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Piróg M, Ząbczyk M, Natorska J, Jach R, Undas A. Reduced protein carbonylation on hormone therapy is associated with improved fibrinolysis in postmenopausal women: the impact of PAI-1 and TAFI activity. J Thromb Thrombolysis 2024:10.1007/s11239-024-03006-w. [PMID: 38981979 DOI: 10.1007/s11239-024-03006-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 07/11/2024]
Abstract
Hormone therapy (HT) has been reported to reduce protein carbonylation (PC) in postmenopausal women, in whom fibrinolysis is impaired. We investigated whether PC affects fibrinolysis and if HT modulates this effect. We enrolled 150 women aged 55.5 ± 4.7 years in a randomized interventional open-label study, including 50 on standard oral HT, 50 on ultra-low-dose HT, and 50 controls. PC, along with global fibrinolysis (clot lysis time, CLT), fibrinolysis proteins, and prothrombotic markers were determined at baseline and at 24 weeks. Patients with the baseline top quartile PC (> 2.07 nM/mg protein) had 10.3% longer CLT, higher activity (but not antigen) of TAFI (+ 19.9%) and PAI-1 (+ 68.1%) compared to the remainder. No differences were observed in thrombin generation, factor VIII, plasminogen or α2-antiplasmin. On-treatment PC decreased by 16.4% (p < 0.0001), without differences related to the type of HT, compared to baseline and by 30% compared to controls, in whom PC and fibrinolysis markers remained unchanged. Patients with PC > 2.07 nM/mg had shortened CLT during HT compared to baseline, along with lower PAI-1 (-69%) and TAFI (-26%) activity. In this subgroup CLT was 5.8% shorter compared to controls with the highest PC. In postmenopausal women with increased PC, HT was accompanied by PC reduction and faster clot lysis together with decreased PAI-1 and TAFI activity.
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Affiliation(s)
- Magdalena Piróg
- Gynecological Endocrinology Department, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Ząbczyk
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Pradnicka 80, 31-202, Krakow, Poland
- Krakow Centre for Medical Research and Technologies, St. John Paul II Hospital, Krakow, Poland
| | - Joanna Natorska
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Pradnicka 80, 31-202, Krakow, Poland
- Krakow Centre for Medical Research and Technologies, St. John Paul II Hospital, Krakow, Poland
| | - Robert Jach
- Gynecological Endocrinology Department, Jagiellonian University Medical College, Krakow, Poland
| | - Anetta Undas
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Pradnicka 80, 31-202, Krakow, Poland.
- Krakow Centre for Medical Research and Technologies, St. John Paul II Hospital, Krakow, Poland.
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Mintziori G, Veneti S, Poppe K, Goulis DG, Armeni E, Erel CT, Fistonić I, Hillard T, Hirschberg AL, Meczekalski B, Mendoza N, Mueck AO, Simoncini T, Stute P, van Dijken D, Rees M, Duntas L, Lambrinoudaki I. EMAS position statement: Thyroid disease and menopause. Maturitas 2024; 185:107991. [PMID: 38658290 DOI: 10.1016/j.maturitas.2024.107991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Thyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide range of symptoms, leading to diagnostic challenges and delayed diagnosis. Aim To construct the first European Menopause and Andropause Society (EMAS) statement on thyroid diseases and menopause. MATERIALS AND METHODS Literature review and consensus of expert opinion (EMAS executive board members/experts on menopause and thyroid disease). SUMMARY RECOMMENDATIONS This position paper highlights the diagnostic and therapeutic dilemmas in managing women with thyroid disease during the menopausal transition, aiming to increase healthcare professionals' awareness of thyroid disorders and menopause-related symptoms. Clinical decisions regarding the treatment of both conditions should be made with caution and attention to the specific characteristics of this age group while adopting a personalized patient approach. The latter must include the family history, involvement of the woman in the decision-making, and respect for her preferences, to achieve overall well-being.
