Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.959
Filtrar
1.
Obstet Gynecol ; 136(4): 675-684, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925623

RESUMO

OBJECTIVE: To identify factors associated with serum estradiol (E2) levels among healthy postmenopausal women using hormone therapy (HT). METHODS: This is an unplanned post hoc analysis of data from ELITE (Early versus Late Intervention Trial with Estradiol), a randomized controlled trial of 1 mg oral E2 with or without vaginal progesterone in healthy early compared with late (<6 years compared with 10 or more years since menopause) postmenopausal women. We included results from visits when women reported at least 80% compliance with HT. Mixed-effects linear models identified factors associated with serum E2 levels while participants were taking HT, assessed every 6 months over a median follow-up of 4.8 years and adjusted for baseline E2 level, visit, and reduced E2 dose. Possible correlates evaluated included demographics, clinical characteristics, medication use, and biomarkers of liver and kidney metabolic function. RESULTS: The analysis included 2,160 E2 measurements in 275 postmenopausal women. Mean±SD age was 55.4±3.9 vs 64.4±5.5 years, and mean±SD time since menopause was 3.6±1.8 vs 16.0±5.6 years for early vs late postmenopausal women. Adjusted for pretreatment E2 level, visit, and reduced dose indicator, higher serum E2 levels were associated with higher body mass index (BMI), higher weight, surgical menopause, alcohol use, and antihypertensive medication use. Current and past smoking and antifungal medication use were associated with lower serum E2 levels. In the multivariable model, higher BMI and alcohol use were associated with higher serum E2 levels, whereas current and past smoking were associated with lower serum E2 levels. These factors were similar between early and late postmenopausal women. CONCLUSION: Factors associated with serum E2 levels among postmenopausal women taking HT include BMI, alcohol use, and smoking. As serum E2 levels relate to HT effect, achievement of desirable E2 levels may be maximized through personalized intervention. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00114517.


Assuntos
Estradiol/sangue , Terapia de Reposição de Estrogênios/métodos , Estrogênios/administração & dosagem , Pós-Menopausa , Progesterona/administração & dosagem , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Causalidade , Vias de Administração de Medicamentos , Monitoramento de Medicamentos/métodos , Feminino , Hormônios/administração & dosagem , Humanos , Testes de Função Renal/métodos , Testes de Função Hepática/métodos , Pessoa de Meia-Idade , Pós-Menopausa/sangue , Pós-Menopausa/efeitos dos fármacos , Fumar/epidemiologia
2.
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
3.
BMC Womens Health ; 20(1): 64, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228557

RESUMO

BACKGROUND: Impaired sleep is common in menopausal women. The aim was to examine associations between uses of systemic menopausal hormone therapy (MHT) and sleep disturbance in a large population sample. METHODS: Female participants aged 45 to 75 years were selected from the Norwegian Health Study in Nord-Trøndelag (HUNT3, 2006-2008) (N = 13,060). Data were linked to the Norwegian Prescription Database, identifying use of prescribed MHT and use of sleep medication. Data were analyzed using multiple linear regression. RESULTS: In total, 996 women used systemic MHT (7.6%), with the highest prevalence of 10.3% among women 55 to 64 years of age. Despite high reports of frequent nocturnal awakening (24.7%) and high reports of hot flashes, use of MHT was low in this large population based survey. Although MHT use was associated with more sleep disturbance in unadjusted analyses, the association was not significant after adjusting for relevant covariates. Using sleep medication, reporting poor health, tobacco and alcohol use, doing daily exercise, having higher levels of anxiety, and being less satisfied with life were factors showing the strongest associations with sleep disturbance. CONCLUSION: The lack of association between MHT and sleep disturbance suggests that other factors, such as self-perceived good health, a healthy lifestyle and anxiety/depression, are more relevant to sleep than MHT.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Menopausa/psicologia , Pós-Menopausa/psicologia , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Idoso , Terapia de Reposição de Estrogênios/métodos , Feminino , Fogachos/epidemiologia , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Sono , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia
4.
Toxicol Appl Pharmacol ; 393: 114928, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32092384

