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1.
Support Care Cancer ; 29(1): 187-191, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32328775

RESUMO

BACKGROUND: Anti-estrogen therapy is an effective intervention for preventing reoccurrence of hormone receptor-positive breast cancer in women. However, the side effects of anti-estrogen therapy, including urogenital symptoms, have been reported to cause significant morbidity. There is controversial data, mainly due to small sample sizes, reporting on the safety and efficacy of using vaginal estrogen to treat urogenital symptoms in patients on aromatase inhibitor therapy. METHODS: We proposed a prospective trial to measure the change in blood estradiol levels in postmenopausal women with hormone receptor-positive breast cancer undergoing treatment with aromatase inhibitors when treated with vaginal estrogen preparation, Estring, for their urogenital symptoms. Only 8 prospective patients were enrolled, and the study was amended to include 6 retrospective patients who were treated similarly. Blood estradiol levels were measured at baseline and at week 16 for all patients. RESULTS: The median age for all patients was 55 years, and the majority of them were treated with anastrozole. There was no significant difference between baseline and week 16 estradiol levels (p = 0.81). In addition, patients in the prospective group reported subjective improvement in their vaginal dryness symptoms questionnaires. CONCLUSIONS: The vaginal estrogen preparation, Estring, did not cause persistent elevations in serum estradiol levels and might be a safer option for women with significant urogenital symptoms requiring estrogen therapy. IMPLICATIONS FOR CANCER SURVIVORS: Vaginal estrogen preparation, Estring, might be an option for women with hormone receptor positive breast cancer who have persistent urogenital symptoms.


Assuntos
Anastrozol/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Estradiol/sangue , Moduladores de Receptor Estrogênico/uso terapêutico , Estrogênios/efeitos adversos , Administração Intravaginal , Anastrozol/efeitos adversos , Moduladores de Receptor Estrogênico/efeitos adversos , Estrogênios/administração & dosagem , Estrogênios/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Estudos Prospectivos , Estudos Retrospectivos , Doenças Vaginais/induzido quimicamente , Doenças Vaginais/tratamento farmacológico
2.
Anticancer Res ; 40(11): 5995-6002, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109537

RESUMO

Steroid contraceptive hormones may promote human papilloma virus (HPV) - DNA integration into the host genome, may bind to specific HPV-DNA sequences within transcriptional regulatory regions, and may modulate cell apoptosis. Most epidemiological studies, reported in this narrative review, have shown that oral contraception is associated with a 1.5-3.3-fold higher relative risk of cervical carcer, but only in users for >5 years and especially in HPV-positive women. The relative risk declines with increasing time since last use and is not different from that of never users after >10 years. Ten-year oral contraceptive use from the age of 20 years is associated with an increase in the cumulative incidence of invasive cervical cancer at the age of 50 years of approximately 1 case per 1,000. Oral contraception has a very small negative impact on the absolute risk of cancer of the uterine cervix.


Assuntos
Anticoncepcionais/efeitos adversos , Estrogênios/efeitos adversos , Progestinas/efeitos adversos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Feminino , Humanos , Papillomaviridae/fisiologia , Fatores de Risco , Neoplasias do Colo do Útero/virologia
3.
Medicine (Baltimore) ; 99(31): e21446, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756162

RESUMO

Aspirin (ASA) exerts an anti-tumor effect via the COX pathway. Clinical studies on the chemopreventive effects of ASA on uterine cancer (UC) remain inconsistent. We used population-based retrospective cohort study to evaluate the UC in ASA users in Taiwanese women. From insurance claims data, we identified 23,342 women received ASA treatment between 2000 and 2010 and a comparison group of same sample size randomly selected from the same database matched by the propensity score. The incidence of UC in the ASA cohort was 10% of that in the comparison group (0.28 vs 2.73 per 10,000 person-years). The Poisson regression analysis estimated adjusted incidence rate ratio (IRR) was 0.10 (95% confidence interval (CI) = 0.09-0.11) for ASA users relatives to comparisons after controlling for covariates. The UC incidence in ASA users decreased with age, from 0.61 per 10,000 person-years in the 20 to 39 years old (adjusted IRR = 0.21, 95% CI = 0.15-0.29) to 0.21 per 10,000 person-years in the 65 to 80 years old (adjusted IRR = 0.15, 95% CI = 0.12-0.16). The incidence was higher in longer term users. Hormone therapy of estradiol was associated with the increase of UC risk in both cohorts, but less in ASA users than comparisons (1.34 vs 4.75 per 10,000 person-years). This study suggests that ASA use was associated with a decreased risk of UC. Further prospective randomized clinical trials are warranted to confirm the association.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Aspirina/farmacologia , Inibidores de Ciclo-Oxigenase/farmacologia , Neoplasias Uterinas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Estudos de Casos e Controles , Quimioprevenção , Estudos de Coortes , Inibidores de Ciclo-Oxigenase/administração & dosagem , Estradiol/efeitos adversos , Estrogênios/efeitos adversos , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Taiwan/epidemiologia
6.
Internist (Berl) ; 61(6): 558-564, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32333087

