Postmenopausal Hormone Replacement Therapy Research Articles

Exogenous Estrogen in the Development of Head and Neck Cancer

Sex differences in head and neck cancer (HNC) incidence suggest a potential contribution of sex hormones. To assess the role of exogenous estrogen exposure in the development of HNC in female patients. This large multicenter cohort study using clinical records from the TriNetX real-world database included 20 years of data (through May 31, 2023) from 87 health care organizations. The TriNetX database was searched for medical records for female patients with and without exogenous estrogen exposure according to their chronological age. Cohort 1 included 731 366 female patients aged 18 to 45 years old with regular oral contraceptive (OC) intake and cohort 2 included 3 886 568 patients in the same age group who did not use OC. Cohort 3 comprised 135 875 female patients at least 50 years old receiving hormone replacement therapy (HRT), whereas cohort 4 included 5 875 270 patients at least 50 years old without HRT. Propensity score matching was performed for the confounders age, alcohol dependence, and nicotine dependence. Data analyses were performed in May 2023. Diagnosis of HNC (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: C00-C14), and after propensity score matching (1:1 nearest-neighbor greedy matching), a risk analysis to investigate risk differences and risk ratios (RRs) with a 95% CI. Among the 718 101 female patients in each of cohorts 1 and 2 (mean [SD] age at diagnosis, 25.9 [6.7] years), those with OC intake had a higher risk of an HNC diagnosis (RR, 1.47; 95% CI, 1.21-1.78) than those without OC use. Among the 131 835 female patients in each of cohorts 3 and 4 (mean [SD] age, 67.9 [12.0] years), those with postmenopausal HRT intake had a lower risk of an HNC diagnosis (RR, 0.77; 95% CI, 0.64-0.92) than those without HRT use. The findings of this cohort study illustrate a positive association between OC and a negative association between HRT and the development of HNC in female patients. Given the limitations of the TriNetX database, future research should include detailed information on the intake of OC and HRT and reproductive health information (eg, age at menarche/menopause, number of pregnancies) to more accurately define the strength and direction of the possible association between exogeneous estrogen exposure and the development of HNC in female patients.

Postmenopausal Hormone Replacement Therapy (HRT) May Cause Dementia: Are There Alternatives?

Postmenopausal Hormone Replacement Therapy (HRT) May Cause Dementia: Are There Alternatives?

Abstract 18381: Long-Term Coronary Artery Disease Risk in Female Adults With Surgically-Induced Menopause : A Systematic Review

Introduction: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in female adults. Prior studies have suggested an association between surgically-induced menopause (SIM) and long-term CAD risk. Yet, the pathophysiology and clinical significance of this relationship remains unclear. As SIM causes a premature cessation of potentially cardioprotective hormones, this review aimed to further investigate if SIM is a risk factor for CAD. Methods: SCOPUS, Web of Science, Cochrane Library, OVID/Embase, SciELO, and LILACS were searched from inception to April 2023 for observational studies reporting the effects of hysterectomy, oophorectomy, and/or salpingectomy prior to age fifty on long-term CAD risk. Results: Among 3056 identified records, nineteen studies were included with a combination of benign and malignant surgical indications. The studies reported on coronary heart disease (n=6), CAD (n=4), ischemic heart disease (n=3), and myocardial infarction (n=7). Sixteen articles with an average of 106,433 participants per study demonstrated a significantly increased risk of CAD following SIM (Table 1). In particular, hysterectomy with or without bilateral oophorectomy, and bilateral oophorectomy alone were found to have the most profound influence. Unilateral oophorectomy or hysterectomy with salpingo-oophorectomy did not appear to increase CAD risk. Average follow-up duration after SIM ranged from six to twenty-four years. Five studies adjusted for post-menopausal hormone replacement therapy use. Conclusions: SIM may elevate long-term CAD risk following hysterectomy and/or bilateral oophorectomy. Given that the majority of SIM are performed pre- or peri-menopausal for benign indications, understanding the associated cardiovascular risks is vital for informed decision-making, early detection, and prevention.