RESUMO

The female gender is protected against immunological complications of endotoxemia. Here we investigated whether gonadal hormone depletion by ovariectomy (OVX) uncovers inflammatory and cardiovascular effects of endotoxemia and whether these effects are reversed by hormone replacement therapies. Changes in inflammatory cytokines, blood pressure (BP), left ventricular (LV) function, and cardiac autonomic activity caused by lipopolysaccharide (LPS) in conscious female rats with different hormonal states were determined. In contrast to no effects in sham-operated females, treatment of OVX rats with LPS (i) decreased BP, (ii) increased spectral low-frequency/high-frequency ratio of HRV, denoting enhanced cardiac sympathetic dominance, (iii) attenuated reflex tachycardic responses to sodium nitroprusside, and (iv) increased systolic contractility (dP/dtmax). The developed hypotension was (i) fully eliminated in estrogen (E2)-pretreated OVX rats, (ii) partially counteracted after selective activation of estrogen receptor-α (PPT) or ß (DPN). All estrogenic compounds abrogated LPS enhancement of cardiac sympathetic drive. However, PPT was more successful than E2 or DPN in compromising LPS depression in baroreflex activity and elevation in dP/dtmax. Molecular studies showed that PPT was most effective in attenuating the upregulated myocardial expressions of NF-κB and iNOS in endotoxic OVX rats. Myocardial expression of the defensive HSP70 was comparably increased by all estrogenic products. Except for improved cardiac spectral activity, none of these functional or molecular entities was affected by medroxyprogesterone acetate (MPA). Overall, our data suggest diverse therapeutic advantages for gonadal hormones in the worsened endotoxic complications in rats with surgical menopause, with probably more favorable role for ERα agonism within this context.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/etiologia , Endotoxemia/complicações , Endotoxemia/tratamento farmacológico , Terapia de Reposição de Estrogênios/métodos , Inflamação/tratamento farmacológico , Inflamação/etiologia , Ovariectomia/efeitos adversos , Animais , Barorreflexo/efeitos dos fármacos , Pressão Sanguínea , Citocinas , Endotoxemia/induzido quimicamente , Estradiol/uso terapêutico , Receptor alfa de Estrogênio/agonistas , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Lipopolissacarídeos , Acetato de Medroxiprogesterona/uso terapêutico , Ratos , Ratos Wistar , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Função Ventricular Esquerda/efeitos dos fármacos
5.
Menopause ; 27(2): 243-248, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31738735

RESUMO

OBJECTIVE: The aim of the study was to review the role of hormone therapy in menopausal patients with breast cancer and gynecologic malignancies. METHODS: We searched MEDLINE (via PubMed) using a combination of keywords and database-specific subject headings for the following concepts: menopause, hormone therapy, and cancer. Editorials, letters, case reports, and comments were excluded, as were non-English articles. Additional references were identified by hand-searching bibliographies of included articles. The searches yielded a total of 1,484 citations. All citations were imported into EndNote X9, where they were screened by the authors. RESULTS: In breast cancer survivors, systemic hormone therapy is not recommended, whereas local low-dose estrogen therapy may be considered after discussion with the patient's oncologist. Among endometrial cancer survivors, hormone therapy is considered safe in low-risk cancers but should be avoided in high-risk subtypes. For survivors of epithelial ovarian cancer and cervical cancer, hormone therapy can be considered, but should be avoided in women with estrogen-sensitive histologic subtypes. CONCLUSIONS: The risks of hormone therapy should be assessed on an individual basis, with consideration of age, type of hormone therapy, dose, duration of use, regimen, route, and prior exposure. Systemic hormone therapy is not recommended in breast cancer survivors, whereas vaginal low-dose estrogen appears safe. Hormone therapy may be used by endometrial, cervical, and ovarian cancer survivors with low-risk, non-estrogen-receptor-positive subtypes. Video Summary: http://links.lww.com/MENO/A516.