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Affiliation(s)
- Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
| | - Stavroula Veneti
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Kris Poppe
- University Hospital CHU St-Pierre UMC, Université libre de Bruxelles (ULB), Belgium
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece and Royal Free Hospital, London, United Kingdom
| | - C Tamer Erel
- Istanbul-Cerrahpaşa University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ivan Fistonić
- Faculty for Health Studies, University of Rijeka, Rijeka, Croatia
| | - Timothy Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset, Poole, UK
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Spain
| | - Alfred O Mueck
- Department of Women's Health, University Hospital Tuebingen, Germany; Beijing OB/GYN Hospital, Capital Medical University, China
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Dorenda van Dijken
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, The Netherlands
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Leonidas Duntas
- Evgenideion Hospital, Unit of Endocrinology and Metabolism, National and Kapodistrian University, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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Wei F, Hughes M, Omer M, Ngo C, Pugazhendhi AS, Kolanthai E, Aceto M, Ghattas Y, Razavi M, Kean TJ, Seal S, Coathup M. A Multifunctional Therapeutic Strategy Using P7C3 as A Countermeasure Against Bone Loss and Fragility in An Ovariectomized Rat Model of Postmenopausal Osteoporosis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308698. [PMID: 38477537 PMCID: PMC11151083 DOI: 10.1002/advs.202308698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Indexed: 03/14/2024]
Abstract
By 2060, an estimated one in four Americans will be elderly. Consequently, the prevalence of osteoporosis and fragility fractures will also increase. Presently, no available intervention definitively prevents or manages osteoporosis. This study explores whether Pool 7 Compound 3 (P7C3) reduces progressive bone loss and fragility following the onset of ovariectomy (OVX)-induced osteoporosis. Results confirm OVX-induced weakened, osteoporotic bone together with a significant gain in adipogenic body weight. Treatment with P7C3 significantly reduced osteoclastic activity, bone marrow adiposity, whole-body weight gain, and preserved bone area, architecture, and mechanical strength. Analyses reveal significantly upregulated platelet derived growth factor-BB and leukemia inhibitory factor, with downregulation of interleukin-1 R6, and receptor activator of nuclear factor kappa-B (RANK). Together, proteomic data suggest the targeting of several key regulators of inflammation, bone, and adipose turnover, via transforming growth factor-beta/SMAD, and Wingless-related integration site/be-catenin signaling pathways. To the best of the knowledge, this is first evidence of an intervention that drives against bone loss via RANK. Metatranscriptomic analyses of the gut microbiota show P7C3 increased Porphyromonadaceae bacterium, Candidatus Melainabacteria, and Ruminococcaceae bacterium abundance, potentially contributing to the favorable inflammatory, and adipo-osteogenic metabolic regulation observed. The results reveal an undiscovered, and multifunctional therapeutic strategy to prevent the pathological progression of OVX-induced bone loss.
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Affiliation(s)
- Fei Wei
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
| | - Megan Hughes
- School of BiosciencesCardiff UniversityWalesCF10 3ATUK
| | - Mahmoud Omer
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
| | - Christopher Ngo
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
| | | | - Elayaraja Kolanthai
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center (NSTC)University of Central FloridaOrlandoFL32826USA
| | - Matthew Aceto
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
| | - Yasmine Ghattas
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
| | - Mehdi Razavi
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
| | - Thomas J Kean
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
| | - Sudipta Seal
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center (NSTC)University of Central FloridaOrlandoFL32826USA
| | - Melanie Coathup
- Biionix ClusterUniversity of Central FloridaOrlandoFL82816USA
- College of MedicineUniversity of Central FloridaOrlandoFL32827USA
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Aquino CI, Stampini V, Osella E, Troìa L, Rocca C, Guida M, Faggiano F, Remorgida V, Surico D. Menopausal Hormone Therapy, an Ever-Present Topic: A Pilot Survey about Women's Experience and Medical Doctors' Approach. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:774. [PMID: 38792957 PMCID: PMC11122847 DOI: 10.3390/medicina60050774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
Background and Objective: Menopause can be associated with many clinical manifestations: vasomotor symptoms, urogenital problems, and additional psychological disturbances, such as anxiety, mood changes, and sleep alterations. The prolonged lack of hormones also increases the risk of long-term consequences. Hormone Replacement Treatment (HRT) in menopause consists of the administration of estrogen, alone or associated to progesterone, to relieve these uncomfortable disturbances and to prevent the onset of other pathologic conditions. The aim of this study is to examine the prevalence of HRT use in a sample of menopausal women and their experience with menopause and HRT. This study also investigates the knowledge of general practitioners (GPs) and gynecologists about HRT and its prescription. Materials and Methods: We conducted a cross-sectional population survey on 126 women of 50-59 years in an industrial city in the North of Italy, Vercelli (Novara), in Eastern Piedmont. We also presented a questionnaire on the topic to 54 medical doctors (GPs and gynecologists) of the same area. Results: The prevalence of HRT use in our sample was 11.9%. In total, a good percentage of the users affirmed to be satisfied with HRT. Additionally, a minority of women reported being ideally against the use of replacement hormones, were advised against using HRT by doctors, and did not use it because of the fear of side effects. We found a positive association between patient education, health care attitude, and HRT usage. A significant number of women knew about HRT from the media, and most of them were not informed by a health professional. Despite this, the interviewed doctors considered their knowledge about HRT as 'good' and would recommend HRT: only 5.6% would not prescribe it. Conclusions: Our results highlight the need for information about HRT among patients and health professionals, along with the need for more effective communication, evaluation, and suggestion of treatment.
