Impact Of Hormone Replacement Therapy Research Articles

Hypothyroidism in older adults: A narrative review.

The prevalence of hypothyroidism increases along with aging, resulting in one of the most common comorbidities among patients over 75 years. The leading causes of hypothyroidism in older adults are iatrogenic, Hashimoto's thyroiditis, and medications. The narrative review aimed to discuss the clinical characteristics of hypothyroidism in older adults and the impact of hormonal replacement therapy on survival rates. Thyroid function declines over time due to physiological changes in the thyroid stimulating hormone signaling, iodine absorption and metabolism, thyroid hormone metabolism, and activity at peripheral sites. A serum TSH value over the upper limit of the normal reference range is not necessarily attributable to hypothyroidism. However, an appropriate diagnostic work-up is required to rule out true hypothyroidism and discriminate the etiology (i.e., thyroid autoimmune diseases, iodine deficiency, drug-induced hypothyroidism). Levothyroxine treatment should be considered in cases of overt hypothyroidism. A complete risk-to-benefit assessment, particularly considering the overall health status, life expectancy, cognitive function, mood, and cardiovascular and neurological background, should be considered before treating subclinical hypothyroidism with more potential benefits in patients under 75 years old. Levothyroxine formulations facilitating hormone absorption and increasing compliance to long-term treatment should be preferred. TSH target should usually be set over 3 mIU/ml. Defining optimal diagnostic approaches and targeted therapeutic strategies should be considered in the personalized management of aged patients with hypothyroidism.

Impact of hormone replacement therapy on cardiovascular risk in patients with hypothyroidism: a systematic review

Hypothyroidism, which is developed in 4-10 % of the population, and subclinical hypothyroidism found in more than 10 % of people which are highly associated with cardiovascular pathophysiology at some level. Hypothyroidism, which is the most frequent endocrine disorder with a lack of enough thyroid hormones, presents a wide range of cardiovascular complications, including coronary artery disease, heart failure, and dyslipidemia. Thyroid hormone replacement therapy, particularly levothyroxine (LT4), continues to be the central management of hypothyroidism, which aims to restore euthyroidism and other cardiac comorbidities as well as relieving symptoms. Nonetheless, the complex interworking of thyroid function and cardiovascular health requires a detailed clarification of the processes associated with disease development and drug therapy. Hypothyroidism triggers a chain of cardiovascular alterations such as aberrant lipid metabolism, endothelial dysfunction, and lessened cardiac contractility primarily by lowering the thyroid hormone level. Besides, these modifications eventually lead to raised rates of atherosclerosis, myocardial infarction, and heart failure. LT4 replacement therapy achieves normalization of hyperthyroidism with the replacement of thyroid hormone deficiency, which restores the cardiovascular system to normal by doing so. LT4 modulates lipid metabolism, improves endothelial function, and stimulates myocardial contractility via several different mechanisms. LT4 therapy acts on systemic inflammation and oxidation to accentuate the protective effects of the cardiovascular system. Apart from this, there is an increasing awareness about the use of new thyroid hormone formulations, like LH4, in the therapy of hypothyroidism. LH4, the thyromimetic compound, demonstrated a similar binding affinity at the thyroid hormone receptor as T3 (triiodothyronine) but with better tissue selectivity and more metabolic stability. Clinical trials have proven the potency of LH4 in lowering symptoms of hypothyroidism, for example, fatigue, weight gain which are leading cause of cardiovascular disorders. LH4 administration has been safe for up to six months, and only mild adverse effects have been reported when it is used more than a year.

Hormone Replacement Therapy and Risks of Various Cancers in Postmenopausal Women with De Novo or a History of Endometriosis.

