Use Of Hormone Therapy In Women Research Articles

Postmenopausal Osteoporosis: Menopause Hormone Therapy and Selective Estrogen Receptor Modulators.

Osteoporosis is a debilitating silent disease with a huge socio-economic impact. Prevention strategies and early detection of osteoporosis need to be carried out in every health care unit to substantially reduce the fracture rates. Indian studies have indicated a knowledge gap on diagnosis and management of osteoporosis amongst medical professionals and consumers. This article reviews the evidences available on searches from PubMed and The National Library of Medicine, author's opinions based on clinical experience. There is a need for escalating the efforts to bridge the knowledge gap regarding various aspects of osteoporosis amongst professionals and consumers. Three indications for postmenopausal hormone therapy (HT), which have constantly withstood the test of time, are symptom relief, urogenital atrophy, and bone health. This article specifically focuses on management of postmenopausal osteoporosis by HT alone or in combinations. Early menopause is within 10years of menopause and late menopause is considered beyond 10years of menopause. HT is a cost-effective therapy in the early post menopause especially in symptomatic women at risk for osteoporosis unless contraindicated. HT prevents all osteoporotic fractures even in low-risk population. All HT preparations including low dose and non-oral routes of estrogen are effective for bone health. The bone protective effect lasts while on HT. Extended use of HT in women after 10years of menopause with reduced bone mass is an option after detailed counselling of the risk benefit analysis compared with the other available therapies for osteoporosis. The primary therapy to prevent bone loss in women with premature menopause and secondary amenorrhea is HT. HT work up and annual follow-up is essential before prescribing HT.

DNA methylation profiling to explore colorectal tumor differences according to menopausal hormone therapy use in women.

Aim: Use of menopausal hormone therapy (MHT) has been associated with a reduced risk for colorectal cancer, but mechanisms underlying this relationship are not well understood. In the colon, MHT appears to act through estrogen receptor β (ERβ) which may influence DNA methylation by binding to DNA. Using genome-wide methylation profiling data, we aimed to identify genes that may be differentially methylated according to MHT use. Materials & methods: DNA methylation was measured using Illumina HumanMethylation450k arrays in two independent tumor sample sets of colorectal cancer patients. Differential methylation was determined using R/limma. Results: In the discovery analysis, two CpG sites showed differential DNA methylation according to MHT use, both were not replicated. In stratified analyses, 342 CpG sites were associated with current MHT use only in ERβ-positive tumors. Conclusion: The suggestive findings of differential methylation according to current MHT use in ERβ-positive tumors warrant further investigation.

Use of hormone therapy (HT) among Swedish women with contraindications – A pharmacoepidemiological cohort study

ObjectivesTo assess how women in Sweden with breast cancer (BC), endometrial cancer (EC), and/or pulmonary embolism (PE) were dispensed menopausal hormone therapy (HT). Study designA retrospective study of Swedish women aged 40 years or more on 31 December 2005 (n = 2,863,643), followed through to December 2011. The study analysed three mandatory national healthcare registries: the Swedish Prescribed Drug Register, the National Inpatient Register and the Cancer Register. New users were defined as having a first dispensation after at least a 9-month break, and thus were possible to identify from April 2006. New users with at least one of the diagnoses BC, EC or PE before the first dispensation were classified as having a relative or absolute contraindication for HT. Main outcome measuresThe relative risks of having HT dispensed after being diagnosed with BC, EC and/or PE. ResultsIn total, 171,714 women had at least one of the diagnoses BC, EC or PE. The relative risk of having hormone therapy dispensed (current and new users) after being diagnosed with any of the diagnoses was significantly lower (PE, IRR 0.11, 95% CI 0.10–0.12;/ BC, IRR 0.12, 95% CI 0.11–0.13; EC, IRR 0.43, CI 0.40–0.46) than for women without these diagnoses. ConclusionsOne in about 250 women started treatment with HT after being diagnosed with BC, PE or EC. Swedish prescribers seem to be well aware of the recommendations for HT use in women with contraindications. A few women, however, are prescribed HT despite having BC, EC or PE, possibly after careful evaluation of the risks and benefits and giving informed consent. Women with a history of PE were prescribed transdermal HT to a larger extent than women in general, in line with results from observational studies.

Prevalence of hormone therapy, factors associated with its use, and knowledge about menopause: a population-based household survey.

The aim of the study was to assess the prevalence of hormone therapy (HT), the factors associated with its use, and the importance of knowledge about menopause and HT. A cross-sectional population-based study with 749 Brazilian women aged 45 to 60 years living in the Campinas Metropolitan Region was carried out between September 2012 and June 2013. The dependent variable was current or previous HT use. The independent variables were sociodemographic data, health-related problems, and knowledge about menopause assessed using a score that was obtained with a questionnaire on various aspects of menopause. The mean age of the women was 52.5 (±4.4) years. With regard to the menopause status, 16% were premenopausal, 16% were perimenopausal, and 68% were postmenopausal. Among all the women included, 19.5% reported current or previous HT use. In multiple regression analysis, being postmenopausal (prevalence ratio [PR] 2.76; 95% CI, 1.74-4.38), receiving information about menopause from physicians and health service workers (PR 2.73; 95% CI, 1.91-3.89), having bilateral oophorectomy (PR 2.18; 95% CI, 1.49-3.17), experiencing work interruption due to hot flashes (PR 1.44; 95% CI, 1.03-2.01), and having extensive knowledge about menopause (PR 1.12; 95% CI, 1.05-1.19) were associated with a higher prevalence of HT use. The prevalence of HT use was 19.5%. Menopause status, information source, surgical menopause, work interruption due to hot flashes, and knowledge about menopause were associated with HT use. Education promoted by healthcare systems can increase HT use in women who have indications for treatment.