The Portuguese state of the art on osteoporosis and fracture risk: an update on the treatment options

AbstractOsteoporosis and fragility fractures are serious public health problems, which greatly impact individual health and the economy of other health services. Pharmacological treatment is still one of the main elements of clinical intervention, combined with non-pharmacological measures, in preventing the occurrence of fragility fractures. The emergence of promising new pharmacological options in the treatment of osteoporosis seems to renew expectations in the prevention of complications and a subsequent reduction in morbidity and mortality, including symptomatic treatment, improved physical function and a better quality of life. This review aims to provide updated information on the pharmacological treatment of osteoporosis in the adult population. A comprehensive PubMed search was performed to review the current evidence on osteoporosis treatment. Of the 378 articles identified from the initial queries, the final review included 80 articles. Currently, the following pharmacological options are available: antiresorptive (bisphosphonates, denosumab, postmenopausal hormone replacement therapy and selective oestrogen receptor modulators), bone-forming agents (essentially, teriparatide and abaloparatide) and the new dual-action therapy (romosozumab), recently approved by the US Food and Drug Administration and the European Medicines Agency, but which is not yet an option in Portugal. Therapeutic selection is essentially based on assessment of cost-effectiveness, since current evidence does not suggest any differences between the distinctive classes in reducing the risk of fractures, but this analysis is limited by the scarcity of comparative intraclass studies. Notwithstanding, romosozumab, as a dual effect therapy, is promising in resolving the physiological limitations resulting from the merely unilateral action of antiresorptive agents and bone-forming agents in the inseparable relationship between bone formation and resorption. However, its cardiovascular safety raises some concerns, and this topic is still being debated. The underdiagnosis and the undertreatment of osteoporosis remain one of the greatest challenges of the 21st century. Over the years, new drugs have appeared that have tried to address these problems with a direct impact on the health of populations, but a long way remains to be come in optimising their effectiveness, safety and tolerability.

Clinical Approaches to Nestorone Subdermal Implant Therapy in Women's Health.

Segesterone acetate (SA) or Nestorone, a fourth-generation progestogen, is a synthetic compound with high progestational activity and no androgenic, glucocorticoid, or anabolic effects. However, due to its oral inactivity, SA must be used by other routes, such as subcutaneous. Thus, considering its peculiar properties, the SA subdermal implant is successfully used in female contraception and postmenopausal hormone replacement therapy (HRT). In recent years, its potential uses in endometriosis, polycystic ovaries syndrome (PCOS), and a new therapeutic possibility for neuroprotection have made this treatment extremely interesting. However, the absence of a standardized dose and the long-term safety of SA implant therapy in women is still controversial. Here, we present the possible indications, doses, limitations, and side effects of SA implant therapy.

Cerebral venous sinus thrombosis cases detected in on-call CT venographies in Sweden, 2019-2022.