Assuntos
Neoplasias da Mama/fisiopatologia , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Neoplasias dos Genitais Femininos/fisiopatologia , Menopausa/efeitos dos fármacos , Adulto , Sobreviventes de Câncer , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Pessoa de Meia-Idade
6.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31613320

RESUMO

CONTEXT: Most Turner syndrome (TS) girls need exogenous estrogen treatment to induce puberty and normal uterine growth. After puberty, the optimal estrogen treatment protocol has not been determined. OBJECTIVE: To compare 2 doses of oral 17ß-estradiol on uterine size. DESIGN: A double-blind, 5-year randomized controlled clinical trial. SETTING: Ambulatory care. PARTICIPANTS: Twenty young TS women (19.2 ± 2.5 years, range 16.0-24.9) participated. Sixteen patients completed the study. No patients withdrew due to adverse effects. INTERVENTION: The lower dose (LD) group took 2 mg 17ß-estradiol/d orally and placebo. The higher dose (HD) group took 4 mg 17ß-estradiol/d orally. MAIN OUTCOME MEASURE(S): Uterine volume evaluated by transabdominal ultrasound yearly. RESULTS: Uterine size increased significantly more in the HD group compared with the LD group (P = 0.038), with a gain in uterine volume within the first 3 years of treatment of 19.6 mL (95% confidence interval [CI] = 4.0-19.0) in the HD group compared with 11.5 mL (95% CI = 11.2-27.9) in the LD group. The difference in 3-year gain was 8.1 mL (95% CI = 0.7-15.9). At the last visit, there were no significant differences in uterine volume between the groups. CONCLUSION: HD oral 17ß-estradiol induces a steeper increase in uterine volume within the first years of treatment compared with the LD. However, the uterine growth potential seems to be the same in most young TS women making the duration of treatment equally significant as estrogen dose, although a few TS women did not experience sufficient uterine growth on 2 mg of estradiol. CLINICALTRIALS.GOV: NCT00134745Abbreviations: BMI, body mass index; BSA, body surface area; DHEAS, dihydroepiandrosteronesulfate; HD, higher dose; HRT, hormone replacement therapy; LD, lower dose; TS, Turner syndrome; US, ultrasound.


Assuntos
Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Estrogênios/administração & dosagem , Puberdade/efeitos dos fármacos , Síndrome de Turner/tratamento farmacológico , Útero/crescimento & desenvolvimento , Adolescente , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Projetos Piloto , Prognóstico , Estudos Prospectivos , Síndrome de Turner/patologia , Ultrassonografia , Útero/diagnóstico por imagem , Útero/efeitos dos fármacos , Adulto Jovem
7.
Am J Obstet Gynecol ; 222(2): 103-113, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31473229

RESUMO

Genitourinary syndrome of menopause is a condition describing the hypoestrogenic effects on the female genitals and lower urinary tract leading to symptoms such as vaginal dryness, vulvar and vaginal burning, dyspareunia and dysuria. Genitourinary syndrome of menopause is experienced by over half of postmenopausal women, and is even more pervasive in women with cancer. Due to treatments such as surgery, chemotherapy, radiation, and hormonal therapy, women may experience early menopause resulting in earlier and more severe symptoms. Understanding the scope of this issue in female breast and gynecologic cancer survivors and identifying treatment options for this complex patient population are paramount. Tailored patient treatments include nonhormonal therapies (vaginal moisturizers, lubricants, pelvic floor physical therapy, dilator therapy, counseling), systemic and local hormonal therapies. Consensus recommendations by medical societies and associated evidence are reviewed, with emphasis on safety and efficacy of local vaginal hormonal therapies, and management variations noted depending on cancer type and characteristics. With knowledge and understanding of the unmet need associated with under-recognition and under-treatment of genitourinary syndrome of menopause, providers caring for women with cancer are in a position to improve the quality of life of their patients by providing safe and effective treatments.


Assuntos
Neoplasias da Mama , Terapia de Reposição de Estrogênios/métodos , Doenças Urogenitais Femininas/terapia , Neoplasias dos Genitais Femininos , Menopausa , Administração Intravaginal , Anestésicos Locais/uso terapêutico , Sobreviventes de Câncer , Dispareunia/terapia , Disuria/terapia , Feminino , Humanos , Terapia a Laser , Lidocaína/uso terapêutico , Lipídeos/uso terapêutico , Lubrificantes/uso terapêutico , Seleção de Pacientes , Diafragma da Pelve , Modalidades de Fisioterapia
8.
Presse Med ; 48(11 Pt 1): 1295-1300, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31735524

