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Writing Group for the Women's Health Initiative Investigators Controlled Trial From the Women's Health Initiative Randomized Healthy Postmenopausal Women: Principal Results Risks and Benefits of Estrogen Plus Progestin in
... A partir daí, uma série de estudos foi feita com variados esquemas de reposição hormonal. Em 2002, foi publicado o WHI EP trial 5,6 , que demonstrou o efeito deletério da terapia hormonal (TH) e iniciou uma grande polêmica. ...
... Apesar dos fortes indícios de que a TH aumenta os riscos de desenvolvimento do câncer de mama 2,5,6,8 , ainda há muitas divergências em relação à sua influência na incidência, no prognóstico e na mortalidade das pacientes portadoras da doença 6 . Além disso, ela pode estar associada aos tipos menos agressivos, sem aumento de mortalidade, o que aponta a necessidade do desenvolvimento de mais pesquisas a esse respeito 4 . ...
... O WHI EP trial5 , o HABITS trial 9 e o LIBERATE study14 demonstraram aumento de risco e maior recidiva do câncer de mama em usuárias de TH. Já o WHI E alone trial 18 e o Stockholm trial 10 obtiveram resultado oposto. ...
... In contrast, the US Preventive Services Task Force recommends against the use of HT for the prevention of chronic conditions in postmenopausal women because the risks outweigh the benefits [8]. The recommendation was predicated on the findings of the Women's Health Initiative (WHI), a large-scale, longitudinal, randomized, controlled trial involving 16,608 women aged 50 to 79 which established that HT use increased the risks of breast cancer, heart attack, stroke, and blood clots [9,10]. Later analyses of the WHI data further differentiated effects by age of initiation, time from menopause and HT used (estrogen with progestin or estrogen alone) [11,12]. ...
... Later analyses of the WHI data further differentiated effects by age of initiation, time from menopause and HT used (estrogen with progestin or estrogen alone) [11,12]. These studies reported that menopausal HT use was appropriate for vasomotor symptom management but not for the prevention of coronary heart disease [9][10][11][12]. To better understand the gap between favorable and unfavorable HT recommendations, this study examined key sources of information about HT to assess their valence and influence, and how these may contribute to the state-of-the-science gap. ...
... It was a little-known fact that Wilson's work publicizing the benefits of HT was funded by hormone manufacturers, Searle, Upjohn and Ayerst Laboratories [15]. In 2002, when findings of the Women's Health Initiative (WHI) study [9,10] were published, HT use dramatically declined [16][17][18]. ...
Objective
Medical reviews and research comprise a key information source for news media stories on medical therapies and innovations as well as for physicians in updating their practice. The present study examined medical review journal articles, physician surveys and news media coverage of hormone replacement therapy (HT) to assess the relationship between the three information sources and whether/if they contributed to a state-of-the-science gap (a condition when the evaluation of a medical condition or therapy ascertained by the highest standards of investigation is incongruent with the science-in-practice such as physician recommendations and patient actions).
Methods
We content-analyzed 177 randomly sampled HT medical reviews between 2002 and 2014, and HT news valence in three major TV networks, newspapers and magazines/internet sites in 2002–2003, 2008–2009 and 2012–14. The focus in both analyses was whether HT benefits outweighed risks, risks outweighed benefits or both risks and benefits were presented. We also qualitatively content-analyzed all 19 surveys of US physicians’ HT recommendations from 2002 to 2009, and 2012 to 2014.
Results
Medical reviews yielded a mixed picture about HT (40.1% benefits, 26.0% risks, and 33.9% both benefits and risks). While a majority of physician surveys were pro-HT 10/19), eight showed varied attitudes and one was negative. Newspaper and television coverage reflected a pro and con balance while magazine stories were more positive in the later reporting period.
Conclusion
Medical journal review articles, physicians, and media reports all provide varying view points towards hormone therapy use thus leading to limited knowledge about the actual risks and benefits of HT among peri- and menopausal women and a state-of-the-science gap.
... The 19 studies we included collectively document 2,305,427 peri/postmenopausal women from 10 countries (see Table 2). Of these women, 34,514 were diagnosed with a first invasive breast cancer through systematic screening and follow-up, which yielded a net invasive breast cancer incidence of 1.50% with mean follow-up of 8.1 years [10,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. ...
... Long lists of adverse radiation-treatment and drug effects on well being, bone, cardiovascular, and sexual function, as well as the cumulative radiation exposure of repetitive mammograms, are the consequences of overdiagnosis [5][6][7]. Among enrollees in the Women's Health Initiative Study, 38% were called back for another screen and subsequent work-up, but <2.5% received invasive breast cancer diagnoses [24,25]. Economic harms from excessive medical costs and lost work are also substantial. ...
... Scatterplot and regression with 95% CI for the relationship between cumulative incidence of invasive breast cancer and duration of followup in the 12 studies of women who were 50 years old or older or surgically menopausal at enrollment. Regression line is based on 12 studies: #1 [18], 3 [20], 4 [21], 5 [22], 6 [23], 7 [24], 8 [25], 11 [27], 12 [28], 13 [29], 14 [30], 17 [33]. Each plotted point is located at the intersection of the duration of study and its cumulative incidence of invasive breast cancer. ...
Earlier studies of breast cancer, screening mammography, and mortality reduction may have inflated lifetime and long-term risk estimates for invasive breast cancer due to limitations in their data collection methods and interpretation.
To estimate the percentage of asymptomatic peri/postmenopausal women who will be diagnosed with a first invasive breast cancer over their next 25 years of life.
A systematic review identified peer-reviewed published studies that: 1) enrolled no study participants with a history of invasive breast cancer; 2) specified the number of women enrolled; 3) reported the number of women diagnosed with a first invasive breast cancer; 4) did not overcount [count a woman multiple times]; and, 5) defined the length of follow-up. Data sources included PubMed, Cochrane Library, and an annotated library of 4,409 full-text menopause-related papers collected and reviewed by the first author from 1974 through 2008. Linear regression predicted incidence of first invasive breast cancer, based on follow-up duration in all studies that met the our inclusion criteria, and in a subset of these studies that included only women who were 1) at least 50 years old and 2) either at least 50 or less than 50 but surgically menopausal at enrollment.
Nineteen studies met the inclusion criteria. They included a total of 2,305,427 peri/postmenopasual women. The mean cumulative incidence rate of first invasive breast cancer increased by 0.20% for each year of age (95% CI: 0.17, 0.23; p < 0.01; R2 = 0.90). Over 25 years of follow-up, an estimated 94.55% of women will remain breast cancer-free (95% CI: 93.97, 95.13). In the 12 studies (n = 1,711,178) that enrolled only postmenopausal women, an estimated 0.23% of women will be diagnosed with a first invasive breast cancer each year (95% CI: 0.18, 0.28; p < 0.01, R2 = 0.88).
The vast majority (99.75%) of screened asymptomatic peri/postmenopasual women will not be diagnosed with invasive breast cancer each year. Approximately 95% will not be diagnosed with invasive breast cancer during 25 years of follow-up. Women who receive clinical examinations, but do not have mammograms, will have higher cancer-free rates because innocuous positives (comprising 30-50% of mammography diagnoses) will remain undetected. Informed consent to asymptomatic women should include these results and consideration of the benefits of avoiding mammograms.