No well-established criteria exist for assessing the risk of cerebral venous sinus thrombosis (CVST). Here, we sought to gain an understanding of CVST cases and associated risk factors, based on the rates of emergency CT venographies (CTVs) performed after hours. Furthermore, we aimed to assess possible correlations between CVST rates and COVID-19, including at the start of the COVID-19 vaccination campaign. We collected reports of emergency CTVs performed after hours at 56 Swedish hospitals between 1/1/2019 and 12/31/2022, and divided them into five groups: (I) from 1/1/2019 to 1/31/2020, before the emergence of COVID-19 cases in Sweden; (II) from 2/1/2020 to 12/26/2020, after the emergence of COVID-19 but before vaccination rollout; (III) from 12/27/2020 to 7/28/2021, from the start of the COVID-19 vaccination campaign until 50% of the adult population in Sweden had been vaccinated; (IV) from 7/29/2021 to 2/1/2022, from when 50% of the adult population was vaccinated until restrictions were lifted; and (V) from 2/2/2022 to 12/31/2022, after restriction measures were suspended. For all included patients, we collected information on demographics and clinical history, including pregnancy, recent partum, and use of oral contraceptives or post-menopausal hormone replacement therapy. In total, we collected 430 reports (92% female, 8% male). The CVST positivity rate was 22.2% in men vs. 2.3% in women. None of the pregnant (n = 49) or postpartum (n = 12) women had CVST positivity. The frequency of CTV examinations was lowest in group 2; during this period, the average time between patients being imaged was 7days. The frequency of CTV examinations was highest in group IV; during this period, a patient underwent this type of scan every 1.5days, on average. The frequency of CVST-positive scans was lowest in group II; during this period, a positive case was found every 66days, on average. The frequency of CVST-positive scans was highest in group IV; during this period, a positive case was found every 62days, on average, and no statistical difference with respect to group II was observed. Pregnancy and recent partum were not significant risk factors for CVST. The elevated CVST positivity rate observed during the height of the COVID-19 pandemic suggested that patients with less likelihood for positive CVST had fewer emergency visits. The positivity rate did not increase with the start of the COVID-19 pandemic or the rollout of COVID-19 vaccination.

Postmenopausal hormone replacement therapy: a practical guide!

ZusammenfassungBis zu 85 % aller peri- bzw. postmenopausalen Frauen leiden unter klimakterischen Beschwerden wie Hitzewallungen, Schlafstörungen, depressiver Verstimmung, Herzbeschwerden und urogenitalen Problemen. Dennoch erhalten nur ca. 3 % eine menopausale Hormonsersatztherapie (MHT), was in erster Linie auf die Veröffentlichung der Women’s Health Initiative (WHI)-Studie 2002 zurückzuführen ist, in welcher ein Zusammenhang zwischen der MHT und einem erhöhten kardiovaskulären Risiko sowie einem höheren Risiko für ein invasives Mammakarzinom gezeigt wurde. Dazu ist kritisch anzumerken, dass die Frauen zum Zeitpunkt des Therapiestarts im Schnitt 63 Jahre alt waren und mit einem synthetischen Gestagen behandelt wurden. Bei Frauen < 60 Jahren konnte u. a. eine Risikoreduktion für Kolonkarzinome, Frakturen, Diabetes mellitus Typ 2 und die Mortalität gezeigt werden. Der Therapiestart einer MHT bei Frauen bis zu 60 Jahren bzw. innerhalb von 10 Jahren nach der letzten Menses scheint aus heutiger Sicht sicher und effektiv zu sein, als Indikation sind klimakterische Beschwerden zu sehen. Zur Anwendung kommt eine Kombinationstherapie aus 17β-Östradiol (oral oder transdermal) und einem natürlichen Progesteron (als zyklische oder kontinuierliche Therapie), von synthetischen Gestagenen ist aufgrund des ungünstigeren Nutzen-Risiko-Profils abzuraten. Eine Östrogenmonotherapie sollte nur bei Frauen nach einer Hysterektomie erfolgen. Wenn die letzte Menses bereits im Alter von < 45 Jahren (frühe Menopause) oder < 40 Jahren (vorzeitige Menopause) erfolgt ist, dann sollte eine Hormonersatztherapie (HRT) erfolgen. Für diese besteht eine klare Indikation auch zur Prävention chronischer Krankheiten wie z. B. kardiovaskulären Erkrankungen und einer Osteoporose.

Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women: A systematic review and meta-analysis.