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Affiliation(s)
- Carmen Imma Aquino
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Viviana Stampini
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Elena Osella
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Libera Troìa
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Clarissa Rocca
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Maurizio Guida
- Department of Neurosciences and Reproductive Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fabrizio Faggiano
- Department for Sustainable Development and Ecological Transition, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Valentino Remorgida
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
| | - Daniela Surico
- Department of Translational Medicine, University of Piemonte Orientale, Gynecology and Obstetrics, “Maggiore della Carità” Hospital, 28100 Novara, Italy
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5
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Oliveira TS, Campos HM, Costa RM, Georg RC, Leite JA, Tostes RC, Costa EA, Santos FCA, Lobato NS, Filgueira FP, Ghedini PC. Estrone-mediated lowering of ROS and NOX4 improves endothelial function in ovariectomized wistar rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03106-7. [PMID: 38643455 DOI: 10.1007/s00210-024-03106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
Estrone (E1) constitutes the primary component in oral conjugated equine estrogens (CEEs) and serves as the principal estrogen precursor in the female circulation in the post-menopause. E1 induces endothelium-dependent vasodilation and activate PI3K/NO/cGMP signaling. To assess whether E1 mitigates vascular dysfunction associated with postmenopause and explore the underlying mechanisms, we examined the vascular effects of E1 in ovariectomized (OVX) rats, a postmenopausal experimental model. Blood pressure was measured using tail-cuff plethysmography, and aortic rings were isolated to assess responses to phenylephrine, acetylcholine (ACh), and sodium nitroprusside. Responses to ACh in rings pre-incubated with superoxide dismutase (SOD), catalase (CAT), or apocynin were also evaluated. Protein expression of SOD, CAT, NOX1, NOX2, and NOX4 was determined by Western blotting. E1 treatment resulted in decreased body weight and retroperitoneal fat, increased uterine weight, and prevented elevated blood pressure in the OVX group. Furthermore, E1 improved endothelium-dependent ACh vasodilation, activated compensatory antioxidant mechanisms - i.e. increased SOD and CAT antioxidant enzymes activity, and decreased NOX4 expression. This, in turn, helped prevent oxidative stress and endothelial dysfunction in OVX rats. Additionally, E1 treatment reversed the increased total LDL cholesterol observed in the OVX group. The findings underscore protective effects of E1 on the cardiovascular system, counteracting OVX-related oxidative stress and endothelial dysfunction in Wistar rats. E1 exhibits promising therapeutic benefits for managing cardiovascular health, particularly in postmenopausal conditions.
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Affiliation(s)
- Thiago S Oliveira
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
- Department of Pharmacy, Laboratory of Experimental Pharmacology, FCBS, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - Hericles M Campos
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
| | - Rafael M Costa
- Department of Pharmacology, Laboratory of Vascular Biology, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- School of Medicine, Federal University of Jataí, Jataí, Brazil
| | - Raphaela C Georg
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
| | - Jacqueline A Leite
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
| | - Rita C Tostes
- Department of Pharmacology, Laboratory of Vascular Biology, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Elson A Costa
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
| | - Fernanda Cristina A Santos
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil
| | - Núbia S Lobato
- School of Medicine, Federal University of Jataí, Jataí, Brazil
| | | | - Paulo César Ghedini
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, GO, Brazil.
