Safety Of Hormone Replacement Therapy Research Articles

Guidance Directed Care of Spontaneous Coronary Artery Dissection: A Healthcare System-Based Experience

IntroductionData on treatment of spontaneous coronary artery dissection (SCAD) has evolved with guidance from national societies beginning around 2018. Given emerging guidance and relatively uncommon presentation of SCAD, we hypothesized that a specialized SCAD clinic would improve guidance-based care. MethodsWe utilized a system-wide electronic medical record search to identify individuals with SCAD diagnosis from 2018 to 2023. All diagnostic angiograms were reviewed to verify diagnosis. We analyzed frequency of guidance-based care since 2018 system-wide. We also compared guidance-based care for individuals with index visits to the SCAD outpatient clinic as compared to non-SCAD clinic providers from initiation of specialty clinic in 2021. ResultsDifferences were observed in pregnancy and contraception discussions (88 % vs 0 %, p < 0.001) among pre-menopausal individuals in SCAD clinic compared to non-SCAD clinics. Safety of hormone replacement therapy (HRT) in menopausal women was addressed more by SCAD clinic providers (85 % vs 7 %, p < 0.001). There was more fibromuscular dysplasia (FMD) screening in SCAD clinic (100 % vs 30 %, p < 0.001). Among individuals with migraines, there was more discussion of triggering medications (triptans) in SCAD clinic (80 % vs 14 %, p = 0.008). In individuals prescribed statins not by primary prevention guidelines and without atherosclerosis, there was a trend toward more discussion of statin use in SCAD clinic follow up vs non-SCAD clinic providers (63 % vs 17 %, p = 0.06). ConclusionsIndividuals with follow up in SCAD clinic compared to non-SCAD clinics were more likely to have future pregnancy and contraception counseling, discussion of HRT safety, and FMD screening following index outpatient visit. Future quality improvement initiatives will target these aspects of guidance-based care among non-SCAD clinic providers with integration into cardiology fellow training.

Hormone replacement therapy and cancer mortality in women with 17 site-specific cancers: a cohort study using linked medical records

BackgroundThere is limited evidence on the safety of Hormone Replacement Therapy (HRT) in women with cancer. Therefore, we systematically examined HRT use and cancer-specific mortality in women with 17 site-specific cancers.MethodsWomen newly diagnosed with 17 site-specific cancers from 1998 to 2019, were identified from general practitioner (GP) records, hospital diagnoses or cancer registries in Scotland, Wales and England. Breast cancer patients were excluded because HRT is contraindicated in breast cancer patients. The primary outcome was time to cancer-specific mortality. Time-dependent Cox regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer-specific mortality by systemic HRT use.ResultsThe combined cancer cohorts contained 182,589 women across 17 cancer sites. Overall 7% of patients used systemic HRT after their cancer diagnosis. There was no evidence that HRT users, compared with non-users, had higher cancer-specific mortality at any cancer site. In particular, no increase was observed in common cancers including lung (adjusted HR = 0.98 95% CI 0.90, 1.07), colorectal (adjusted HR = 0.79 95% CI 0.70, 0.90), and melanoma (adjusted HR = 0.77 95% CI 0.58, 1.02).ConclusionsWe observed no evidence of increased cancer-specific mortality in women with a range of cancers (excluding breast) receiving HRT.

AB024. SOH24AB_017. Evaluating the oncological safety of hormone replacement therapy in BRCA alteration carriers who have undergone a bilateral oophorectomy: a systematic review and meta-analysis

AB024. SOH24AB_017. Evaluating the oncological safety of hormone replacement therapy in BRCA alteration carriers who have undergone a bilateral oophorectomy: a systematic review and meta-analysis

Prescription of hormone replacement therapy in women with surgically induced menopause and borderline ovarian tumors: Should we be doing more?

Borderline Ovarian Tumors (BOT) are often diagnosed in premenopausal women and the likely precursors to ovarian low-grade serous carcinoma (LGSC), a hormonally sensitive malignancy. The safety of hormone replacement therapy (HRT) after surgical treatment of BOT is unknown. We aimed to describe the HRT prescribing and preventive services practice patterns in women with surgically induced menopause (SIM) after surgery for BOT. (See Table 1.)