The cardioprotective effect of postmenopausal hormone replacement therapy (HRT) has been demonstrated in several studies. Similarly, physical exercise has yielded positive results. However, the effects of their combination remain inconclusive. This review describes the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We searched the Scopus, Web of Science, PubMed, and Embase databases and included randomized controlled trials published up to December 2021 on the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We identified 148 articles, of which only seven met the inclusion criteria (386 participants; 91 [23%] HRT + exercise; 104 [27%] HRT; 103 [27%] exercise; 88 [23%] placebo). The combined treatment further decreased systolic blood pressure (SBP) compared to the isolated effect of aerobic training (AT) (mean difference [MD]=-1.69; 95% confidence interval [CI]=-2.65 to -0.72, n=73). Nevertheless, it attenuated the decrease in diastolic blood pressure (DBP) (MD=0.78; 95%CI: 0.22-1.35, n=73), and the increase in peak oxygen consumption (VO2 peak) promoted by exercise (AT + HRT=2.8±1.4 vs AT + placebo=5.8±3.4, P=0.02). The combination of AT and oral HRT improved SBP. However, AT alone seemed to have a better effect on physical fitness and DBP in postmenopausal women.

Causes of incontinence in the elderly

The article analyzes the causes of incontinence, which affect the quality of life of men and women and are often related to the phenomenon of aging.
 Objective. To examine the causes of urinary incontinence among elderly based on the results of the scientific literature.
 Research methods. Data was collected in: Am J Obstet Gynecol, Clin Geriatric Med, Am J of nursing, BMC, PubMed database. Full-text articles on urinary incontinence were used for the analysis, when their title, keywords: incontinence, cause of urinary incontinence, elderly people, lack of knowledge about urinary incontinence (incontinenza urinaria) met the purpose of the review. Only publications in English, which were published in the period 2017–2022, were analyzed 27 scientific papers on the subject are included and analyzed in the systematic review.
 Research results and conclusions. The results showed that incontinence is associated with age, overweight, chronic diseases, bad habits, post-menopausal hormone replacement therapy. Incontinence increases social isolation, anxiety, and depression. Non-invasive methods are used to eliminate the causes of incontinence: psychological training, giving up bad habits, promoting a healthy and balanced diet, regulating body weight. Botulinum toxin injections, urological surgery or sacral nerve stimulation are used to enhance the treatment effect. The knowledge of patients and medical staff about the urinary incontinence is fundamental.

Epigenetic mismatch repair deficiency in endometrioid endometrial cancer correlates with poor outcome (385)

Epigenetic mismatch repair deficiency in endometrioid endometrial cancer correlates with poor outcome (385)

The Effect of Cumulative Lifetime Estrogen Exposure on Cognition in Depressed Versus Non-Depressed Older Women.

Two-thirds of individuals living with Alzheimer's disease are women. Declining estrogen levels influence mood and cognition. Cumulative lifetime estrogen exposure (CLEE) correlates with cognition later in life. We examined the relationship of CLEE to depression and cognition in older women with major depression compared to non-depressed women. Older women (age ≥60years) with depression were compared to non-depressed women using a lifetime estrogen exposure questionnaire. CLEE was defined as combined durations of reproductive span (age of menopause minus age of menarche) and any post-menopausal hormone replacement therapy use. Higher vs lower CLEE groups were based on a median of 474 months of estrogen exposure. University hospital outpatient research program. 135 women ≥60 years; 64 depressed and 71 non-depressed. Participants completed a comprehensive cognitive test battery. General linear models were used to examine the association between cognitive domain scores and CLEE in depressed and non-depressed women, controlling for age, education, and ethnicity. Depressed and non-depressed groups had significantly different levels of CLEE, measured in months: mean 495.7 (SD 108.6) vs 456.4 (SD 66.0) months, F(1,130) = 5.01, p = .03. Within the non-depressed participants, higher CLEE was associated with improved delayed recall (F(1,59) = 5.94, p = .02, effect size = .61), while no such relationship was observed in the depressed group. Higher CLEE was associated with improvement in delayed recall among non-depressed, but not among depressed participants. This suggests a protective role of estrogen on memory in non-depressed older postmenopausal women. Further research should examine the role of the CLEE in antidepressant response and cognitive decline.