This study examined the impact of hormone replacement therapy (HRT) on the occurrence of various cancers in postmenopausal women with de novo or a history of endometriosis. In the datasets for ten cancers (cervical, uterine, ovarian, breast, colon, gastric, liver, lung, pancreatic, and thyroid), women who received HRT (the HRT group) and those who did not (the control group) were selected by a 1:1 matching with those who met the study criteria. In the dataset for each cancer, the incidence of each cancer was very low (0.2% to 1.5% in the HRT group and 0.2% to 1.3% in the control group). The duration of HRT was 1.3 ± 2.1 years. After adjusting for co-variables, HRT was a significant risk factor for uterine cancer (p < 0.05). However, the risk of liver cancer decreased significantly with duration of HRT (p < 0.05). Moreover, combined estrogen and progesterone decreased the risks of liver and thyroid cancers significantly (p < 0.05), and estrogen alone decreased the risks of breast and lung cancers significantly (p < 0.05). Tibolone was not associated with the risk of any of the cancers assessed. These results can help guide the use of HRT in women with de novo or a history of endometriosis.

Short-term Impact of Hormone Replacement Therapy on Risk of Breast Cancer in BRCA Mutation Carriers: A Nationwide Study in South Korea.

BRCA1/2 mutations are well-known risk factors for breast and ovarian cancers in women. Risk-reducing salpingo-oophorectomy (RRSO) is the standard treatment for preventing ovarian cancer with BRCA mutations. Postmenopausal syndrome (symptoms after RRSO can be alleviated by hormone replacement therapy (HRT); however, the use of HRT in carriers of BRCA mutations has been controversial because of the concern that HRT increases the risk of breast cancer. This study aimed to evaluate the effects of HRT in BRCA mutation carriers who underwent RRSO. A total of 151 carriers, who underwent RRSO between 2013 and 2020 after the diagnosis of BRCA1 or BRCA2 mutations were selected and followed up for a median of 3.03 years. Patients were divided into two groups: those who received HRT after RRSO (n=33) and those who did not (n=118). We compared the incidence of breast cancer over time between these two groups. There was no significant difference in the incidence of breast cancer between women who received HRT and those who did not (p=0.229). Multivariate logistic regression analysis, adjusted for age and parity revealed no significant difference in the risk of breast cancer between these two groups (hazard ratio, 0.312; 95% confidence interval, 0.039 to 2.480; p=0.278). In this study, we found no relationship between post-RRSO HRT and breast cancer in the population with BRCA mutations. Therefore, healthcare providers may consider the alleviation of symptoms of postmenopausal syndrome through HRT in patients who underwent RRSO.

Impact of Hormone Replacement Therapy on Risk of Ovarian Cancer in Postmenopausal Women with De Novo Endometriosis or a History of Endometriosis.

The effect of hormone replacement therapy (HRT) on the malignant transformation of postmenopausal endometriosis remains unclear. This study aimed to investigate the impact of HRT on ovarian cancer occurrence in postmenopausal women with de novo endometriosis or a history of endometriosis. A total of 10,304 women that received HRT (the HRT group) and 10,304 that did not (the control group) were selected by 1:1 matching those that met the study criteria. Incidences of ovarian cancer (0.3% in the HRT group and 0.5% in the control group) and cumulative incidence rates of ovarian cancer were similar in the two groups. The overall mean duration of HRT was 1.4 ± 2.2 years, but the duration of HRT in women with ovarian cancer was 2.2 ± 2.9 years. After adjusting for co-variables, receipt of HRT, duration of HRT, combined use of estrogen and progesterone, and tibolone were not found to be risk factors for ovarian cancer. However, the use of estrogen alone was found to be a significant risk factor for ovarian cancer (HR 2.898; 95% CI 1.251-6.715; p = 0.013). With the exception of HRT using estrogen alone, HRT did not increase the risk of ovarian cancer in postmenopausal women with a history of endometriosis or de novo endometriosis.

The Role of Sex Hormones in Pain-Related Conditions.

Millions of people are affected by pain-related conditions worldwide. Literature has consistently shown that each individual experiences and perceives pain in a unique manner due to biological, environmental, and cultural factors in which they have been raised. It has been established that biological males and females perceive pain differently and that it may be partially explained by their distinct hormonal profiles since birth, which are only further magnified during puberty. For biological males, high levels of testosterone have shown to increase their pain threshold; and for biological females, estrogen fluctuations have shown to increase pain intensity and perception. However, sex hormones have not been studied in the context of pain treatment or their impact on biochemical pathways involved in pain perception. For this purpose, the transgender community serves as a unique population to investigate the impact of hormone replacement therapy on molecular pathways involved in the perception of pain. The purpose of this review is to explore the biochemistry of hormone replacement in transgender patients who also have other pain-related conditions such as headaches, fibromyalgia, temporomandibular myalgia, and visceral pain.

