1
|
Laing A, Hillard T. Oestrogen-based therapies for menopausal symptoms. Best Pract Res Clin Endocrinol Metab 2024; 38:101789. [PMID: 37453831 DOI: 10.1016/j.beem.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE To summarise the dosing options, regimens, pharmacokinetics, risks and benefits of oestrogen-based therapies for the treatment of menopausal symptoms. METHODS A review of the literature was undertaken using multiple databases. Randomised trials, observational studies, meta-analyses and review papers were included. RESULTS Multiple systemic preparations of oestrogen exist and all appear comparable in terms of efficacy. They differ by pharmacokinetics and those preparations that avoid hepatic metabolism have a lower risk profile in general although their use can be limited by skin barriers or patient acceptability. All vaginal oestrogen treatments are comparable in efficacy and have not been associated with any health risks. Side-effects between all preparations differ. CONCLUSIONS With regards to oestrogen treatments there is not a one size fits all. Multiple treatments are available and a clinician's role is to guide and help women make evidence based, unbiased and informed choices.
Collapse
Affiliation(s)
- Abbie Laing
- Poole Menopause Centre, University Hospitals Dorset, Poole UK.
| | - Tim Hillard
- Poole Menopause Centre, University Hospitals Dorset, Poole UK.
| |
Collapse
|
2
|
Gupta D, Prabhakar B, Wairkar S. Non-oral routes, novel formulations and devices of contraceptives: An update. J Control Release 2022; 345:798-810. [PMID: 35378212 DOI: 10.1016/j.jconrel.2022.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Family planning enables society to prevent unintended pregnancies and helps in attaining desired spacing between the pregnancies. It is done with the use of contraceptive methods and infertility treatments. The use of contraceptives serves to ease maternal ill-health and reduce pregnancy-related deaths and helps to decrease the number of unsafe abortions and HIV transmission from mothers to newborns. The most popular contraception method is a daily dose of combined oral contraceptives pills. However, poor compliance and various adverse effects are common problems of oral contraceptives that considerably reduce their long-term use. Thus, several non-oral contraceptive options have been developed for better compliance, reduced side effects and improved therapeutic efficacy. This review presented the non-oral contraceptive formulations given by different routes such as transdermal, nasal, subcutaneous, intramuscular, intrauterine and vaginal routes. These formulations delivering contraceptives, mainly through devices, include transdermal patches and microneedles, nasal sprays, intrauterine devices and intrauterine systems, vaginal rings, contraceptive implants and contraceptive injections, which are unique in their specific advantages and drawbacks.
Collapse
Affiliation(s)
- Deepak Gupta
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India.
| |
Collapse
|
3
|
Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
Collapse
Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| |
Collapse
|
4
|
Özen İ, Wang X. Biomedicine: electrospun nanofibrous hormonal therapies through skin/tissue—a review. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1985493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- İlhan Özen
- Textile Engineering Department, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Xungai Wang
- Institute for Frontier Materials, Deakin University, Geelong, Australia
| |
Collapse
|
5
|
Prakapenka AV, Quihuis AM, Carson CG, Patel S, Bimonte-Nelson HA, Sirianni RW. Poly(lactic-co-glycolic Acid) Nanoparticle Encapsulated 17β-Estradiol Improves Spatial Memory and Increases Uterine Stimulation in Middle-Aged Ovariectomized Rats. Front Behav Neurosci 2021; 14:597690. [PMID: 33424559 PMCID: PMC7793758 DOI: 10.3389/fnbeh.2020.597690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022] Open
Abstract