Caffeine, chocolate, and adenosine antagonism in Parkinson’s disease

Parkinson’s disease (PD) is the second most common neurodegenerative disorder. It is generally accepted that dopamine replacement therapy substantially improves motor symptoms; however, there is a worldwide tendency to include nutrients in treatment strategies. In the present review, caffeine and chocolate are discussed. Caffeine use seems to postpone the occurrence of PD in men, and perhaps also in women who do not take postmenopausal hormone replacement therapy. There are contradictory data concerning possible caffeine-induced improvements in PD symptoms. Given that the basic action of caffeine is the antagonism of adenosine receptors, adenosine antagonists may be a new option for treating PD patients. Furthermore, PD patients tend to have increased chocolate consumption; this may be causally related to ingredients such as phenylethylamine. Thus, nutrients such as caffeine and chocolate may play an important role in postponing and/or improving symptoms in PD.

The Pathological Mechanisms of Estrogen-Induced Cholestasis: Current Perspectives.

Estrogens are steroid hormones with a wide range of biological activities. The excess of estrogens can lead to decreased bile flow, toxic bile acid (BA) accumulation, subsequently causing intrahepatic cholestasis. Estrogen-induced cholestasis (EIC) may have increased incidence during pregnancy, and within women taking oral contraception and postmenopausal hormone replacement therapy, and result in liver injury, preterm birth, meconium-stained amniotic fluid, and intrauterine fetal death in pregnant women. The main pathogenic mechanisms of EIC may include deregulation of BA synthetic or metabolic enzymes, and BA transporters. In addition, impaired cell membrane fluidity, inflammatory responses and change of hepatocyte tight junctions are also involved in the pathogenesis of EIC. In this article, we review the role of estrogens in intrahepatic cholestasis, and outlined the mechanisms of EIC, providing a greater understanding of this disease.

A prolonged hiatus in postmenopausal HRT, does not nullify the therapy's positive impact on ageing related sarcopenia.

BackgroundPrevious work suggest a positive skeletal muscle effect of hormone replacement therapy (HRT) on skeletal muscle characteristics This study aimed to quantify any continued positive effect of HRT even after a sustained hiatus in treatment, controlling for two key muscle modulation hormones: Estradiol (E2) and Tri-iodo-thyronine (T3).Method and findingsIn 61 untrained women (18-78yrs) stratified as pre-menopausal, post-menopausal without (No_HRT) and post-menopausal with (Used_HRT) HRT history, body composition, physical activity, serum E2 and T3 were assessed by dual energy x-ray absorptiometry, Baecke questionnaire and ELISA. Gastrocnemius medialis (GM) and tibialis anterior (TA) electromyographic profiles (mean power frequency (mPowerF)), isometric plantar-flexion (PF) and dorsi-flexion (DF) maximum voluntary contraction (MVC), rate of torque development (RTD), isokinetic MVC and muscle volume, were assessed using surface electromyography, dynamometry and ultrasonography. Muscle quality was quantified as MVC per unit muscle size. E2 and E2:T3 ratio were significantly lower in postmenopausal participants, and were positively correlated with RTD even after controlling for adiposity and/or age. Pre-menopausal females had greater MVC in 8/8 PF and 2/5 DF (23.7–98.1%; P<0.001–0.049) strength measures compared to No_HRT, but only 6/8 PF (17.4–42.3%; P<0.001–0.046) strength measures compared to Used_HRT. Notably, Used_HRT had significant higher MVC in 7 PF MVC (30.0%-37.7%; P = 0.006–0.031) measures than No_HRT, while premenopausal and Used_HRT had similar uncorrected muscle size or quality. In addition, this cross-sectional data suggest an annual reduction in GM muscle volume corrected for intra-muscular fat by 1.3% in No_HRT and only 0.5% in Used_HRT.ConclusionEven years after cessation of the therapy, a history of HRT is positively associated with negating the expected post-menopausal drop in muscle quantity and quality. Whilst mPowerF did not differ between groups, our work highlights positive associations between RTD against E2 and E2:T3. Notwithstanding our study limitation of single time point for blood sampling, our work is the first to illustrate an HRT attenuation of ageing-related decline in RTD. We infer from these data that high E2, even in the absence of high T3, may help maintain muscle contractile speed and quality. Thus our work is the first to points to markedly larger physiological reserves in women with a past history of HRT.

