, after adjustment for age, alcohol consumption, smoking status, degree of obesity, and leisure-time exercise); premenopausal and postmenopausal DZ twins were alike to the same extent (r(i) = 0.31 and r(i) = 0.32, respectively, adjusted as above). These data suggest that either postmenopausal MZ twins have a greater degree of shared environment than postmenopausal DZ twins (e.g., postmenopausal female hormone use) or that genetic mechanisms that affect individual variation in HDL level differ in pre- and postmenopausal women. Data were not available on postmenopausal female hormone use. If genetic mechanisms that influence variation in HDL levels differ between pre- and postmenopausal women, genetic epidemiologic methods that assume that genetic and environmental sources of variation are the same for all groups of individuals may lead to false conclusions.

Population correlates of plasma fibrinogen and factor VII, putative cardiovascular risk factors

Recent prospective investigations have reported that higher plasma fibrinogen concentrations and higher factor VII coagulant activity are associated with greater risk of cardiovascular disease. To discover what characteristics may influence fibrinogen and factor VII, we analyzed data from the Atherosclerosis Risk in Communities Study obtained from over 12000 men and women, aged 45–64 years, from four communities in December 1986 to June 1989. Fibrinogen was higher in blacks than whites and in women than men; in general, it increased with age, smoking, body size, diabetes, fasting serum insulin, LDL cholesterol, lipoprotein(a), leukocyte count, and menopause, and it decreased with ethanol intake, physical activity, HDL cholesterol, and female hormone use. Factor VII was higher in women than men and, in women, increased with age; in both sexes, it increased with body size, triglycerides, LDL cholesterol, and HDL cholesterol, and it decreased with ethanol intake. These findings indicate that elevations in fibrinogen and factor VII may be modifiable through appropriate lifestyle changes.

Medical correlates of urinary incontinence in the elderly

A probability sample of noninstitutionalized elderly people in Washtenaw County, Michigan, was interviewed to determine the relationship between urinary incontinence and various health conditions. The results show that between both male and female respondents physical mobility problems, specific neurologic symptoms, lower urinary tract problems, bowel problems, respiratory problems, and history of genital surgery are more prevalent among those who are incontinent than among those who are continent. Additional factors associated with incontinence in females are: history of parent and sibling incontinence, incontinence either during pregnancy or postpartum, hearing problems, use of female hormones, and vaginal infections. Incontinence among males is associated with vision problems and a history of and symptoms of cardiovascular disease. These findings suggest urinary incontinence is part of a complex and multifactorial problem. Further studies are needed to confirm and explain these findings.

Polyps in the Gallbladder

The prevalence of gallbladder polyps as assessed by ultrasonography in a random population was 4.6% among men and 4.3% among women. The size of most polyps was 3 mm or more but never exceeded 10 mm. The prevalence of polyps was not significantly associated with age, sex, social factors, weight factors, physical activity, diabetes mellitus, pregnancies, use of exogenous female hormones, intake of alcohol, or plasma lipids. Polyps among men were significantly associated with a history of no smoking. This lack of risk factor profile resembled that of cholesterolosis, as seen in the literature, whereas it was quite different from that of gallstones. It is concluded that polyps in the gallbladder are common in a random population, and, although it is known from the literature that some cases may represent gallstones, the vast majority most probably represent the polypoid variation of cholesterolosis.

Exogenous female hormones and rheumatoid arthritis: a methodological view of the contradictions in the literature.

The purpose of this review is not to resolve the contradictory findings that are present in the literature. Rather, it considers a selected number of issues that may pertain to some future understanding of the current controversy. Furthermore, certain issues such as biological plausibility and the absence of a definitive dose, duration, or timing relationships are not discussed. If the association of the use of exogenous female hormones with the prevention of rheumatoid arthritis came to be accepted as likely causal, basic scientists might well unravel the biological processes involved. The dose and duration of exposure to the hormones and the timing of the exposure (current use versus past use) in relation to the preventative effect remains unclear. While clearly a point against a causal relationship the possibility exists that this may result from errors in recall or that prior hormone exposure may 'vaccinate' a woman against the disease. A number of studies have been published only in abstract or are still underway. Reanalysis of existing data sets may also provide some insight into the contradictory findings. The issues raised in this review are of relevance to investigators. They may also be used by readers interested in this topic who wish to attempt to resolve the conflicts in the hormone-rheumatoid arthritis literature for themselves.

