Undergoing Hormone Replacement Therapy Research Articles

Determination of a Normal Level of Serum CA125 in Postmenopausal Women as a Tool for Preoperative Evaluation and Postoperative Surveillance of Endometrial Carcinoma

In an attempt to determine a normal level of CA125 in postmenopausal women, CA125 levels of normal postmenopausal women (n= 36, 58.2 ± 8.1 years) and postmenopausal women undergoing hormone replacement therapy (HRT) (n= 111, 56.8 ± 6.1 years) were studied. A mean CA125 concentration of 10.0 ± 3.8 U/ml was found in postmenopausal women without HRT and was significantly lower than that of postmenopausal women undergoing HRT (12.8 ± 3.8 U/ml), indicating that the cutoff level of CA125 in postmenopausal women or women without reproductive organs should be estimated at a level lower than that conventionally accepted. A receiver operating characteristic (ROC) curve for a preoperative evaluation of myometrial invasion was analyzed in postmenopausal women with endometrial cancer (n= 110). A novel cutoff level of 20 U/ml of CA125 could detect myometrial invasion to more than one-half of the myometrium with sensitivity of 69.0%, specificity of 74.1%, positive predictive value of 58.8%, and negative predictive value of 81.6%. In addition, the distribution of CA125 levels was analyzed in patients who had undergone an operation for endometrial cancer more than 2 years earlier and as yet had no clinical evidence of recurrence of the disease. Ninety-six point two percent of 619 measurement values were lower than 20 U/ml. These results suggest that the novel CA125 level of 20 U/ml is clinically useful for preoperative evaluation and postoperative surveillance of endometrial carcinoma.

Reduction of intraocular pressure in a glaucoma patient undergoing hormone replacement therapy

Objectives: To show the reducing effect of estrogens and progestins on the elevated intraocular pressure (IOP) in the case of a 56-year-old woman showing typical climacteric complaints, who was admitted to the menopause outpatient unit. She also suffered from a primary open-angle glaucoma treated with betaophtiole eye drops with intraocular pressures of 16–20 mmHg under this local therapy. Methods: IOP patterns were monitored by means of standardised daily pressure profiles four times a day before as well as 4 and 12 weeks after the beginning of hormone replacement therapy (HRT). The local glaucoma therapy remained unchanged. Results: During HRT, IOP levels were reduced from 16–20 mmHg before therapy to 12–15 mmHg at week 4 and to 13–15 mmHg at week 12 after the beginning of HRT. Conclusion: The finding of a close chronological relationship between the onset of menopause and the development of a glaucoma is a potentially new indication for HRT.

A COMPARATIVE STUDY ON BIOCHEMICAL MARKERS OF BONE COLLAGEN BREAKDOWN IN POST-MENOPAUSAL WOMEN

The aim of this study was to compare urinary galactosylhydroxylysine (GHyl) and deoxypyridinoline (d-Pyr) as biochemical markers of bone resorption in post-menopausal women treated and untreated with estrogen and cyclic etidronate. Fasting urinary GHyl,d-Pyr, pyridinoline, serum osteocalcin and total alkaline phosphatase were measured in three subgroups, i.e. post-menopausal women undergoing hormone replacement therapy, untreated post-menopausal women and post-menopausal women with low BMD treated with disodium etidronate. The results indicated that GHyl did not significantly discriminate between untreated post-menopausal women and estrogen replated ones unless an osteoporotic untreated group was selected.d-Pyr and GHyl showed similar performances when their values after bisphosphonate treatment were compared to those found in untreated post-menopausal women, thus suggesting that both markers were equal in their ability to detect the bone response to cyclic etidronate administration. This observation further proves the statment that GHyl is prone to confounding factors under estrogen therapy but it is adequate as isd-Pyr in monitoring the bone response to bisphosphonate treatment.

Mammography in women undergoing hormone replacement therapy. Possible effects revealed at routine examination.

A retrospective study of screen-film mammographs was performed in 960 postmenopausal women to evaluate the possible effects of hormonal replacement therapy on the breast parenchymal pattern. Screen-film mammographs of 754 women (mean age 51.4 years) who had undergone hormonal replacement therapy (estrogen, gestagen; mean duration 2.4 years) were compared with findings in 206 women who had not received hormonal replacement therapy (mean age 52.3 years). Mastopathic changes were analyzed according to a 4-grade scale and the incidence of circumscribed lesions (such as fibroadenomas, cysts and malignancies) was further evaluated. In the treated women we found moderate mastopathic changes in 47.2%, intermediate changes in 2.4%, and extensive proliferations in 0.7%. For the untreated women the corresponding figures were 33.5%, 4.8%, and 1.4%. In the treated patients fibroadenomas were apparent in 3.9%, cystic lesions in 3.3%, and malignant lesions in 1.4%. In the untreated women fibroadenomas were evident in 11.6%, cystic lesions in 7.2%, and malignant lesions in 2.4%. Mastopathic changes might increase under hormonal replacement therapy. However, the higher incidence of circumscribed lesions in the untreated women might be due to the higher number of symptomatic women who sought examination. We also speculate as to whether the increased density of the breast parenchyma in the treated women might cause a higher number of mammographically undedectable lesions.