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Oyelese Y. Randomized controlled trials: not always the "gold standard" for evidence in obstetrics and gynecology. Am J Obstet Gynecol 2024; 230:417-425. [PMID: 37838101 DOI: 10.1016/j.ajog.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/20/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
Randomized controlled trials are considered the "gold standard" for therapeutic interventions, and it is not uncommon for sweeping changes in medical practice to follow positive results from such trials. However, randomized controlled trials are not without their limitations. Physicians frequently view randomized controlled trials as infallible, whereas they tend to dismiss evidence derived from sources other than randomized controlled trials as less credible or reliable. In several situations in obstetrics and gynecology, there are no randomized controlled trials to help guide the clinician. In these circumstances, it is important to evaluate the entire body of evidence including observational studies, rather than dismiss interventions altogether simply because no randomized controlled trials exist. Randomized controlled trials and observational studies should be viewed as complementary rather than at odds with each other. Some reversals in widely adopted clinical practice have recently been implemented following subsequent studies that contradicted the outcomes of major randomized controlled trials. The most notable of these was the withdrawal from the market of 17-hydroxyprogesterone caproate for preterm birth prevention. Such reversals could potentially have been averted if the inherent limitations of randomized controlled trials were carefully considered before implementing these universal practice changes. This Clinical Opinion underscores the limitations of an exclusive reliance on randomized controlled trials while disregarding other evidence in determining how best to care for patients. Solutions are proposed that advocate that clinicians adopt a more balanced perspective that considers the entirety of the available medical evidence and the individual patient characteristics, needs, and wishes.
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Affiliation(s)
- Yinka Oyelese
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA.
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7
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Petrone M, Catania M, De Rosa LI, Degliuomini RS, Kola K, Lupi C, Brambilla Pisoni M, Salvatore S, Candiani M, Vezzoli G, Sciarrone Alibrandi MT. Role of Female Sex Hormones in ADPKD Progression and a Personalized Approach to Contraception and Hormonal Therapy. J Clin Med 2024; 13:1257. [PMID: 38592079 PMCID: PMC10932431 DOI: 10.3390/jcm13051257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
This review navigates the intricate relationship between gender, hormonal influences, and the progression of autosomal dominant polycystic kidney disease (ADPKD), highlighting the limited literature on this crucial topic. The study explores the impact of female sex hormones on liver and renal manifestations, uncovering gender-specific differences in disease progression. Actually, hormonal therapy in women with ADPKD remains a challenging issue and is a source of concern regarding its potential impact on disease outcomes, particularly at the hepatic level. Notably, women with ADPKD exhibit a slower renal disease progression compared to men, attributed to hormonal dynamics. This review sheds light on the role of estrogen in regulating pathways of the renin-angiotensin-aldosterone system, revealing its complex interplay and implications for cardiovascular and renal health. Therapeutic considerations for fertile women with ADPKD, including contraception options, are discussed, emphasizing the necessity for personalized approaches. In the postmenopausal phase, the review evaluates the role of hormonal replacement therapy, considering its potential benefits and risks in the context of ADPKD. The review concludes by underscoring the imperative need for tailored treatment approaches for ADPKD patients, considering individual risks and benefits. The scarcity of literature underlines the call for further research to enhance our understanding of optimal hormonal therapies in the context of ADPKD, ultimately paving the way for innovative and personalized therapeutic interventions.
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Affiliation(s)
- Micaela Petrone
- O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.P.); (R.S.D.); (C.L.); (S.S.); (M.C.)
| | - Martina Catania
- O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (L.I.D.R.); (K.K.); (M.B.P.); (G.V.); (M.T.S.A.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Liliana Italia De Rosa
- O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (L.I.D.R.); (K.K.); (M.B.P.); (G.V.); (M.T.S.A.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Rebecca S. Degliuomini
- O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.P.); (R.S.D.); (C.L.); (S.S.); (M.C.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Kristiana Kola
- O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (L.I.D.R.); (K.K.); (M.B.P.); (G.V.); (M.T.S.A.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Chiara Lupi
- O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.P.); (R.S.D.); (C.L.); (S.S.); (M.C.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Matteo Brambilla Pisoni
- O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (L.I.D.R.); (K.K.); (M.B.P.); (G.V.); (M.T.S.A.)
| | - Stefano Salvatore
- O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.P.); (R.S.D.); (C.L.); (S.S.); (M.C.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Massimo Candiani
- O.U. Obstetric and Gynecology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.P.); (R.S.D.); (C.L.); (S.S.); (M.C.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Giuseppe Vezzoli
- O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (L.I.D.R.); (K.K.); (M.B.P.); (G.V.); (M.T.S.A.)
