Hormone Replacement Therapy In Women Research Articles

Hormone replacement therapy in young women with surgical primary ovarian insufficiency.

Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency, an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy (HRT) most of these women develop severe symptoms of estrogen (E) deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality. In cases in which a hysterectomy has been performed at the time of bilateral oophorectomy transdermal or transvaginal E2 replacement therapy without cyclic progestin replacement is the optimum hormonal management for these women. There is substantial evidence this approach even reduces the risk for breast cancer. Unfortunately, unwarranted fear of all menopausal HRTs has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of E therapy, even in women in whom HRT is clearly indicated. Discussion of possible ovarian conservation in women who are premenopausal is an integral part of the preoperative planning for any women undergoing hysterectomy. Timely and effective HRT for women who will experience surgical primary ovarian insufficiency is clearly indicated.

Hormone replacement therapy for women previously treated for endometrial cancer

Hormone replacement therapy for women previously treated for endometrial cancer

Ovarian Hormone Replacement Therapy in Gynecological Cancer Survivors

The number of survivors after gynecological cancer is increasing. In order to improve their quality of life, the need was felt to review the present status of ovarian steroid hormone replacement therapy (HRT) in them. The purpose was to examine the published literature on menopause management in them and highlight the risks and benefits. The literature search on menopause management in cancer survivors was performed. The research and review articles in English language on the subject that were available and accessible were reviewed. And the recommendations and opinions were presented as working guidelines. Treatment of some of gynecological cancers and the breast cancer results in abrupt loss of ovarian function and severe menopausal symptoms. Use of HRT in women with a genetic predisposition for or development of a gynecological malignancy suggests no proven adverse oncologic effects as a result of short-term use. The main concerns are the potential stimulation of residual cancer and the induction of new hormone-dependent disease. The majority of the most common gynecological malignancies like squamous cell carcinomas of the cervix, serous papillary epithelial ovarian carcinomas and squamous cell carcinomas of the vulva are not estrogen dependent. HRT is not shown to adversely affect the outcome in patients after treatment for hormone-sensitive cancers like early-stage endometrioid adenocarcinomas of the endometrium. In cases with low-grade endometrial stromal sarcomas, it is an absolute contraindication. The option needs to be discussed individually with the survivor providing unbiased information.

ПРИМЕНЕНИЕ ПРЕПАРАТА НЕБИВАЛОЛ В КОМБИНАЦИИ С ГОРМОНАЛЬНОЙ ЗАМЕСТИТЕЛЬНОЙ ТЕРАПИЕЙ У ЖЕНЩИН СО СТАБИЛЬНОЙ СТЕНОКАРДИЕЙ ПРИ ИНТАКТНЫХ КОРОНАРНЫХ АРТЕРИЯХ

ПРИМЕНЕНИЕ ПРЕПАРАТА НЕБИВАЛОЛ В КОМБИНАЦИИ С ГОРМОНАЛЬНОЙ ЗАМЕСТИТЕЛЬНОЙ ТЕРАПИЕЙ У ЖЕНЩИН СО СТАБИЛЬНОЙ СТЕНОКАРДИЕЙ ПРИ ИНТАКТНЫХ КОРОНАРНЫХ АРТЕРИЯХ

Sa1892 Menopause and Hormone Replacement Therapy in Women with Inflammatory Bowel Diseases in CCFA Partners

Sa1892 Menopause and Hormone Replacement Therapy in Women with Inflammatory Bowel Diseases in CCFA Partners

ESHRE Guideline: management of women with premature ovarian insufficiency.

What is the optimal management of women with premature ovarian insufficiency (POI) based on the best available evidence in the literature? The guideline development group (GDG) formulated 99 recommendations answering 31 key questions on the diagnosis and treatment of women with POI. NA. This guideline was produced by a multidisciplinary group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to September 2014 and consensus within the guideline group on all recommendations. The GDG included a patient representative to ensure input from women with POI. After finalization of the draft, the European Society for Human Reproduction and Embryology (ESHRE) members and professional organizations were asked to review the guideline. NA. The guideline provides 17 recommendations on diagnosis and assessment of POI and 46 recommendations on the different sequelae of POI and their consequences for monitoring and treatment. Furthermore, 24 recommendations were formulated on hormone replacement therapy in women with POI, and two on alternative and complementary treatment. A chapter on puberty induction resulted in five recommendations. The main limitation of the guideline is that, due to the lack of data, many of the recommendations are based on expert opinion or indirect evidence from studies on post-menopausal women or women with Turner Syndrome. Despite the limitations, the guideline group is confident that this document will be able to guide health care professionals in providing the best practice for managing women with POI given current evidence. Furthermore, the guideline group has formulated research recommendations on the gaps in knowledge identified in the literature searches, in an attempt to stimulate research on the key issues in POI. The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the implementation of the guideline. The guideline group members did not receive payment. Dr Davies reports non-financial support from Novo Nordisk, outside the submitted work; the other authors had nothing to disclose. NA.