Mammography in women undergoing hormone replacement therapy

Mammography in women undergoing hormone replacement therapy

Transdermal estroprogestins versus transdermal estrogen plus oral dihydrogesterone replacement in menopause.

We studied 18 early (6 to 36 months) postmenopausal patients with a mean age of 51 years (47-53), who had never undergone hormone replacement therapy before and had no contraindications to hormone replacement. All cases of menopause were spontaneous. The treatment consisted in the continuous transdermal administration of 17-beta-estradiol (50 microg/daily) by skin patch to be replaced every 84 hours. The patients were further treated with a two-week progestogen administration every fortnight. This consisted of transdermal norethisterone acetate (0.25 mg/daily) combined with estradiol in the same patch in the first year, and oral dihydrogesterone (10 mg/daily) in the second year, without wash-out period. Before treatment (T0), and at the 12th (T1) and 24th (T2) month we measured the body mass index, the arterial blood pressure (AP), lipoproteins, coagulation parameters and bone metabolism parameters. The systolic pressure presented mean values (+/-SD) equal to 128.5+/-10.2 mmHg (T0), 131.1+/-7.4 mmHg (T1) and 130.4+/-7.5 mmHg (T2). Diastolic pressure values showed mean value ranging from 85.4+/-8.7 mmHg (T0) to 83.9+/-5.3 (T1) and 83.4+/-5.8 mmHg (T2). The detailed analysis of values of triglycerides, HDL cholesterol, apolipoprotein A1, apolipoprotein B and coagulation parameters at different times of therapy showed no statistically significant changes. With regard to bone metabolism, no statistically significant changes from baseline values were observed in parathormone, alkaline phosphatase, calcitonin, urinary calcium/creatinine ratio, and bone mineral content expressed by the bone density.

The effects of menopause and hormone replacement therapies on prednisolone and erythromycin pharmacokinetics*

The pharmacokinetics of oral and intravenous prednisolone and intravenous erythromycin were examined in premenopausal women, postmenopausal women not undergoing hormone replacement therapy, postmenopausal women undergoing estrogen replacement therapy, and postmenopausal women undergoing estrogen and progestin replacement therapy. The unbound clearance of prednisolone was significantly lower in postmenopausal women (11.6 +/- 2.3 ml/min/kg) than in premenopausal women (16.6 +/- 3.5 ml/min/kg). A comparable difference was also observed in total clearance and in half-life. The bioavailability and volume of distribution of prednisolone were unaffected by menopausal status. Hormone replacement therapies did not significantly affect prednisolone pharmacokinetics. In contrast to prednisolone elimination, erythromycin elimination, as measured by the erythromycin breath test, was not significantly affected by either menopausal status or hormone replacement therapy. In addition, there was no correlation between prednisolone clearance and the erythromycin breath test result. Although cytochrome P450 3A4 (CYP3A4) has been implicated in steroid hormone metabolism, these results suggest that another enzyme system, which is decreased in menopause (rather than simply an age effect), is also involved in prednisolone metabolism.

Long-term bone mass evaluation of mandible and lumbar spine in a group of women receiving hormone replacement therapy.

The overall aim of this study was to examine the relationship between bone mass of the jaw and the axial skeleton. Sixty-nine subjects (age at entry: 32-64), who underwent hormone replacement therapy during the study period, participated. Bone mass of the lumbar spine was determined using dual photon absorptiometry. The jaw-bone of the posterior region of the mandible was evaluated by means of standardized long-cone radiography using individual bite-blocks. A densitometric wedge in the film holder provided a reference to quantify bone mass. From both measurements, it appeared that the bone mass of the mandible and the lumbar spine showed a moderate relationship. The present results also confirmed that estrogen replacement therapy had a positive effect on the bone mass of the mandible and the lumbar spine. Different estrogen regimens resulted in different increases in bone mass during the observation period, which was on average 5 yr.

Advances in hormone replacement therapy.

Thousands of women in the UK undergo hormone replacement therapy each year. Many of them experience side-effects and choose to discontinue treatment. In this article, the authors review some of the products currently available and the new approaches to therapy that are under investigation.