- Vita Salute San Raffaele University, 20132 Milan, Italy
| | - Maria Teresa Sciarrone Alibrandi
- O.U. Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (L.I.D.R.); (K.K.); (M.B.P.); (G.V.); (M.T.S.A.)
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8
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Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metab 2024; 36:240-262. [PMID: 38280383 PMCID: PMC10871592 DOI: 10.1016/j.cmet.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Metabolic health is characterized by optimal blood glucose, lipids, cholesterol, blood pressure, and adiposity. Alterations in these characteristics may lead to the development of type 2 diabetes mellitus or dyslipidemia. Recent evidence suggests that female reproductive characteristics may be overlooked as risk factors that contribute to later metabolic dysfunction. These reproductive traits include the age at menarche, menstrual irregularity, the development of polycystic ovary syndrome, gestational weight change, gestational dysglycemia and dyslipidemia, and the severity and timing of menopausal symptoms. These risk factors may themselves be markers of future dysfunction or may be explained by shared underlying etiologies that promote long-term disease development. Disentangling underlying relationships and identifying potentially modifiable characteristics have an important bearing on therapeutic lifestyle modifications that could ease long-term metabolic burden. Further research that better characterizes associations between reproductive characteristics and metabolic health, clarifies underlying etiologies, and identifies indicators for clinical application is warranted in the prevention and management of metabolic dysfunction.
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Affiliation(s)
- Amy R Nichols
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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9
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Bakhshi P, Ho JQ, Zanganeh S. Sex-specific outcomes in cancer therapy: the central role of hormones. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1320690. [PMID: 38362126 PMCID: PMC10867131 DOI: 10.3389/fmedt.2024.1320690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
Sex hormones play a pivotal role in modulating various physiological processes, with emerging evidence underscoring their influence on cancer progression and treatment outcomes. This review delves into the intricate relationship between sex hormones and cancer, elucidating the underlying biological mechanisms and their clinical implications. We explore the multifaceted roles of estrogen, androgens, and progesterone, highlighting their respective influence on specific cancers such as breast, ovarian, endometrial, and prostate. Special attention is given to estrogen receptor-positive (ER+) and estrogen receptor-negative (ER-) tumors, androgen receptor signaling, and the dual role of progesterone in both promoting and inhibiting cancer progression. Clinical observations reveal varied treatment responses contingent upon hormonal levels, with certain therapies like tamoxifen, aromatase inhibitors, and anti-androgens demonstrating notable success. However, disparities in treatment outcomes between males and females in hormone-sensitive cancers necessitate further exploration. Therapeutically, the utilization of hormone replacement therapy (HRT) during cancer treatments presents both potential risks and benefits. The promise of personalized therapies, tailored to an individual's hormonal profile, offers a novel approach to optimizing therapeutic outcomes. Concurrently, the burgeoning exploration of new drugs and interventions targeting hormonal pathways heralds a future of more effective and precise treatments for hormone-sensitive cancers. This review underscores the pressing need for a deeper understanding of sex hormones in cancer therapy and the ensuing implications for future therapeutic innovations.
