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In recent years, studies have found that breast microbiota differs between breast cancer tissue and normal breast tissue. Breast microbiota is closely related to the occurrence and development of breast cancer, and its mechanism includes affecting estrogen levels, lipid metabolism, immune regulation, and inflammatory response. Adjusting diet, rational use of antibiotics and oral probiotics can regulate breast microbiota, which is a new direction for the prevention and treatment of breast cancer.
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Objective To study the regulation effects of Bazhen Decoction combined with Baizhu Fuzi Decoction on glucose metabolism and estrogen level in rats with polycystic ovary syndrome.Methods The rat model of polycystic ovary syndrome was established by subcutaneous injection of human chorionic gonadotropin(HCG)combined with insulin.Rats were randomly divided into the polycystic ovary syndrome group,the Baizhu Fuzi Tang group(6.4 g/kg),the Bazhen Tang group(9.2 g/kg),the Bazhen Tang combined with Baizhu Fuzi Tang group(11.55 g/kg)and the diethylstilbestrol group(0.5 mg/kg).A blank control group(unmodulated rats)was set up with 10 rats in each group.The uterine index of rats was determined and calculated.Fasting blood glucose(FBG),2 h postprandish blood glucose(2 h PBG)and fasting insulin(FINS)were determined and insulin sensitivity index(ISI)and insulin resistance index(IR)were calculated.Serum estradiol(E2),testosterone(T),luteinizing hormone(LH),follicle stimulating hormone(FSH),prolactin(PRL),anti-Mullerian tube hormone(AMH)and insulin-like growth factor 1(IGF-1),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,total peroxidase activity(T-AOC),superoxide dismutase(SOD)and malondialdehyde(MDA)levels in ovarian tissue were detected by enzyme-linked immunosorbent assay(ELISA).The pathological changes of ovarian tissue were detected by hematoxylin-eosin(HE)staining.Real-time quantitative polymerase chain reaction(qPCR)was used to determine mRNA levels of ARA70,CBP,SCR1 and HOXA10 in endometrium and mRNA expressions of AMPK,GLUT4 and PPARγ in ovarian tissue.Western blot assay was used to determine expression levels of AMPK,GLUT4 and PPARγ in ovarian tissue.Results Compared with the polycystic ovary syndrome group,uterine index,FINS,FBG,2 h PBG,IR levels,serum T,LH,FSH,PRL,AMH,IGF-1 levels,ovarian tissue CRP,IL-6,TNF-α,T-AOC and MDA level,endometrial ARA70,CBP,SCR1 mRNA level of rats decreased significantly in the Baizhu Fuzi decoction group,the Bazhen decoction group and the Bazhen decoction combined with Baizhu Fuzi decoction group(P＜0.05).ISI level,serum E2 level,ovarian tissue SOD level,endometrial HOXA10 mRNA level,ovarian tissue AMPK,GLUT4 and PPARγ mRNA and protein levels were significantly increased(P＜0.05).The above indexes were significantly changed in the Bazhen decoction and Bazhu Fuzi decoction group than those of the Bazhu Fuzi decoction group and the Bazhen decoction group(P＜0.05).Conclusion Bazhen Decoction combined with Baizhu Fuzi Decoction can regulate glucose metabolism,inhibit ovarian tissue oxidation and inflammatory damage,improve endometrium tolerance,regulate estrogen level,and improve the progression of polycystic ovary syndrome in rats.The mechanism may be related to the regulation of AMPK/GLUT4/PPARγ pathway.
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Abstract Objective To evaluate the effects of estrogen, raloxifene and genistein on the expression of KISS1 (kisspeptin), KISS1R (kisspeptin receptor), AR (androgen receptor) and INSR (insulin receptor) in the bones of ovariectomized rats. Methods Forty-eight adult rats were randomly divided into 6 groups, containing 8 animals each: G1-nonovariectomized control; G2-ovariectomized and treated with conjugated equine estrogens (50 µg/Kg/day); G3-ovariectomized and treated with raloxifene (0.75 mg/kg/day); G4-ovariectomized animal that received soy extract with genistein (300 mg/kg/day); G5-ovariectomized animal that received estrogen and genistein; and G6-ovariectomized animal that received estrogen and raloxifene. Three months after surgery, the castrated animals received the drugs orally daily for 120 days. All animals were sacrificed after this period, by deepening the anesthesia. The left tibia was removed for total RNA extraction and analysis of gene expression of KISS1, KISS1R, AR and INSR, by quantitative real-time polymerase chain reaction (qRT-PCR). Results KISS1 was not detected in any of the treated groups. KISS1R, INSR and AR showed higher expression in the G3 group (p < 0.001), while lower levels of transcripts for these genes were observed in G4 and G5. G2 animals showed hypoexpression of the evaluated genes. Conclusion The results indicate that raloxifene, alone or combined with estrogen, was able to induce the expression of genes associated with the recovery of bone tissue homeostasis in ovariectomized rats.