Safety of hormone replacement therapy in women with a history of cervical adenocarcinoma.

Studies investigating the safety of hormone replacement therapy in cervical cancer have predominantly included patients with squamous disease. Pathological studies have identified estrogen receptor positivity in cervical adenocarcinomas. A recent small case-control study suggested a trend towards reduced survival with hormone replacement therapy in cervical adenocarcinomas. Our objective was to determine if hormone replacement therapy use in patients treated for cervical adenocarcinomas is detrimental to survival. A retrospective review of all women under the age of 50 with stage 1B-2B cervical adenocarcinomas diagnosed between 1 November 2000 and 24 September 2019. Women were categorised into three groups: ovaries conserved (OVCON); or iatrogenic menopause with (IM-HRT) or without (IM-NOHRT) hormone replacement therapy. Hormone replacement therapy use was defined on an intention to treat basis. Statistical analysis was performed using Kaplan-Meier and Cox proportional hazards methods. Overall (OS), disease specific (DSS) and progression free (PFS) survival. A total of 58 women (mean age 38.5 ± 6.6) were included in the study of whom 25 (43.1%) had OVCON, 20 (34.4%) had IM-HRT and 13 (22.4%) had IM-NOHRT. No menopause-associated deaths occurred. Although five-year DSS was 73% in IM-NOHRT compared to 95% in IM-HRT and 95% in OVCON, these differences were not statistically significant. Five-year PFS was 68% in IM-NOHRT compared to 90% in IM-HRT and 81% in OVCON but again, these differences were not statistically significant. In this small study, hormone replacement therapy does not appear to be detrimental to survival in cervical adenocarcinomas. There is a trend towards improved survival with hormone replacement therapy. Larger studies are required to substantiate these findings.

Hormone therapy after risk-reducing surgery in patients with BRCA1/BRCA2 mutation: evaluation of potential benefits and safety.

Women with mutations in the BRCA 1 and 2 genes are at increased risk for ovarian and breast cancer and therefore candidates for risk-reducing surgery, including salpingo-oophorectomy and mastectomy. Risk-reducing salpingo-oophorectomy (RRSO) is considered the most effective prophylactic measure for ovarian cancer prevention in this group of patients. This procedure involves loss of ovarian function and induced menopause. Estrogen therapy is the most effective treatment for controlling vasomotor symptoms and improving the quality of life of climacteric women. However, the potential hormonal stimulation of these tumors and the risk of breast cancer are a concern regarding the safety of hormone replacement therapy (HRT) in this population. This article aims to review the current evidence regarding the potential benefits and safety of HRT after RRSO.

Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers.

Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) is the most effective option and the gold standard for ovarian cancer (OC) risk-reduction, particularly given the absence of an effective national OC screening programme. However, premenopausal RRSO leads to premature surgical menopause with detrimental long-term health sequelae particularly in women who do not/are unable to take hormone replacement therapy (HRT). HRT uptake in women undergoing pre-menopausal oophorectomy appears low and is dependent on informed counselling, the safety of HRT and efficacy in mitigating the health sequelae of premature menopause. Acceptance of a central role for the fallopian tube in OC etiopathogenesis, coupled with the detrimental consequences of premature menopause, has led to the attractive proposal of early-salpingectomy with delayed oophorectomy as an alternative OC surgical prevention strategy in premenopausal women who have completed childbearing but decline or wish to delay RRSO. The successful implementation of risk reducing surgery for OC prevention depends on the acceptability of surgery to both, recipients (e.g. BRCA1/BRCA2 carriers) and intervention deliverers (healthcare professionals/researchers). Acceptability is also informed by an understanding of health outcomes following risk reducing surgery and the safety of HRT. It is therefore vital to understand the effects of surgery on important health outcomes such as cardiovascular health, neurological function and bone health. We present a comprehensive review of acceptability, the selected health outcomes mentioned above and HRT safety following risk reducing surgery.