... e WHI study assessed the benefits and risks of HRT in advanced age menopausal women and came to conclude that even though HRT decreased fracture rates and vasomotor symptoms in postmenopausal patients, it did not increase their quality of life. Moreover, it showed unexpectedly that HRT use leads to an increased incidence of cardiac events, stroke, deep venous thrombosis, and breast cancer which led to the premature closure of the study [5]. In the direct post-WHI era and being affected by the WHI results as well as by the American College of Obstetrics and Gynecology (ACOG) [6] and the U.S. Preventive Services Task Force recommendations, health care providers and obstetricians started to avoid using HRT offering menopausal patients less effective alternative treatments [7]. ...
... HRT were developed to ease these changes that are associated with the hormonal imbalance as well as maintenance of women's health. Data concerning the safety of HRT were contradictory, especially with the publication of the WHI study; however, recent clarifications were published by scientific bodies and guidelines were set for HRT use [5,8,13]. e main limiting factor for HRT use in many parts of the world nowadays remains to be the knowledge and attitudes towards HRT in the general population. ...
Objectives:
Hormone replacement therapy (HRT) had been the gold standard for the treatment of menopausal symptoms until the publication of the World Health Initiative (WHI) study. After the WHI study, the use of HRT changed among the physicians and patients all over the world despite newer more reassuring data. This study aimed to investigate the knowledge and attitudes of women towards HRT and the factors affecting it for better counseling. Study design. A clinic-based cross-sectional study using a survey was offered to women aged 40 years and above coming to the women's health center at the American University of Beirut Medical Center (AUBMC) from October 1st, 2017, till March 31st, 2018. The questionnaire included questions about demographics and menopausal symptoms in addition to knowledge and attitudes towards menopause and HRT. Main outcome measures. Our main hypothesis was that women would be aware of HRT as a treatment modality; however, the majority would have a negative attitude towards its usage.
Results:
The response rate was 87.8%. Seventy-three percent of the respondents had already heard about HRT with 57.9% supporting the use of HRT; however, 47.9% did not know when to use it. The significant predictor for having heard about HRT and a positive attitude towards HRT were having HRT prescribed as a part of treatment and employment status, respectively.
Conclusions:
Lebanese women are aware of HRT as a treatment option; however, a lack of both proper information and positive attitude towards HRT use was noted.
... 6 In a large-scale randomised trial, the U.S. Women's Health Initiative (WHI) study, the risks of long-term MHT use were shown to outweigh its benefits in terms of serious, potentially life-threatening disease. 8 Substantial falls in MHT use following the publication of the WHI trial results, and a subsequent decline in breast cancer incidence, have now been reported in a number of countries, including Australia. [9][10][11] However, a substantial proportion of menopausal women continue to use MHT in Australia [12][13][14] and elsewhere. ...
... In the past decade, a number of ecological studies in various countries [9][10][11]32 have documented falls in rates of breast cancer in women aged over 50 years, but not in younger women, following substantial reductions in MHT use after the publication of the initial findings of the WHI combined oestrogen-progestagen trial results in 2002. 8 In Australia, MHT use peaked in 2001 and had dropped by 40% by 2003 and by 55% by 2005 (referenced to 2001 levels). 11,32 This was mirrored by a corresponding decline in breast cancer incidence of 6.7% by 2003 and 8.8% by 2005 (referenced to 2001 levels) in women over the age of 50 years, but not in younger women. ...
Menopausal Hormone Therapy (MHT) use in Australia fell by 55% from 2001 to 2005, following the release of large-scale findings on its risks and benefits. Comprehensive national data, including information on overall prevalence of MHT use as well as information on duration of use in Australia have not been reported since the 2004-5 National Health Survey, when 11% of women aged 45+ years were estimated to be current MHT users. No national data are available on prevalence of use of "bioidentical" hormone therapy (BHT). The objective of this study was to determine recent prevalence of MHT and BHT use. A cross-sectional, national, age-stratified, population survey was conducted in 2013. Eligible women, aged 50-69 years, resident in Australia were randomly sampled in 5-year age groups from the Medicare enrolment database (Australia's universal health scheme). The response rate was 22% based on return of completed questionnaires, and analyses were restricted to 4,389 women within the specified age range. The estimated population-weighted prevalence of current use of MHT was 13% (95%CI 12-14), which was broadly similar to the previously reported national figures in 2004-5, suggesting that the use of MHT in Australia has largely stabilised over the past decade. A total of 39% and 20% of current-users with an intact uterus reported use of oestrogen-progestagen MHT and oestrogen-only MHT, respectively, whereas 77% of hysterectomised current-users used oestrogen-only MHT. Almost three-quarters of current-users [population-weighted prevalence 9% (95%CI 8-10)] had used MHT for ≥5 years. In regard to BHT, estimated population-weighted prevalence of ever use was 6% (95%CI 6-7) and 2% (95%CI 2-3) for current use. The population-weighted prevalence of MHT and BHT combined, in current users in their fifties and sixties was 15% (95%CI 14-16). These data provide a recent national "snapshot" of Australian women's use of both conventional MHT and of BHT.
... 6 In a large-scale randomised trial, the U.S. Women's Health Initiative (WHI) study, the risks of long-term MHT use were shown to outweigh its benefits in terms of serious, potentially life-threatening disease. 8 Substantial falls in MHT use following the publication of the WHI trial results, and a subsequent decline in breast cancer incidence, have now been reported in a number of countries, including Australia. [9][10][11] However, a substantial proportion of menopausal women continue to use MHT in Australia [12][13][14] and elsewhere. ...
... In the past decade, a number of ecological studies in various countries [9][10][11]32 have documented falls in rates of breast cancer in women aged over 50 years, but not in younger women, following substantial reductions in MHT use after the publication of the initial findings of the WHI combined oestrogen-progestagen trial results in 2002. 8 In Australia, MHT use peaked in 2001 and had dropped by 40% by 2003 and by 55% by 2005 (referenced to 2001 levels). 11,32 This was mirrored by a corresponding decline in breast cancer incidence of 6.7% by 2003 and 8.8% by 2005 (referenced to 2001 levels) in women over the age of 50 years, but not in younger women. ...
Randomised controlled trials and large scale observational studies have found that current use of Menopausal Hormone Therapy (MHT) is associated with an increased risk of breast cancer; this risk is higher for oestrogen-progestagen combination therapy than for oestrogen only therapy. The current study was designed to estimate MHT-associated breast cancer risk in a population of Australian women. Data were analysed for postmenopausal women with self-reported incident invasive breast cancer (n=1,236) and cancer-free controls (n=862), recruited between 2006 and 2014 into a large case-control study for all cancer types, the NSW CLEAR study. Information on past and current MHT use was collected from all participants, along with other lifestyle and demographic factors, using a self-administered questionnaire. Unmatched multivariable logistic regression was performed, adjusting for socio-demographic, reproductive and health behaviour variables, body mass index and breast screening history. Compared to never-users of MHT, the adjusted odds ratio (aOR) for breast cancer in current users of any type of MHT was 2.09(95%CI: 1.57-2.78; p<0.0001) and for past users of any type of MHT the aOR was 1.03(0.82-1.28; p=0.8243). For current users of oestrogen-only and oestrogen-progestagen therapy, aORs were 1.80(1.21-2.68; p=0.0039) and 2.62(1.56-4.38; p=0.0003), respectively. These findings are consistent with those from other international observational studies, that current, but not past, use of MHT is associated with a substantially increased risk of breast cancer. This article is protected by copyright. All rights reserved.