Resumo Objetivo Avaliar os efeitos do estrogênio, raloxifeno e genisteína na expressão de KISS1 (kisspeptina), KISS1R (receptor da kisspeptina), AR (receptor de androgênio) e INSR (receptor de insulina) nos ossos de ratas ovariectomizadas. Métodos Quarenta e oito ratas adultas foram divididas aleatoriamente em 6 grupos, contendo 8 animais cada: G1-controle não ovariectomizado); G2-ovariectomizado e tratado com estrogênios conjugados equinos (50 µg/Kg/dia); G3-ovariectomizado e tratado com raloxifeno (0,75 mg/kg/dia); G4-ovariectomizado que recebeu extrato de soja com genisteína (300 mg/kg/dia); G5-ovariectomizado que recebeu estrogênio e genisteína; e G6-ovariectomizado que recebeu estrogênio e raloxifeno. Após 3 meses da cirurgia, os animais castrados receberam os fármacos diariamente por via oral, durante 120 dias. Todos os animais foram sacrificados após esse período, por aprofundamento da anestesia. A tíbia esquerda foi removida para extração de RNA total e análise da expressão gênica de KISS1, KISS1R, AR e INSR, por reação de cadeia de polimerase quantitativa em tempo real (quantitative real-time polymerase chain reaction, qRT-PCR, em inglês). Resultados KISS1 não foi detectado em nenhum dos grupos tratados. KISS1R, INSR e AR mostraram maior expressão no grupo G3 (p < 0,001), enquanto menores níveis de transcritos para esses genes foram observados em G4 e G5. Os animais de G2 apresentaram hipoexpressão dos genes avaliados. Conclusão Os resultados indicam que o raloxifeno, isolado ou combinado com estrogênio, foi capaz de induzir a expressão de genes associados à recuperação da homeostase do tecido ósseo em ratas ovariectomizadas.
Subject(s)
Animals , Rats , Osteoporosis , Genistein , Raloxifene Hydrochloride/therapeutic use , Estrogens , Kisspeptins摘要
Los síntomas vasomotores (SVM) asociados a la menopausia suelen disminuir la calidad de vida de las mujeres, al generar un elocuente malestar. La terapia hormonal de la menopausia (THM) es el estándar en el tratamiento de los síntomas de la menopausia, siendo el único tratamiento que ha demostrado ser eficaz para los SVM. Objetivo: describir la eficacia y seguridad de la terapia hormonal de la menopausia vía transdérmica (THM TD) para aliviar los síntomas de la menopausia. Métodos: se hizo una revisión sistemática de la literatura en diferentes bases de datos electrónicas (CINAHL Plus, EMBASE, Scopus, Lilacs, Medline, Pubmed, entre otras), a través de términos de búsqueda estandarizados. Los desenlaces evaluados incluyeron los estudios donde se publicó cualquier tratamiento o intervención con la THM TD en mujeres tratadas por síntomas de la menopausia, porcentajes de alivio de los síntomas climatéricos y proporción de eventos adversos asociados. Resultados: se incluyeron 45 publicaciones, y convienen en aconsejar el tratamiento con la THM TD, en vista de un alivio de los síntomas climatéricos cerca del 90%, asimismo de ser más segura y potencialmente más eficaz que la terapia oral; con resultados normales en la evaluación mamográfica, y sin eventos adversos relacionados después de 5 años de seguimiento. Conclusiones: la terapia hormonal en la menopausia vía transdérmica es segura y eficaz para aliviar los síntomas de la menopausia. Al evitarse el metabolismo hepático, alcanza mejores beneficios clínicos, a la vez que minimiza la exposición de eventos adversos. Las publicaciones revisadas demuestran que la vía transdérmica es la mejor forma de tratar los síntomas de la menopausia.