Is Hormone Replacement Therapy Safe in Women With a BRCA Mutation?

Women with a BRCA1 or BRCA2 mutation are recommended to undergo prophylactic (or risk reducing) bilateral salpingo-oophorectomy (BSO) before age 40, resulting in surgical menopause. Given the concerns of estrogen deprivation on overall health, hormone therapy (HT) is often discussed, yet safety concerns persist. We performed a systematic literature review of the safety of HT in women with a BRCA mutation undergoing prophylactic BSO. Although there remains a paucity of data on this topic, as evidenced by this systematic review of the contemporary literature, these patients do benefit from treatment, especially as it relates to menopausal symptoms without an apparently increased risk of breast cancer. Decisions regarding the use of HT in women who undergo BSO after detection of a BRCA mutation must be individualized based on careful consideration of the risks and benefits. However, the risks of a subsequent cancer diagnosis appear small, particularly in regards to the benefits of treatment afforded by HT.

Changes in Invasive Breast Cancer and Ductal Carcinoma In Situ Rates in Relation to the Decline in Hormone Therapy Use

To assess trends in invasive breast cancer and ductal carcinoma in situ (DCIS) incidence in association with changes in hormone therapy (HT) use in regular mammography screeners. We included 2,071,814 screening mammography examinations performed between January 1997 and December 2006 on 696,385 women age 40 to 79 years; 9,586 breast cancers were diagnosed within 12 months of a screening examination. We calculated adjusted annual rates (mammogram level) for prevalent HT use, incident invasive breast cancer (overall and by tumor histology and estrogen receptor [ER] status), and incident DCIS. After a precipitous decrease in HT use in 2002, the incidence of invasive breast cancer decreased significantly in 2002 to 2006 among women age 50 to 69 years (P(trend(2002-2006)) = .005) and 70 to 79 years (P(trend(2002-2006)) = .003) but not in women age 40 to 49 years (P(trend(2002-2006)) = .45). DCIS rates significantly decreased in women age 50 to 69 years after 2002 (P(trend(2002-2006)) = .02). Invasive ductal tumors significantly declined in women age 50 to 69 years and 70 to 79 years in 2002 to 2006. In women age 50 to 69 years, invasive lobular and ER-positive cancer rates declined steadily in 2002 to 2005 (P(trend(2002-2005)) = .02 and .03, respectively), but an elevated rate in 2006 rendered the overall trend nonsignificant (P(trend(2002-2006)) = .89 and .91, respectively). In parallel to the sharp decline in HT use in women undergoing regular mammography screening, invasive breast cancer rates decreased in women age 50 to 69 and 70 to 79 years after 2002, and DCIS rates decreased in women age 50 to 69 years, consistent with evidence that HT cessation reduces breast cancer risk. However, the decrease in incidence may have started to level off in 2006; this finding has not been uniformly reported in other populations, warranting further investigation.

Soy use and vasomotor symptoms: Soy Estrogen Alternative follow-up study

PurposeTo evaluate vasomotor symptoms and soy and hormone therapy use in women who had previously participated in the Soy Estrogen Alternative (SEA) study, a trial conducted to compare the effects of soy protein supplements containing differing levels of isoflavones on menopausal symptoms, chronic disease risk factors, and health-related quality of life in perimenopausal and postmenopausal women.Participants and methodsTwo years after the SEA study ended participants were recontacted to complete questionnaires to quantify their health status, medications, menopausal symptoms, and their use of hormone therapy and soy-based foods and supplements. Participants were also asked to record vasomotor symptoms for seven days.ResultsSurveys were collected from 182 of the 241 participants who had been enrolled in the SEA study (76% response rate). Women were 55 ± 2.8 years of age, well educated (80% more than high school), and 93% reported good to excellent health. All but six reported experiencing at least one menopausal symptom, and 56% reported one or more hot flashes on one or more days. Eighty-one women (45%) continued to use soy for menopausal symptom relief, and 58 (32%) were using hormone therapy. Women taking hormone therapy were experiencing fewer and less severe hot flashes than those who were not taking hormone therapy (P < 0.001); hot flash frequency and severity did not differ significantly between those who did and did not use soy, after controlling for hormone therapy use.ConclusionMost participants reported they were still experiencing menopausal symptoms. Additionally, half of the most symptomatic women (not taking hormone therapy) were still consuming soy products for vasomotor symptoms.