... The gold standard in the treatment of vaginal atrophy is the systemic or topical use of estrogen with or without progesterone. 18,19 Nonetheless, the safety and prolonged use of these compounds are still controversial issues, especially in postmenopausal and high-risk women (i.e. women with a history of breast and endometrial cancer and thromboembolic diseases, etc.). ...
Genitourinary syndrome of menopause is a major issue in menopausal health. Because unlike vasomotor symptoms, it has a progressive trend. In this regard we conducted a systematic review to evaluate the efficacy of intravaginal oxytocin on postmenopausal vaginal atrophy. A search was performed for published studies in Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar and Persian databases without time and language limitations. Only randomized controlled trials that compared intravaginal oxytocin with placebos were included. The outcome measures were objective and subjective assessed symptoms of vaginal atrophy. Statistical heterogeneity was evaluated using the I 2. The standardized mean differences were pooled the fixed effects model. Of the five included studies, four studies meta-analysed. The meta-analysis in terms of the cytological analysis (standardized mean difference: 35.13, 95% confidence interval: 32.59-37.67, n ¼ 218, I 2 ¼ 96%) was statistically significant. In terms of histological assessments (standardized mean difference: À0.38, 95% confidence interval: À0.94 to 0.17, n ¼ 38, I 2 ¼ 0%) and endometrial thickness (standardized mean difference: 0.05, 95% confidence interval: À0.20 to À0.31, n ¼ 95, I 2 ¼ 0%), there were no statistically significant differences between the groups. Three studies reported a statistically significant improvement in the subjective symptoms; however, we were unable to perform a meta-analysis. Four of the included studies assessed side effects, but only two studies reported them. Oxytocin as a nonestrogenic compound can be a suitable alternative for the treatment of vaginal atrophy, especially in women with contraindications for using estrogenic compounds. Further good quality clinical trials with long-term follow-ups are recommended to demonstrate the effects of intra-vaginal gel in the treatment of vaginal atrophy.
... This therapy resulted associated with an increased incidence of breast cancer, compared with placebo, at a follow-up of 5.2 years (hazard ratio [HR]: 1.26; 95% CI: 1.00-1.59) 15 . The study was then stopped early due to the unfavorable risk-benefit ratio of HRT. ...
Hot flushes (HFs) are a very frequent condition in menopausal women, associated with a marked decrease in quality of life, impaired ability to carry on daily activities and sleep disturbances. However, this condition is often only given poor attention in daily practice and in clinical research.
Indeed, several treatments for HFs exist. The most effective is considered to be hormone replacement therapy, but this strategy has been associated with a poor risk-benefit ratio given its link with the development of cancer. Other treatments have been tested and are currently used, but they are usually only poorly effective or cannot be recommended in all patients due to potential side effects or interference with other molecules. Therefore, there is a major need for new treatment options for HFs.
β-alanine supplementation is widely used for the enhancement of energetic metabolism and is known to be devoid of any relevant adverse effect. BA has also been widely used for the treatment of HFs.
This narrative review will discuss the current pharmacological management of HFs and will present the role of β-alanine in this setting.
... The guidelines of American Association of Clinical Endocrinologists are important benchmarks while selecting various therapeutic and preventive regimens for relieving the symptomatology of menopause. However, the failure of HRT to gain popularity can be ascribed to a multitude of factors that include but not limited to: [8][9][10][11][12] • Fear of development of neoplasia especially of breast and uterus • Onset of breakthrough or cyclic vaginal bleeding • The higher expense HRT intervention when compared with other remedies • Unavailability in majority of the rural areas of India • Reluctance to imbibe a regular medicine-taking habit • Shortage of specialists having knowledge of administration of HRT • Shortage of appropriate facilities in the peripheral sector • Lack of compliance and a regular follow-up • Need for screening before initiation of HRT such as mammography, lipid profile, pap smear, ECG, and blood sugar leads to many dropouts. • Considered to be a natural phenomenon by many and therefore do not think any need for initiating HRT. ...
... The Long-term Intervention on Fractures with Tibolone (LIFT) study conducted in postmenopausal women was shown its beneficial effects on reduction of fracture risk at vertebral (45%) and at nonvertebral (26%) sites [55]. It was shown that HRT can increase the risk of venous thromboembolic disorders, breast cancer, cardiac event and stroke, while ERT could enhance the risk of venous thromboembolic disorders, stroke, and endometrial cancer [23,56]. Thus, estrogen replacement is recommended at the lowest effective dose and just for a short period. ...
Background:
Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects.
Main body:
This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed.
Short conclusion:
The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended. Summary of treatment modalities for osteoporosis.
... Hormonal supplementation in peri-and postmenopausal women is a promising preventive or treatment option for neurodegenerative conditions such as AD [228]. However, due to side effects, including heightened risk of breast cancer, coronary heart disease and stroke, associated with hormone replacement therapy (HRT), it remains a source of great health concern [229,230]. To avoid these, it is critical to set the appropriate time when HRT is initiated and terminated, the treatment regime, dosage, formulation and combination of HRT [231,232]. ...
The basal forebrain is home to the largest population of cholinergic neurons in the brain. These neurons are involved in a number of cognitive functions including attention, learning and memory. Basal forebrain cholinergic neurons (BFCNs) are particularly vulnerable in a number of neurological diseases with the most notable being Alzheimer's disease, with evidence for a link between decreasing cholinergic markers and the degree of cognitive impairment. The neurotrophin growth factor system is present on these BFCNs and has been shown to promote survival and differentiation on these neurons. Clinical and animal model studies have demonstrated the neuroprotective effects of 17β-estradiol (E2) on neurodegeneration in BFCNs. It is believed that E2 interacts with neurotrophin signaling on cholinergic neurons to mediate these beneficial effects. Evidence presented in our recent study confirms that altering the levels of circulating E2 levels via ovariectomy and E2 replacement significantly affects the expression of the neurotrophin receptors on BFCN. However, we also showed that E2 differentially regulates neurotrophin receptor expression on BFCNs with effects depending on neurotrophin receptor type and neuroanatomical location. In this review, we aim to survey the current literature to understand the influence of E2 on the neurotrophin system, and the receptors and signaling pathways it mediates on BFCN. In addition, we summarize the physiological and pathophysiological significance of E2 actions on the neurotrophin system in BFCN, especially focusing on changes related to Alzheimer's disease.
... Hormone therapy is also an effective and appropriate treatment for women under the age of 60 or women experiencing menopause for less than 10 years [39]. For MHT, the principles are: 1. Women Health Initiative (WHI) study [40] reported the use of conjugated equine estrogen (CEE) with medroxy progesterone acetate (MPA) for 5 years and found that this regimen can reduce the incidence of vertebra fracture and hip fracture with clinical symptoms by 34% and other bone fractures by 23%. 2. MHT should be considered for each individual case. This consideration should include: quality of life, importance of health problem, age, duration of menopause, risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer. ...