RESUMO

Can menopausal hormone therapy (HT) be used in hypertensive women? The group of experts of the French Society of Hypertension has carried out a review of the recent literature in order to answer this question, based on the most recent scientific publications. If use of oral HT is associated with a discreet increase in blood pressure, the transdermal route seems to be safer. The first results of major randomized trials of HT had alerted to an increase in cardiovascular events and breast cancer with the use of oral HT, generally, tipping the benefit-risk balance of the deleterious side. Complementary analyzes have shown the importance of the window of intervention (less than 10 years after the menopause) and the age of the woman to start the HT. On the contrary, they have shown a significant decrease of the coronary events. For woman suffering from hypertension and important climacteric symptoms, it is important to evaluate the whole cardiovascular risk in order to decide the possibility of prescribing a HT. Thus, the group of experts proposes a prescription assistance algorithm based on the stratification of cardiovascular risk, always favoring, when it is authorized, HT by transdermal route of administration.


Assuntos
Neoplasias da Mama/induzido quimicamente , Doenças Cardiovasculares/induzido quimicamente , Terapia de Reposição de Estrogênios/métodos , Hipertensão , Menopausa , Administração Cutânea , Administração Oral , Fatores Etários , Algoritmos , Pressão Sanguínea/efeitos dos fármacos , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo
9.
Curr Osteoporos Rep ; 17(6): 465-473, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31741221

RESUMO

PURPOSE OF REVIEW: The goal of the review is to assess the appropriateness of menopausal hormone therapy (MHT) for the primary prevention of bone loss in women at elevated risk in the early years after menopause. RECENT FINDINGS: Estrogen alone or combined with progestin to protect the uterus from cancer significantly reduces the risk of osteoporosis-related fractures. MHT increases type 1 collagen production and osteoblast survival and maintains the equilibrium between bone resorption and bone formation by modulating osteoblast/osteocyte and T cell regulation of osteoclasts. Estrogens have positive effects on muscle and cartilage. Estrogen, but not antiresorptive therapies, can attenuate the inflammatory bone-microenvironment associated with estrogen deficiency. However, already on second year of administration, MHT is associated with excess breast cancer risk, increasing steadily with duration of use. MHT should be considered in women with premature estrogen deficiency and increased risk of bone loss and osteoporotic fractures. However, MHT use for the prevention of bone loss is hindered by increase in breast cancer risk even in women younger than 60 years old or who are within 10 years of menopause onset.


Assuntos
Osso e Ossos/metabolismo , Neoplasias da Mama/epidemiologia , Terapia de Reposição de Estrogênios/métodos , Estrogênios/uso terapêutico , Osteoporose Pós-Menopausa/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Progestinas/uso terapêutico , Reabsorção Óssea , Colágeno Tipo I/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Osteoblastos , Osteoclastos , Osteócitos , Osteogênese , Osteoporose Pós-Menopausa/metabolismo , Medição de Risco , Linfócitos T , Resultado do Tratamento
10.
Menopause ; 26(11): 1318-1323, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688579

RESUMO

OBJECTIVE: The aim of this study was to determine the efficacy of transdermal estradiol (E2) plus intermittent progesterone (EPT) for improving self-reported sleep in perimenopausal women, after controlling for vasomotor symptoms (VMS) bother and depressive symptoms. METHODS: Using a double-blind, placebo-controlled design, 172 healthy women meeting STRAW+10 criteria for being in the menopausal transition or early postmenopause were randomized to 12 months of transdermal E2 (0.1 mg/d) + 200 mg progesterone (12 d every 3 mo) or placebo. Using standard questionnaires, self-reported sleep, depression, and VMS bother were obtained at baseline and bimonthly postrandomization. RESULTS: Controlling for baseline levels, EPT (vs placebo) led to reductions in minutes to fall asleep (estimate = -0.12, P = 0.002) and number of awakenings (estimate = -0.24, P = 0.04) over the 12 months. Controlling for changes in VMS bother and depressive symptoms, EPT still predicted reductions in minutes to fall asleep (estimate = -0.28, P = 0.02) and number of awakenings (estimate = -0.11, P = 0.02) over the 12 months. CONCLUSIONS: We extend existing research by demonstrating that hormone therapy (HT) in subjective sleep cannot be fully explained by improvements in VMS bother or depressive symptoms. Research to examine the mechanism (s) underlying HT's effects on sleep would have public health significance for perimenopausal women and also advance our general understanding of the pathophysiology of impaired sleep.