Beliefs About Osteoporosis

To the Editor. —Dr Meuleman's review article Beliefs About Osteoporosis: A Critical Appraisal, 1 is useful. I trust that the following comments regarding this subject and his article are also useful. Measurements of bone mineral density utilizing dual photon absorptiometry are very precise (reproducible). This methodology (unlike all other techniques) permits repetitive accurate assessment of bone mineral density in the lumbar spine and the femoral neck. Therefore, it permits assessment of the effectiveness of a therapeutic strategy in the osteoporotic patient. It permits more rational decisions regarding the use of female gonadal hormones, fluorides, and calcitonin. This review (like most of our literature) focuses primarily on the women at risk. Males also develop osteoporosis and experience important fractures (of the femoral neck) as a consequence. Prediction of nonviolent fracture risk will not be clarified until longitudinal data of the frequency of these fractures is correlated with bone mineral density measurements

Reproductive and hormonal factors and breast cancer in a Northern Italian population.

Between January 1980 and March 1983, data were collected to evaluate risk factors for breast cancer in a case-control study based on 368 women with breast cancer admitted to the General Hospital of Pordenone (a district in North Eastern Italy with a particularly high breast cancer mortality rate), and 373 age-matched controls. Nulliparity or low parity, late age at first birth and later menopause were associated with an increased risk of breast cancer. The elevated risk associated with nulliparity could be almost completely explained by marital status, thus pointing to a specific protection given by parity, rather than some putative influence of infertility or subfertility in breast cancer cases. Likewise, risk did not vary materially according to history of abortions when marital status was controlled for. Increased risk associated with later age at first birth, on the other hand, was not accounted for by marital status or parity. The population studied, though frequently multiparous, showed late average at first birth: this might, at least partly, explain its high mortality rate from breast cancer. The risk estimate was higher if menarche occurred below age 15; however, there was no evidence of a trend for the relative risk to rise with lower age at menarche. The use of oral contraceptives or other female hormones (such as oestrogen replacement therapy) did not appear to be related to the risk of breast cancer. The role of the major menstrual and reproductive variables considered (age at menarche, parity, age at first birth) was apparently stronger in pre-menopausal women, thus suggesting an influence of these factors (and possibly, their hormonal correlates) on one of the latter stages of the process of carcinogenesis.

A administração de esteróides sexuais no inicio da gravidez provoca malformações fetais?

On the basis of recent literature review we cannot assume that the use of human female sex steroids at the beginning of pregnancy is related to human malformation syndromes in organs and tissues that are not those of the genital area. The literature references do not give us information which permits us to come to the conclusion that in special conditions to be better defined, these hormones will play a role in the causes of fetal malformations, based upon a dose effect or interaction with other environmental agents. We presume that this subject will be better studied in a prospective investigation with a large number of cases. Until the conclusion of such a study the use of sex female hormones during pregnancy should be avoided.

Effects of smoking on the development of female reproductive cancers.

The effect of smoking on the development of breast, endometrial, and ovarian cancers is evaluated among cases identified between November 1980 and July 1982 in the Iowa Surveillance, Epidemiology, and End Results Cancer Registry. Population-based, age-frequency matched controls were also evaluated, adjusting for potential confounders: Age, age of menarche, age of menopause, duration of menses, female family reproductive cancer history, obesity, parity, infertility, and lifetime steroid hormone use. Logistic regression analyses of total pack-years of cigarette exposure indicate that smoking is not significantly related to the development of breast cancer [relative risk (RR) = .99; confidence interval (CI) = .97, 1.02] or ovarian cancer (RR = 1.00; CI = 1.00, 1.00). Among women with endometrial cancer, the risk for those who smoke is increased among premenopausal women (RR = 1.27; CI = .65, 2.59) and decreased among postmenopausal women (RR = .41; CI = .16, 1.04).

Risk factors for pathologically confirmed benign breast disease.