Estrogen cholestasis induces gut and liver injury in rats involving in activating PI3K/Akt and MAPK signaling pathways

BackgroundsEstrogen and its metabolites often lead to intrahepatic cholestasis in susceptible women with pregnancy, administration of oral contraceptives and postmenopausal hormone replacement therapy. Recently, dysfunction of the gut-liver axis has been suggested to play a pivotal role in the progression of cholestasis, but details about estrogen cholestasis (EC)-induced gut and liver injury are still largely unknown. This study aims to gain insight into EC-induced gut and liver injury and cell signaling implicated. MethodsMale rats were exposed to 5 and 10 mg/kg of 17α-ethinylestradiol via subcutaneous injection for 5 successive days to simulate human EC. ResultsBy detection of these estrogen cholestatic rats, we found that EC induced inflammation in the liver but not in the intestine through activating NF-κB signaling pathway. EC strongly induced oxidative stress in both the liver and intestine, and activated the hepatic Nrf2/Gclm/Gclc pathway and the intestinal Nrf2/Ho-1 pathway, respectively, for adaptively regulating oxidative stress. EC increased cell apoptosis in both the liver and intestine. Additionally, EC elevated phosphorylation of Akt, ERK1/2, and p38 in the liver and increased phosphorylation of p38 in the intestine. ConclusionsEC induces liver inflammation, both gut and liver oxidative stress and apoptosis, involving in activating PI3K/Akt and MAPK signaling pathways. Investigation of EC-induced gut and liver injury contributes to the development of new potential therapeutic strategies.

The Effect of Cumulative Lifetime Estrogen Exposure on Cognition in Depressed versus Non-Depressed Older Women