RESUMO

Peri- and postmenopausal disorders can have a significant impact on quality of life. Hormone replacement therapy (HRT) might be necessary in order to decrease women's symptoms. The German S3 guideline "Peri- and Postmenopause-Diagnostics and Therapy" (2020) provides recommendations that include the most recent evidence as well as the Women's Health Initiative (WHI) study results from 2002 and 2004. These results led to reduced prescription patterns due to a high risk of cardiovascular diseases as well as an increased risk for breast cancer if HRT had been administered. Both ongoing analyses of subgroups and other studies extenuated the WHI data, since the increased risks were neither generalizable to the typical postmenopausal patient (regarding age and risk profile) nor to the medication being used today. This article summarizes all aspects of HRT in peri- and postmenopausal women (indications, contraindications, practical approaches, risks, prevention) and provides recommendations with respect to the most recent S3 guideline.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Terapia de Reposição Hormonal , Perimenopausa/efeitos dos fármacos , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/psicologia , Progesterona/efeitos adversos , Idoso , Terapia de Reposição de Estrogênios/métodos , Estrogênios/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Perimenopausa/fisiologia , Perimenopausa/psicologia , Pós-Menopausa/fisiologia , Progesterona/uso terapêutico , Qualidade de Vida , Saúde da Mulher
7.
PLoS One ; 15(2): e0228566, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040517

RESUMO

OBJECTIVE: Although sacrocolpopexy (SCP) can provide durable apical support, the use of mesh may give rise to various complications, including vaginal mesh erosion. The aim of this study was to identify the risk factors for vaginal mesh erosion after SCP in Korean women. METHODS: This retrospective cohort study included 363 women who underwent SCP with type 1 polypropylene mesh. They were evaluated at 1, 4, and 12 months after surgery and then annually thereafter with respect to anatomy and complications. Univariate and multivariate analyses using the Cox proportional hazard model were performed to identify the risk factors for mesh erosion. RESULTS: During the median 2-year follow-up period, vaginal mesh erosion was found in 29 women (8.0%). Among them, 19 (65.5%) required surgical correction. Estrogenic status was the only independent risk factor for mesh erosion. The risk for mesh erosion was 4.5 times higher in premenopausal women than in menopausal women not on estrogen replacement therapy (ERT) (95% confidence intervals [CI] 1.9-10.9, p<0.01). Menopausal women on ERT also had an increased risk, with a statistically marginal significance (hazard ratio 2.5, 95% CI 0.9-6.6; p = 0.07). CONCLUSIONS: Premenopausal or menopausal women on ERT are at high risk for mesh erosion after SCP with type 1 polypropylene mesh, and two-thirds of mesh erosion cases require reoperation. This information should be incorporated into patient counseling and treatment decisions.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Prolapso Uterino/cirurgia , Vagina/cirurgia , Idoso , Tomada de Decisões , Estrogênios/efeitos adversos , Feminino , Seguimentos , Humanos , Menopausa , Pessoa de Meia-Idade , Polipropilenos/química , Complicações Pós-Operatórias , Período Pós-Operatório , Pré-Menopausa , Reoperação , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
8.
Ann Intern Med ; 172(3): 202-209, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016334