Vasomotor symptoms (VMS) associated with menopause usually reduce the quality of life of women, generating eloquent discomfort. Menopausal hormone therapy (MHT) is the standard in the treatment of menopausal symptoms, being the only treatment that has been shown to be effective for VMS. Objective: to describe the efficacy and safety of transdermal menopausal hormone therapy (THM TD) to relieve menopausal symptoms. Methods: a systematic review of the literature was carried out in different electronic databases (CINAHL Plus, EMBASE, Scopus, Lilacs, Medline, Pubmed, among others), through standardized search terms. The outcomes evaluated included studies where any treatment or intervention with TD MHT was published in women treated for menopausal symptoms, percentages of relief of climacteric symptoms and proportion of associated adverse events. Results: 45 publications were included, and they agree in advising treatment with MHT TD, in view of a relief of climacteric symptoms close to 90%, as well as being safer and potentially more effective than oral therapy; with normal results in mammographic evaluation, and without related adverse events after 5 years of follow-up. Conclusions: transdermal hormonal therapy in menopause is safe and effective in relieving menopause symptoms. By avoiding hepatic metabolism, it achieves better clinical benefits, while minimizing the exposure to adverse events. The reviewed publications demonstrate that the transdermal route is the best way to treat menopause symptoms.
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SUMMARY OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.
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Skin quality deteriorates with age for various reasons, including hormone deficiencies. In women, the decline in estrogen levels during menopause plays an important role in skin degeneration, with consequent atrophy, collagen reduction, loss of elasticity, and impaired wound healing. Research has demonstrated the beneficial effects of topical phytoestrogen in preventing and repairing skin aging, with localized action and without side effects. The objective of this study was to review the relevant literature, demonstrating that this can be a safe and effective alternative for treating the skin of perimenopausal women.
A qualidade da pele deteriora-se com a idade por vários motivos, incluindo as deficiências hormonais. Nas mulheres, o declínio dos níveis de estrógeno, durante a menopausa, tem papel importante na degeneração cutânea, com consequente atrofia, redução do colágeno, perda de elasticidade e deficiência da cicatrização de feridas. Pesquisas têm demonstrado efeitos benéficos do fitoestrogênio tópico na prevenção e reparação do envelhecimento cutâneo, com ação localizada e sem efeitos colaterais. O objetivo deste estudo foi revisar a literatura pertinente ao assunto, demonstrando que esta pode ser uma alternativa segura e eficaz para o tratamento da pele de mulheres na perimenopausa.
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RESUMEN INTRODUCCIÓN La migraña es una condición médica prevalente y altamente discapacitante. Por lo general, durante el embarazo hay una reducción de los síntomas migrañosos, sin embargo, en ocasiones la sintomatología puede no mostrar mejoría, y en algunos casos empeorar. Por tanto, es necesario que el médico del servicio de urgencias realice un correcto diagnóstico de esta enfermedad, que descarte otros tipos de cefaleas y brinde el mejor y el más seguro tratamiento analgésico de acuerdo con la edad gestacional y perfil clínico de cada paciente. En esta revisión se abordará la relación entre la migraña y el embarazo, el papel de los estrógenos en la génesis de la migraña, así como también los datos más actuales en cuanto al tratamiento del manejo agudo de esta patología durante la gestación. MATERIALES Y METODOS: Se realizó una revisión sistemática de la literatura mundial sobre la relación entre la migraña y el embarazo y el manejo agudo en esta población, obteniéndose un total de 83 referencia bibliográficas. RESULTADOS: Como manejo inicial, se recomienda el uso de Acetaminofén más metoclopramida en cualquier etapa de la gestación. El uso de AINE debe evitarse a partir de la semana 20 de gestación. El Sumatriptán puede ser utilizado como segunda línea en cualquier trimestre. A todas las pacientes se les debe brindar manejo no farmacológico. CONCLUSIONES: Actualmente se cuenta con varios medicamentos y procedimientos seguros para el manejo agudo de la migraña en gestantes, sin embargo, debe tenerse en cuenta la edad gestacional ante su administración.
ABSTRACT INTRODUCTION: Migraine is a prevalent and highly disabling condition. Usually during pregnancy there is relief of symptoms, however, sometimes headache cannot improve, and some cases may get worse. Therefore, it is necessary for physicians who work at the emergency department perform a correct diagnosis of this pathology, rule-out other types of headaches and give the best and safest treatment according to gestational age and clinical profile of each patient. This review will address the relationship between migraine and pregnancy, the role of estrogens in the genesis of migraine. Updated information with respect to acute treatment of migraine during this period will be discussed. METHODS: A systematic review of the world literature on the relationship between migraine and pregnancy and acute management in this population was carried out, obtaining a total of 83 bibliographic references. RESULTS: As an initial management, the use of acetaminophen plus metoclopramide is recommended at any stage of pregnancy. The use of NSAIDs should be avoided from week 20 of gestation. Sumatriptan can be used as a second line in any trimester. Non-pharmacological management should be provided to all patients. CONCLUSIONS: There are currently safe drugs and procedures for the acute management of migraine in pregnant women, however, gestational age should be taken into account before administering them.