Pregnancy in women 50 or more years of age: outcomes of 22 consecutively established pregnancies from oocyte donation

To describe the reproductive and obstetric outcomes of women > or = 50 years attempting pregnancy using donor oocytes. The IVF program at the University of Southern California. Thirty-six postmenopausal women aged 50 to 59 years, mean 52.3 +/- 2.6 years (mean +/- SD) were screened medically, reproductively, and psychologically and enrolled in a trial of oocyte donation. Recipients underwent hormone replacement therapy using oral micronized E2 and IM administered P. Oocytes were provided by designated gamete donors (mean age 30.5 +/- 4.4 years). Embryos (4.3 +/- 1.2) were transferred transcervically. Rates for embryo implantation, spontaneous abortion, ongoing and delivered pregnancies, as well as the gestational age at delivery, birthweights, complications, and postpartum outcomes. Forty-five aspirations resulted in 22 pregnancies (48.9%): 3 preclinical, 2 ending in spontaneous abortion, and 17 viable pregnancies (37.8%). The embryo implantation rate was 20.6%. Nine of 17 pregnancies (52.9%) were multiple gestations (6 twins; 1 triplet; and 2 quadruplets, selectively terminated to twins). All pregnancies delivered beyond 32 weeks: mean gestational age for singletons was 38.4 +/- 1.9 weeks (range 35 to 41 weeks); mean gestational age for twins was 36.3 +/- 1.4 weeks (range 34 to 38 weeks); the triplet pregnancy delivered at 32 weeks. Complications occurred in eight patients; gestational hypertension (n = 7), preterm labor (n = 3), gestational diabetes (n = 2), and pre-eclampsia (n = 1). One infant was trisomy-21. Patients > or = 50 years experience similar pregnancy rates after oocyte donation as younger women and are at equal risk for multiple gestation. Antenatal complications were experienced by the majority of patients, underscoring the importance of high risk obstetric surveillance and care.

92018926 A morphometric study of the uterine glandular epithelium in women with premature ovarian failure undergoing hormone replacement therapy

92018926 A morphometric study of the uterine glandular epithelium in women with premature ovarian failure undergoing hormone replacement therapy

A morphometric study of the uterine glandular epithelium in women with premature ovarian failure undergoing hormone replacement therapy

In this study we examined the fine structure of the human glandular epithelium in women with idiopathic ovarian failure in artificial cycles produced by two different types of hormone replacement therapy (oestradiol valerate orally and either intramuscular injection of progesterone or progesterone via vaginal pessary), both of which had been claimed to be capable of supporting successful implantation. Biopsies were performed on day 19 of the artificial cycle. A variety of sterological probes were used to quantify the structural characteristics of these cells and the results obtained were compared with those from normal fertile subjects biopsied on days 2 and 5 after the luteinizing hormone (LH) surge. The glandular epithelial cells from the vaginal group had a less elaborate secretory apparatus when compared with the intramuscular group or with LH + 5 controls. Many of the features of the vaginal group suggested a continued oestrogenic influence, while the intramuscular group seemed to be more advanced than LH + 5.

The effect of aging on hypothalamic function in oophorectomized women

To detect age-related changes intrinsic to hypothalamic-pituitary function, we studied plasma gonadotropin levels in 12 oophorectomized women ages 27 to 64 years who were not undergoing hormone replacement therapy. Blood drawn from an indwelling catheter every 10 minutes for 5 hours was assayed for follicle-stimulating hormone, luteinizing hormone, estradiol, and prolactin concentrations. All estradiol levels were less than 20 pg/ml and prolactin values were normal. Mean gonadotropin concentrations, pulse frequency, and pulse amplitude were no different in women aged 27 to 49 years as compared with subjects 52 to 64 years old. When grouped according to gynecologic age (years since puberty) or years after oophorectomy, luteinizing hormone and follicle-stimulating hormone mean concentrations, mean pulse frequency, and mean pulse amplitude were comparable to those grouped according to chronologic age. On the basis of our findings, lack of response from postmenopausal ovaries to endogenous gonadotropin stimulation is a result of primary age-related change in the ovary, not in the hypothalamus.

Mammographic changes associated with postmenopausal hormone replacement therapy: a longitudinal study.

A retrospective study of radiologic findings from 50 postmenopausal women who underwent hormone replacement therapy was performed to determine the frequency and distribution of changes in the screen-film mammographic appearance of breast tissue between pretreatment and posttreatment mammography. Twelve (24%) of the women developed increased parenchymal density during a median follow-up of 18 months (range, 6-39 months). Mammographic changes included diffuse increase in density in seven (14%) of the women; increased multifocal, asymmetric densities in two (4%); and cyst formation in three (6%). A greater percentage of women who received estrogen-progesterone replacement (26%, 10 of 38) demonstrated changes than those who received estrogen alone (17%, two of 12), but the difference was not statistically significant. The authors conclude that benign increases in mammographic density associated with postmenopausal hormone replacement therapy are not uncommon, and they suggest that the serial changes observed in some women may diminish the sensitivity of mammography for the earlier detection of breast cancer.