RESUMO

The term transgender refers to persons whose gender identity is different from that recorded at birth. Similar to other marginalized populations, transgender patients commonly experience discrimination in the health care setting, and they may not have access to medical professionals who can provide competent care. In addition to primary medical and preventive health care, transgender patients need access to gender-affirming interventions, including hormone therapy and surgeries. In 2017, the Endocrine Society updated its clinical practice guideline for the care of transgender persons on the basis of the best available evidence from systematic reviews and individual studies. Among its general requirements for adolescents and recommendations for adults were the following: Involvement of a mental health professional who is knowledgeable about the diagnostic criteria for gender dysphoria and criteria for gender-affirming treatment, has training and experience in assessing psychopathology, and is willing to participate in ongoing care. Hormone therapy should be offered to transgender adult patients, with levels maintained within the normal range for gender identity and treatment appropriately monitored. Clinicians involved in the care of transgender adult patients should be knowledgeable about diagnostic criteria for gender dysphoria/gender incongruence, the use of medical and surgical gender-affirming interventions, and appropriate monitoring for reproductive organ cancer risk. Here, 2 clinicians with expertise in this area debate whether psychological evaluation is warranted in a transgender patient requesting gender-affirming hormones or surgery, the potential risks and benefits of estrogen therapy, and the role of the primary care practitioner in the care of transgender persons.


Assuntos
Serviços de Saúde Mental , Atenção Primária à Saúde , Pessoas Transgênero/psicologia , Adulto , Doenças Cardiovasculares/induzido quimicamente , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Feminino , Humanos , Papel do Médico , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , Fatores de Risco , Procedimentos de Readequação Sexual , Tromboembolia/induzido quimicamente
9.
Biochemistry (Mosc) ; 85(Suppl 1): S79-S107, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32087055

RESUMO

The review summarizes the data on the role of metabolic and repair systems in the mechanisms of therapy-related carcinogenesis and the effect of their polymorphism on the cancer development risk. The carcinogenic activity of different types of drugs, from the anticancer agents to analgesics, antipyretics, immunomodulators, hormones, natural remedies, and non-cancer drugs, is described. Possible approaches for the prevention of drug-related cancer induction at the initiation and promotion stages are discussed.


Assuntos
Carcinogênese/induzido quimicamente , Carcinógenos , Neoplasias/induzido quimicamente , Neoplasias/prevenção & controle , Animais , Antineoplásicos/efeitos adversos , Ácidos Aristolóquicos/efeitos adversos , Arsênico/efeitos adversos , Dano ao DNA/efeitos dos fármacos , Dietilestilbestrol/efeitos adversos , Estrogênios/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Fenacetina/efeitos adversos , Medicina de Precisão , Fatores de Risco
10.
Expert Rev Clin Pharmacol ; 13(2): 163-182, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31975619

RESUMO

Introduction: Steroid hormones are responsible for specific changes in the endometrium during the menstrual cycle, when they are sequentially secreted and, because of this, in the early days sequential combined oral contraceptive regimens were utilized. The same basic concept has been utilized with multi-phasic regimens, in order to produce endometrial pictures mimicking the normal cycle.Areas covered: The Endometrial effects of progestins and estrogens; combined monophasic high- (50 µg), medium- (30 µg), low- (20 µg), ultralow- (15 µg) estrogen content; sequential regimens; multiphasic combinations; treatment schedules.Cervical effects of combined high-dose and sequential combinations, including evidence for an increase in malignant lesions.Expert opinion: Overall, combined oral contraceptives (COCs) inhibit normal proliferative changes and the endometrium becomes thin, narrow, with widely spaced glands and pre-decidual changes in the stroma. During the first few cycles the progestin induces a coexistence of proliferative and secretory features; with time, the picture changes because the progestin induces a down-regulation of estrogen receptors, resulting in tortuous glands similar to those in the secretory phase, but characterized by a quiescent, atrophic glandular epithelium.In the cervical epithelium, under the influence of high-dose COCs, endocervical glands became hypersecretory and in some instances, distinctive type of atypical polypoid endocervical hyperplasia is found.