Assuntos
Estradiol/administração & dosagem , Estrogênios/administração & dosagem , Perimenopausa , Progesterona/administração & dosagem , Sono/efeitos dos fármacos , Administração Cutânea , Depressão/tratamento farmacológico , Depressão/etiologia , Método Duplo-Cego , Terapia de Reposição de Estrogênios/métodos , Feminino , Fogachos/tratamento farmacológico , Fogachos/etiologia , Humanos , Pessoa de Meia-Idade , Autorrelato , Resultado do Tratamento , Sistema Vasomotor/efeitos dos fármacos
11.
Menopause ; 26(11): 1334-1341, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567867

RESUMO

OBJECTIVE: Vasomotor symptoms (VMS) have been consistently reported as the leading predictor of health-related quality of life (HRQOL) among menopausal women, and the strongest indication for treatment. The North American Menopause Society endorses the use of oral estrogen for the treatment of VMS based on a Cochrane meta-analysis. The Cochrane review concludes that oral hormone therapy reduces the frequency and severity of VMS. The objective of this review is to critically appraise the outcome measures used in these clinical trials to evaluate whether there is adequate evidence that oral hormone therapy improves HRQOL. METHODS: Each trial in the 2004 Cochrane review of oral hormone therapy for the management of VMS was evaluated with respect to study design, outcome measures, and method of analysis. RESULTS: Twenty-four randomized, double-blind, placebo-controlled clinical trials were appraised. Six trials were excluded from the Cochrane meta-analysis due to inadequate reporting of outcome measures. Of the remaining trials, 15 trials assessed only symptom frequency and/or severity. One trial used a subscale of the General Health Questionnaire. Two trials used the Greene Climacteric Scale, a validated outcome measure in menopausal women, to directly assess the impact of hormone therapy on HRQOL. Both studies showed an improvement in HRQOL in the hormone-treated group, although the sample size was small (n = 118) and the effect was modest. CONCLUSION: Although oral hormone therapy improves VMS scores, there is a paucity of evidence on whether it improves HRQOL in menopausal women. Future studies using validated, patient-reported outcome measures that directly assess HRQOL are needed.


Assuntos
Terapia de Reposição de Estrogênios/psicologia , Menopausa/psicologia , Qualidade de Vida , Avaliação de Sintomas/métodos , Sistema Vasomotor/efeitos dos fármacos , Método Duplo-Cego , Terapia de Reposição de Estrogênios/métodos , Feminino , Fogachos/diagnóstico , Fogachos/tratamento farmacológico , Fogachos/psicologia , Humanos , Menopausa/efeitos dos fármacos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Medicina (Kaunas) ; 55(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31500138

RESUMO

Background and Objectives: Data emerging from the Women's Health Initiative (WHI) study point toward an association between menopausal hormone therapy (MHT) and cardiovascular (CV) risk. However, post hoc subgroup analyses stratifying participants according to their age and time since menopause, have opened the way to a better understanding of the relationship between estrogen and CV risk. The aim of this review was to revise the current literature and evaluate the CV risk or benefit following administration of MHT considering several factors such as MHT timing, dose, route of administration, and formulation. Materials and Methods: An electronic databases search of MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, congress abstracts, and Grey literature (Google Scholar; British Library) was performed, with the date range from each database's inception until June 2019. All the studies evaluating MHT and cardiovascular risk, including thromboembolism or stroke, were selected. Results: Timing of MHT initiation was shown to be a critical factor in CV risk assessment. In concordance with the "timing hypothesis", healthy symptomatic women who initiated MHT when aged younger than 60 years, or who were within 10 years of menopause onset, have demonstrated a reduction in both coronary heart disease (CHD) risk and all-cause mortality. In particular, MHT therapy was associated with improvement of subclinical signs of atherosclerosis. Venous thromboembolism (VTE) risk is reduced when low doses of oral estrogen are used. Moreover, transdermal hormonal application significantly reduces CV risk compared with oral administration. MHT impact on the CV system is influenced by either factors inherent to the specific regimen, or factors inherent to the specific patient. Hence, individualization of care is necessary. Conclusion: CV risk calculation should be considered by clinicians in order to exclude patients with high CV risk, in whom MHT is contraindicated. Assessing risks and benefits in a patient-centered approach according to individual's features, health status, and personal preferences is important in order to realize a safe and effective treatment.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Terapia de Reposição de Estrogênios/normas , Resultado do Tratamento , Idoso , Doenças Cardiovasculares/tratamento farmacológico , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco
14.
J Vis Exp ; (150)2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31475965