Subject(s)
Pregnancy , Migraine without Aura , Estrogens , Therapeutics摘要
Objective:To investigate the association between reproductive lifespan duration (RLD) and urinary albumin-creatinine ratio (UACR) in a Chinese postmenopausal population.Methods:This cross-sectional study included 11 055 naturally postmenopausal women from seven regions of China from May to December 2011. RLD was divided into four groups. Propensity score matching was performed to reduce bias, and logistic regressions and stratifications were conducted to investigate the association between RLD and increased UACR (≥30 mg/g). Mediation effect analysis was performed to quantify the effect of RLD on cardiovascular disease (CVD) induced by elevated UACR.Results:There were 2 373 participants with a RLD of 18-31 years, 2 888 participants with a RLD of 32-34 years, 2 472 participants with a RLD of 35-36 years, and 3 322 participants with a RLD of 37-50 years. The shortest RLD (18-31 years) group was characterized with older age ( P<0.001), a higher incidence of CVD ( P=0.025), and the highest level of UACR ( P<0.001). After adjusting for confounders, women with a longer RLD (37-50 years group) exhibited a lower risk of UACR elevation compared with those with the shortest RLD (18-31 years group) ( OR=0.72, 95% CI 0.64-0.82, P<0.001). Every 1-year extension in RLD was linked to a 2% reduction in the risk of UACR elevation ( OR=0.98, 95% CI 0.97-0.99, P<0.001). Stratified analysis revealed a more significant association between RLD and UACR in women who were a normal weight ( P=0.003) or overweight ( P=0.001), in those without CVD history ( P=0.001), and in those with impaired estimated glomerular filtration rate ( P=0.004). The mediation casual analysis showed that 3.0% of proteinuria inducing CVD events was mediated by RLD ( P=0.048). Conclusion:A longer RLD (37-50 years) is associated with a lower UACR in Chinese postmenopausal women.
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Objective:To investigate the efficacy and safety of promestriene vaginal gelatin capsules administered through different schemes in the treatment of postmenopausal female urethral syndrome.Methods:A total of 120 patients with postmenopausal female urethral syndrome who received treatment in General Hospital of Medical and Health Group of Cixi Third People's Hospital from January 2021 to June 2022 were included in this study. They were randomly divided into groups A and B ( n = 60/group). Group A was treated with vaginal gelatin capsules containing 10 mg promestriene once a day. Group B was treated with vaginal gelatin capsules containing 10 mg promestriene twice a day. Both groups were treated for 20 days as a course of treatment. The improvement of symptoms, lower urinary tract symptom score, quality of life score, estradiol level, follicle stimulating hormone level, and endometrial thickness were compared between the two groups. Results:After treatment, the scores of incomplete urination, urination interval, intermittent urination, dysuria, thinner urine line, urination force, and nocturnal urination times in group A were (2.51 ± 1.76) points, (2.66 ± 1.08) points, (2.61 ± 1.45) points, (2.48 ± 1.42) points, (2.85 ± 1.03) points, (2.48 ± 1.42) points, and (2.52 ± 1.72) points, respectively, which were significantly lower than (3.15 ± 1.35) points, (3.23 ± 1.14) points, (2.99 ± 1.57) points, (3.08 ± 1.09) points, (3.45 ± 1.72) points, (3.25 ± 1.08) points, and (3.21 ± 1.87) points, respectively, in group B ( t = 10.57, 9.78, 13.83, 10.34, 9.35, 12.34, 9.45, all P < 0.05). The quality of life score in group A was (2.45 ± 0.86) points, which was significantly lower than (3.51 ± 0.92) points in group B ( t = 5.45, P < 0.05). There were no significant differences in estradiol and follicle stimulating hormone levels and endometrial thickness between the two groups before and after treatment (all P > 0.05). There was no significant difference in the incidence of adverse reactions between the two groups. Conclusion:Local application of promestriene vaginal gelatin capsules can improve the urethral syndrome in postmenopausal women. The once daily 10 mg promestriene vaginal gelatin capsule administration scheme can achieve better efficacy and safety than the twice daily administration scheme. The study is innovative, scientific, and worthy of clinical promotion.