Assuntos
Anticoncepcionais Orais Combinados/administração & dosagem , Estrogênios/administração & dosagem , Progestinas/administração & dosagem , Animais , Colo do Útero/efeitos dos fármacos , Colo do Útero/metabolismo , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Combinados/farmacologia , Relação Dose-Resposta a Droga , Endométrio/efeitos dos fármacos , Endométrio/metabolismo , Epitélio/efeitos dos fármacos , Epitélio/metabolismo , Estrogênios/efeitos adversos , Estrogênios/farmacologia , Feminino , Humanos , Progestinas/efeitos adversos , Progestinas/farmacologia
11.
Curr Vasc Pharmacol ; 18(3): 254-261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30843488

RESUMO

Supplementary estrogen plays important roles for female patients as convenient birth control, relief of postmenopausal symptoms, and in the management of other selected problems. However, as is the case for essentially all medications, there are side effects. Short of a major pulmonary embolus, the most severe side effect of estrogen would appear to be sporadic, rare, and severe hypertriglyceridemia associated with acute pancreatitis. The occurrence of this fortunately rare problem usually happens in the presence of some preexisting and usually mild increase in triglycerides (TG). A case of chronic and severe recurrent acute pancreatitis is described in the introduction and the management was complete estrogen avoidance. Started close to menopause and continued for a relatively short period, estrogens may have some cardiovascular (CV) benefit but the general recommendation is not to prescribe them for CV disease prevention. Estrogens may contribute to decreased diabetes mellitus (DM) risk and control. Administration of estrogens by the transdermal route may decrease some problems such as venous thromboembolism (VTE) and elevation of TG. Administration of estrogen in the right situation brings significant benefit to the female patient but skillful, careful, and knowledgeable use is essential.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Hipertrigliceridemia/induzido quimicamente , Triglicerídeos/sangue , Animais , Biomarcadores/sangue , Tomada de Decisão Clínica , Estrogênios/administração & dosagem , Feminino , Humanos , Hipertrigliceridemia/sangue , Hipertrigliceridemia/diagnóstico , Hipertrigliceridemia/epidemiologia , Pancreatite/induzido quimicamente , Pancreatite/epidemiologia , Seleção de Pacientes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Regulação para Cima
12.
Environ Toxicol Pharmacol ; 74: 103305, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790957

RESUMO

Glycogen and lipid disruptions represent a spectrum of metabolic disorders that are crucial risk factors for cardiovascular disease in estrogen-progestin oral contraceptive (COC) users. l-glutamine (GLN) has been shown to exert a modulatory effect in metabolic disorders-related syndromes. We therefore hypothesized that GLN supplementation would protect against myocardial and renal glycogen-lipid mishandling in COC-treated animals by modulation of Glucose-6-phosphate dehydrogenase (G6PD) and xanthine oxidase (XO) activities. Adult female Wistar rats were randomly allotted into control, GLN, COC and COC + GLN groups (six rats per group). The groups received vehicle (distilled water, p.o.), GLN (1 g/kg), COC containing 1.0 µg ethinylestradiol plus 5.0 µg levonorgestrel and COC plus GLN respectively, daily for 8 weeks. Data showed that treatment with COC led to metabolically-induced obesity with correspondent increased visceral and epicardial fat mass. It also led to increased plasma, myocardial and renal triglyceride, free fatty acid, malondialdehyde (MDA), XO activity, uric acid content and decreased glutathione content and G6PD activity. In addition, COC increased myocardial but not renal glycogen content, and increased myocardial and renal glycogen synthase activity, increased plasma and renal lactate production and plasma aspartate transaminase/alanine aminotransferase (AST/ALT) ratio. However, these alterations were attenuated when supplemented with GLN except plasma AST/ALT ratio. Collectively, the present results indicate that estrogen-progestin oral contraceptive causes metabolically-induced obesity that is accompanied by differential myocardial and renal metabolic disturbances. The findings also suggest that irrespective of varying metabolic phenotypes, GLN exerts protection against cardio-renal dysmetabolism by modulation of XO and G6PD activities.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Estrogênios/efeitos adversos , Glutamina/administração & dosagem , Miocárdio/química , Obesidade/prevenção & controle , Progestinas/efeitos adversos , Animais , Colágeno/metabolismo , Anticoncepcionais Orais Hormonais/administração & dosagem , Estrogênios/administração & dosagem , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Glucosefosfato Desidrogenase/metabolismo , Glutamina/farmacologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Modelos Animais , Obesidade/induzido quimicamente , Progestinas/administração & dosagem , Distribuição Aleatória , Ratos , Ratos Wistar , Xantina Oxidase/metabolismo
13.
Int Immunopharmacol ; 78: 106080, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855692

RESUMO

Gonadal hormones, estrogen and androgen are strongly involved in the control of the bradykinin production. Estrogen may worsen whereas androgen can be part of the long-term prophylactic treatment. In this review, we will describe the potential impact of estrogen in the pathophysiology of hereditary angioedema (HAE). Then we will review the different hormone treatments and their implication on the course of HAE in women and men: contraception, Assisted Reproductive Technology (ART), menopause, hormone dependent cancers in women and men, treatment of hyperandrogenism in women.