Impact of Hormone Replacement Therapy on the Overall Survival and Progression Free Survival of Ovarian Cancer Patients: A Systematic Review and Meta-Analysis.

Background: Frequently, patients treated for Ovarian Cancer (OC) undergo menopause with subsequent symptoms. This review scrutinised the impact of Hormone Replacement Therapy (HRT) on the Overall Survival (OS) and Progression-Free Survival (PFS) of patients diagnosed with OC. Methods: A systematic literature search was conducted in the most popular English databases. Inclusion and exclusion criteria were applied to select publications that evaluate OS and PFS in these patients. End-point analysis targeted values of log(HR) and its Standard Error (SE). Results: Up to 1 September 2022, 11 studies were included in the qualitative synthesis. Eight publications, totalling 4191 patients, were included in the meta-analyses. Eight studies were considered for the OS analysis and pooled an HR of 0.66 with respective 95% CI between 0.57 and 0.76, with a p-value < 0.00001 at a Z value of 5.7, in favour of the HRT group. Results for PFS showed an overall HR of 0.73 in favour of the HRT group; CI between 0.57 and 0.95, p = 0.02 at a Z value of 2.36. Further subgroup analyses highlighted the non-inferiority of this treatment. Conclusions: Patients treated for OC that receive HRT for menopausal symptoms after various treatments appeared to have better OS than never-users.

Review of the literature on the impact of hormone replacement therapy on the cognitive functions of pos- tmenopausal women

Review of the literature on the impact of hormone replacement therapy on the cognitive functions of pos- tmenopausal women

S886 Hormone Replacement Therapy Is Associated With Disease Activity Improvement Among Post-Menopausal Women With Inflammatory Bowel Disease

Introduction: There have been limited data on the impact of hormone replacement therapy (HRT) in post-menopausal women with inflammatory bowel disease (IBD). In this study, we sought to characterize the population of post-menopausal women with IBD and to determine the effect of HRT on disease activity. Methods: A retrospective cohort study of postmenopausal women with IBD at the University of Minnesota and Jefferson University Hospital was conducted from 1/1/2000-1/1/2020. Electronic health records were manually reviewed for demographics, menopause history, IBD history including disease activity, surgeries, hospitalizations, and medications pre- and post-HRT. The physician global assessment (PGA) score was used to quantify disease activity. To control for the effects of menopause, IBD patients who had not undergone HRT were used as controls. Patients were matched by age at menopause onset (+/- 5 years) and IBD type. McNemar’s test was used to compare outcomes pre- and post-HRT given the paired nature of the data. Pearson's chi-squared test was used to compare patients and controls. Results: Of the 249 patients recognized from the initial search, we identified 37 women who were menopausal and started on HRT. Mean age of menopause onset in the HRT patients was 46 years, 59% had Crohn’s disease (CD) and 41% had ulcerative colitis (UC). 31 matched controls that were within a 5-year range of menopause of the HRT patients were selected (61% CD, 39% UC). Based on PGA score, there was greater disease severity in the HRT cohort pre-menopause (p=0.03) and trend towards greater frequency of PGA score ≥2 (p=0.11). There was a significant reduction in frequency of PGA ≥2 post-HRT treatment (p< 0.01). HRT treatment was associated with a 5.6x increase in odds of post-HRT PGA score improvement compared to controls (OR 5.6; 95% CL 1.6, 19.7) in univariate logistic regression analysis. (Table) Conclusion: Post-menopausal IBD women who underwent HRT therapy had a significant improvement in their disease activity following HRT compared to post-menopausal women without HRT therapy, who showed no change in disease activity. Pre-HRT disease activity seemed to be higher in patients who underwent HRT compared to the controls. While we found more women with active disease underwent HRT, further study in a larger cohort of patients is needed to confirm this finding. Table 1. - Outcomes pre and post hormone replacement therapy Pre-HRT Post-HRT P-value Hospitalized (n=25) 10 (40%) 8 (32%) 0.32 Surgery 17 (46%) 5 (14%) < 0.01 PGA scores < 0.05 Remission 9 (24%) 17 (46%) Mild 16 (43%) 17 (46%) Moderate 7 (19%) 1 (3%) Severe 5 (14%) 2 (5%) Moderate to severe disease 12 (32%) 3 (8%) < 0.01

Postoperative Hormone Replacement Therapy and Survival in Women with Ovarian Cancer.