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Objective@#To investigate the effects of estrogen deficiency on depression-like behavior and mitochondrial function in hippocampus，and to study the underlying mechanisms．@*Methods@#The female adult C57BL /6 mice were randomly assigned to Sham group，Ovx group and Ovx + E2 group．On the 7th day after operation，Ovx + E2 group was subcutaneously injected with 17 β-estradiol ( E2 ) for 4 weeks．Then another 48 female adult C57BL /6 mice were randomly divided into Sham group，Sham + MnTBAP group，Ovx group and Ovx + MnTBAP group．After operation for one week，MnTBAP was injected into the hippocampus of mice in Sham + MnTBAP group and Ovx + MnTBAP group．The depression-like behaviors of the mice were monitored by sucrose preference test and forced swimming test．Then the mice were decapitated，and the hippocampus samples were collected．Mitochondria of hippocampus were isolated using mitochondria fractionation kit．The concentrations of adenosine triphosphate (ATP) ， reactive oxygen species ( ROS) and mitochondrial membrane potential were determined，respectively. @*Results@#Compared with Sham mice，Ovx showed a decrease in the percentage of sucrose consumption，an increase in immobility time and the alterations of hippocampal mitochondrial function，which were reversed by estrogen treatment. Intrahippocampal injection of MnTBAP significantly increased the percentage of sucrose consumption and decreased immobility time in Ovx mice．@*Conclusion@#Hippocampal mitochondrial dysfunction contributes to estrogen deficiency-induced depression-like behaviors.
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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.
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Abstract Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).
Resumo Objetivo Avaliar a eficácia das abordagens hormonais e não hormonais para os sintomas de disfunção sexual e atrofia vaginal em mulheres na pós-menopausa. Fontes de Dados Pesquisamos as bases de dados PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), e Cumulative Index to Nursing and Allied Health Literature (CINAHL), assim como bancos de dados de ensaios clínicos. Foram analisados estudos publicados entre 1996 e 30 de maio de 2020. Nenhuma restrição de idioma foi aplicada. Seleção dos Estudos Foram selecionados ensaios clínicos randomizados que avaliavam o tratamento das disfunções sexuais em mulheres na pós-menopausa. Coleta de Dados Três autores (ACAS, APFC e JL), revisaram cada artigo com base em seu título e resumo. Os dados relevantes foram posteriormente retirados do texto completo do artigo. Quaisquer discrepâncias durante a revisão foram resolvidas por consenso entre todos os autores listados. Síntese dos Dados Ao todo, 55 estudos foram incluídos na revisão sistemática. As abordagens testadas para tratar a disfunção sexual foram: lubrificantes e hidratantes (18 estudos); fitoestrogênios (14 estudos); deidroepiandrosterona (DHEA; 8 estudos); ospemifeno (5 estudos); testosterona vaginal (4 estudos); exercícios para os músculos do assoalho pélvico (2 estudos); oxitocina (2 estudos);laser de CO2 vaginal (2 estudos); lidocaína (1 estudo), e vitamina E vaginal (1 estudo). Conclusão Identificou-se falta de coerência na literatura quanto aos tratamentos propostos e medidas de resultados selecionadas. Apesar da grande diversidade de modalidades de tratamento e medidas de resultados, esta revisão sistemática pode lançar luz sobre alvos potenciais para o tratamento, que é considerado necessário para a disfunção sexual, assumindo que a maioria dos estudos randomizados foi avaliada com baixo risco de viés de acordo com a ferramenta de avaliação de risco de viés de Cochrane Collaboration. Esta revisão tem cadastro no International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).
Subject(s)
Humans , Female , Orgasm , Sexual Dysfunction, Physiological , Postmenopause , Dyspareunia , Estrogens/therapeutic use摘要
Introdução: os anticoncepcionais orais hormonais são fármacos constituídos por hormônios, geralmente combinados, estrogênio e progestogênio, ou apenas progestogênio. Devido às propriedades características desses hormônios, são também responsáveis por diversos efeitos colaterais, o que tem levado a uma evolução contínua das formulações e tem-se observado vários benefícios não contraceptivos à saúde da mulher. Objetivo: o objetivo dessa revisão foi analisar os usos não contraceptivos dos anticoncepcionais orais hormonais, evidenciando sua eficácia e segurança. Metodologia: A pesquisa foi realizada em bases de dados eletrônicos e portais de busca, priorizando materiais publicados na faixa anual de 2008 a 2018, sendo encontrados 332 e utilizados 148 materiais de estudo. Resultados: esses fármacos tem sido uma alternativa eficaz de tratamento da síndrome do ovário policístico, uma vez que reduzem os androgênios circulantes e induzem a melhora dos sintomas como acne, irregularidade menstrual e dismenorreia. Estão associados ao tratamento da endometriose e à menor incidência de câncer de ovário. Neste último, exercem um efeito protetor durante anos, até mesmo após a interrupção. Conclusão: assim, os anticoncepcionais orais hormonais têm representado uma nova proposta terapêutica simples, segura e eficaz, para diversas utilidades não contraceptivas, e seus benefícios ultrapassam os riscos associados, proporcionando uma terapia adequada e individualizada para cada mulher.