Assuntos
Androgênios/uso terapêutico , Angioedemas Hereditários/tratamento farmacológico , Bradicinina/imunologia , Estrogênios/efeitos adversos , Progestinas/uso terapêutico , Antagonistas de Androgênios/efeitos adversos , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/etiologia , Angioedemas Hereditários/prevenção & controle , Bradicinina/metabolismo , Proteína Inibidora do Complemento C1/genética , Proteína Inibidora do Complemento C1/metabolismo , Contraceptivos Hormonais/efeitos adversos , Feminino , Humanos , Hiperandrogenismo/tratamento farmacológico , Hiperandrogenismo/imunologia , Masculino , Menopausa/imunologia , Mutação , Técnicas de Reprodução Assistida/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/imunologia
14.
Vascul Pharmacol ; 124: 106600, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31629918

RESUMO

Cardiovascular disease (CVD) is the major cause of morbidity and mortality worldwide. The implication of estrogen in this disease has been extensively studied. While the vast majority of published research argue for a cardioprotective role of estrogen in vascular inflammation such as in atherosclerosis, the role of estrogen in hypertension remains far from being resolved. The vasorelaxant effect of estrogen has already been well-established. However, emerging evidence supports a vasoconstrictive potential of this hormone. It has been proposed that the microenvironment dictates the effect of estrogen-induced type 1 nitric oxide synthase-1 (nNOS) on vasotone. Indeed, depending on nNOS product, nitric oxide or superoxide, estrogen can induce vasodilation or vasoconstriction, respectively. In this review, we discuss the evidence supporting the vasorelaxant effects of estrogen, and the molecular players involved. Furthermore, we shed light on recent reports revealing a vasoconstrictive role of estrogen, and speculate on the underlying signaling pathways. In addition, we identify certain factors that can account for the discrepant estrogenic effects. This review emphasizes a yin-yang role of estrogen in regulating blood pressure.


Assuntos
Pressão Sanguínea , Estrogênios/metabolismo , Hipertensão/metabolismo , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Vasoconstrição , Animais , Anticoncepcionais Orais Hormonais/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Músculo Liso Vascular/fisiopatologia , Fatores de Risco , Fatores Sexuais , Transdução de Sinais , Vasodilatação
15.
Int J Mol Sci ; 20(21)2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661891

RESUMO

: Worldwide, breast cancer (BC) is the most common malignancy in women, in regard to incidence and mortality. In recent years, the negative role of obesity during BC development and progression has been made abundantly clear in several studies. However, the distribution of body fat may be more important to analyze than the overall body weight. In our review of literature, we reported some key findings regarding the role of obesity in BC development, but focused more on central adiposity. Firstly, the adipose microenvironment in obese people bears many similarities with the tumor microenvironment, in respect to associated cellular composition, chronic low-grade inflammation, and high ratio of reactive oxygen species to antioxidants. Secondly, the adipose tissue functions as an endocrine organ, which in obese people produces a high level of tumor-promoting hormones, such as leptin and estrogen, and a low level of the tumor suppressor hormone, adiponectin. As follows, in BC this leads to the activation of oncogenic signaling pathways: NFκB, JAK, STAT3, AKT. Moreover, overall obesity, but especially central obesity, promotes a systemic and local low grade chronic inflammation that further stimulates the increase of tumor-promoting oxidative stress. Lastly, there is a constant exchange of information between BC cells and adipocytes, mediated especially by extracellular vesicles, and which changes the transcription profile of both cell types to an oncogenic one with the help of regulatory non-coding RNAs.