The adjusted incidence rate of hip fracture in Thailand has increased more than 31% from 1997 to 2006. Mortality and morbidity after hip fracture are also high. One year mortality after a hip fracture has increased from 18% in 1999 to 21% in 2007. The Thai Osteoporosis Foundation (TOPF) developed the first Clinical Practice Guideline (CPG) in 2002 and keeps updating the CPG since then. This latest version of the CPG is our attempt to provide comprehensive positional statement on the diagnosis, prevention and treatment of osteoporosis in Thailand. The study group who revised this position statement contains experts from the TOPF, Four Royal Colleges of Thailand, includes the Orthopaedic Surgeons, Gynecologists and Obstetricians, Physiatrists, Radiologists and 2 Associations of Endocrinologists and Rheumatologists which have involved in the management of patients with osteoporosis.
... Wyeth has set aside over $16 billion to compensate the thousands of patients who have developed valvular heart disease and pulmonary hypertension after taking Fen-Phen [18]. A 2002 National Institutes of Health study found that hormone replacement therapy was associated with such an elevated risk of heart disease, stroke, pulmonary emboli, and breast cancer that the study was stopped prematurely [19]. Selective serotonin reuptake inhibitors are currently embroiled in controversy over whether they are associated with an elevated risk of suicide [20]. ...
to the debate: A variety of biomedical technologies are being developed that can be used for purposes other than treating disease. Such "enhancement technologies" can be used to improve our appearance and regulate our emotions, with the goal of feeling "better than well." While these technologies can help people adapt to their rapidly changing lifestyles, their use raises important ethical issues.
... [6] After tens of millions of prescriptions had been written, a large U.S. government-funded randomized clinical trial found that such unapproved uses of the drugs significantly increased risks of developing coronary heart disease, stroke, pulmonary embolism, and invasive breast cancer, and that these risks exceeded the drugs' benefits in reducing the incidence of hip fracture and colorectal cancer. [7] A recent observational study in Canada likewise found that the majority of off-label uses lacked strong scientific support and that patients prescribed drugs for those uses had an increased risk of suffering adverse drug events compared with patients prescribed drugs for approved uses. [8] Because marketing drugs approved for one use for a different, unapproved use can pose considerable threats to public health, such marketing is prohibited by U.S. law. ...
... Reduction in cardiovascular disease, stroke, mental function have all been attributed to the presence of estrogen. Unfortunately, the Women's Health Initiative (WHI) study [1] and the Million Women Study (MWS) [2] showed an increase in breast cancer, cardiovascular disease, and venous thromboembolic events among postmenopausal estro-progestogen therapy (EPT) users. This was largely publicized in the media which resulted in a dramatic decrease in the use of estrogenic menopausal hormone therapy [3] . ...
Objective:
To review the endometrial safety and patient acceptability of long-term use of continuous transdermal estrogen substitution combined with intrauterine release of levonorgestrel (LNG) in postmenopausal women.
Design:
One-hundred and fifty-three women who utilized the regimen for 2 IUD cycles were followed-up for a period of 10 years. Histology of the endometrium was evaluated at the end of this period to assess endometrial safety and the acceptability of the method was assessed based on the replacement rate of the LNG-IUS and continuation of ET.
Results:
The regimen, administered over a 10-year period, was very well tolerated and the IUD was retained well and no expulsions occurred. The dominant endometrial histologic picture was that of inactive endometrium characterized by glandular atrophy and stroma decidualization (Kurman classification 5b). No cases of endometrial hyperplasia were found.
Conclusion:
The low systemic absorption of LNG could be desirable, thus allowing for maximization of the beneficial effects of ET on organ tissues (e.g. cardiovascular tissues and breast). Repeat LNG-IUS is associated with high patient satisfaction. If started before the age of 60, this regimen could be advised for lifelong prevention of cardiovascular disease and other prevention measures. The LNG-IUS was shown to effectively oppose the secondary effects of systemic estrogen on the endometrium tissue resulting in strong suppression during the entire period of EPT.
... As indicated by the Women's Health Initiative trial [34] and by the Million Women Study trial, [35] hormone replacement therapy in postmenopausal women using combined estrogen and progesterone increases the risk of breast cancer, but not with 'estrogen only' therapy. Postmenopausal hormone replacement therapy was practically unknown to both our populations. ...
Aims and Objective: Incidence of breast cancer is on the rise in developed as well as in developing countries. In India it has superseded cervical cancer as the commonest malignancy in women in urban areas. A lot of risk factors have been proposed from time to time that play a causative role in the natural course of this disease. However, they are based on data accumulated from studies conducted mostly in developed countries. Aim of this study was to find out whether these known and/or presumptive breast cancer risk factors hold true for women of developing countries like India also.
Materials and Methods: From 2008 to 2012; 1,463 breast cancer patients were compared side by side with 1,440 matched controls by predetermined questionnaire and anthropometric variables. Data were analyzed by Statistical Package for Social Sciences (SPSS) V19 software todetermine whether selected risk factors were more common in the patient group than the control group.
Results and Analysis: The risk factors under study were also found to be statistically significant for the study populationexcept duration of breastfeeding and family history of breast and ovarian cancers.
Conclusion: Risk factors for breast cancer do not differ significantly between developed and developing countries. Hence appropriate time has come for developing countries to incorporate breast cancer risk factors in health education and to consider pharmacological interventions in high risk women.
... Hormone therapy (HT), however, is associated with a number of risks such as thromboembolic events and breast cancer, and some troublesome side effects such as breast tenderness and irregular bleeding. [17][18][19][20][21] Many women seek alternatives such as other pharmaceutical agents, herbal or dietary remedies, or behavioral therapies. [22][23][24][25] Unfortunately, many of these agents also have side effects and/or have not been shown to be effective. ...
Objective:
The aim of the study was to evaluate the short and long-term effects of acupuncture on vasomotor symptoms (VMS) and quality of life-related measures.
Methods:
A total of 209 perimenopausal and postmenopausal women aged 45 to 60 years, experiencing four or more VMS per day, were recruited from the community and randomized to receive up to 20 acupuncture treatments within the first 6 months (acupuncture group) or the second 6 months (waitlist control group) of the 12-month study period. The primary outcome was mean daily frequency of VMS. Secondary outcomes were VMS interference with daily life, sleep quality, depressive symptoms, somatic and other symptoms, anxiety, and quality of life.
Results:
The VMS frequency declined by 36.7% at 6 months in the acupuncture group and increased by 6.0% in the control group (P < 0.001 for between-group comparison). At 12 months, the reduction from baseline in the acupuncture group was 29.4% (P < 0.001 for within-group comparison from baseline to 12 months), suggesting that the reduction was largely maintained after treatment. Statistically significant clinical improvement was observed after three acupuncture treatments, and maximal clinical effects occurred after a median of eight treatments. Persistent improvements were seen in many quality of life-related outcomes in the acupuncture group relative to the control group.
Conclusions:
We found that a course of acupuncture treatments was associated with significant reduction in VMS, and several quality-of-life measures, compared with no acupuncture, and that clinical benefit persisted for at least 6 months beyond the end of treatment.