Simple SummaryPrevious studies have reported that hormone replacement therapy (HRT) after surgery for ovarian cancer has no significant effect on survival. However, a prospective study and a randomized controlled study showed that HRT administration provided survival benefits. Therefore, this study aimed to investigate the impact of postoperative HRT on survival in women with ovarian cancer using the nationwide cohort study. This cohort study was conducted on 1784 women aged ≤60 and diagnosed with ovarian cancer. Overall survival was significantly greater for women that received HRT than for women that did not after a mean follow-up of 5.6 ± 2.9 years (85.3% vs. 76.6%, respectively). Postoperative HRT may be considered a maintenance therapy in women diagnosed with ovarian cancer at ≤60 years of age.The effect of postoperative hormone replacement therapy (HRT) on survival in women with ovarian cancer remains unclear. This study aimed to investigate the impact of postoperative HRT on survival in women with ovarian cancer using the nationwide cohort study. Women aged ≤60 and diagnosed with ovarian cancer that received primary surgery were followed-up for 5.6 ± 2.9 years. Mean ages of women administered HRT (the HRT group; n = 263) or not administered HRT (the control group; n = 1521) were 41.5 ± 8.5 and 41.0 ± 11.4 years, respectively. After adjustment for covariables, OS was significantly greater in the HRT group (HR 0.618; 95% CI 0.414–0.922; p = 0.018). Kaplan–Meier curve analysis showed OS was significantly higher in the HRT group (85.3% vs. 76.6%; p = 0.016). The ratio of women with HRT to women without HRT increased significantly with time (restricted mean survival times for OS, p < 0.001). In addition, OS was significantly greater for those that received HRT for >5 years than for those that received HRT for ≤0.5 years (HR 0.234; 95% CI 0.059–0.936; p = 0.040). Postoperative HRT improved survival among women with ovarian cancer. The impact of HRT on survival increased with time and treatment duration.

EP136: An exploration of the impact of Hormonal Replacement Therapy (HRT) upon vocabulary skills in males with 49,XXXXY