Antiandrogens or estradiol treatments or both during hormone replacement therapy in transitioning transgender women

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objective of this proposed systematic review and meta‐analysis is to assess the efficacy and safety of hormone replacement therapy with antiandrogens or estradiol or both in transitioning transgender women.

Therapeutic evaluation of hormone replacement therapy with combination of Fosamax and alone use of Fosamax in osteoporosis and steopenia of perimenopausal women

Objective To explore the efficacy and safety of hormone replacement therapy with combination of Fosamax and simple use of Fosamax in osteoporosis and steopenia of perimenopausal women. Methods One hundred and thirteen perimenopausal women with osteoporosis accepted treatment in Outpatient Clinic of Panyu Convalescent Hospital of Guangzhou from December 2010 to June 2014 were chosen and divided into the control group(n=55) and the observation group(n=58) according to therapeutic method.The control group was treated with Fosamax alone while the observation group was treated with HRT basing on the simple use of Fosamax.The therapeutic effect, lumbar and hip bone mineral density(BMD) level, tibial ultrasound velocity(SOS) and T values of tibia, gonadal hormone concentrations, endometrial thickness and adverse reaction of the two groups before and after the therapy were compared. Results (1)The total effective rate of the observation group after the treatment was 93.10%, significantly higher than that of the control group(78.18%, χ2=3.829, P=0.034). (2)Before and after treatment in two groups, there were statistically significant differences in terms of lumbar spine BMD, hip BMD, SOS of tibia, blood follicle stimulating prime(FSH) and estradiol(E2)(P<0.05), and there were statistically significant differences between the two groups after the treatment in terms of lumbar spine BMD, hip BMD, SOS of tibia, FSH and E2(t=3.389, 5.012, 3.997, 5.829, 3.902; P=0.035, 0.028, 0.033, 0.024, 0.038). (3)There was statistically significant differences in term of the incidence of adverse reactions between the observation group and the control group(6.90% vs. 16.36%; χ2=8.273, P=0.012). Conclusion Compared with alone use of Fosamax, the therapeutic effect of hormone replacement therapy with combination of Fosamax and in osteoporosis and steopenia of perimenopausal women is more significant with low occurrence rate of adverse reaction.It is worth popularization. Key words: Osteoporosis in perimenopausal women; Hormone replacement therapy; Fosamax; Bone mineral density

LATE ONSET HYPOGONADISM: TO TREAT, NOT TO TREAT AND WHO MUST TREAT?

The article presents a review of the literature, which indicate the current understanding of the clinical significance of late onset hypogonadism and types of its correction. The results of studies demonstrate the efficacy and safety of hormone replacement therapy. The authors point to the need for health care professionals to understand and see the benefits of substitution treatment. But the priority in the appointment and monitoring of therapy should be for the urologist and endocrinologist.

Treatment of climacteric symptoms in breast cancer patients: A retrospective study from a medication databank

Introduction: Women affected by breast cancer (BC) will often go through menopause at an earlier age and display more frequent and severe symptoms than women who have a natural menopause. The safety of hormone replacement therapy (HRT) and vaginal estrogens for BC survivors has been debated over time and remains unclear. Non-hormonal therapies such as antidepressants, gabapentine and clonidine may be useful for those patients but there are few data about their safety.

Relationship of locus of control and depression to treatment adherence in gynecologic oncology patients

CAH and EIN who underwent any type of hysterectomy. Of these patients, 2315 had concurrent bilateral or unilateral oophorectomy (83.2%). Occult ovarian cancer was found in 27 of these cases, representing an overall risk of 1.2%. Stratified by age, 15 of 1838 women b65 years of age and 12 of 477 who were ≥65 years old had ovarian cancer on final pathology, representing an 0.8% and 2.5% risk of ovarian cancer in these age groups, respectively. We determined the relative risk of occult ovarian malignancy at the time of surgical management of CAH to be 3.1 at age ≥65 vs. age b65 years (relative risk 3.08, 95% CI 1.5–6.5, Fisher's exact test P b 0.006). Conclusions: Conventional management of CAH/EIN in women who have completed childbearing does not differ from that of endometrial cancer, including total abdominal hysterectomy/bilateral salpingooophorectomy. This practice is compelled by the theoretical risk of continued hormonal stimulation of residual endometrial disease, the risk of a synchronous ovarian malignancy, and the risk of metastasis to the ovary. Studies endorsing the safety of hormone replacement therapy in endometrial cancer patients argue against the detrimental effect of estrogen in endometrial cancer patients and, therefore, in CAH/ EIN as well. Our study demonstrates a low incidence of ovarian malignancy in women with CAH/EIN, especially in women b65 years of age, providing compelling evidence to support ovarian preservation. As data increase regarding the health benefits of ovarian preservation in postmenopausal women, a paradigm shift in the surgical management of CAH in these same women should follow.