<h3>Introduction</h3> There are sex differences in the prevalence and age-matched incidence of Alzheimer's Disease (AD), with women constituting up to two-thirds of individuals living with AD in the United States. Symptoms of depression and anxiety are also higher in women and can increase dementia risk. Additionally, the decline in estrogen level impacts cognitive function, often leading to difficulties with memory, attention, and concentration. Estrogen withdrawal during menopause also precipitates an increase in depressive symptoms and cognitive decline. Cumulative lifetime estrogen exposure (CLEE), estimated by variables known to influence estrogen levels across the life span, has been correlated with cognitive function later in life. In particular, higher levels of CLEE are associated with improvement in memory performance in older women. Our report is the first to examine how CLEE relates to depression and cognitive function in older women with depression compared to non-depressed controls. <h3>Methods</h3> A total of 135 participants aged 60 years and older were included in the analysis. Sixty-four clinically depressed women (mean age 69.1 (SD 6.4) years) were compared to 71 non-depressed age-matched controls (mean age 66.1 (SD 8.3) years) using a lifetime estrogen exposure questionnaire. Depressed participants were included with the 24-item Hamilton Rating Scale for Depression (HAMD) score of > 14 at baseline. CLEE was defined by combining the reproductive span (age of menopause minus age of menarche) and any post-menopausal hormone replacement therapy use. Participants were divided into higher versus lower CLEE groups based on a median of 480 months of estrogen exposure. Participants completed a comprehensive neuropsychological test battery that evaluated learning (California Verbal Learning Test-II [Trial 1 through 5 Total] or Hopkins Verbal Learning Test [Total Recall], Rey–Osterrieth Complex Figure Test [3-minute recall]); delayed recall (California Verbal Learning Test-II [long delayed free recall] or Hopkins Verbal Learning Test [Delayed Recall], Rey–Osterrieth Complex Figure Test [30-minute delayed recall]); and executive functioning (Trail Making Test B, Controlled Oral Word Association test [FAS]).We transformed raw scores to <i>z</i>-scores for each test score for each participant. <i>Z-</i>scores were reversed when necessary so that high <i>z</i>-scores represented good performance for all measures. These <i>z</i>-scores were averaged within each neuropsychological domain to produce composite scores.General linear models were used to examine whether cognitive domain scores were associated with CLEE in depressed and non-depressed women, controlling for age, educational level and ethnicity. <h3>Results</h3> Depressed and non-depressed women had significantly different levels of CLEE: 448.6 (SD 66.0) vs. 487.3 (SD 108.6), t(133) = 2.52, p = .01. CLEE was not associated with cognitive performance in the combined sample of depressed and non-depressed participants, controlling for depression status. However, amongst non-depressed participants, higher CLEE group was significantly associated with better performance on delayed recall (F(1,60) = 5.45, p=0.02; effect size = .64). <h3>Conclusions</h3> Consistent with previous findings, higher CLEE was associated with better performance on delayed recall, though we found this effect only among non-depressed participants. This suggests an enduring protective role of estrogen on memory in non-depressed older postmenopausal women. CLEE was not associated with cognitive function in older women with depression. Further research should examine the role of the CLEE in older women in depression, treatment response and in cognitive decline. <h3>Funding</h3> K24 AT009198 R01 AT008383 (NCCIH) R01 AT008383-04S (NCCIH)

Patterns of Migraine in Postmenopausal Women: A Systematic Review

IntroductionMigraine prevalence is higher in fertile than in postmenopausal women. However, few literature data are available on the prevalence and characteristics of migraine after the menopause and on the effect of hormones in postmenopausal women with migraine.MethodsWe performed a systematic literature review of studies available on Scopus and Web of Science from the beginning off indexing until October 18th, 2020. We included both randomized trials and observational studies.ResultsWe included 12 papers, six of which assessed the prevalence and characteristics of migraine in postmenopausal women, while the other six assessed the effect of hormones on migraine after the menopause. One of the studies was a randomized trial, while the remaining 11 were observational studies. Ten studies were clinic-based, while the remaining two were population-based. Studies assessing the prevalence and characteristics of migraine after the menopause reported inconsistent findings; in studies performed in headache clinics, likely affected by selection bias towards the most severe cases, a relevant proportion of women reported migraine worsening after the menopause. Studies assessing the effect of hormones on migraine after the menopause showed that postmenopausal hormone replacement therapy was invariably associated with migraine worsening, if containing estrogen.ConclusionOur systematic review showed that migraine could be a relevant health problem in postmenopausal women, mostly in headache clinics. However, the available studies allow a limited assessment of the prevalence and characteristics of postmenopausal migraine. Further large studies are needed to better determine the burden of migraine after the menopause according to migraine characteristics and the impact of hormonal treatments.

Sexual dysfunction in Chinese women at different reproductive stages and the positive effect of hormone replacement therapy in the early postmenopause