Hormone therapy that contains 17β-estradiol (E2) is used commonly for treatment of symptoms associated with menopause. E2 treatment has been shown to improve cognitive function following the decrease in ovarian hormones that is characteristic of menopause. However, once in circulation, the majority of E2 is bound to serum hormone binding globulin or albumin, becoming biologically inactive. Thus, therapeutic efficacy of E2 stands to benefit from increased bioavailability via sustained release of the hormone. Here, we focus on the encapsulation of E2 within polymeric nanoparticles composed of poly(lactic-co-glycolic) acid (PLGA). PLGA agent encapsulation offers several delivery advantages, including improved bioavailability and sustained biological activity of encapsulated agents. We hypothesized that delivery of E2 from PLGA nanoparticles would enhance the beneficial cognitive effects of E2 relative to free E2 or non-hormone loaded nanoparticle controls in a rat model of menopause. To test this hypothesis, spatial learning and memory were assessed in middle-aged ovariectomized rats receiving weekly subcutaneous treatment of either oil-control, free (oil-solubilized) E2, blank (non-hormone loaded) PLGA, or E2-loaded PLGA. Unexpectedly, learning and memory differed significantly between the two vehicle control groups. E2-loaded PLGA nanoparticles improved learning and memory relative to its control, while learning and memory were not different between free E2 and its vehicle control. These results suggest that delivery of E2 from PLGA nanoparticles offered cognitive benefit. However, when evaluating peripheral burden, E2-loaded PLGA was found to increase uterine stimulation compared to free E2, which is an undesired outcome, as estrogen exposure increases uterine cancer risk. In sum, a weekly E2 treatment regimen of E2 from PLGA nanoparticles increased cognitive efficacy and was accompanied with an adverse impact on the periphery, effects that may be due to the improved agent bioavailability and sustained biological activity offered by PLGA nanoparticle encapsulation. These findings underscore the risk of non-specific enhancement of E2 delivery and provide a basic framework for the study and development of E2's efficacy as a cognitive therapeutic with the aid of customizable polymeric nano-carriers.
Collapse
Affiliation(s)
- Alesia V Prakapenka
- Department of Psychology, Arizona State University, Tempe, AZ, United States.,School of Life Sciences, Arizona State University, Tempe, AZ, United States.,Arizona Alzheimer's Consortium, Phoenix, AZ, United States
| | - Alicia M Quihuis
- Department of Psychology, Arizona State University, Tempe, AZ, United States.,Arizona Alzheimer's Consortium, Phoenix, AZ, United States
| | - Catherine G Carson
- Department of Psychology, Arizona State University, Tempe, AZ, United States.,Arizona Alzheimer's Consortium, Phoenix, AZ, United States
| | - Shruti Patel
- Department of Psychology, Arizona State University, Tempe, AZ, United States.,Arizona Alzheimer's Consortium, Phoenix, AZ, United States
| | - Heather A Bimonte-Nelson
- Department of Psychology, Arizona State University, Tempe, AZ, United States.,Arizona Alzheimer's Consortium, Phoenix, AZ, United States
| | - Rachael W Sirianni
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
6
|
Parhi R, Swain S. Transdermal Evaporation Drug Delivery System: Concept to Commercial Products. Adv Pharm Bull 2018; 8:535-550. [PMID: 30607327 PMCID: PMC6311647 DOI: 10.15171/apb.2018.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/27/2018] [Accepted: 10/14/2018] [Indexed: 02/02/2023] Open
Abstract
Since two decades or so transdermal route established itself as better alternative to traditional oral route. This is possible due to continuous innovations in transdermal drug delivery (TDD), which not only enables researchers from academia and industry to successfully develop and launch many new pharmaceuticals but also allow to include new classes of drugs that can be developed into transdermal formulations. These successes are achieved due to the use of novel techniques based on either physical or chemical approaches. However, both of these techniques suffer due to their own disadvantages. Comparatively, a simple method of supersaturation to enhance drug permeation across skin has created a new wave of interest. Even though the application supersaturated principle in topical and TDD has been used from 1960s, but proper control of drug release and formation of stable supersaturated states has been the core of intense research in the last decade. Out of various methods used to get supersaturated system, evaporation method is considered as most efficient and practically feasible for TDD. Therefore, in this review concept of supersaturation, selection of solvent system and the mechanism of inhibition of crystallization are discussed. Application of evaporation systems in the development of transdermal formulations such as solutions, semisolids and metered dose therapeutic systems (MDTS) and the commercial evaporative systems are also discussed in this review.