49,XXXXY is a rare variant of 47,XXY, Klinefelter syndrome, that occurs in approximately 1 in 100,000 live male births. It is the most uncommon and complex X and Y chromosomal variation consisting of neurodevelopmental, physical, and medical complications. These boys are at an increased risk for musculoskeletal abnormalities and health difficulties. Intellectual disability, motor deficits, and severe speech dysfunction are common to this population. Specifically, receptive language skills are typically more advanced than expressive language skills, with some individuals being nonverbal. Childhood Apraxia of Speech (CAS) is thought to be the origin of speech and expressive language dysfunction in these boys suggesting that the core challenge is rooted in motor planning deficiency. Challenges in expressive language typically affect all aspects of daily life for males with 49,XXXXY, as it is difficult for them to convey their thoughts and feelings. This often leads to difficulties expressing themselves, social communication challenges, and peer isolation. Males with 49,XXXXY have androgen deficiency that benefits from hormonal replacement therapy (HRT). HRT has been found to have positive effects on neurodevelopmental capabilities in males with 49, XXXXY. Specifically, treated individuals have been found to have improved neurodevelopmental function than the untreated and may therefore have a potential beneficial impact on social skills. Two types of HRT are common during infancy and the childhood years: early hormonal treatment (EHT) and hormonal booster therapy (HBT). EHT is often administered during the “mini-puberty” period, ideally given at 4, 5, and 6 months old, but can be given up until 2 years of age. HBT may be recommended during the school-aged population, often beginning around 5 years old and given up until 11years old. The current study explores the effect of HRT upon expressive and receptive vocabulary skills in males with 49,XXXXY. One hundred and one participants with a diagnosis of 49,XXXXY were evaluated for this study (CA: 88.9 months). Participants completed the Expressive One-Word Picture Vocabulary Test 4th Edition (EOWPVT-4) and the Receptive One-Word Picture Vocabulary Test 4th Edition (ROWPVT-4). Subjects were segregated into four different groups according to their HRT status: no-T, EHT, HBT, and EHT&HBT. EHT consisted of 3 intramuscular injections of 25 mg of testosterone enanthate, once monthly, for three months given between 4 and 24 months of age. HBT consisted of 3 intramuscular injections of 50 mg of testosterone enanthate, once monthly for three months administered between the ages of 5 and 11. Two-tailed t-tests were completed to assess the differences within HRT groups between performance on the EOWPVT-4 and ROWPVT-4. The no-T group (CA: 90.3 months, N = 20) showed a significant difference between EOWPVT-4 and ROWPVT-4 scores (p = .00888) with receptive capabilities being higher than their expressive skills. The EHT group (CA: 79.3 months, N = 44) approached significance with greater skills on the ROWPVT-4 in comparison to the EOWPVT-4 (p = .0556). Finally, the HBT (CA: 104.5 months, N = 8) and EHT&HBT groups (CA: 98.1 months, N = 29) showed no differences between their receptive and expressive capabilities (p = .532; p = .700). The current study expands on the neurocognitive profile of boys with 49,XXXXY and the impact of HRT on their expressive and receptive vocabulary skills. Individuals with 49,XXXXY typically present with severely depressed expressive capabilities in comparison to their receptive skills. The no-T group had this typical presentation with higher receptive language abilities in comparison to expressive capabilities while the EHT, HBT, and EHT&HBT groups showed no differences between receptive and expressive vocabulary skills. Participants who received EHT, HBT, or a combination performed higher on the EOWPVT-4 and presented with commensurate and higher receptive and expressive vocabulary skills than those who had not been treated. These results suggest a positive treatment effect of both EHT and HBT on expressive vocabulary capabilities in boys with 49,XXXXY.

Female Reproductive Factors and Incidence of Nontuberculous Mycobacterial Pulmonary Disease Among Postmenopausal Women in Korea.

There are conflicting results regarding endogenous estrogen exposure and risk of incident nontuberculous mycobacterial pulmonary disease (NTM-PD). In addition, evidence on impact of hormone replacement therapy (HRT) on risk of NTM-PD is lacking. This study aimed to evaluate the impacts of endogenous estrogen exposure and HRT on risk of NTM-PD in postmenopausal women. This population-based cohort study comprised 1400095 postmenopausal women without previous NTM-PD who participated in the 2009 national health screening exam in South Korea. The cohort was followed until the date of incident NTM-PD, death, or December 2018. We evaluated whether lifetime endogenous estrogen exposure and HRT were associated with incident NTM-PD. Endogenous estrogen exposure was evaluated using age at menarche and menopause and reproductive period (duration between age at menarche and age at menopause). During a median of 8.4 (interquartile range, 8.2-8.7) years of follow-up, 0.1% of participants (1818/1400095) developed NTM-PD, with an incidence rate of 0.15/1000 person-years. Multivariable Cox regression analyses showed no significant relationship between endogenous estrogen exposure (age at menarche, age at menopause, and reproductive period) and risk of NTM-PD. In contrast, duration of HRT showed a significant dose-response relationship with incident NTM-PD even after adjustment for demographics and reproductive factors (adjusted hazard ratio [95% CI]: 1.30 [1.12-1.51] in HRT for <2 years; 1.28 [1.03-1.59] in 2-5 years; and 1.65 [1.33-2.05] in ≥5 years). While there was no significant association with endogenous estrogen exposure, HRT was monotonically associated with increased risk of NTM-PD in postmenopausal women.

Clinical Impact of Hormone Replacement Therapy on Atrial Fibrillation in Postmenopausal Women: A Nationwide Cohort Study.