Основные проблемы старения и ограниченные возможности заместительной гормональной терапии у женщин

Основные проблемы старения и ограниченные возможности заместительной гормональной терапии у женщин

Metabolic Syndrome and Osteoporosis in Relation to Muscle Mass.

This study aimed to examine the relationship between metabolic syndrome (MetS) and osteoporosis according to muscle mass levels and the joint relationship of MetS and muscle mass with osteoporosis in a representative population-based sample from the Korea National Health and Nutrition Examination Survey in 2010-2011. In 1654 men and 1979 women aged 50-93 years, body composition and bone mineral density at the femur and lumbar spine were measured using dual-energy X-ray absorptiometry. Low- and high-muscle mass groups were identified using the mean sex-specific muscle mass of appendicular muscle mass/height(2). The covariates were age, health behaviors, serum 25-OH vitamin D and parathyroid hormone, calcium intake, and hormone replacement therapy for women. Men and women with MetS (defined by the Adult Treatment Panel III) had 43 and 31% lower odds for osteoporosis, respectively, compared with their MetS-free counterparts after adjusting for muscle mass and covariates. When stratified by muscle mass, MetS was not associated with osteoporosis in men, while associated in women with higher muscle mass (OR 0.65, 95% CI 0.46-0.91). Compared with MetS-free men and women with lower muscle mass, the odds for osteoporosis were 45% and 23, 52 and 15%, and 72 and 46% lower among those with low muscle mass and MetS, high muscle mass without MetS, and high muscle mass and MetS, respectively (P for trend <0.001). Combination of high muscle mass and MetS was associated with lower prevalence of osteoporosis in Korean men and women.

Association of sex hormones with carotid artery distensibility in men and postmenopausal women: multi-ethnic study of atherosclerosis.

The decline in carotid distensibility with age is steeper in women than in men, however, the correlates of this sex difference are not known. We examined the association of bioavailable testosterone, estradiol, dehydroepiandrosterone, and sex hormone-binding globulin, in 2783 postmenopausal women and 2987 men aged 45 to 84 years at the Multi-Ethnic Study of Atherosclerosis baseline examination. Carotid artery lumen diameters by ultrasound and brachial artery blood pressures were measured at systole and diastole. Regression models to determine the association of carotid distensibility coefficient and lumen diameter with sex-specific quartiles of sex hormones were adjusted for age, race, height, weight, diabetes mellitus, current smoking, antihypertensive medication use, total and high-density lipoprotein cholesterol levels, and hormone replacement therapy in women. A higher DC indicates a more distensible vessel. In women, higher dehydroepiandrosterone (P=0.008) and lower sex hormone-binding globulin (P=0.039) were associated with lower distensibility; higher dehydroepiandrosterone and lower estradiol were associated with smaller carotid diameters. In men, higher Bio-T (P=0.009) and lower estradiol (P=0.007) were associated with greater distensibility and also with smaller diameters (P=0.012 and 0.002, respectively). An androgenic internal milieu is associated with lesser carotid distensibility and diameter remodeling in women, but the opposite is true for men. Higher levels of estradiol are associated with smaller carotid diameters in both the sexes. Future longitudinal and experimental studies are needed to reveal the mechanism and clinical consequences of these associations.

Potential benefits of berberine in the management of perimenopausal syndrome.

Cardiovascular diseases are one of the leading causes of morbidity and mortality in women after menopause and 56% of all causes of death in Western European countries. Nowadays, with increasing life span, women spend approximately one-third of their life-time in postmenopausal state; therefore, the development of new strategies to improve the prevention and treatment of menopause-associated pathologies is important topic in clinical practice. The studies to assess the safety of hormone replacement therapy in women with estrogen deficiency have not been conclusive due to the relative contraindications; therefore, hormone replacement therapy is prescribed only in selected cases and for a limited time. For this reason, today women are encouraged to use naturally available compounds to prevent or to attenuate menopausal symptoms and correlated pathologies, with fewer side effects. Among these compounds, berberine, an isoquinoline alkaloid derived from plants of the generis Berberis, has been recognized as being capable of decreasing oxidative stress, LDL, triglycerides, and insulin resistance and of improving the mood. This review describes the cellular and clinical effects associated with the use of berberine, which suggest that this molecule could be an effective natural supplement to ensure a smooth peri- and postmenopausal transition.