Collapse
Affiliation(s)
- Rabinarayan Parhi
- GITAM Institute of Pharmacy, GITAM (Deemed to be University), Gandhi Nagar Campus, Rushikonda, Visakhapatnam-530045, Andhra Pradesh, India
| | - Suryakanta Swain
- Southern Institute of Medical Sciences, College of Pharmacy, Department of Pharmaceutics, SIMS Group of Institutions, Mangaldas Nagar, Vijyawada Road, Guntur-522 001, Andhra Pradesh, India
| |
Collapse
|
7
|
Beck KL, Anderson MC, Kirk JK. Transdermal estrogens in the changing landscape of hormone replacement therapy. Postgrad Med 2017; 129:632-636. [DOI: 10.1080/00325481.2017.1334507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Keli L. Beck
- Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, U.S.A
| | - Michelle C. Anderson
- College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, U.S.A
| | - Julienne K. Kirk
- Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, U.S.A
| |
Collapse
|
8
|
Zhang C, Li H, Xiong X, Zhai S, Wei Y, Zhang S, Zhang Y, Xu L, Liu L. An open-label, two-period comparative study on pharmacokinetics and safety of a combined ethinylestradiol/gestodene transdermal contraceptive patch. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:725-731. [PMID: 28331292 PMCID: PMC5354542 DOI: 10.2147/dddt.s131123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We investigated the pharmacokinetics and safety profiles of a newly developed combined ethinylestradiol (EE)/gestodene (GSD) transdermal contraceptive patch after a single-dose administration and compared with the market available tablet formulation in healthy adult subjects. An open-label, two-period comparative study was conducted in 12 healthy women volunteers. A single dose of the study combined EE/GE transdermal contraceptive patch and oral tablet (Milunet®) were administered. Blood samples at different time points after dose were collected, and concentrations were analyzed. A reliable, highly sensitive and accurate high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC/MS/MS) assay method was developed in this study to determine the plasma concentrations of EE and GSD. Compared to the tablet, the study patch had a significantly decreased maximum plasma concentration (Cmax), extended time to reach the Cmax and half-life, as well as increased clearance and apparent volume of distribution. The half-lives of EE and GSD of the patch were 3.3 and 2.2 times, respectively, than the half-life of the tablet. The areas under the plasma concentration–time curve (AUCs) of EE and GSD of the patch were 8.0 and 16.2 times, respectively, than the AUC of the tablet. No severe adverse event was observed during the whole study, and the general safety was acceptable. In conclusion, compared to the oral tablet Milunet, the study contraceptive patch was well tolerated and showed potent drug exposure, significant extended half-life and stable drug concentrations.
Collapse
Affiliation(s)
| | - Haiyan Li
- Institute of Clinical Trial, Peking University Third Hospital, Beijing, People's Republic of China
| | | | | | - Yudong Wei
- Institute of Clinical Trial, Peking University Third Hospital, Beijing, People's Republic of China
| | - Shuang Zhang
- Institute of Clinical Trial, Peking University Third Hospital, Beijing, People's Republic of China
| | | | - Lin Xu
- Institute of Clinical Trial, Peking University Third Hospital, Beijing, People's Republic of China
| | | |
Collapse
|
9
|
Nelson AL. Transdermal contraception methods: today’s patches and new options on the horizon. Expert Opin Pharmacother 2015; 16:863-73. [DOI: 10.1517/14656566.2015.1022531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Corbelli J, Shaikh N, Wessel C, Hess R. Low-dose transdermal estradiol for vasomotor symptoms. Menopause 2015; 22:114-21. [DOI: 10.1097/gme.0000000000000258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
11
|
Kellner T, Ehmann HMA, Schrank S, Kunert B, Zimmer A, Roblegg E, Werzer O. Crystallographic textures and morphologies of solution cast Ibuprofen composite films at solid surfaces. Mol Pharm 2014; 11:4084-91. [PMID: 25275801 PMCID: PMC4223873 DOI: 10.1021/mp500264e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
![]()
The preparation of thin composite
layers has promising advantages
in a variety of applications like transdermal, buccal, or sublingual
patches. Within this model study the impact of the matrix material
on the film forming properties of ibuprofen–matrix composite
films is investigated. As matrix materials polystyrene, methyl cellulose,
or hydroxyl-ethyl cellulose were used. The film properties were either
varied by the preparation route, i.e., spin coating or drop casting,
or via changes in the relative ratio of the ibuprofen and the matrix
material. The resulting films were investigated via X-ray diffraction
and atomic force microscope experiments. The results show that preferred
(100) textures can be induced via spin coating with respect to the
glass surface, while the drop casting results in a powder-like behavior.