Individuals with atrial fibrillation (AF), especially women, have an increased risk of stroke and death. Although hormone replacement therapy (HRT) is widely used in postmenopausal women, the association between HRT use and AF risk is unclear. We aimed to investigate the association between various types of HRT and AF. This was a population-based retrospective cohort study from The Korean National Health Insurance Service-National Sample Cohort (2004–2015). Participants were aged 45–60 years and were free from cardiovascular disease and AF at baseline. Overall, 13,452 (64.03%) women had never received HRT, 5671 (26.99%) had received HRT, and 1885 (8.98%) were currently receiving HRT. In multivariable analysis, the relative hazards for AF were significantly higher among current users (p < 0.001) and lower among past users (p = 0.069). Current users—except those using estradiol-only HRT—had significantly elevated AF risk. Among past users, only estradiol plus progestin HRT users had a reduced AF risk after adjusting for covariates (p = 0.027). Ongoing HRT posed an increased risk of AF. The degree of risk varied based on the specific type of estrogen and progestins co-administration. These findings indicate that, with respect to AF risk, oral estradiol-containing HRT is superior to HRT containing oral conjugated equine estrogen or tibolone.

Disorders of the eye, ear, skin, and nervous system in women with Turner syndrome -a nationwide cohort study.

The literature about eye, ear, nose, skin, and nervous system disorders in women with Turner syndrome is equivocal. Impaired vision and hearing in women with Turner syndrome have been described, and case reports of Turner syndrome girls suffering from epilepsy have been published, but no large population-based-studies have explored the occurrence of any of these disorders. We aimed to investigate the risk of admission with disorders related to the eye, ear, nose, skin, and nervous system, compared with background females, and the impact of hormone replacement therapy on these conditions. 1,156 females with TS diagnosed during 1960-2014 were identified using the Danish Cytogenetic Central Registry and linked with personal-level data from the National Patient Registry and the Medication Statistics Registry. Statistics Denmark randomly identified 115,577 age-matched background females. Negative binomial regression was used to analyze hospital discharge diagnoses, reporting incidence rate ratios (IRR). Women with Turner syndrome have an increased risk of developing eye disorders (IRR 4.3 (95% CI 3.5-5.4), including cataract, glaucoma, ocular movement, and accommodation. The risk of ear disorders (IRR 35.0 (27.9-43.9)) and nose (IRR 2.2 (1.4-3.6)) was increased in women with Turner syndrome, due to otitis media, cholesteatoma, and hearing loss. Disorders of the nervous system such as epilepsy were increased IRR 6.2 (2.4-15.9), along with skin conditions IRR 2.2 (95%CI 1.7-2.7) like psoriasis, atopic dermatitis, and ingrown nails.

Clinical impact of hormone replacement therapy on lone atrial fibrillation in postmenopausal women: a nationwide cohort study

Clinical impact of hormone replacement therapy on lone atrial fibrillation in postmenopausal women: a nationwide cohort study

Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study

The impact of hormone replacement therapy (HRT) on clinical outcomes in menopausal women is uncertain. To investigate the association between use of HRT and severe asthma exacerbation in perimenopausal and postmenopausal women with asthma. We used the Optimum Patient Care Research Database, a population-based longitudinal primary care database in the United Kingdom, to construct a 17-year (January 1, 2000, to December 31, 2016) cohort of perimenopausal and postmenopausal (46-70 years, N= 31,656) women. We defined use of HRT, its subtypes, and duration of HRT use. Severe asthma exacerbation was defined as an asthma-related hospitalization, emergency department visits due to asthma, and/or prescription of oral corticosteroids. Analyses were undertaken using multilevel mixed-effects Poisson regression. At baseline, 22% of women were using any HRT, 11% combined HRT, and 11% estrogen-only HRT. Previous, but not current, use of any (incidence rate ratio [IRR]: 1.24, 95% confidence interval [CI]: 1.22-1.26), combined (IRR: 1.28, 95% CI: 1.25-1.31), and estrogen-only HRT (IRR: 1.18, 95% CI: 1.14-1.21), and longer duration (1-2 years: IRR: 1.16, 95% CI: 1.13-1.19; 3-4 years: IRR: 1.43, 95% CI: 1.38-1.48; 5+ years: IRR: 1.32, 95% CI: 1.28-1.36) of HRT use were associated with increased risk of severe asthma exacerbation compared with nonuse. The risk estimates were greater among lean women (body mass index [BMI] <25 kg/m2) than among heavier women (BMI 25-29.9 kg/m2 and ≥30 kg/m2) and higher among smokers than nonsmokers. Use of HRT and subtypes, particularly previous, but not current, use and use for more than 2 years, is associated with an increased risk of severe asthma exacerbation in perimenopausal/postmenopausal women with established asthma. Lean women and smokers are at greater risk than heavier women and nonsmokers, respectively.