... CHC was the most favoured hormonal option and recommended by one third of HCP (33.7%). Although CHC and menopause-type hormone therapies have traditionally been used for osteoporosis in perimenopausal and postmenopausal women [39,40], evidence in premenopausal women is lacking Both neutral and negative effects on BMD from premenopausal CHC use have been reported [41,42,23,24]. A systemic review in 2006 demonstrated only fair BMD evidence supporting CHC in premenopausal women with oligoamenorrhoea [43]. ...
... When initiated years after menopause, oral hormone therapy (eg, estrogens alone or in combination with a progestin), may increase ASCVD risk and may increase the risk of stroke among women without ASCVD. [172][173][174] Postmenopausal hormone therapy should not be administered specifically to reduce ASCVD risk. ...
The National Lipid Association (NLA) Annual Summary of Clinical Lipidology is a yearly updated summary of principles important to the patient-centered evaluation, management, and care of patients with dyslipidemia. This summary is intended to be a “living document,” with future annual updates based on emerging science, clinical considerations, and new NLA Position, Consensus, and Scientific Statements, thus providing an ongoing resource that applies the latest in medical science towards the clinical management of patients with dyslipidemia. Topics include the NLA Recommendations for Patient-Centered Management of Dyslipidemia, genetics, Familial Hypercholesterolemia, secondary causes of dyslipidemia, biomarkers and advanced lipid testing, nutrition, physical activity, obesity, adiposopathy, metabolic syndrome, diabetes mellitus, lipid pharmacotherapy, lipid-altering drug interactions, lipoprotein apheresis, dyslipidemia management and treatment based upon age (children, adolescents, and older individuals), dyslipidemia considerations based upon race, ethnicity and gender, dyslipidemia and human immune virus infection, dyslipidemia and immune disorders, adherence strategies and collaborative care, and lipid-altering drugs in development. Hyperlinks direct the reader to sentinel online tables, charts, and figures relevant to lipidology, access to online atherosclerotic cardiovascular disease risk calculators, worldwide lipid guidelines, recommendations, and position/scientific statements, as well as links to online audio files, websites, slide shows, applications, continuing medical education opportunities, and patient information.
... A terapia de reposição hormonal (TRH), realizada pela ingestão de hormônios sintéticos (estrógenos e progesterona) constitui-se o principal tratamento (Sociedade Brasileira de Climatério, 2003). O estrogênio exerce diversas ações benéficas sobre os parâmetros de risco cardiovascular, além de prevenir a osteoporose (AMB, 2001 (WHI, 2002). ...
In Brazil, the National Health and Sanitation Inspectorate (ANVISA) approves the use of isoflavones to treat hot flushes and as an adjuvant in serum cholesterol reducing treatments. Thus, the purpose of this study was to evaluate how isoflavones are prescribed, in terms of dose, dosing regimen and the indication criteria, comparing results with literature data. Fifty-nine physicians (gynecologists), attending in private surgeries in a medium-sized city in upstate São Paulo, were interviewed. The data were collected through standardized and pretested structured questionnaires with 10 specific questions about dosage, indications and therapeutic follow-up. Just 54.2% (n= 32) of the interviewees prescribed isoflavones and the data obtained from these 32 physicians showed that the theoretical references used for indication, dose and regimen are inadequate when compared to information available in published meta-analyses or consensus guidelines in the area. It should be emphasized that inappropriate use of such substances can predispose patients to faulty therapy, unregulated indication and unscientific medical practice. Physicians should always keep up-to-date, using sources that cite clinical evidence to justify an appropriate indication and dosing schedule.
... However, there is significant, mounting evidence of the risk of hormone therapy, outweighing the benefits. Hormone therapy was associated with a higher risk of breast cancer, stroke and venous thromboembolism and it may increase the risk of heart disease (7) . Therefore, there has been great interest in finding alternative, nonhormonal strategies for the management of menopausal symptoms. ...
Objective: To examine the efficacy of extended-release venlafaxine for the treatment of post-menopausal symptoms, especially the vasomotor symptoms. Methods: Twenty-eight postmenopausal women were recruited for Ulis observational study and received treatment with open-label extended-release venlafaxine, 75mg daily for 6 weeks. Menopausal symptoms were evaluated with Green Climacteric Scale (GCS) and for inclusion a GCS total score > 20 was required. Results: GCS mean scores declined for each subscale: Psychological Subscale mean score decreased over the 6 weeks of treatment from 14.4 to 8.9; Somatic subscale mean score decreased from 5.9 to 3.8; and Vasomotor Subscale mean score decreased from 5.3 to 31, a decrease with 41.5% from baseline. The most frequent adverse events were nausea and dry mouth. Conclusion: Extended-release venlafaxine, 75 mg per day, appears to be effective for treating postmenopausal symptoms and thus may be a possible alternative to hormonal therapy for postmenopausal women.
... 17 Hormoontherapie voor menopauzale vrouwen is niet alleen onnodig, maar zelfs schadelijk en leidt tot meer cardiovasculaire gebeurtenissen. 6,18 Recent is het effect van continue venoveneuze hemofiltratie om het ontstaan van contrastnefropathie als bijwerking van coronaire angiografie tegen te gaan, betwist en ziet men geen plaats meer voor routinematige toepassing ervan. 18 ...
... The trial was designed to assess whether the combination of HRT and low-dose tamoxifen retains the benefits while reducing the risks of either agent alone. Unfortunately, the recruitment was jeopardized by the results of the WHI HRT trial, which dramatically decreased the use of HRT in western countries [43]. Among a total of 1,884 participants randomized to either tamoxifen 5 mg or placebo, a trend toward a beneficial effect from low dose tamoxifen in reducing breast cancer events was observed ( [45]. ...
Pharmacologic interventions for cancer risk reduction involve the chronic administration of synthetic or natural agents to reduce or delay the occurrence of malignancy. Despite the strong evidence for a favorable risk-benefit ratio for a number of agents in several common malignancies such as breast and prostate cancer, the public's attitude toward cancer chemoprevention remains ambivalent, with the issue of toxicity associated with drugs being perceived as the main barrier to widespread use of preventive therapy by high-risk subjects. Among the strategies to overcome such obstacles to preventive therapies, two novel and potentially safer modes of administering agents are discussed in this paper. The first strategy is to lower the dose of drugs that are in common use in the adjuvant setting based on the notion that prevention of cancer cells from developing should require a lower dose than eradicating established tumor cells. A second approach is to adopt an intermittent administration similar to what is used in the chemotherapy setting in an attempt to minimize risks while retaining benefits. This article provides a detailed discussion of the principles and future development of these two approaches in the direction of a precision preventive medicine.
... The 5-year survival rate for BC patients is 89 %. The incidence rate for female breast cancer was rising until recently, due to common use of menopausal hormone therapy, but began to decline after publication of the landmark Women's Health Initiative study in 2002 [3]. Since about 2003, breast cancer incidence rates have been fairly stable [2]. ...
Colorectal and breast cancers are the second most common causes of cancer deaths in the US. Population cancer screening rates are suboptimal and many cancers are diagnosed at an advanced stage, which results in increased morbidity and mortality. Younger populations are more likely to be diagnosed at a later stage, and this age disparity is not well understood. We examine the associations between late-stage breast cancer (BC) and colorectal cancer (CRC) diagnoses and multilevel factors, focusing on individual state regulations of insurance and health practitioners, and interactions between such policies and age. We expect state-level regulations are significant predictors of the rates of late-stage diagnosis among younger adults.