RESUMO

Postmenopausal women are at greater risk of developing cardiovascular diseases than premenopausal women. Female mice ovariectomized (OVX) at weaning display increased atherosclerotic lesions in the aorta compared with female mice with intact ovarian function. However, laboratory models involving estrogen-deficient mice with atherosclerosis-prone status are lacking. This deficit is crucial because clinical estrogen deficiency in menopausal women may aggravate the incidence of pre-existing or ongoing lipid disruption and atherosclerosis. In this study, we establish an in vivo estrogen-deficient mouse model by bilateral ovariectomy via a double dorsal-lateral incision in apolipoprotein E (apoE)-/- mice. We then compare the effects of 17ß-estradiol and pseudoprotodioscin (PPD) (a phytoestrogen) perorally administered via hazelnut spread. We find that although PPD exerts some effect on reducing final body weight and plasma TG in OVX apoE-/- mice, it has anti-atherosclerotic and cardiac-protective capacities comparable with its 17ß-estradiol counterpart. PPD is a phytoestrogen that has been reported to exert anti-tumor properties. Thus, the proposed method is applicable for screening phytoestrogens via peroral administration to substitute for traditional hormone replacement therapy in postmenopausal women, which has been reported to have potentially deleterious tumorigenetic capacity. Peroral administration via hazelnut spread is noninvasive, rendering it widely applicable to many patients. This article contains step-by-step demonstrations of bilateral ovariectomy via the double dorsal-lateral incision in apoE-/- mice and peroral 17ß-estradiol or phytoestrogen hormone replacement via hazelnut spread. Plasma lipid and cardiovascular function analyses using echocardiography follow.


Assuntos
Aterosclerose/tratamento farmacológico , Aterosclerose/metabolismo , Estradiol/uso terapêutico , Terapia de Reposição de Estrogênios/métodos , Estrogênios/deficiência , Menopausa/metabolismo , Animais , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Modelos Animais de Doenças , Estradiol/farmacologia , Feminino , Menopausa/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Ovariectomia/efeitos adversos , Resultado do Tratamento
15.
Ann Plast Surg ; 83(4): 401-403, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31524732

RESUMO

In male-to-female gender transition, individuals request a number of interventions, including hormonal therapy, to promote feminizing characteristics. Estrogen-based medication is prescribed to increase breast development, decrease facial hair, promote feminine adipose tissue deposition, and soften skin. Surgical breast augmentation to supplement unsatisfying breast growth after hormonal therapy is a common and well-studied course of management for such transgender patients. In a departure from convention, the authors present a case of symptomatic macromastia requiring surgical breast reduction in a transgender woman following 24 years of hormonal therapy and illicit silicone injections in multiple areas of her body, including the breasts.


Assuntos
Mama/anormalidades , Terapia de Reposição de Estrogênios/efeitos adversos , Hipertrofia/induzido quimicamente , Hipertrofia/cirurgia , Mamoplastia/métodos , Pessoas Transgênero , Adulto , Mama/cirurgia , Estética , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Masculino , Mastectomia/métodos , Satisfação do Paciente , Medição de Risco , Resultado do Tratamento
16.
Ann Intern Med ; 171(6): 406-414, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31499528