Increased occurrence of liver and gastrointestinal diseases and anaemia in women with Turner syndrome - a nationwide cohort study.

Liver and gastrointestinal diseases are frequent in women with Turner syndrome. However, their association with bleeding disorders, anaemia and the impact of hormone replacement therapy is unknown. To investigate the risk of liver and gastrointestinal diseases, haemorrhage and anaemia in women with Turner syndrome compared with the female background population, and the long-term impact of hormone replacement therapy on these conditions. One thousand one hundred and fifty-six women with Turner syndrome diagnosed during 1960-2014 were identified using the Danish Cytogenetic Central Registry and linked with personal-level data from the National Patient Registry and the Medication Statistics Registry. Statistics Denmark randomly identified 115577 age-matched female controls. Negative binomial regression was used to analyse hospital discharge diagnoses. Medical prescriptions, mortality and the effect of hormone replacement therapy were estimated using stratified Cox regression. Liver disease increased 13-fold (IRR 12.9 (95% CI 5.8-28.8)), due to toxic liver disease (IRR 8.0 (95% CI 1.8-35.4)), liver insufficiency (IRR 6.7 (95% CI 1.7-26.9)), fibrosis/cirrhosis (IRR 16.5 (95% CI 2.2-122.1)) and unspecified liver disease (IRR 10.6 (95% CI 4.4-25.3)). Furthermore, presence of abnormal liver enzymes increased 12-fold (IRR 12.4 (95% CI 4.2-36.6)). The risk of gastrointestinal haemorrhage (IRR 3.4 (95% CI 1.8-6.2)), anaemia (IRR 3.2 (95% CI 2.0-5.0)) and coagulation disorders (IRR 2.9 (95% CI 1.1-7.1)) was increased. However these diagnoses were not associated with inflammatory bowel disease. Gastrointestinal mortality was increased three-fold (HR 3.1 (95% CI 1.5-6.2)), partly due to death by liver disease (HR 3.0 (95% CI 1.1-8.2)), gastrointestinal haemorrhage (HR 29.6 (95% CI 3.1-285.1)) and capillary malformations (HR 18.6 (95% CI 4.1-85.0)). There was no effect of hormone replacement therapy on gastrointestinal risk but a trend towards a beneficial impact on liver diseases. The risk of being diagnosed with liver disease was higher than previously reported. The occurrence of gastrointestinal haemorrhage and anaemia was increased in Turner syndrome. There was no effect of hormone replacement therapy on gastrointestinal risk but a trend towards a beneficial impact on liver diseases was detected.

Impact of Hormonal Replacement Therapy on Bone Mineral Density in Premature Ovarian Insufficiency Patients.