The morphologies of the films are strongly impacted by the ibuprofen
amount rather than the preparation method. A comparison of the various
matrix materials in terms of their impact on the dissolution properties
show a two times faster zero order release from methyl cellulose matrix
compared to a polystyrene matrix. The slowest rate was observed within
the hydroxyl ethyl cellulose as the active pharmaceutical ingredients
(APIs) release is limited by diffusion through a swollen matrix. The
investigation reveals that the ibuprofen crystallization and film
formation is only little effected by the selected matrix material
than that compared to the dissolution. A similar experimental approach
using other matrix materials may therefore allow to find an optimized
composite layer useful for a defined application.
Collapse
Affiliation(s)
- Thomas Kellner
- Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology, Karl-Franzens University Graz , 8010 Graz, Austria
| | | | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Morton TL, Gattermeir DJ, Petersen CA, Day WW, Schumacher RJ. Steady-State Pharmacokinetics Following Application of a Novel Transdermal Estradiol Spray in Healthy Postmenopausal Women. J Clin Pharmacol 2013; 49:1037-46. [DOI: 10.1177/0091270009339187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
14
|
Abstract
Context: The female athlete triad (the triad) is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density; it is relatively common among young women participating in sports. Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team. Evidence Acquisition: Articles from 1981 to present found on PubMed were selected for review of major components of the female athlete triad as well as strategies for diagnosis and treatment of the conditions. Results: The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. While no specific drug intervention has been shown to consistently improve bone mineral density in this patient population, maximizing energy availability and optimizing vitamin D and calcium intake are recommended. Conclusions: Treatment requires a multidisciplinary approach involving health care professionals as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.
Collapse
Affiliation(s)
| | - Kathryn E. Ackerman
- Division of Sports Medicine, Children’s Hospital Boston and Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Address correspondence to Kathryn E. Ackerman, MD MPH Division of Sports Medicine Children’s Hospital Boston 319 Longwood Avenue, Boston, MA 02115 (e-mail: )
| |
Collapse
|
15
|
Carroll N. A review of transdermal nonpatch estrogen therapy for the management of menopausal symptoms. J Womens Health (Larchmt) 2012; 19:47-55. [PMID: 20088658 DOI: 10.1089/jwh.2008.1206] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During the transition into menopause, women may experience a wide range of symptoms that negatively impact quality of life. The vasomotor symptoms (VMS) of hot flushes and night sweats are common and vary widely in frequency and severity. The treatment of menopause-associated VMS is a frequently encountered clinical challenge, with the goal of tailoring treatment for each individual woman's needs. Estrogen therapy is the most effective treatment for menopausal VMS. Current guidelines suggest that estrogen therapy be prescribed at the lowest effective dose for the shortest duration of time. Transdermal estrogen therapy has dominated the menopause prescribing practice in Europe for decades; however, in the United States, oral estrogen therapy is most commonly prescribed. Transdermal estrogen therapy can be prescribed at considerably lower doses than oral therapy yet has similar efficacy on the symptoms of menopause. Emerging research demonstrates transdermal estrogen, particularly 17beta-estradiol, may have the potential for fewer health risks than oral estrogen therapy. This review article discusses the spectrum of menopausal symptoms, addresses prevailing issues in the treatment of menopause, elaborates on the risks and benefits of oral and transdermal hormone therapies, and focuses on five nonpatch transdermal estradiol therapies currently available in the United States.