RESUMO

Background: Whether health outcomes of menopausal estrogen therapy differ between women with and without bilateral salpingo-oophorectomy (BSO) is unknown. Objective: To examine estrogen therapy outcomes by BSO status, with additional stratification by 10-year age groups. Design: Subgroup analyses of the randomized Women's Health Initiative Estrogen-Alone Trial. (ClinicalTrials.gov: NCT00000611). Setting: 40 U.S. clinical centers. Participants: 9939 women aged 50 to 79 years with prior hysterectomy and known oophorectomy status. Intervention: Conjugated equine estrogens (CEE) (0.625 mg/d) or placebo for a median of 7.2 years. Measurements: Incidence of coronary heart disease and invasive breast cancer (the trial's 2 primary end points), all-cause mortality, and a "global index" (these end points plus stroke, pulmonary embolism, colorectal cancer, and hip fracture) during the intervention phase and 18-year cumulative follow-up. Results: The effects of CEE alone did not differ significantly according to BSO status. However, age modified the effect of CEE in women with prior BSO. During the intervention phase, CEE was significantly associated with a net adverse effect (hazard ratio for global index, 1.42 [95% CI, 1.09 to 1.86]) in older women (aged ≥70 years), but the global index was not elevated in younger women (P trend by age = 0.016). During cumulative follow-up, women aged 50 to 59 years with BSO had a treatment-associated reduction in all-cause mortality (hazard ratio, 0.68 [CI, 0.48 to 0.96]), whereas older women with BSO had no reduction (P trend by age = 0.034). There was no significant association between CEE and outcomes among women with conserved ovaries, regardless of age. Limitations: The timing of CEE in relation to BSO varied; several comparisons were made without adjustment for multiple testing. Conclusion: The effects of CEE did not differ by BSO status in the overall cohort, but some findings varied by age. Among women with prior BSO, in those aged 70 years or older, CEE led to adverse effects during the treatment period, whereas women randomly assigned to CEE before age 60 seemed to derive mortality benefit over the long term. Primary Funding Source: The WHI program is funded by the National Heart, Lung, and Blood Institute; National Institutes of Health; and U.S. Department of Health and Human Services. Wyeth Ayerst donated the study drugs.


Assuntos
Terapia de Reposição de Estrogênios/métodos , Estrogênios Conjugados (USP)/uso terapêutico , Ovariectomia , Fatores Etários , Idoso , Neoplasias da Mama/epidemiologia , Causas de Morte , Neoplasias Colorretais/epidemiologia , Doença das Coronárias/epidemiologia , Feminino , Seguimentos , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Menopausa , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
17.
Clin Obstet Gynecol ; 62(4): 677-686, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31503029

RESUMO

Hormone therapy remains the most effective treatment for menopausal symptoms but decisions are complex, requiring an assessment of benefits and risks and determination of best treatment type, dose, and duration. Benefits exceed risks for most women with bothersome menopausal symptoms or high risk for fracture if initiated under age 60 years or within 10 years since menopause. Long-term mortality and safety data from the Women's Health Initiative is reassuring, with no increase in deaths from cardiovascular disease or cancer compared with placebo after 18 years of follow-up and a trend towards less mortality in those who initiate hormone therapy ages 50 to 59 years.


Assuntos
Terapia de Reposição de Estrogênios/métodos , Menopausa , Doenças Cardiovasculares/prevenção & controle , Esquema de Medicação , Terapia de Reposição de Estrogênios/mortalidade , Feminino , Fraturas Ósseas/prevenção & controle , Fogachos/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Saúde da Mulher/estatística & dados numéricos
19.
JAMA Netw Open ; 2(8): e1910154, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31461147

RESUMO

Importance: Hormone therapy (HT) has been suggested for protection against age-related muscle weakness in women. However, the potential for HT-associated health risks necessitates a better understanding of the direction and magnitude of the association between HT and health outcomes, such as lean body mass (LBM). Objective: To determine whether HT was associated with reduced LBM loss compared with not receiving HT among postmenopausal women aged 50 years and older. Data Sources: MEDLINE, Embase, AgeLine, CINAHL, and SportDiscus (searched from inception until April 25, 2018). Study Selection: For this systematic review and meta-analysis, randomized clinical trials including postmenopausal women undergoing HT and control groups of women not receiving HT were selected by 2 reviewers. Studies were included if LBM or fat-free mass were measured as an outcome. Studies with participants from hospitals, long-term care facilities, or with specific diseases were excluded. Data Extraction and Synthesis: Information regarding study characteristics and outcome measures were extracted by 1 reviewer and verified by another. Risk of bias was evaluated. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to abstract data and assess data quality/validity. Data were pooled using a fixed-effects model. Main Outcomes and Measures: The primary study outcome was the overall absolute change in LBM (measured in kilograms), captured by dual-energy x-ray absorptiometry, dual-photon absorptiometry, or bioelectrical impedance analysis imaging. Results: Of 8961 studies that met selection criteria, 12 were included, with a total of 4474 recruited participants. Of the participants, mean (SD) age was 59.0 (6.1) years. Data on ethnicity were collected by 2 of the studies. Of the 22 HT intervention arms, 15 used estrogen-progesterone combination HT and 7 used estrogen-only HT. Control participants were women who received no HT at all or who received placebo. The median follow-up duration was 2 years (range, 6 months to 6 years). Seven treatment arms showed a loss of LBM, and 14 were protective. Overall, HT users lost 0.06 kg (95% CI, -0.05 to 0.18) less LBM compared with control participants, but the difference was not statistically significant (P = .26). The results were unchanged when stratified based on treatment type and dosage, duration of follow-up, time since menopause, study quality, and type of LBM measurement, with HT users losing between 0.06 kg more to 0.20 kg less LBM compared with control participants for all strata. The quality of evidence based on GRADE was low. Conclusions and Relevance: This systematic review and meta-analysis did not show a significant beneficial or detrimental association of HT with muscle mass. Although muscle retention in aging women is of crucial importance, these findings suggest that interventions other than HT should be explored.