We included adults of all ages, with BC or CRC diagnosed between 2004 -2009, obtained from a newly available cancer population database covering 98 % of all known new cancer cases. We included personal characteristics, linked with a set of county and state-level predictors based on residence. We applied multilevel models to robustly examine differences in risk of late-stage cancer diagnosis across age groups (defined as age 65+ or < 65), focusing specifically on the effects of state regulatory factors and their interactions with age.
Late stage BC diagnoses range from 24 %-36 %, while CRC diagnoses range from 54 %-60 % of newly diagnosed BC or CRC cases across states. After controlling statistically for many confounding factors at three levels, age < 65 is the largest person-level predictor for CRC, while black race is the largest predictor for BC. State regulations of health markets exhibit significant interactions with age groups.
The state regulatory climate is an important predictor of late-stage BC and CRC diagnoses, especially among people younger than Medicare eligible age (65). State regulations can enhance the climate of access for younger, less well-insured or uninsured persons who fall outside normative screening guidelines.
... Thirdly, it has been repeatedly demonstrated that estrogen and progesterone treatment in animal models, including rodents and monkeys, can promote mammary carcinogenesis and this is critically dependent on functional estrogen and progesterone receptors (ER and PR) [3][4][5]. Finally, there have been numerous epidemiological studies which have reported increases in breast cancer risk in women with increased exposure to endogenous and exogenous hormones [10,11]. Endogenous and exogenous hormones can promote tumour formation by driving cell proliferation, subsequently increasing the number of cell divisions as well as the opportunity for random genetic errors [2]. ...
Breast cancer is the most common malignancy that develops in women worldwide, its incidence continues to rise and it is responsible for the highest death rates. Breast cancer can be classified as sporadic or familial – the strongest risk factor today is a family history. Germline mutations in high-penetrance breast cancer susceptibility genes BRCA1 and BRCA2 have been strongly implicated in the genetic predisposition of approximately 20% of familial breast cancers. Although BRCA1 and BRCA2 do not account for all familial breast cancers, there are currently no other genes that have been identified which segregate with familial breast cancer as strongly. Despite large-scale attempts to identify genetic risk factors associated with breast cancer, the variants identified through genome-wide association studies (GWAS), only confer a modest increase in risk of breast cancer and at present lack clinical utility. This review will discuss the known genetic risk factors for developing breast cancer and how far the field has progressed since the identification of BRCA1.
... 7 Stališče do HNZ se je močno spremenilo leta 2002 po objavi prvih rezultatov predčasno prekinjene, velike, randomizirane, s placebom kontrolirane raziskave (RCT) Women's Health Initiative (WHI). 8 Od takrat dalje velja, da HNZ lahko uporabljamo le za blaženje menopavznih simptomov v najnižjem še učinkovitem odmerku, kar najkrajši možni čas, ne pa za preventivo kroničnih bolezni. 9 V skladu s tem smo zaostrili tudi naše smernice. ...
BACKGROUND
Osteoporosis affects almost every other woman after menopause. Fractures due to osteoporosis are a significant cause of disability and death, therefore we try to prevent themwith antiosteoporotic medications.Hormone replacement therapy (HRT) had been a mainstay of osteoporosis preventionand treatment for a long time, although only with the publication of the breakthroughWomen’s Health Initiative study in 2002 we got consistent data about beneficial effects ofHRT on bone mass and fracture prevention. Paradoxically, the same study provided alsodata on harmful cardiovascular effects of HRT and considerably limited its use in the field.However, more recent data showed that HRT is safe for younger women immediately aftermenopause, so it could be easily prescribed for vasomotor symptoms relief. At the sametime, HRT is beneficial for bones, as well. On the other hand, HRT is mainly not suitable forolder women and long-term treatment.
CONCLUSIONS
As older women are those who sustain the majority of osteoporotic fractures, HRT isleaving its main role in osteoporosis prevention and treatment to other drugs, first of all tobisphosphonates and strontium ranelate
... Therefore, we included inflammatory mechanisms into the program. Just prior to the Conference the data from an observational follow-up study on women recruited to HERS (HERS II) [5] and data from the first randomized study on primary prevention, the Women Health Initiative (WHI) [6] study were released. The estrogen Á/progestogen arm of the WHI study, with an originally planned study period of 8.5 years, was stopped prematurely after 5.2 years because the Data and Safety Monitoring Board considered that the risks, mainly breast cancer, but also CVD, outweighed the benefits. ...
... Epidemiological studies are essential for generating new hypothesis, and in many situations they will provide the best information. Considering primary prevention of CHD the strengths of the largest study conducted to date the Women's Health Initiative (WHI) study are obvious, but several shortcomings do exist such as only one oestrogen/progestin combination investigated, high mean age of the study population, co-medication for existing diseases (e.g hypertension and diabetes), high BMI, low compliance and no external validation on prevalence of index variables in similar age groups in the background population [1]. ...
Osteoporosis is a systemic skeletal disorder that affects bone microarchitecture resulting to fragility fractures. Randomized controlled trials have shown efficacy of antiresorptives and osteoanabolic agents in addressing concerns of osteoporosis especially in the older population. However, published guidance from several organizations started to focus as well on the perceived harms most especially of bisphosphonates considering their persistent effect on the bones. Similar to other chronic diseases, decision on whether or not to continue therapy depends on factors that might persistently provide signal on the individual’s further risk of unwanted but preventable outcomes.
A review:
1- Summarising recent findings on the implication of hypothalamic-pituitary dysregulation (GH/Gonads & INSL-3/Thyroid/Adrenals) in the pathogenesis of sarcopenia and frailty;
2- Looking at other endocrine factors such as sarcopenic obesity and its interaction with inflammation; metabolic dysfunction including insulin resistance; vitamin D status and nutrition.
3- Outlining current research priorities in this area.
Introduction and hypothesis
There is clear evidence of the presence of estradiol receptors (ERs) in the female lower urinary and genital tract. Furthermore, it is a fact that estrogen deficiency after menopause may cause atrophic changes of the urogenital tract as well as various urinary symptoms. Moreover, the effect of hormone replacement therapy (HRT) on urinary incontinence (UI) symptoms as well as pelvic organ prolapse (POP), anal incontinence (AI) and vulvovaginal symptoms (VVS) is still a matter of debate. This committee opinion paper summarizes the best evidence on influence of sex steroids as well as hormonal treatment (local and systemic) in postmenopausal women with pelvic floor disorders.
Methods
A working subcommittee from the International Urogynecology Association (IUGA) Research and Development Committee was formed. A thorough literature search was conducted and an opinion statement expressed. The literature regarding hormones and pelvic floor disorders was reviewed independently and summarized by the individual members of the sub-committee.
Results
The majority of studies reported that vaginal estrogen treatment when compared with placebo has more beneficial effects on symptoms and signs of vaginal atrophy including sensation of burning, dyspareunia and UI symptoms. Definitive evidence on local estrogen application and prolapse treatment or prevention is lacking. A statistically significant increase in risk of worsening of UI as well as development of de novo incontinence was observed with estrogen-only or combination systemic HRT.