Limited training exposure in intraoperative radiation therapy (IORT) may result in omission of its use in treating locally advanced gynecologic malignancies

CAH and EIN who underwent any type of hysterectomy. Of these patients, 2315 had concurrent bilateral or unilateral oophorectomy (83.2%). Occult ovarian cancer was found in 27 of these cases, representing an overall risk of 1.2%. Stratified by age, 15 of 1838 women b65 years of age and 12 of 477 who were ≥65 years old had ovarian cancer on final pathology, representing an 0.8% and 2.5% risk of ovarian cancer in these age groups, respectively. We determined the relative risk of occult ovarian malignancy at the time of surgical management of CAH to be 3.1 at age ≥65 vs. age b65 years (relative risk 3.08, 95% CI 1.5–6.5, Fisher's exact test P b 0.006). Conclusions: Conventional management of CAH/EIN in women who have completed childbearing does not differ from that of endometrial cancer, including total abdominal hysterectomy/bilateral salpingooophorectomy. This practice is compelled by the theoretical risk of continued hormonal stimulation of residual endometrial disease, the risk of a synchronous ovarian malignancy, and the risk of metastasis to the ovary. Studies endorsing the safety of hormone replacement therapy in endometrial cancer patients argue against the detrimental effect of estrogen in endometrial cancer patients and, therefore, in CAH/ EIN as well. Our study demonstrates a low incidence of ovarian malignancy in women with CAH/EIN, especially in women b65 years of age, providing compelling evidence to support ovarian preservation. As data increase regarding the health benefits of ovarian preservation in postmenopausal women, a paradigm shift in the surgical management of CAH in these same women should follow.

Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine

In 2002, the Women's Health Initiative, a large-scale study of the safety of hormone replacement therapy (HRT) for women conducted in the United States, released results suggesting that use of postmenopausal HRT increased women's risks of stroke and breast cancer. In the years that followed, as rates of HRT prescription fell, another hormonal therapy rose in its wake: bioidentical hormone replacement therapy (BHRT). Anti-aging clinicians, the primary prescribers of BHRT, tout it as a safe and effective alternative to treat menopausal symptoms and, moreover, as a preventative therapy for age-related diseases and ailments. Through in-depth interviews with 31 U.S.-based anti-aging clinicians and 25 female anti-aging patients, we analyze attitudes towards BHRT. We illustrate how these attitudes reveal broader contemporary values, discourses, and discomforts with menopause, aging, and biomedicine. The attraction to and promise of BHRT is rooted in the idea that it is a “natural” therapy. BHRT is given both biomedical and embodied legitimacy by clinicians and patients because of its purported ability to become part of the body's “natural” processes. The normative assumption that “natural” is inherently “good” not only places BHRT beyond reproach, but transforms its use into a health benefit. The clinical approach of anti-aging providers also plays a role by validating patients' embodied experiences and offering a “holistic” solution to their symptoms, which anti-aging patients see as a striking contrast to their experiences with conventional biomedical health care. The perceived virtues of BHRT shed light on the rhetoric of anti-aging medicine and a deeply complicated relationship between conventional biomedicine, hormonal technologies, and women's bodies.

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.