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Affiliation(s)
- Parisa Bakhshi
- Research and Development, MetasFree Biopharmaceutical Company, Mansfield, MA, United States
| | - Jim Q. Ho
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Steven Zanganeh
- Research and Development, MetasFree Biopharmaceutical Company, Mansfield, MA, United States
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Porterfield L, Davis JW, Weller SC, Chen L, Wilkinson G. Does hormone therapy exacerbate other venous thromboembolism risk factors? Menopause 2024; 31:123-129. [PMID: 38270903 DOI: 10.1097/gme.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Postmenopausal symptoms in women at higher risk for venous thromboembolism (VTE) due to comorbidities are often undertreated because of concerns that hormone therapy (HT) may increase VTE risk; however, it is unclear how much HT impacts risk of VTE when compared with other risk factors. METHODS This is a case-control study in a commercial claims database from 2007 to 2019. Women aged 50 to 64 years (n = 223,949) were classified as cases if they had an International Classification of Diseases code indicating an acute VTE plus a filled prescription for an anticoagulant, placement of intravascular vena cava filter, or death within 30 days of diagnosis. Controls were matched 10:1 to each case by index date and age. Risk factors and comorbidities present within the year before index were examined. Exposure was defined as a HT prescription within 60 days before index. RESULTS There were 20,359 VTE cases and 203,590 matched controls. A conditional logistic regression indicated that the greatest risks for VTE were from metastatic cancer (odds ratio [OR], 13.66; 95% CI, 12.64-14.75), hospitalization/surgery (OR, 8.51; 95% CI, 8.09-8.96), trauma (OR, 3.52; 95% CI, 3.32-3.73), comorbidity burden (OR, 3.51; 95% CI, 3.34-3.69), history of hypercoagulable condition (OR, 3.10; 95% CI, 2.87-3.36), and varicose veins (OR, 2.87; 95% CI, 2.56-3.22). Regarding hormone exposure, we observed ORs of 1.51 (95% CI, 1.43-1.60) for any recent hormone exposure; 1.13 (95% CI, 1.04-1.23; number needed to harm, 4,274) for unopposed estrogen menopausal HT; 1.23 (95% CI, 1.10-1.38; number needed to harm, 2,440) for combined menopausal HT; and 5.22 (95% CI, 4.67-5.84) for combined hormonal contraceptives compared with no recent HT exposure. CONCLUSIONS Hormone therapy exposure did not appear to adversely influence other risk factors, and exposure generally played a minor role in VTE risk. Contraceptives, however, were a strong risk factor.
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Affiliation(s)
| | - John W Davis
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Susan C Weller
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Lu Chen
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Gregg Wilkinson
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
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Ekanayake A, Peiris S, Ahmed B, Kanekar S, Grove C, Kalra D, Eslinger P, Yang Q, Karunanayaka P. A Review of the Role of Estrogens in Olfaction, Sleep and Glymphatic Functionality in Relation to Sex Disparity in Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2024; 39:15333175241272025. [PMID: 39116421 PMCID: PMC11311174 DOI: 10.1177/15333175241272025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Several risk factors contribute to the development of Alzheimer's disease (AD), including genetics, metabolic health, cardiovascular history, and diet. It has been observed that women appear to face a higher risk of developing AD. Among the various hypotheses surrounding the gender disparity in AD, one pertains to the potential neuroprotective properties of estrogen. Compared to men, women are believed to be more susceptible to neuropathology due to the significant decline in circulating estrogen levels following menopause. Studies have shown, however, that estrogen replacement therapies in post-menopausal women do not consistently reduce the risk of AD. While menopause and estrogen levels are potential factors in the elevated incidence rates of AD among women, this review highlights the possible roles estrogen has in other pathways that may also contribute to the sex disparity observed in AD such as olfaction, sleep, and glymphatic functionality.
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Affiliation(s)
- Anupa Ekanayake
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
- Grodno State Medical University, Grodno, Belarus
| | - Senal Peiris
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Biyar Ahmed
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Sangam Kanekar
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Cooper Grove
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Deepak Kalra
- Department of Neurology, Penn State University College of Medicine, Hershey, PA, USA
| | - Paul Eslinger
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
- Department of Neurology, Penn State University College of Medicine, Hershey, PA, USA
| | - Qing Yang
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
- Department of Neurosurgery, Penn State University College of Medicine, Hershey, PA, USA
| | - Prasanna Karunanayaka
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
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Sassarini J, Anderson RA. Elinzanetant: a phase III therapy for postmenopausal patients with vasomotor symptoms. Expert Opin Investig Drugs 2024; 33:19-26. [PMID: 38224099 DOI: 10.1080/13543784.2024.2305122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Menopausal vasomotor symptoms (VMS) are experienced by most women and are often debilitating and can last for years. While hormone replacement therapy is effective, it carries risks that have impacted its wider use, and it can be contraindicated. There is a large unmet need for a safe, effective non-hormonal therapy. AREAS COVERED The importance of the neurokinin (NK) system in the hypothalamic regulation of the vasomotor center has become clear. NK antagonists, previously developed for other indications, have therefore been investigated for the treatment of VMS. Elinzanetant is a potent antagonist at both NK1 (endogenous ligand Substance P) and NK3 (neurokinin B) receptors, whereas other related drugs in development are selective NK3 antagonists. Elinzanetant has been investigated in 2 Phase II trials for menopausal VMS, demonstrating rapid onset and dose-dependant efficacy for the relief of VMS and improvement in quality of life for up to 12 weeks. Phase III trials are underway in women both with physiological menopause and after treatment for breast cancer. EXPERT OPINION Elinzanetant is a very promising non-hormonal approach to a highly prevalent symptom constellation, with rapid onset and high efficacy. Wider indications are being explored in current Phase III trials.