Introduction: hormonal oral contraceptives are drugs consisted by hormones, usually combined, estrogen and progestogen, or just progestins. Due to the characteristic properties of these hormones, they are also responsible for several side effects, which has led to a continuous evolution of the formulations and various non-contraceptive benefits to women's health have been observed. Objective:the objective of this review was to analyze the non-contraceptive uses of hormonal oral contraceptives, showing their effectiveness and safety. Methodology: the research was conducted in electronic databases and search portals, prioritizing materials published in the annual range from 2008 to 2018, with 332 found and 148 study materials used. Results: these drugs have been an effective alternative for the treatment of polycystic ovary syndrome, since they reduce circulating androgens and induce improvement in symptoms such as acne, menstrual irregularity and dysmenorrhea. They are associated with the treatment of endometriosis and a lower incidence of ovarian cancer. In the latter, they have a protective effect for years, even after the interruption. Conclusion: thus, hormonal oral contraceptives have represented a new simple, safe and effective therapeutic proposal, for several non-contraceptive uses, and their benefits outweigh the associated risks, providing an adequate and individualized therapy for each woman
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Progestins , Pharmaceutical Preparations , Contraceptive Agents , Estrogens , Hormones摘要
ABSTRACT Introduction: Catamenial epilepsy refers to the worsening or exacerbation of seizures due to hormonal changes during the menstrual cycle. It is thought to be secondary to the neuroactive properties of endogenous steroid hormones and the natural cyclic variation in their serum levels throughout the menstrual cycle. Case presentation: A 31-year-old female patient from Bogotá (Colombia) was admitted to the emergency department due to an episode of tonic-clonic seizure associated with the menstrual period. Since the onset of the seizures was related to menstruation (every 28 days), it was established that the patient had structural focal epilepsy with catamenial features. Advantages of medical vs. surgical treatment were discussed during a multidisciplinary medical board and it was decided to start pharmacological treatment with progestogens, which resulted in complete remission of the seizures as established during a follow-up visit. Conclusions: Catamenial epilepsy should be considered as a cause of epilepsy refractory to antiepileptic medications. Furthermore, it should be approached from a multidisciplinary perspective and its management should be focused on improving the patients' quality of life.
RESUMEN Introducción. La epilepsia catamenial se define como un empeoramiento o la exacerbación de las crisis epilépticas en relación con el cambio hormonal durante el ciclo menstrual femenino. Se cree que esta se produce por las propiedades neuroactivas de las hormonas esteroides endógenas y la variación cíclica natural en sus niveles séricos a lo largo de dicho ciclo. Presentación del caso. Mujer de 31 años de Bogotá (Colombia), quien fue llevada al servicio de urgencias por un episodio de crisis epiléptica con convulsiones tonicoclónicas asociado al período menstrual. Debido a que la aparición de las crisis epilépticas se asociaba con la menstruación (cada 28 días), se estableció que la paciente presentaba epilepsia focal estructural de características catameniales. En junta médica multidisciplinar se discutieron las ventajas del manejo médico y el manejo quirúrgico, y se decidió instaurar tratamiento farmacológico con progestágenos, el cual, tras seguimiento, evidenció supresión total de las crisis. Conclusiones. La epilepsia catamenial debe considerarse como una causa de epilepsia refractaria al tratamiento antiepiléptico. Además, su abordaje debe ser multidisciplinario y su tratamiento debe ir enfocado a mejorar la calidad de vida de los pacientes.
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Resumen La enfermedad cardiovascular sigue siendo la principal causa de muerte en el mundo. Las mujeres presentan un factor protector frente a esta durante la edad reproductiva debido al efecto de los estrógenos sobre el endotelio vascular, propio de esta etapa de la vida; posteriormente, la perimenopausia y la posmenopausia dan lugar a estados de hipoestrogenemia que generan un incremento en el riesgo de enfermedad cardiovascular y muerte por esta causa. En tal sentido, la terapia hormonal es un pilar fundamental para el tratamiento de los síntomas vasomotores en la menopausia; además, tiene impacto positivo en otros desenlaces, como el riesgo cardiovascular, la protección ósea y la depresión. Se presenta un compendio de conceptos respecto a la menopausia y el riesgo cardiovascular; aspectos históricos y medidas de tratamiento basadas en la terapia hormonal.