A Review of Paroxetine for the Treatment of Vasomotor Symptoms

Background: Studies in recent years have exposed concerns about the safety of hormone replacement therapy (HRT) in the treatment of vasomotor symptoms (VMS) in menopausal women. Numerous studies have examined the use of antidepressants for relief of VMS. Despite recommendations to deny approval of paroxetine mesylate (Brisdelle™) for the treatment of VMS, the Food and Drug Administration (FDA) recently granted it approval for this indication. Objective: To evaluate all published literature examining use of paroxetine salts (mesylate and hydrochloride) in the treatment of menopausal VMS. Methods: Both PubMed and International Pharmaceutical s (IPA) were searched using the keywords hot flashes, vasomotor symptoms, menopause, and paroxetine. In PubMed, MeSH terms were used for paroxetine, menopause, and hot flashes. Searches were limited to humans, English language, and clinical trial design. The references for each study identified in this search process were examined in order to locate any additional relevant articles. Results: Compared with placebo, paroxetine salts offer a modest benefit in the treatment of menopausal VMS reducing the frequency and severity of weekly hot flashes. Conclusion: Paroxetine (mesylate or hydrochloride) is an effective alternative to HRT for the reduction in VMS in menopausal women. Future head-to-head studies with active medications are needed in order to identify the best algorithm of treatment for this condition.

Menopause: modern concepts of safety and effectiveness of treatment

In lectures presented data on pathogenesis, clinical manifestations and current treatment of menopausal syndrome. Questions of safety of hormone replacement therapy are being discussed.

Treatment of climacteric symptoms in breast cancer patients: A retrospective study from a medication databank

IntroductionWomen affected by breast cancer (BC) will often go through menopause at an earlier age and display more frequent and severe symptoms than women who have a natural menopause. The safety of hormone replacement therapy (HRT) and vaginal estrogens for BC survivors has been debated over time and remains unclear. Non hormonal therapies such as antidepressants, gabapentine and clonidine may be useful for those patients but there are few data about their safety. AimThis retrospective study analyses the use by BC patients of treatments known to alleviate climacteric symptoms. Material and methodPost-menopausal Estrogen Receptors positive (ER+) BC patients, aged 45–69, were identified as having bought, at least once, an aromatase inhibitor (AI) or tamoxifen between the years 2000 and 2012 through a pharmaceutical databank in Belgium. Among them, we defined users of a climacteric treatment those who bought, at least once, HRT, vaginal topical estrogens, antidepressants, clonidine and gabapentine. ResultsWe identified 2530 BC patients. Among them, 45% were buying a treatment known to alleviate menopausal symptoms. The majority of these treatments were non-HRT therapies. HRT and vaginal estrogens were seldom bought (respectively 1.1% and 6%), but 3% bought vaginal estrogens while buying AI. About 9.2% of tamoxifen users patients bought antidepressants implicated in tamoxifen metabolism at the same time as tamoxifen. ConclusionsMost BC patients follow current guidelines contra-indicating the use of HRT after BC, they use non hormonal therapies. In some cases they use unfortunately antidepressants that may alter the metabolism of tamoxifen.

Should HRT be duration limited?

Hormone Replacement Therapy (HRT) has received consistently bad press, despite re-analysis of previous data new studies and supporting Consensus Statements from leading national and international societies. Many women have been convinced by women's journals and the media not to even consider HRT as an option and, General Practitioners, still limit duration to 5 years or, will, arbitrarily, discontinue prescriptions in the early 50s. This article seeks to make sense of our current position. Previous and new evidence on the safety of HRT is reviewed. New data on the long-term consequences of non-treatment of women with Premature Ovarian Insufficiency (POI) is presented and the dichotomy of the older female workforce is explored. From this, a logical plan of management emerges.

Menopause: a new look at an old problem

The article presents the basic principles of the International Menopausal Society Guidelines on the hormone replacement therapy (2011), and describes the main benefits and risks of hormone replacement therapy.Safety of hormone replacement therapy largely depends on age. Healthy women younger than 60 years should not be overly concerned about the safety of hormone replacement therapy. If hormone replacement therapy is initiated within a few years after menopause, the potential beneficial effects of it are numerous and risks are minor in most cases.Women can use hormone replacement therapy as long as it has a beneficial effect on the symptoms and the patient aware of the possible risks.