Conclusions
In summary, local estrogen seems to be safe and effective in the treatment of VVS and can also improve urinary symptoms in postmenopausal patients with UI, but most of these recommendations correspond to evidence level 2C. The evidence in POP is still scarce but not in favor of benefit. Finally, the duration of local estrogen treatment (LET), optimal dosage, long-term effects and cost-effectiveness compared with current practice are still unknown.
Purpose of Review
Cardiovascular disease (CVD) is known to be an increasing cause of mortality among women, particularly postmenopausal women. Hormone replacement therapy (HRT) is a topic that has been investigated over the past decade for its known impact on the cardiovascular system. This review summarizes the evidence and current opinion on the associations between HRT and CVD, evidence both supporting and against HRT use as a prevention to the development of coronary heart disease (CHD).
Recent Findings
The majority of the new data available suggests the use of HRT has the potential to be more beneficial in the prevention of CVD if started in women at younger ages. Current studies also suggest that while starting HRT in older postmenopausal women may be associated with an initial slight increase in CVD, the overall lifetime occurrence rate is not increased. Several studies have also started to use the “timing hypothesis” to suggest that HRT initiated soon after menopause has the potential of being the greatest cardiovascular benefit to the patient. Overall, the data support the finding that HRT should be used only for symptomatic treatment, not in an attempt to slow progression of CVD.
Summary
Current evidence does not support the use of HRT for either primary or secondary prevention of CHD. HRT has different implications based on the temporal relationship in which it is initiated in relation to the onset of menopause. Overall, the use of HRT should be an individualized decision with each patient on the basis of the individual’s symptoms and overall risk profile.
Objective:
The objective of this study was to compare the performance of screening mammography versus magnetic resonance imaging (MRI) in hormone replacement therapy (HRT) users.
Methods:
We performed a retrospective review of 4628 women who had mammography or breast MRI screening from the beginning of HRT use at three institutions from April 2005 to December 2015. Information of demographics, number of biopsies performed and pathologic outcomes were collected. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of screening mammography and MRI were compared.
Results:
Totally 11,540 screening studies were collected, including 9580 mammography studies and 1960 MRI studies. Breast cancer was diagnosed in 26 patients. Of the 26 cancers, MRI detected 24 and mammography detected 15. For mammography, the sensitivity, specificity, PPV, and NPV were 57.7%, 99.1%, 14.6%, and 99.9%, respectively; for MRI, those values were 92%, 92.5%, 14.2%, and 99.9%, respectively. MRI screening was much more sensitive than mammography screening (p < 0.05, 92% vs 57.7%). There was no difference of specificity, PPV and NPV between two modalities.
Conclusions:
Our data showed that screening breast MRI may be a useful adjunct modality of mammography in HRT users.
Background
Some women with genetic risk of breast and/or ovarian cancer (e.g., BRCA1/2) opt to undergo prophylactic salpingo-oophorectomy (PSO, or surgical removal of the ovaries & fallopian tubes) in order to reduce their risk of cancer. As a consequence, these women experience “surgical menopause” – accompanied by more severe climacteric symptoms that occur in a much shorter time frame. While the risk of coronary artery disease (CAD) rises with menopause, little is known about how the sudden loss of ovarian function from PSO alters the whole-body physiology, and whether it predisposes women to premature CAD.
Methods/Design
To manage CAD risk there is a prerequisite for reliable biomarkers that can help guide risk assessment and therapeutic interventions. To address these needs, this prospective, observational cohort study will evaluate surrogate markers reflective of CAD health in women experiencing surgical menopause after PSO. Twenty women representing each of the following groups will be enrolled over 3 years (total participants = 240): (i) pre-menopausal PSO, (ii) post-menopausal PSO, (iii) pre-menopausal women undergoing other pelvic surgery, and (iv) pre-menopausal controls (no surgery). All participants will provide blood plasma samples pre- and 1, 3, 6, & 12 months post-operatively, with serial samples collectively assessed for measurements of the study’s primary endpoints of interest. These include a hormone profile (estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone) and both conventional (lipid profile) and novel biomarkers (Heat Shock Protein 27 (HSP27), HSP27-antibodies (HSP27 Ab), proprotein convertase subtilisin/kexin 9 (PCSK9), inflammatory cytokines) of CAD. Another aspect of this study is the measurement and analysis of retinal vessel diameters – an emerging physiological parameter reflective of CAD risk. Finally, a patient engagement exercise will result in the drafting of patient-generated questionnaires that address the well-being and health concerns of these women as they transition through premature menopause and work with our research team to identify and discuss their health priorities.
Discussion
The protocol of our planned study investigating the effects of PSO on CAD is described herein. Characterization of novel CAD markers in women experiencing surgical menopause will yield new insights into the role of the functional ovary in modulating lipid parameters and other CAD risk factors such as HSP27 and HSP27 Ab.
Purpose:
Transgender patients undergoing transitions often receive cross-sex hormonal therapies, placing them at uncertain risk for developing breast cancer. There is limited population-based information about the extent to which transgender patients undergo mammography screening. Our purpose was to determine the extent to which transgender patients undergo mammography screening using nationally representative survey data.
Methods:
Transgender participants between ages 40-74 in the 2014 Behavioral Risk Factor Surveillance System survey were included. Proportions undergoing mammography screening in the last year or two years were calculated stratified by age category and transition status [male to female(MtF), female to male(FtM), non-conforming]. For each transition status, predictors of mammography screening were calculated using logistic regression.
Results:
220 transgender patients were within 40-74 years old(35% were MtF, 51% were FtM, 14% were non-conforming). 60.0% underwent mammography screening within the last year (MtF-54.5%, FtM-64.3%, non-conforming-58.1%). 74.1% underwent screening within the last two years(MtF-70.1%, FtM-75.9%, non-conforming-77.4%). For all transgender patients, income category (OR 1.16, 0.82-1.64), higher education category (OR 1.09, 0.31-3.86) and health insurance (OR 0.38, 0.10-1.41) were not associated with increased adherence to mammography screening. Transgender patients were comparably likely to undergo mammography screening compared with non-transgender patients (Adjusted OR 0.97, 0.58-1.62).
Conclusions:
High proportions of transgender survey respondents undergo mammography screening (57.9-66.1% within the last year, 71.9-74.4% within the last two years) in our sample, proportions comparable to non-transgender survey respondents.
The aim of this study was to demonstrate the efficacy, safety and tolerability of - 1 mg estradiol + 2 mg drospirenone (ANGELIQ® ) - in menopause symptoms
A Terapia com Hormônios Sexuais Femininos tem como efeito colateral o surgimento de fenômenos tromboembólicos em suas usuárias, ao longo da história inúmeras medidas foram tomadas em busca de se minimizar esse malefício. Este trabalho foi dividido em dois grandes temas: Anticoncepcionais Hormonais Combinados Orais (AHCO) e Terapia de Reposição Hormonal (TRH). Os riscos reais que se tem ao se fazer uso de um AHCO é desconhecido pela população leiga, ao passo que esta mesma refere grande temor em relação a TRH, sendo que esta última já tem seus benefícios bem estabelecidos, bem como suas indicações. Exposto o contexto, este trabalho visa levantar estudos atuais que revelem quais os riscos reais aos quais a mulher é exposta quando se submete a essas terapias. Para a confecção deste trabalho, foi feito uma busca em revistas da área medica, assim como pesquisa em bases de dados. Terapia com hormônios sexuais femininos faz com que a mulher passe para um estado de hipercoagubilidade sanguínea, baixas dosagens hormonais conferem menor risco, AHCO de segunda geração são menos trombogênicos que os de terceira e quarta geração, por isso devem ser usados com mais parcimônia e a TRH tem benefícios bem estabelecidos e por isso deve ser mais difundida e prescrita.