Abstract 2808: Alcohol consumption and mortality in men and women in a large prospective cohort study

Abstract Previous studies have shown moderate drinking of alcohol to be inversely related to heart disease but heavy drinking directly associated with some cancers and other chronic diseases. Moreover, there has been some question about whether the relation between alcohol and health differs by sex. We therefore investigated alcohol consumption in relation to both total and cause-specific mortality in the National Institutes of Health (NIH)-AARP Diet and Health study, a large prospective cohort of men and women. The NIH-AARP study recruited over 500,000 men and women, 50-71 years old and living in one of eight states in 1995-96. At baseline, we assessed diet including alcohol with a food frequency questionnaire and collected information on demographics, lifestyle, and medical history. Vital status and specific causes of death were ascertained through a periodic linkage of the cohort to the Social Security Administration Death Master File and the National Death Index Plus. We estimated relative risks (RR) and 95% confidence intervals using Cox proportional hazards models adjusting for age, race, body mass index, marital status, self-rated health status, physical activity, smoking status, time since quitting smoking, smoking dose, aspirin use, menopausal hormone therapy use in women, and intakes of red meat and total energy. After excluding participants with prevalent cancer and chronic diseases, the analytic cohort consisted of 218,953 men and 168,660 women. During an average of 9 years of follow-up, we identified a total of 20,081 deaths in men and 11,246 deaths in women. 18% of the men and 26% of the women did not drink alcohol, whereas 12% of the men drank 3+ drinks/day and 5% of women drank 2+ drinks/day. In men, compared to 2-0-&amp;lt;2/wk, 4-&amp;lt;7/wk, 1-&amp;lt;2/day, 2-&amp;lt;3/day, 3-&amp;lt;6/day, and 6+/day were 1.23, 1.05, referent, 0.99, 0.99, 0.99, 1.17 and 1.35 for of total mortality; 1.09, 0.97, referent, 0.83, 0.83, 0.90, 1.11, and 1.15 for cardiovascular disease (CVD) death; and 1.19, 1.06, referent, 1.04, 1.04, 1.01, 1.17, and 1.34 for cancer death. In women, compared to 2-0-&amp;lt;2/wk, 4-&amp;lt;7/wk, 1-&amp;lt;2/day, 2-&amp;lt;4/day, and 4+/day were 1.20, 1.01, referent, 0.95, 1.06, 1.21, and 1.32 for total death; 1.48, 1.15, referent, 1.21, 1.07, 1.34, and 1.59 for CVD death; and 1.03, 0.96, referent, 0.85, 0.98, 1.18, and 1.30 for cancer death. Non-drinkers, compared to 2-&amp;lt;4/wk drinkers, had increased risk of total and cancer death in men and total and CVD death in women. Among drinkers, men with &amp;lt;3 drinks/day and women with &amp;lt;2 drinks/day showed lowered risk of CVD death, but not of total and cancer death. Men consuming 3+ drinks/day and women consuming 2+ drinks/day had significantly increased risk of total, CVD and cancer death. In conclusion, the effect of alcohol on mortality may differ by sex, disease and the amount consumed. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2808.

Hormone therapy and stroke: Is it all about timing?

Although women have a lower incidence of stroke than men in most age groups, women have an overall increased lifetime risk of stroke. Women also have unique risk factors for stroke, including the menopausal transition, the existence of debilitating vasomotor symptoms for some women, and the issues related to hormonal treatment for those symptoms. Although the initial studies of hormone therapy (HT) use in postmenopausal women suggested significant protection against heart disease, there was no obvious protection against stroke. Randomized trials of HT for secondary prevention showed a lack of benefit for both heart disease and stroke, and the suggestion of some early risk after initiation. However, the Women's Health Initiative (WHI), a primary prevention study of the impact of HT on women aged 50 to 79 years, showed an increased risk of stroke, whether the HT was estrogen alone or estrogen combined with progestin. Therefore, HT is not recommended for stroke prevention, and it appears to cause harm. The reason for this increased stroke risk is not understood, but some have suggested that the initiation of HT closest to the time of menopausal transition should decrease the risk. Although there was a lower risk of heart disease when HT was initiated earlier, the risk appeared to be the same for stroke regardless of the timing. This was shown in both the WHI and the Nurses' Health Study cohorts. Therefore, more research is needed to understand the mechanisms for the increased stroke risk and to identify those who may be at risk because of HT for vasomotor symptoms, atrophic vaginitis, or osteoporosis, the three remaining indications for HT use in women. Trials are under way to assess the intermediate outcomes of HT on subclinical vascular disease in perimenopausal/early postmenopausal women.

P2-393: Cognitive benefits of hormone therapy use in women matched for cardiovascular risk factors

P2-393: Cognitive benefits of hormone therapy use in women matched for cardiovascular risk factors

Raloxifene reduced vertebral fractures and breast cancer regardless of prior hormone therapy use in women

Johnell O, Cauley JA, Kulkarni PM, et al. Raloxifene reduces risk of vertebral fractures and breast cancer in postmenopausal women regardless of prior hormone therapy. J Fam Pract 2004;53:789–96. [OpenUrl][1][PubMed][2][Web...