Correction of early menopausal disorders in women with anamnesis of uterine myoma

The study of the efficacy and safety of using Sagenit in patients with uterine myoma in the anamnesis and menopausal disorders in early menopause was performed. 52 women with neurovegetative symptoms during menopause of 2 years were under the supervision. Sagenit effectively normalized hormones, quickly relieved the early perimenopausal disorders. Sagenit is not associated with sensitive receptors reproductive organs, does not lead to proliferative changes in the uterus and can be used as the drug of choice alternative to hormonal replacement therapy in women with uterine myoma in the anamnesis and climacteric disorders in early menopausal.

Hormone therapy in survivors of gynaecological and breast cancer

Key content Gynaecological and breast cancers affect premenopausal and perimenopausal women at rates ranging 15–70% and treatment often causes the abrupt onset of menopause. Available studies do not show an increase in recurrence or decrease in survival among women with endometrial, ovarian or cervical cancer who use hormone replacement therapy (HRT). Data regarding the risks of systemic HRT in survivors of breast cancer are varied, and an increase in breast cancer recurrence with the use of systemic HRT has been demonstrated in randomised controlled trials. Limited data exist regarding the use of vaginal estrogen, however, no effect on recurrence has been demonstrated. The decision regarding the use of HRT in women with cancer must be individualised and should take into account issues regarding quality of life. Learning objectives To review the evidence regarding the cancer‐specific risks, that is, recurrence or death, of HRT in survivors of gynaecological and breast cancer. To provide recommendations for the use of HRT in survivors of gynaecological and breast cancer. Ethical issues How to balance the risks of HRT with quality of life concerns in survivors of gynaecological and breast cancer when evidence to guide our recommendations is limited?

Use of selective modulators of estrogen receptors in the treatment of menopausal symptoms

We evaluated the effectiveness of the drug Sahenit in women with climacteric syndrome of varying degrees of severity. Established that drug Sahenit is a selective estrogen receptor modulators that is highly effective in treatment of psycho-emotional and neurovegetative disorders in menopause. The lack of proliferative effect of the drug on the endometrium of the uterus enables its extensive use as an alternative to hormone replacement therapy in women in risk group and with complicated gynecological history.

Antiestrogenic effects of the fetal estrogen estetrol in women with estrogen-receptor positive early breast cancer.

Estetrol (E4) is a fetal estrogen with estrogenic effects on reproductive organs and bone in preclinical models and in postmenopausal women. However, E4 exerts antiestrogenic effects on breast cancer (BC) cell growth in vitro and in vivo. We have investigated the effect of 14 days preoperative treatment with 20mg E4 per day on tumor proliferation markers, sex steroid receptor expression and endocrine parameters in a prospective, randomized, placebo-controlled, preoperative window trial in 30 pre- and post-menopausal women with estrogen-receptor positive early BC. E4 had a significant pro-apoptotic effect on tumor tissue, whereas Ki67 expression remained unchanged in both pre- and post-menopausal women. E4 increased sex-hormone-binding globulin significantly thereby reducing the concentrations of bioavailable estradiol. Follicle-stimulating hormone levels decreased in postmenopausal women only and luteinizing hormone levels remained unchanged. Systemic insulin growth factor-1 levels decreased significantly. Intratumoral epithelial ERα expression decreased significantly and a trend was found towards an increased expression of ERβ. This clinical data support the preclinical findings that E4 has antiestrogenic effects on BC cells, whereas earlier studies have shown that E4 has estrogenic effects on reproductive tissues and bone. Further clinical studies seem acceptable and are needed to confirm the safety and efficacy of E4 for the breast in hormone replacement therapy, including hormone replacement therapy in women who have or have had BC, especially in those BC patients treated with aromatase inhibitors and suffering from serious complaints due to estrogen deficiency.

Functions of Danggui Buxue Tang, a Chinese Herbal Decoction Containing Astragali Radix and Angelicae Sinensis Radix, in Uterus and Liver are Both Estrogen Receptor-Dependent and -Independent.