Collapse
|
16
|
Choi DS, Lee DY, Yoon BK. Effects of Transdermal Estrogen Gel in Postmenopausal Korean Women. ACTA ACUST UNITED AC 2012. [DOI: 10.6118/jksm.2012.18.2.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dong-Seok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Koo Yoon
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Development and evaluation of matrix type transdermal patch of ethinylestradiol and medroxyprogesterone acetate for anti-implantation activity in female Wistar rats. Contraception 2011; 84:533-8. [DOI: 10.1016/j.contraception.2011.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 03/06/2011] [Accepted: 03/08/2011] [Indexed: 11/22/2022]
|
18
|
Bahamondes L, Bahamondes MV, Fernandes AMDS, Monteiro I. Emerging female contraceptives. Expert Opin Emerg Drugs 2011; 16:373-87. [DOI: 10.1517/14728214.2011.536761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
19
|
Sabban EL, Maharjan S, Nostramo R, Serova LI. Divergent effects of estradiol on gene expression of catecholamine biosynthetic enzymes. Physiol Behav 2009; 99:163-8. [PMID: 19638280 DOI: 10.1016/j.physbeh.2009.07.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 07/10/2009] [Accepted: 07/13/2009] [Indexed: 12/15/2022]
Abstract
Within the catecholaminergic systems, there are contradictory findings regarding ability of estradiol to regulate expression of genes related to catecholamine biosynthesis. Several parameters important for effects of estradiol on the catecholamine (CA) related enzyme gene expression were examined in two CA regions. Ovariectomized (OVX) female rats were given prolonged estradiol treatments, either in a pulsatile fashion by injections or continuously by pellets. The mode affected the response of tyrosine hydroxylase (TH) and GTP cyclohydrolase I (GTPCH) mRNAs differentially in the nucleus of solitary tract (NTS) and the locus coeruleus (LC). In rostral-medial NTS, TH mRNA levels were increased with injections, but declined in rats administered estradiol by pellets. In LC, a significant change was only observed in GTPCH with injections. These differences may reflect activation of different estrogen receptors (ER). The response to estradiol in the presence of ERalpha and ER beta was examined in PC12 cell culture. Estradiol directly regulated promoter activity of TH, GTPCH and dopamine beta-hydroxylase (DBH) genes. With ERalpha, 17 beta-estradiol elevated TH promoter activity, while there was a decline with ERbeta. In contrast, both DBH and GTPCH promoters were enhanced by 17 beta-estradiol over a wide range of concentrations with either ER subtype. Thus, mode of administration, location examined and ER subtype expressed are important considerations in the overall response of catecholamine related enzymes to estradiol.
Collapse
Affiliation(s)
- Esther L Sabban
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York 10595, USA.
| | | | | | | |
Collapse
|
20
|
Sitruk-Ware R. New hormonal therapies and regimens in the postmenopause: routes of administration and timing of initiation. Climacteric 2009; 10:358-70. [PMID: 17852138 DOI: 10.1080/13697130701609121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Since the publication of the Women's Health Initiative (WHI) study followed by the results of the Million Women Study (MWS), the role of hormonal therapy in postmenopausal women has been further challenged. The risks attributed to hormone therapy have been overestimated and the data has been wrongly extrapolated to the whole class of therapies. The trends in postmenopausal hormonal therapy seem now to favor the non-oral delivery routes for both the estrogen and the progestin for women with an intact uterus, based on the assumption that a lesser stimulation of the liver proteins and a neutral metabolic profile would be more favorable in terms of cardiovascular and venous risk. The combination of non-oral administration of estradiol and local delivery of progesterone or a progestin such as levonorgestrel by means of gels, sprays, vaginal rings or intrauterine systems would represent new methods of replacement therapy for the menopausal woman, improving compliance and minimizing the risks of hormone replacement. Several of these systems are either available or in development. Long-term studies on the risk/benefit of various non-oral formulations are certainly warranted.