The Female Sex Hormone therapy has, as side effects, the emergence of thromboembolic events in their users. Throughout history many steps have been taken aiming the minimization of this harm. This work was divided into two main themes: Combined Oral Contraceptive Pill (COCP) and Hormone Replacement Therapy (HRT). The real risks related to making use of a COCP is unknown by the lay population, whereas it concerns great fear about HRT, but this one has well-established benefits as well as indications. This paper aims to raise current studies showing the actual risks to which women are exposed when subjected to these therapies. For the preparation of this work, searches in medical journals of the area, as well as research in databases was done. Therapy with female sex hormones makes a woman go into a state of blood hypercoagulability, low hormone levels show lower risk, second generation COCP are less thrombogenic than third and fourth generation, so they should be used more sparingly used and HRT has well established benefits, therefore it should be more widespread and prescribed.
Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients’ fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature (‘organ’ and ‘gamete’). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.
Over the past few years, perceptible changes – both fundamental and specific – have taken place in pharmaceutical care for men. While the most striking difference persists, namely that between somatic drug therapies for men and drugs for the treatment of psychological disorders and diseases, the large discrepancies that long existed between the quantities prescribed for men and women have meanwhile not only evened out, but men are even prescribed larger quantities than women if they undergo drug therapy. An analysis of the drugs prescribed particularly for men revealed that they are primarily prescribed for the treatment of cardiovascular diseases (hypertension and cardiac insufficiency) and metabolic disorders (diabetes, gout), especially in elderly patients. The evaluation also showed that the drugs prescribed most frequently for younger men also included psychostimulants and antidepressants, such as SSRIs, for diagnoses of ADHD and depression.
Besides these prescribed medicaments, other drugs must also be taken into account that reflect men’s gender-specific everyday needs. These include drugs for treating erectile dysfunction, hair growth products or drugs for male menopause or to build muscle. The sometimes serious undesired effects of these products are often given small attention because of the desired benefit of supporting the perceived male role. While hormones are widely used in anabolic steroids, the use of hormones in contraceptive pills for men is evidently still far away from the aforementioned trends in pharmaceutical care for men.
Objective: To assess the effects of 2 months of treatment with Femarelle for climacteric syndrome in Taiwanese postmenopausal women.
Materials and methods: A multi-center, open-label trial of 260 postmenopausal women, age ≥ 45 years with vasomotor symptoms. Women were enrolled after obtaining a detailed medical history and a thorough physical examination. They then received Femarelle (640 mg/d) twice daily for 8 weeks. The primary outcome was the changes in the frequency and severity of hot flushes from baseline to 4 weeks (1 month) and 8 weeks (2 months). Changes of general climacteric syndrome were assessed using a modified climacteric scale designed by Greene.
Results: The frequency and severity of hot flushes were significantly improved with Femarelle use (p
This investigation examines perceptions of normality emerging from two distinct studies of information behavior associated with life disrupting health symptoms and theorizes the search for normality in the context of sense making theory. Study I explored the experiences of women striving to make sense of symptoms associated with menopause; Study II examined posts from two online discussion groups for people with symptoms of obsessive compulsive disorder. Joint data analysis demonstrates that normality was initially perceived as the absence of illness. A breakdown in perceived normality because of disruptive symptoms created gaps and discontinuities in understanding. As participants interacted with information about the experiences of health-challenged peers, socially constructed notions of normality emerged. This was internalized as a “new normal.” Findings demonstrate normality as an element of sense making that changes and develops over time, and experiential information and social contexts as central to health-related sense making. Re-establishing perceptions of normality, as experienced by health-challenged peers, was an important element of sense making. This investigation provides nuanced insight into notions of normality, extends understanding of social processes involved in sense making, and represents the first theorizing of and model development for normality within the information science and sense making literature. (published online June 06, 2016)
ECKO Extension Protocol 2005—Protocol for the Trial Extension
(119 KB PDF)
Purpose of the study:
A comparison of longitudinal global cognitive functioning in women Veteran and non-Veteran participants in the Women's Health Initiative (WHI).
Design and methods:
We studied 7,330 women aged 65-79 at baseline who participated in the WHI Hormone Therapy Trial and its ancillary Memory Study (WHIMS). Global cognitive functioning (Modified Mini-Mental State Examination [3MSE]) in Veterans (n = 279) and non-Veterans (n = 7,051) was compared at baseline and annually for 8 years using generalized linear modeling methods.
Results:
Compared with non-Veterans, Veteran women were older, more likely to be Caucasian, unmarried, and had higher rates of educational and occupational attainment. Results of unadjusted baseline analyses suggest 3MSE scores were similar between groups. Longitudinal analyses, adjusted for age, education, ethnicity, and WHI trial assignment revealed differences in the rate of cognitive decline between groups over time, such that scores decreased more in Veterans relative to non-Veterans. This relative difference was more pronounced among Veterans who were older, had higher educational/occupational attainment and greater baseline prevalence of cardiovascular risk factors (e.g., smoking) and cardiovascular disease (e.g., angina, stroke).
Implications:
Veteran status was associated with higher prevalence of protective factors that may have helped initially preserve cognitive functioning. However, findings ultimately revealed more pronounced cognitive decline among Veteran relative to non-Veteran participants, likely suggesting the presence of risks that may impact neuropathology and the effects of which were initially masked by Veterans' greater cognitive reserve.
Many commonly prescribed medications, such as selective serotonin reuptake inhibitors, proton pump inhibitors, thiazolidinediones, aromatase inhibitors, and androgen deprivation therapy, have been associated with adverse skeletal effects. The levels of evidence in support of a causal relationship between drug use and the development of bone loss and fractures are variable. For some drugs, a causal relationship is suspected (but not proven) based on observational studies, while in others causality is firmly established with randomized, controlled clinical trials. The mechanism of action for skeletal damage is poorly understood for some drugs and well known for others. Guidelines for managing bone health in patients taking some medications with potential skeletal toxicity have been developed using the best available evidence and expert opinion. This is a review of selected medications that have been associated with bone loss and fractures, with recommendations for clinical care.
Managing the symptoms of menopause after a diagnosis of breast cancer offers some unique clinical challenges. For some women, vasomotor symptoms can be severe and debilitating and hormone therapy is at least relatively contraindicated. Non-oestrogen therapies for hot flushes include SSRIs, clonidine, gabapentin and perhaps black cohosh extracts. Vulvovaginal atrophy can usually be alleviated by simple moisturizers, although some may need specialized physiotherapy such as vaginal dilators. In a small number, topical oestrogens may be the only treatment that works. The CO2 laser may be a novel, non-oestrogen therapy to alleviate this unpleasant symptom. Bone loss can be accelerated in some patients on AIs or those who had early menopause induced by chemotherapy.
ResearchGate has not been able to resolve any references for this publication.