Between November 1981 and March 1983, data were collected to evaluate risk factors for benign breast lesions in a case-control study based on 288 women with histologically proven benign breast disease, admitted for biopsy to the Tumor Institute of Milan, and 285 age-matched controls. Questions were asked about menstrual and reproductive characteristics, marital status, education, history of various diseases, and lifetime use of oral contraceptives and other hormonal treatments. Nulliparity or low parity, late age at first birth, and late menopause were associated with an increased risk of benign breast disease. The elevated risk associated with late age at first birth was not accounted for by parity. Early age at menarche was associated with an increased risk, but the estimate was not statistically significant. The data do not suggest that the use of oral contraceptives or other female hormones (such as estrogen replacement therapy) is related to the risk of benign breast disease. Risk was apparently lower, however, among current and long-term oral contraceptive users. There was no evidence of a trend with reference to body mass index. The present data indicate a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease, not only directly, by showing a relationship with parity, age at first birth, and age at menopause, but also indirectly, by failing to produce evidence that greater weight or the use of oral contraceptives has a protective effect.

Oestrogens and Obesity as Risk Factors for Endometrial Cancer in Italy

In a case-control study to evaluate risk factors for endometrial cancer, obesity, history of various diseases, reproductive and menstrual characteristics, marital status, education, and lifetime use of female hormones were examined in 173 histologically proven endometrial cancers and 347 controls. Obesity, non-contraceptive oestrogen use, late menopause, low parity and history of uterine fibromyomas were associated with an increased risk of endometrial cancer. The relative risks of obesity and oestrogen use seem to fit well for an additive model. Histological differentiation was positively correlated both to oestrogen use and to level of overweight, supporting the hypothesis of a specific role of oestrogens in endometrial cancer.

Use of postmenopausal hormones and risk of myocardial infarction.

Information was collected by mail survey about myocardial infarction (MI), use of female hormones after menopause, and coronary risk factors 121,964 registered nurses ages 30-55 years. One hundred twenty-three women with a known type of prior menopause reported hospitalization for MI. Overall, use of female hormones by these women was very similar to that of control women matched for age and type of menopause. Compared with nonusers, the relative risk (RR) for women who had ever taken female hormones was 0.9 (95% confidence limits 0.6-1.2), and for current users the RR was 0.7 (0.5-1.1). For women with bilateral oophorectomy, the RR for current users was 0.4 (0.2-0.8). These data imply that, at present, a decision to prescribe postmenopausal hormones should be based primarily on weighing possible benefits from the relief of menopausal symptoms against unknown or suspected risks of other diseases, particularly uterine cancer in women with an intact uterus.

High blood pressure and oral contraceptives: Changes in plasma renin and renin substrate and in aldosterone excretion

A group of patients is described in whom the development or augmentation of hypertensive disease was associated with use of oral contraceptives. The experience suggests a causal role for these hormonal substances in certain susceptible individuals. Factors which might sensitize to the pressor effect of these drugs remain undefined. However, the effect may be related to marked associated changes observed in certain components of the renin-angiotensin-aldosterone hormonal interaction. The contraceptive medications consistently produced large sustained increases in plasma concentration of renin substrate. Less consistently, transient or sustained increases in plasma renin and in aldosterone were also observed. Parallel in vitro studies demonstrated that renin substrate is normally not present in excess because the contraceptive-induced increased substrate concentration was always accompanied by a significantly increased capacity for angiotensin formation when renin was added to the plasma. It seems possible that, in certain susceptible subjects, these induced hormonal changes, together with associated changes in sodium metabolism, could compromise the buffer capacity of the renin-angiotensin-aldosterone hormonal system, permitting exaggerated (pressor) responses to circulating renin when it is released by the normal physiologic stimuli. These observations also may be relevant to the use of female hormones in other clinical situations, and they may be applicable to the study of hypertension in experimental models.

Smith, George Van S.: The Use of Female Sex Hormones in Disorders of Women: New England J. Med. 225: 719, 1941

Smith, George Van S.: The Use of Female Sex Hormones in Disorders of Women: New England J. Med. 225: 719, 1941

The Use of Female Sex Hormones in Disorders of Women

The Use of Female Sex Hormones in Disorders of Women