Collapse
Affiliation(s)
- R Sitruk-Ware
- Center for Biomedical Research, Population Council and Rockefeller University, New York, NY 10021, USA
| |
Collapse
|
21
|
Kopper NW, Gudeman J, Thompson DJ. Transdermal hormone therapy in postmenopausal women: a review of metabolic effects and drug delivery technologies. DRUG DESIGN DEVELOPMENT AND THERAPY 2009; 2:193-202. [PMID: 19920906 PMCID: PMC2761184 DOI: 10.2147/dddt.s4146] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vasomotor symptoms (VMS) associated with menopause can cause significant discomfort and decrease the quality of life for women in the peri-menopausal and post-menopausal stages of life. Hormone therapy (HT) is the mainstay of treatment for menopausal symptoms and is currently the only therapy proven effective for VMS. Numerous HT options are available to treat VMS, including estrogen-only and estrogen-progestogen combination products to meet the needs of both hysterectomized and nonhysterectomized women. In addition to selecting an appropriate estrogen or estrogen-progestogen combination, consideration should be given to the route of administration to best suit the needs of the patient. Delivery systems for hormone therapy include oral tablets, transdermal patches, transdermal topical (nonpatch) products, and intravaginal preparations. Oral is currently the most commonly utilized route of administration in the United States. However, evidence suggests that oral delivery may lead to some undesirable physiologic effects caused by significant gut and hepatic metabolism. Transdermal drug delivery may mitigate some of these effects by avoiding gut and hepatic first-pass metabolism. Advantages of transdermal delivery include the ability to administer unmetabolized estradiol directly to the blood stream, administration of lower doses compared to oral products, and minimal stimulation of hepatic protein production. Several estradiol transdermal delivery technologies are available, including various types of patches, topical gels, and a transdermal spray.
Collapse
Affiliation(s)
- Nathan W Kopper
- KV Pharmaceutical, 2503 South Hanley Road, St. Louis, MO 63144, USA.
| | | | | |
Collapse
|
22
|
Abstract
The term disorders of sex development (DSD) includes congenital conditions in which development of chromosomal, gonadal or anatomical sex is atypical. Mutations in genes present in X, Y or autosomal chromosomes can cause abnormalities of testis determination or disorders of sex differentiation leading to 46,XY DSD. Detailed clinical phenotypes allow the identification of new factors that can alter the expression or function of mutated proteins helping to understand new undisclosed biochemical pathways. In this review we present an update on 46,XY DSD aetiology, diagnosis and treatment based on extensive review of the literature and our three decades of experience with these patients.
Collapse
MESH Headings
- Chromosomes, Human, X/genetics
- Chromosomes, Human, Y/genetics
- Disorders of Sex Development/diagnosis
- Disorders of Sex Development/genetics
- Disorders of Sex Development/therapy
- Female
- Gonadal Dysgenesis, 46,XY/diagnosis
- Gonadal Dysgenesis, 46,XY/genetics
- Gonadal Dysgenesis, 46,XY/therapy
- Humans
- Male
- Mutation/genetics
- Testis/abnormalities
- Testosterone/metabolism
Collapse
Affiliation(s)
- Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular, LIM 42, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.