Objectives The aims of the study were to investigate female sexual dysfunction (FSD) at different reproductive stages and the effect on FSD of hormone replacement therapy (HRT). Methods Participants (N = 524) were divided into six groups according to the Stages of Reproductive Aging Workshop (STRAW + 10): reproductive age (R), early (ET)/late (LT) menopausal transition, early (EP)/late (LP) postmenopause and early postmenopause in women using HRT (EP-HRT; oestradiol sequentially combined with dydrogesterone). The Female Sexual Function Index (FSFI) was used to assess FSD. Univariate and multivariate logistic regression analysis was carried out to predict FSD risk factors. Results There was an increase in FSD in groups EP and LP, but not in groups R, ET and LT; most FSFI scores were lower in groups EP and LP than in groups R, ET and LT (p < .05). There was no difference in FSD between groups EP and LP, but lubrication and pain scores were higher in group EP (p < .05). The prevalence of FSD was lower in group EP-HRT; most FSFI scores were higher in group EP-HRT compared with group EP as control (p < .05). Further risk factors for FSD were identified as neutral and dissatisfied marital relations, lower educational level and smoking (p < .05). Conclusion We report a clear association between deteriorating sexual function and increasing STRAW + 10 classification, suggesting the consequence of decreasing ovarian function. HRT containing ‘natural hormones’ was shown to have a beneficial effect on FSD. The results are reported here for the first time in Chinese women.

Controversies Regarding Postmenopausal Hormone Replacement Therapy for Primary Cardiovascular Disease Prevention in Women.

The debate over the safety and benefit of hormone replacement therapy (HRT) in postmenopausal women for primary prevention of cardiovascular disease (CVD) has been ongoing for the past several decades. Observational trials in the 1980s suggested a benefit of HRT for primary CVD prevention. However, randomized controlled trials in the 1990s suggested potential harm. Because of these discrepancies, recommendations from authorities on the usage of postmenopausal HRT have fluctuated. Many believed that the timing of HRT initiation relative to the onset of menopause, also known as the "timing hypothesis," was the factor that could explain the differences among these studies. Some recent investigations have concluded that HRT initiated in postmenopausal women near the onset of menopause confers a cardioprotective benefit, while others simply showed that HRT does not cause harm. Research has expanded to evaluate alternative doses, preparations, routes, and formulations, including selective estrogen receptor modulators, to demonstrate their suitability for this purpose. This article is a review of the major research studies of HRT in postmenopausal women with respect to its safety and efficacy for the primary prevention of CVD.

ASSOCIATION OF GASTROESOPHAGEAL REFLUX SYMPTOMS (FREQUENCY AND SEVERITY) WITH BODY MASS INDEX IN FEMALES WITH GASTROESOPHAGEAL REFLUX DISEASE

ABSTRACT&#x0D; BACKGROUND &amp; OBJECTIVE: Overweight individuals have a greater tendency to develop gastroesophageal reflux disease (GERD). This study aims at comparing gastroesophageal reflux symptoms (frequency and severity) in females with different body mass index (BMI) categories.&#x0D; METHODOLOGY: This cross-sectional comparative research study was conducted over duration of 8 months. Both indoor and outdoor patients of medical unit – II Benazir Bhutto Hospital, Rawalpindi, fulfilling the inclusion criteria i.e. females 30-55 years of age with confirmed diagnosis of GERD and informed consent were included. Subjects with history of cigarette smoking, diabetes, use of postmenopausal hormone replacement therapy (HRT), anti-hypertensive or asthma medication were all excluded. Data were collected via proforma and analyzed on SPSS version 17.&#x0D; RESULTS: Among 360 enrolled women, 08 (2.2%) subjects were underweight, 109 (30.3%) had normal BMI, 151 (41.9%) were overweight, 88 (24.4%) subjects were obese and 04 (1.1%) belonged to morbidly obese group. Among 109 subjects with normal BMI, 53 (48.6%) had mild, 40 (36.69%) moderate, 13 (11.9%) severe and 03 (2.75%) very severe GERD. Among 151 overweight subjects, 37 (24.50%) were with mild severity, 64 (42.38%) with moderate, 35 (23.17%) severe and 15 (9.93%) had very severe GERD. Among 04 morbidly obese subjects, 02 (50%) had severe while remaining 02 (50%) had very severe GERD (p=0.000).&#x0D; CONCLUSION: Association of GERD symptoms and BMI were found in both normal and overweight women. Reflux symptoms may be exacerbated or even caused by moderate weight gain in people with normal weight.