Danggui Buxue Tang (DBT), a herbal decoction containing Astragali Radix (AR) and Angelicae Sinensis Radix (ASR), has been used in treating menopausal irregularity in women for more than 800 years in China. Pharmacological results showed that DBT exhibited significant estrogenic properties in vitro, which therefore suggested that DBT could activate the nuclear estrogen receptors. Here, we assessed the estrogenic properties of DBT in an ovariectomized in vivo rat model: DBT was applied to the ovariectomized rats for 3 days. The application of DBT did not alter the weight of uterus and liver, as well as the transcript expression of the proliferation markers including the estrogen receptors α and β. However, DBT stimulated the transcript expression of the estrogen responsive genes. In addition, the inductive role of DBT on the expression of members of the aryl hydrocarbon receptor family in uterus and liver of ovariectomized rats was confirmed. These responses of DBT however were clearly distinct from the response pattern detectable here for 17β-estradiol. Therefore, DBT exhibited weak, but significant, estrogenic properties in vivo; however, some of its activities were independent of the estrogen receptor. Thus, DBT could be an exciting Chinese herbal decoction for an alternative treatment of hormone replacement therapy for women in menopause without subsequent estrogenic side effects.

Abstract 18168: Plasma Free Fatty Acids, Fatty Acid-Binding Protein 4, and Mortality in Older Adults in the Cardiovascular Health Study

Background: Plasma free fatty acids (FFA) are important in energy homeostasis and fatty acid-binding protein 4 (FABP4) is a key cytoplasmic chaperone of fatty acids. While both FFA and FABP4 have been associated with cardiovascular risk factors and cardiovascular events, limited and inconsistent data are available on the relation of these biomarkers with cardiovascular and total mortality. Methods and Results: We studied 4,707 participants with plasma FFA and FABP4 measured at baseline (1992-1993) in the Cardiovascular Health Study. The mean age of the participants was 75 (range 64-98) and 58.3% were women. Over a median follow-up of 11.8 years, 3,555 of the participants died. Cox proportional hazard models were used to estimate hazard ratios (HR) for mortality. After adjustment for age, sex, race, clinic, education, body-mass index, cystatin c, albumin, physical activity, alcohol intake, smoking, hormone replacement therapy in women, self-reported health status, systolic blood pressure, LDL cholesterol, HDL cholesterol, hypertensive medication, and lipid-lowering medication, FFA (HR: 1.14, 95% CI 1.09-1.18 per SD [0.2 mEq/L] higher FFA) but not FABP4 (HR: 1.04 (95% CI: 0.98-1.09 per SD [18.9 ng/mL] higher FABP4) levels were associated with total mortality. In a cause-specific mortality analysis, higher concentrations of FFA were associated with a greater risk of death due to cardiovascular and certain non-cardiovascular causes (Table 1). Conclusion: In a cohort of community-dwelling older individuals, elevated plasma concentrations of FFA (but not FABP4) were associated with cardiovascular and non-cardiovascular mortality.

Hormone replacement therapy for women with type 1 diabetes mellitus

There is conflicting information about the impact of the menopause on glycaemic control amongst women with type 1 diabetes. Some menopausal women with type 1 diabetes are treated with hormone replacement therapy (HRT) but the effects of this treatment have, to date, not been established. To assess the effects of HRT for women with type 1 diabetes mellitus. We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO from their inception to June 2012. Thelast search was run for all databases on 18 June 2012. We selected randomised controlled trials or controlled clinical trials that involved peri- or postmenopausal women with type 1 diabetes undergoing HRT as an intervention. Two researchers independently applied the inclusion criteria to the identified studies and assessed risk of bias. Disagreements were resolved by discussion or by intervention by a third party. Descriptive analysis was conducted for the review. Ninety-two publications were screened. No studies met the inclusion criteria exclusively but one study that included both type 1 and type 2 diabetes participants was considered.This randomised clinical trial (RCT) compared HRT (N = 27) with placebo (N = 29) over 12 months. The outcome measures were cardiovascular risk factors, including lipid profile, glycaemic control, blood pressure and body weight. No significant differences between placebo and HTR were detected. Patient-important outcomes like all-cause mortality, cardiovascular disease, diabetic complications or health-related quality of life were not investigated. There is a lack of evidence around the use of HRT in women with type 1 diabetes. The one study that has been undertaken in this area is underpowered. More RCTs are required in the area to examine the impact of HRT on glycaemic control and cardiovascular outcomes.