| | | | | | | |
Collapse
|
23
|
|
24
|
Transdermal estradiol gel 0.1% for the treatment of vasomotor symptoms in postmenopausal women. Menopause 2009; 16:132-40. [DOI: 10.1097/gme.0b013e31817d5372] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Abstract
The clinical aftermath of the reporting of the initial findings of the Women's Health Initiative (WHI) in 2002 was a profound reduction in the use of hormone therapies by menopausal women. This reduction led to a well documented increase in vasomotor symptoms and vaginal atrophy among those women who discontinued their hormone regimens. However, another adverse impact among these women, as well as many other menopausal women, is the well recognized increased likelihood of osteoporosis resulting from the decline in circulating estradiol levels associated with natural and surgical menopause. Although the use ofnon-hormonal drugs such as bisphosphonates has been shown to reduce the risk of fracture in women with osteoporosis, bisphosphonates have not been shown to reduce the risk of fracture in non-osteoporotic women. Indeed, only oral estrogen (as demonstrated in the WHI studies) has been shown to reduce the risk of fracture in osteoporotic and non-osteoporotic women. As non-oral hormone therapies have been shown to be as effective in treating vasomotor symptoms and vulvovaginal atrophy and to have a different (and perhaps more beneficial) physiological effect than oral regimens, it behooves us to assess the impact of non-oral hormone regimens on bone mineral density and fracture risk. Although there are no clinical trials that primarily assess the impact of non-oral regimens on fracture risk in menopausal women, numerous studies are consistent in demonstrating the positive impact of non-oral regimens in maintaining and increasing bone mineral density among users, even for those women using estrogen doses that are considered to be "too low" to have a beneficial impact on other menopausal symptoms.
Collapse
Affiliation(s)
- Lee P Shulman
- Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.
| |
Collapse
|
26
|
Low-Dose Transdermal Estrogens. Obstet Gynecol 2008. [DOI: 10.1097/01.aog.0000299138.89893.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Hung CF, Lin YK, Huang ZR, Fang JY. Delivery of Resveratrol, a Red Wine Polyphenol, from Solutions and Hydrogels via the Skin. Biol Pharm Bull 2008; 31:955-62. [DOI: 10.1248/bpb.31.955] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Yin-Ku Lin
- Graduate Institute of Clinical Medical Sciences, Chang Gung University
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital
| | - Zih-Rou Huang
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University
| | - Jia-You Fang
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University
| |
Collapse
|
28
|
An initial pharmacokinetic study with a Metered Dose Transdermal System® for delivery of the progestogen Nestorone® as a possible future contraceptive. Contraception 2007; 76:432-8. [DOI: 10.1016/j.contraception.2007.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 08/09/2007] [Accepted: 08/15/2007] [Indexed: 11/19/2022]
|
29
|
Simon JA, Snabes MC. Menopausal hormone therapy for vasomotor symptoms: balancing the risks and benefits with ultra-low doses of estrogen. Expert Opin Investig Drugs 2007; 16:2005-20. [DOI: 10.1517/13543784.16.12.2005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
30
|
Burkman RT. Transdermal hormonal contraception: benefits and risks. Am J Obstet Gynecol 2007; 197:134.e1-6. [PMID: 17689623 DOI: 10.1016/j.ajog.2007.04.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 03/10/2007] [Accepted: 04/18/2007] [Indexed: 11/23/2022]
Abstract
Transdermal drug delivery systems have been available in the United States for >20 years. Since the introduction of the first transdermal patch (scopolamine) for the treatment of motion sickness, >35 transdermal patch products have been approved by the US Food and Drug Administration for a variety of indications that include hormone replacement therapy, nicotine replacement therapy, chronic pain (fentanyl), angina (nitroglycerin), hypertension (clonidine), and more recently, overactive bladder (oxybutynin), and contraception (ethinyl estradiol/norelgestromin). Clinical data demonstrated the efficacy and safety of the contraceptive patch; however, concerns regarding estrogen levels and reports of venous thromboembolism led to the development of 2 epidemiologic studies and, subsequently, revised product labeling. Despite this, the contraceptive patch may be an appropriate option for some patients.