Assuntos
Neoplasias da Mama/etiologia , Neoplasias da Mama/metabolismo , Obesidade Abdominal/complicações , Obesidade Abdominal/metabolismo , Adiponectina/efeitos adversos , Adiponectina/metabolismo , Tecido Adiposo/imunologia , Tecido Adiposo/metabolismo , Neoplasias da Mama/fisiopatologia , Transformação Celular Neoplásica/metabolismo , Estrogênios/efeitos adversos , Estrogênios/metabolismo , Complexo Multienzimático de Ribonucleases do Exossomo/metabolismo , Feminino , Humanos , Inflamação/fisiopatologia , Leptina/imunologia , Leptina/metabolismo , Menopausa/metabolismo , MicroRNAs/metabolismo , Obesidade Abdominal/fisiopatologia , Transdução de Sinais/genética , Microambiente Tumoral/imunologia
16.
Presse Med ; 48(10): 1085-1091, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31662219

RESUMO

Most of breast cancers are hormonedependent. Hormone treatment (contraception and menopause hormone treatment) has a promoter effect on preexisting lesions: the increase in risk decreases after stopping treatment. Hormonal contraception increases modestly the risk in current users but the amplitude of the risk remains low up to 40 years when this increase is more significant due of the number of breast cancer occurring at that age. Pregnancy decreases the risk if at a young age but after 25 years may increase the risk. Combined menopause hormone treatment is associated to a greater risk than estrogens alone. Breast cancer associated with hormone treatment is estradiol receptor positive. There is an increase in the risk with duration. Combining the hormone treatment with an anti-estrogen could decrease the risk of breast cancer and help to keep the benefits of estrogens.


Assuntos
Neoplasias da Mama/etiologia , Contraceptivos Hormonais , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Menopausa , Fatores Etários , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Gravidez
17.
Curr Opin Obstet Gynecol ; 31(6): 452-458, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31573998

RESUMO

PURPOSE OF REVIEW: Combined hormonal contraception has been contraindicated in migraines, especially in migraines with aura, because of ischemic stroke risk. Newer formulations are now available and physicians may unnecessarily be limiting access to contraceptive and medical therapeutic options for patients with migraines. This review summarizes the available data regarding ischemic stroke risk of modern combined hormonal contraception in the setting of migraines. RECENT FINDINGS: Limited data exists on current formulations of combined hormonal contraception and outcomes in migraine patients. Studies indicate ischemic stroke risk may be estrogen dose related with high dose formulations having the highest risk. Absolute risk of ischemic stroke with combined hormonal contraception and migraines is low. SUMMARY: Ischemic stroke risk in combined hormonal contraception users in the setting of migraines is low and an individual approach may be more appropriate than current guidelines.


Assuntos
Isquemia Encefálica/induzido quimicamente , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Enxaqueca com Aura/complicações , Acidente Vascular Cerebral/induzido quimicamente , Adulto , Isquemia Encefálica/prevenção & controle , Contraindicações de Medicamentos , Estrogênios/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Risco , Acidente Vascular Cerebral/prevenção & controle
18.
Cells ; 8(10)2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31597326

RESUMO

Recent analysis of clinical trials on estrogen therapy proposes the existence of a therapeutic window of opportunity for the cardiovascular benefits of estrogens, which depend on women's age and the onset of therapy initiation. In this study, we aimed to determine how vascular senescence and the onset of estrogen treatment influence the common carotid artery (CCA) function in senescent and non-senescent females. Ovariectomized female senescence-accelerated (SAMP8) or non-senescent (SAMR1) mice were treated with vehicle (OVX) or 17ß-estradiol starting at the day of ovariectomy (early-onset, E2E) or 45 days after surgery (late-onset, E2L). In SAMR1, both treatments, E2E and E2L, reduced constriction to phenylephrine (Phe) in CCA [(AUC) OVX: 193.8 ± 15.5; E2E: 128.1 ± 11.6; E2L: 130.2 ± 15.8, p = 0.004] in association with positive regulation of NO/O2- ratio and increased prostacyclin production. In contrast, E2E treatment did not modify vasoconstrictor responses to Phe in OVX-SAMP8 and, yet, E2L increased Phe vasoconstriction [(AUC) OVX: 165.3 ± 10; E2E: 183.3 ± 11.1; E2L: 256.3 ± 30.4, p = 0.005]. Increased vasoconstriction in E2L-SAMP8 was associated with augmented thromboxane A2 and reduced NO production. Analysis of wild-type receptor alpha (ERα66) expression and its variants revealed an increased expression of ERα36 in E2L-SAMP8 in correlation with unfavorable effects of estrogen in those animals. In conclusion, estrogen exerts beneficial effects in non-senescent CCA, regardless of the initiation of the therapy. In senescent CCA, however, estrogen loses its beneficial action even when administered shortly after ovariectomy and may become detrimental when given late after ovariectomy. Aging and onset of estrogen treatment are two critical factors in the mechanism of action of this hormone in CCA.