Menopausal Symptoms after the Discontinuation of Long-Term Hormone Replacement Therapy in Women under 60: A 3-Year Follow-Up

Background: Prescriptions for hormone replacement therapy (HRT) declined following the publication of the Women's Health Initiative study. The number of women who experience recurrence of menopausal symptoms after discontinuation of long-term HRT (LT-HRT), the length of time these symptoms last and the preferred alternative treatments remain unknown. Methods: This prospective 3-year follow-up study analyses the prevalence and intensity of menopausal symptoms that occur in young postmenopausal women who discontinued LT-HRT. Symptoms were evaluated using the Menopause Rating Scale. Results: Women (254) who discontinued LT-HRT (mean use: 6.9 ± 2.3 years) were recruited. Mean age at menopause was 48.1 ± 3.4 years. Mean age at discontinuation was 56.8 ± 3.7 years. 23% of the women were lost to follow-up. Of the remaining 196 women, 93% experienced a recurrence of menopausal symptoms within the first year, 25% resumed low-dose HRT, 62% used vaginal estrogens, 54% used phytoestrogens, and 2% used alternative therapies. A decrease in symptom prevalence and intensity was observed during the 3-year follow-up. Conclusions: Symptoms re-appeared in a significant proportion of patients within the first year after discontinuation of LT-HRT. However, after 3 years, the majority of these women were asymptomatic. Patients who discontinue LT-HRT may require a more detailed follow-up immediately after the discontinuation of treatment.

Hormone replacement therapy (HRT) prescribing patterns among gynecologic oncologists.

e20637 Background: Gynecologic cancer survivors have indicated inadequate treatment of their menopausal symptoms; and while HRT can significantly improve quality of life (QOL) its safety is still debated. Our objective was to evaluate HRT practice patterns and identify potential barriers to prescribing HRT among gynecologic oncologists (GO). Methods: SGO members with active electronic mail (n=823) were queried with single answer and Likert-style questions using an internet-based program. Email reminders were sent at 3, 6, and 9 weeks. Results: Of 207 respondents (25%), 123 (59%) were male and 84 (41%) female. Providers identified personal history of blood clot (81.5%) or breast cancer (75.6%) as contraindications to prescribing HRT. More women than men cited breast cancer and personal history of a blood clot (p=0.038, p=0.08) as contraindications. HRT candidates were women with vasomotor symptoms (sx)(96.1%), those at risk for osteoporosis (55.1%), and postmenopausal women (47.8%). Sx considered amenable to HRT were hot flashes (98.5%), vaginal atrophy (89.3%) and osteoporosis (60%). Fewer women than men (p=0.02) thought HRT was acceptable treatment for vaginal atrophy. Most practitioners would recommend HRT for sexual dysfunction (61.5%). Physicians indicated that they would prescribe HRT for ovarian (55.1%) and endometrial (58.7%) cancer survivors in surveillance. Compared to females, males were more likely to prescribe HRT to ovarian cancer patients who were newly diagnosed (p=0.005), disease-free after adjuvant chemotherapy (p=0.004), on surveillance (p&lt;0.001), or with recurrent disease (p=0.008). Similar trends occurred with endometrial cancer patients. 75% of physicians would prescribe HRT for women with cervical, vaginal, or vulvar cancer following definitive treatment. There was no consensus regarding the duration of HRT once initiated for any cancer. Interestingly, 56-71% of respondents cited evidence- based medicine as the basis for their recommendations. Conclusions: Our survey demonstrated a wide spectrum in HRT prescribing patterns of GO. As more emphasis is placed on QOL and survivorship, rigorous study of the outcomes of HRT use in our patients is of paramount importance.

An update on menopausal hormone replacement therapy in women and cardiovascular disease

This review presents the available evidence for effects of menopausal hormone replacement therapy (MHT), more specifically estrogen, and selective estrogen receptor modulators on the cardiovascular system with a focus on randomized controlled trials (RCTs) published since 2010. In contrast to early observational studies, the Women's Health Initiative, the largest randomized controlled trial of MHT in generally healthy women, suggested harmful cardiovascular effects. Subsequent subanalyses of the Women's Health Initiative and other studies suggest the cardiovascular effects of MHT may vary by age and time since menopause, giving rise to a 'timing hypothesis'. Recent trials have looked at this issue by evaluating surrogate markers of cardiovascular disease (CVD) or CVD events adjudicated as secondary outcomes in RCTs and show a reduction in events with MHT. Athough the data overall do not support the use of MHT or selective estrogen receptor modulator for primary prevention of CVD, evidence is accumulating that careful use of MHT for perimenopausal symptoms may not carry CVD harm. This review highlights some of the strengths and weaknesses of these recent reports. Ongoing studies of MHT will shed more light on the interaction between age or time after menopause and the vascular effects of MHT.