Abstract Cardiovascular disease continues to be the main cause of death in the world. Women present a protective factor against it during the reproductive age due to the effect of estrogens on the vascular endothelium typical of this stage of life; later, perimenopause and post-menopause give rise to hypoestrogenemia states that generate an increased risk of cardiovascular disease and death from this cause. Hormone replacement therapy is a fundamental pillar for the treatment of vasomotor symptoms in menopause, it also has a positive impact on other outcomes such as cardiovascular risk, bone protection, depression, among other pathologies. We present a compendium of concepts regarding menopause and cardiovascular risk; historical aspects and treatment measures based on hormone replacement therapy.
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Adipose tissue is not only involved in energy metabolism, but also recognized as an important endocrine organ.With declining ovarian function, endogenous estrogen levels decrease, leading to body fat mass accumulation and centripetal redistribution in postmenopausal women.Furthermore, energy metabolism, adipokine levels, local estrogen synthesis and the expression of estrogen receptors in adipose tissue also undergo changes, which may induce adipose tissue dysfunction.Changes in body fat mass and fat distribution and adipose tissue dysfunction are associated with increased risk of metabolic diseases and cardiovascular diseases in postmenopausal women, which have a negative impact on their health and quality of life.In this paper, the impact of menopause on body fat mass, regional distribution and adipose tissue functions and the underlying mechanisms are reviewed.
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Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syn-drome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)"is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Addi-tional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a"win-dow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endome-trial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a"worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only"conjugated equine estro-gens"and"medroxprogesterone acetate"have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound receptors in breast cancer tissue or blood can increase this risk.To reduce the risk of venous thromboembolism and stroke,transdermal estradiol(gels,patches,)should be used,in free combination with progesterone or dydrogesterone as"golden standard"in patients with increased risk.To increase the compliance in our patients without special risks we mostly use the available fix-combinations of estradiol/dydrogesterone getting strong efficacy,good menstrual regulation or amenorrhea,respectively,but also other combinations may be indicated to take advantage of for example androgenic or antiandrogenic pro-gestogens.
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Colorectal cancer (CRC) is one of the most common clinical malignancies, its morbidity and mortality are still on the rise. Colorectal tumorous polyp is the main precancerous lesion of CRC. The morbidity and mortality of colorectal neoplasms in men are higher than those in women, and exogenous estrogen supplementation can reduce the incidence of CRC in women, which suggests that estrogen may play a protective role in the occurrence and development of colorectal neoplasms. This article reviewed the research progress on the relationship between estrogen and colorectal neoplasms.
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A osteoporose é uma doença sistêmica multifatorial, caracterizada pela redução da massa óssea. A osteoporose pode ser primária ou secundária ao uso de medicamentos como os inibidores de aromatase. Estes medicamentos interferem com a conversão de andrógenos a estrogênios, reduzindo a produção destes e sendo indicados para tratamento do câncer de mama dependente de estrógeno. O diagnóstico da osteoporose é baseado em critérios densitométricos da Organização Mundial de Saúde com referência na classificação do T-score, realizada pela técnica de absorciometria de energia dupla de raios X (DXA). Por se tratar de uma doença sistêmica, a osteoporose também afeta os ossos maxilares. Entretanto, a ocorrência e extensão de perda de estrutura do osso alveolar na osteoporose, bem como o risco destes pacientes à doença periodontal e perdas dentárias não estão claramente definidos. Este estudo teve como objetivo identificar os parâmetros clínicos, periodontais, nutricionais e bioquímicos envolvidos na perda óssea em pacientes em uso de inibidores de aromatase. A perda óssea foi avaliada por absorciometria dupla de raios-X (DXA). Foram coletados dados sobre estado nutricional, antropométrico, bucal e periodontal e qualidade de vida relacionada à saúde bucal (OHRQoL). Citocinas e adipocinas foram quantificadas na saliva e soro. Foi realizado um estudo transversal do tipo caso-controle, com um grupo de comparação, no serviço de densitometria óssea do Hospital Mater Dei, no período de 2018 a 2021. A amostra foi constituída por 72 mulheres divididas em dois grupos: em uso de inibidores de aromatase (IAs) (n=40) e pacientes sem uso de inibidores de aromatase (controle) (n=32). Do total da amostra, 39 pacientes (57,4%) foram diagnosticados com perda de massa óssea. Os resultados mostraram que as mulheres idosas em uso de inibidores de aromatase (p=0,009) e fumantes (p=0,034) apresentaram maior perda óssea. Não houve diferença significativa entre os grupos considerando-se as comorbidades analisadas. A análise antropométrica demonstrou que os indivíduos em uso de inibidores de aromatase com perda óssea apresentaram menor peso (p=0,028). O modelo de regressão revelou que a única variável que explica a perda óssea é o uso de antirreabsortivos sendo a perda óssea significativamente reduzida nos indivíduos que usaram esse medicamento (p=0,022). Embora a frequência de periodontite tenha sido semelhante comparando todos os grupos, maiores valores de IL-6 (p=0,004); IL-1ß (p=0,002) e IL-33 (p=0,006) na saliva foram relacionados à pior condição periodontal. Indivíduos que usaram inibidores de aromatase foram 1,18 mais propensos a relatar uma melhor qualidade de vida relacionada à saúde bucal (OHRQoL) do que os controles. Conclusão: Enquanto idade avançada, tabagismo e menor peso são fatores associados à perda óssea, o uso de antirreabsortivos foi fator protetor em indivíduos em uso de inibidores de aromatase.