: IntroductionPremature ovarian insufficiency (POI) is a type of hypergonadotropic hypogonadism caused by impaired ovarian function before the age of 40. Due to the hypoestrogenism, women with POI experience a variety of health complications, including an increased risk of bone mineral density loss and developing osteopenia and osteoporosis, which poses an important problem for public health. Purpose: The aim of this study was to evaluate and compare the values of bone mineral density (BMD), T-score and Z-score within the lumbar spine (L1-L4) using the dual energy X-ray absorptiometry method. The dual-energy X-ray absorptiometry (DXA) scans described in this original prospective article were performed at the time of POI diagnosis and after treatment with sequential hormone replacement therapy (HRT). Materials and methods: This study included 132 patients with a mean age of 31.86 ± 7.75 years who had been diagnosed with idiopathic POI. The control group consisted of 17 healthy women with regular menstrual cycles, with a mean age of 23.21 ± 5.86 years. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17-estradiol (E2), prolactin (PRL), testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), thyroid-stimulating hormone (TSH), free thyroxine (fT4), insulin, and fasting serum glucose were measured. Lumbar spine (L1-L4) BMD was assessed by means of dual-energy X-ray absorptiometry. DXA scans were performed at the time of diagnosis and following treatment with sequential hormone replacement therapy (HRT) comprised of daily oral 2 mg 17-β-estradiol and 10 mg dydrogesterone. The mean time of observation was 3 ± 2 years. Results: Patients in the POI group presented with characteristic hypergonadotropic hypogonadism. They had a significantly decreased mean lumbar spine BMD when compared to healthy controls (1.088 ± 0.14 g/cm2) vs. 1.150 ± 0.30 g/cm2) (p = 0.04) as well as a decreased T-score (0.75 ± 1.167 vs. −0.144 ± 0.82) (p = 003). There was a significant increase in BMD (1.088 ± 0.14 vs. 1.109 ± 0.14; p < 0.001), T-score (−0.75 ± 1.17 vs. −0.59 ± 1.22; p < 0.001), and Z-score (−0.75 ± 1.12 vs. −0.49 ± 1.11; p < 0.001) after the implementation of HRT when compared to pre-treatment results. Conclusions: In conclusion, this study has demonstrated that patients with POI often have decreased bone mineral density and that the implementation of HRT has a significant and positive influence on bone mass. The implementation of full-dose HRT and monitoring of bone status is particularly important in these patients.

Effect of HRT on biogas yield in treating dairy industry wastewater using Upflow Anaerobic Sludge Fixed Film reactor

Abstract Nowadays dairy and milk-based merchandise has become most essential and vital role in day-after-day lifetime of human. The milk undergoes varied process in dairy farm industries to supply different dairy products. More water and different chemicals are needed during a dairy unit. The amount of water employed in a dairy trade depends upon the supply of water, process technique and sort of flow. The wastewater after every step of process is discharged into either the natural water bodies or to the surroundings that alters the ecological balance. This study illustrates the impact of hormone replacement therapy on performance of work Upflow Anaerobic Sludge Fixed Film (UASFF) reactor on treatment of dairy industry. The UASFF reactor was designed for an efficient volume of 0.013 m3 with Fujino Spirals as packing media at the highest of reactor and operated underneath mesophilic condition. when startup amount, the reactor was operated with HRTs of 30, 24, 18, 12 and 6hr for the common inflowing COD concentrations of 8500 mg/L, 10000 mg/L, 11500 mg/L, 13000 mg/L and 14500 mg/L severally. The results showed that the utmost biogas yield efficiencies were within the vary of 0.162–0.505 m3/kg COD at inflowing concentration of 8500 mg/L and 14500 mg/L severally.

Organ of hearing and balance in peri- and postmenopausal women. Effects of hormone replacement therapy on hearing and balance in peri- and post-menopausal women: The current state of knowledge.

Sensory-neural hearing loss in people over 50 - senile deafness - is currently an increasing problem due to the growing proportion of the elderly people in the population. We can find a number of worldwide publications on hearing loss and dizziness in peri-menopausal women, but the data is inconsistent. Reports describing the influence of sex hormones on the ear and its aging are similarly controversial. This review attempts to summarize the current state of knowledge regarding hearing and balance in women during menopause, based on recent studies in this field. It describes the possible causes of hearing and balance impairment in post-menopausal women other than the mere physiological aging of the ear. The review concludes that impairment of hearing and balance is significantly related to osteoporosis, which results from estrogen deficiency during menopause. It also presents the results of studies on the impact of hormone replacement therapy (HRT) and of particular hormonal components of HRT on hearing and balance. The European population is aging, so accurate knowledge about the effects of HRT on hearing and balance is crucial in the context of improving the quality of life of elderly women through appropriate qualification for hormone substitution therapy. Further detailed and extensive study is necessary to verify the impact of sex hormones on hearing in post-menopausal women, taking into account the type of HRT used, serum hormone levels and the presence or absence of osteoporosis.