Assuntos
Composição Corporal/efeitos dos fármacos , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Debilidade Muscular/tratamento farmacológico , Músculo Esquelético/efeitos dos fármacos , Pós-Menopausa/efeitos dos fármacos , Absorciometria de Fóton/métodos , Idoso , Estudos de Casos e Controles , Impedância Elétrica , Terapia de Reposição de Estrogênios/métodos , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Feminino , Seguimentos , Terapia de Reposição Hormonal/métodos , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Placebos/administração & dosagem , Pós-Menopausa/etnologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Cancer Prev Res (Phila) ; 12(10): 711-720, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31420361

RESUMO

Interventions that relieve vasomotor symptoms while reducing risk for breast cancer would likely improve uptake of chemoprevention for perimenopausal and postmenopausal women. We conducted a pilot study with 6 months of the tissue selective estrogen complex bazedoxifene (20 mg) and conjugated estrogen (0.45 mg; Duavee) to assess feasibility and effects on risk biomarkers for postmenopausal breast cancer. Risk biomarkers included fully automated mammographic volumetric density (Volpara), benign breast tissue Ki-67 (MIB-1 immunochemistry), and serum levels of progesterone, IGF-1, and IGFBP3, bioavailable estradiol and testosterone. Twenty-eight perimenopausal and postmenopausal women at increased risk for breast cancer were enrolled: 13 in cohort A with baseline Ki-67 < 1% and 15 in cohort B with baseline Ki-67 of 1% to 4%. All completed the study with > 85% drug adherence. Significant changes in biomarkers, uncorrected for multiple comparisons, were a decrease in mammographic fibroglandular volume (P = 0.043); decreases in serum progesterone, bioavailable testosterone, and IGF-1 (P < 0.01), an increase in serum bioavailable estradiol (P < 0.001), and for women from cohort B a reduction in Ki-67 (P = 0.017). An improvement in median hot flash score from 15 at baseline to 0 at 6 months, and menopause-specific quality-of-life total, vasomotor, and sexual domain scores were also observed (P < 0.001). Given the favorable effects on risk biomarkers and patient reported outcomes, a placebo-controlled phase IIB trial is warranted.


Assuntos
Biomarcadores Tumorais , Densidade da Mama/efeitos dos fármacos , Neoplasias da Mama/etiologia , Estrogênios Conjugados (USP)/farmacologia , Indóis/farmacologia , Sistema Vasomotor/efeitos dos fármacos , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Mama/efeitos dos fármacos , Mama/patologia , Neoplasias da Mama/sangue , Neoplasias da Mama/diagnóstico , Estradiol/sangue , Terapia de Reposição de Estrogênios/métodos , Estrogênios Conjugados (USP)/uso terapêutico , Estudos de Viabilidade , Feminino , Humanos , Indóis/uso terapêutico , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/análise , Fator de Crescimento Insulin-Like I/metabolismo , Antígeno Ki-67/análise , Antígeno Ki-67/sangue , Mamografia , Menopausa/sangue , Menopausa/efeitos dos fármacos , Menopausa/fisiologia , Pessoa de Meia-Idade , Projetos Piloto , Pós-Menopausa , Progesterona/sangue , Qualidade de Vida , Fatores de Risco , Testosterona/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...