Osteoporosis is a multifactorial systemic disease characterized by reduced bone mass. Osteoporosis can be primary or secondary to the use of drugs such as aromatase inhibitors. These drugs interfere with the conversion of androgens to estrogens, reducing their production and are indicated for the treatment of estrogen-dependent breast cancer. The diagnosis of osteoporosis is based on densitometric criteria of the World Health Organization with reference to the T-score classification, performed by the technique of dual energy x-ray absorptiometry (DXA). Because it is a systemic disease, osteoporosis also affects the jaw bones. However, the occurrence and extent of loss of alveolar bone structure in osteoporosis, as well as the risk of these patients for periodontal disease and tooth loss, are not clearly defined. This study aimed to identify clinical, periodontal, nutritional and biochemical determinants involved with bone loss in patients using aromatase inhibitors. Bone loss was assessed by dual X- ray absorptiometry (DXA). Data on nutritional, anthropometric, oral and periodontal status and oral health-related quality of life (OHRQoL) were collected. Cytokines and adipokines were quantified in saliva and serum. A cross-sectional case-control type study, with a comparison group, was conducted at the bone densitometry service of Hospital Mater Dei from 2018 to 2021. The sample consisted of 72 women divided into two groups: using aromatase inhibitors (AIs) (n=40) and patients not using aromatase inhibitors (control) (n=32). Of the total sample, 39 patients (57.4%) were diagnosed with bone loss. The results showed that elderly women using aromatase inhibitors (p=0.009) and smokers (p=0.034) had greater bone loss. There was no significant difference between the groups considering the analyzed comorbidities. Anthropometric analysis showed that individuals using aromatase inhibitors with bone loss had lower weight (p=0.028). The regression model revealed that the only variable that explains bone loss is the use of antiresorptive drugs, with bone loss significantly reduced in individuals who used this medication (p=0.022). Although the frequency of periodontitis was similar comparing all groups, higher values of IL-6 (p=0.004); IL-1ß (p=0.002) and IL-33 (p=0.006) in saliva were related to worse periodontal status. Subjects who used aromatase inhibitors were 1.18 times more likely to report a better oral health-related quality of life (OHRQoL) than controls. Conclusion: While advanced age, smoking and lower weight are factors associated with bone loss, the use of antiresorptives was a protective factor in individuals using aromatase inhibitors.
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Osteoporosis , Periodontal Diseases , Breast Neoplasms , Bone Density , Dental Care , Aromatase Inhibitors , Estrogens摘要
Abstract This study aimed to evaluate the associations between oral health-related quality of life (OHRQoL) and patient-associated factors and polymorphisms in the estrogen receptor 1 (ESR1) and 2 (ESR2) genes in patients with dentofacial deformities (DFD). This cross-sectional study included 234 adult individuals. Data such as age, sex, and the type of facial profile (I, II, or III), were collected, and the short-form oral health impact profile 14 (OHIP-14) questionnaire was used to assess their OHRQoL. DNA was collected from oral mucosa cells, and the polymorphisms in ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) were evaluated using real-time polymerase chain reaction. The data were subjected to statistical analysis at a significance level of 5%. Individuals over 28 years of age exhibited worse OHRQoL (p = 0.003) than individuals aged less than or equal to 28 years. Women had worse OHRQoL than men (p < 0.001). Profile II individuals had worse OHRQoL in the social disability domain than profile III individuals (p = 0.030). Genetic analysis showed that rs9340799 was associated with OHRQoL in the functional limitation domain, and GG individuals exhibited worse OHRQoL than individuals carrying the AA/AG genotypes (p < 0.030). In the social handicap domain, individuals with GG genotype in rs9340799 exhibited worse OHRQoL than AG individuals (p < 0.043). Collectively, our results reveal that factors including age, sex, and type of facial profile, are associated with OHRQoL in patients with DFD. In addition, individuals with the GG genotype in rs9340799 (ESR1) may experience a negative impact on OHRQoL in the functional limitation and social handicap domains.