Collapse
Affiliation(s)
- Ronald T Burkman
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA 01199, USA.
| |
Collapse
|
31
|
Schwarz S, Völzke H, Baumeister SE, Hampe J, Dören M. Menopausal hormone therapy and gallbladder disease: the Study of Health in Pomerania (SHIP). Clin Endocrinol (Oxf) 2007; 67:51-9. [PMID: 17437513 DOI: 10.1111/j.1365-2265.2007.02834.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies suggest that oral menopausal hormone therapy (MHT) is associated with an increased risk of gallbladder disease. It has been hypothesized that nonoral MHT may reduce the risk of cholelithiasis. The objective of the present study was to analyse the association between (1) use of life-time MHT (ever use) and gallbladder disease and (2) nonoral use of MHT and gallbladder disease. DESIGN Cross-sectional study using population-based data from the Study of Health in Pomerania (SHIP). POPULATION The study population included 994 postmenopausal women, aged 40-79 years. The subgroup of current oral and nonoral MHT users comprised 139 women. METHODS AND MEASUREMENTS Sociodemographic, medical and reproductive characteristics were based on computer-assisted personal interviews, and selected laboratory parameters were analysed. Gallbladder disease was defined by either a prior history of cholecystectomy or the presence of current sonographically diagnosed gallstones. Data analyses consisted of descriptive, bivariable and multivariable procedures. We performed Poisson regression with Huber/White standard errors to investigate the association between ever use, current nonoral use of MHT and gallbladder disease. RESULTS We found no significant association between ever use of MHT and gallbladder disease and sonographically diagnosed gallstones in fully adjusted analyses. Women who used MHT had a significantly higher risk for cholecystectomy compared to nonusers. There was no association between nonoral use of MHT and gallbladder disease. CONCLUSIONS Our analyses do not lend support to the hypothesis that use of MHT is associated with gallbladder disease.
Collapse
Affiliation(s)
- S Schwarz
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Clinical Research Centre of Women's Health, Berlin, Germany.
| | | | | | | | | |
Collapse
|
32
|
Standard and Low-dose Hormone Therapy for Postmenopausal Women—Focus on the Breast. Taiwan J Obstet Gynecol 2007; 46:127-34. [DOI: 10.1016/s1028-4559(07)60006-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
33
|
Abstract
HRT should not be used for the prevention or treatment of chronic disease (eg, heart disease, osteoporosis, dementia). HRT is effective in alleviating moderate to severe menopausal symptoms. Clinicians must be aware of the risks and benefits of HRT and discuss them thoroughly with their patients. As new forms and lower doses of hormones become available, additional studies will be needed to compare therapeutic strategies adequately. Studies of younger perimenopausal and menopausal women are needed. Whatever regimen is chosen, the lowest allowable estrogen dose to relieve symptoms for the shortest time is recommended. Alternatives to hormonal therapy are being examined and some may be considered. Table 1 provides an evidence-based summary of current recommendations.
Collapse
Affiliation(s)
- Pamela Dull
- OSU Department of Family Medicine, 1492 East Broad Street, Suite 1302, Columbus, OH 43205, USA.
| |
Collapse
|
34
|
Abstract
OBJECTIVE To review the pharmacology, pharmacokinetics, safety, and efficacy of a gel containing estradiol that is applied to the skin. DESIGN MEDLINE and EMBASE searches were conducted from 1966 to March 2005. Additional references were identified from bibliographies from selected studies in addition to approved product information. RESULTS Estradiol gel is indicated for the relief of moderate to severe vasomotor symptoms in menopausal women, and moderate to severe symptoms of vulvar and vaginal atrophy. Women who are intolerant of the oral route, have had previous hypersensitivity skin reactions, or have had difficulties with adhesive patches are ideal candidates for estradiol gel. CONCLUSIONS Estradiol gel can effectively reduce menopause symptoms with minimal side effects. Long-term safety data of estradiol gel are required.
Collapse
Affiliation(s)
- Mark Naunton
- Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands.
| | | | | | | |
Collapse
|
35
|
Desindes S, Bélisle S, Graves G. Menopause and Age-Related Concerns. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006. [DOI: 10.1016/s1701-2163(16)32078-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|