Assuntos
Envelhecimento , Artérias Carótidas/fisiopatologia , Receptor alfa de Estrogênio/genética , Estrogênios/efeitos adversos , Prostaglandinas/metabolismo , Vasoconstrição , Animais , Artérias Carótidas/metabolismo , Estrogênios/uso terapêutico , Feminino , Regulação da Expressão Gênica , Camundongos
19.
Medicina (Kaunas) ; 55(9)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480288

RESUMO

Background and Objectives: Hormonal replacement therapy (HRT) is effective in treating many debilitating symptoms of menopause. However, its use in women with uterine fibroids is widely debated, based on the susceptibility of these tumors to sexual steroids. This review aims to ascertain the effects of HRT on leiomyomas development and growth in postmenopausal women. Materials and Methods: Electronic databases (i.e., MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) were searched from January 1990 until May 2019. All English-written studies evaluating the impact of various HRT regimens on uterine leiomyomas were selected. Results: Seventeen papers, considering a total of 1122 participants, were included. Fifteen of these were prospective trials, of which nine were randomized controlled trials. The remaining two works were a retrospective observational trial and a retrospective case series respectively. Five studies evaluated the effects of tibolone, also comparing it with various estrogen/progestin combinations, while two were about raloxifene. Thirteen studies compared different combinations of estrogens/progestins, the most common being transdermal estrogens (used in nine studies) and medroxyprogesterone acetate at different doses (used in 10 studies). Conclusions: For women with uterine fibroids, the choice of the most appropriate HRT regimen is crucial to avoid leiomyomas growth and the symptoms possibly related to it. Available data are conflicting, but suggest that uterine fibroids might be influenced by HRT, without representing an absolute contraindication to hormonal replacement therapy. Women with uterine fibroids subjected to HRT should be periodically examined and hormonal treatment should be discontinued if leiomyomas appear to increase in size. Moreover, the minimal effective dose of progestin should be employed.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Leiomioma/fisiopatologia , Progestinas/farmacologia , Neoplasias Uterinas/fisiopatologia , Progressão da Doença , Estrogênios/efeitos adversos , Estrogênios/farmacologia , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/tratamento farmacológico , Pós-Menopausa , Progestinas/efeitos adversos , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/tratamento farmacológico , Útero/efeitos dos fármacos
20.
J Am Anim Hosp Assoc ; 55(6): e55604, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31525086

RESUMO

A 6 yr old female spayed Chihuahua was presented for evaluation of intermittent vulvar discharge, stranguria, and vomiting. This dog had an ovariohysterectomy as a puppy and did not experience any evidence of estrous until 4.5 yr later. The owner had been using a topical hormone replacement therapy (estradiol spray) twice daily for the duration of the dog's clinical signs of 1 yr. On presentation, the dog had truncal alopecia, comedones, enlarged vulva with a malodorous, and purulent discharge. Bloodwork showed a leukocytosis with a neutrophilia, döhle bodies, and moderate toxic changes. An abdominal ultrasound revealed an enlarged uterine stump with a thickened wall, ovoid projection cranially, and echogenic luminal contents. An exploratory laparotomy identified an enlarged cervical stump. Histopathology revealed chronic suppurative vaginitis with endometritis, necrosis, and intraluminal coccoid bacteria. The dog recovered well from surgery. A baseline estrogen level post operatively was measured at 56.4 pg/mL (<50.0 pg/mL for a spayed bitch), at this time, the dog had been separated from the owner for 7 days. After surgery, the clinical signs disappeared, and the dog's dermatologic changes improved. This is the first reported case of stump pyometra following exposure to the owner's topical estradiol replacement medication.


Assuntos
Doenças do Cão/patologia , Estradiol/toxicidade , Estrogênios/toxicidade , Piometra/veterinária , Administração Tópica , Animais , Antibacterianos/uso terapêutico , Doenças do Cão/etiologia , Doenças do Cão/terapia , Cães , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios , Estrogênios/efeitos adversos , Feminino , Humanos , Histerectomia/veterinária , Ovariectomia/veterinária , Piometra/etiologia , Piometra/terapia
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