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Affiliation(s)
- Jenifer Sassarini
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Richard A Anderson
- Centre for Reproductive Health, Institute for Repair and Regeneration, University of Edinburgh, Edinburgh, UK
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William N, Osmani R, Acker JP. Towards the crux of sex-dependent variability in red cell concentrates. Transfus Apher Sci 2023; 62:103827. [PMID: 37793959 DOI: 10.1016/j.transci.2023.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Donor sex can alter the RBC 'storage lesion' progression, contributing to dissimilarities in blood product quality, and thus adverse post-transfusion reactions. The mechanisms underlying the reduced sensitivity of female RBCs to storage-induced stress are partially ascribed to the differential effects of testosterone, progesterone, and estrogen on hemolytic propensity. Contributing to this is the increased proportion of more robust, biologically 'young' subpopulations of RBCs in females. Herein, we discuss the impact of sex hormones on RBCs and the relevance of these biological subpopulations to provide further insight into sex-dependent blood product variability.
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Affiliation(s)
- Nishaka William
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Rafay Osmani
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada.
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Inayama Y, Mizuno K, Egawa M, Yamaguchi K, Hamanishi J, Takeuchi M, Mandai M, Kawakami K. Real-world practice of estrogen and progestogen prescriptions in menopausal women in Japan: A descriptive study using a Japanese claims database. J Obstet Gynaecol Res 2023; 49:2952-2961. [PMID: 37752731 DOI: 10.1111/jog.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
AIM This study aimed to investigate the real-world clinical practice of estrogen and progestogen prescriptions for menopausal women. METHODS Using a health care database in Japan, we conducted a cross-sectional study on estrogen prescriptions and detailed analyses of newly initiated estrogens and concomitant prescriptions of progestogens. Data between January 2005 and December 2021 were analyzed. RESULTS In 2021, the proportion of women aged 45-49 years receiving estrogens was 25.8 [95% confidence interval (CI): 25.3, 26.3] per 1000 women, while it was 6.4 [95% CI: 6.0, 6.7] for those aged ≥60 years. The prescription of estrogens gradually increased in women aged 50-59 years after 2009. In women without a history of hysterectomy, transdermal estradiol was the primary form of estrogens prescribed for ≥180 days, in women aged <60 years. The proportion of transdermal estradiol gradually increased each year, whereas that of oral-conjugated equine estrogens decreased. Among progestogen, the proportions of dydrogesterone and transdermal norethisterone acetate increased over time, while that of medroxyprogesterone acetate decreased. Approximately 30% of women prescribed estrogens for ≥180 days did not initiate progestogen concurrently. In women undergoing hysterectomy, progestogen was not initiated in >90% of cases, and transdermal estradiol was prescribed in approximately 80% of cases in 2021. CONCLUSIONS This study reviewed the prescription of estrogens in menopausal women in Japan. A considerable number of women with a uterus are receiving estrogen therapy rather than estrogen-progestogen therapy (EPT), despite the guidelines recommending the use of EPT in these women.
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Affiliation(s)
- Yoshihide Inayama
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Miho Egawa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Villar-López M, Soto-Becerra P, Chedraui P, Osorio-Manyari JD, Al-Kassab-Córdova A, Osorio-Manyari AA, Fernandez-Sosaya JL, Moya-Silvestre E, Rojas PA, Lugo-Martínez G, Mezones-Holguín E. Short-term effects and safety of a natural oral supplement containing glucosinolates, phytosterols, and citrus flavonoids compared with hormone treatment for the management of postmenopausal symptomatic women: a pilot single-center randomized phase 2 clinical trial. Menopause 2023; 30:1230-1240. [PMID: 37874969 DOI: 10.1097/gme.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE This study aimed to evaluate the short-term efficacy and safety of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids for menopausal symptoms in comparison with estrogen plus progestogen therapy (EPT) among postmenopausal women. METHODS This was a pilot single-blinded, three-armed phase II randomized clinical trial, controlled with EPT. Sixty participants were randomly assigned to receive treatment for 3 months: (1) an oral herbal supplement of 1,500 mg/d (G1, n = 20), (2) an oral herbal supplement of 3,000 mg/d (G2, n = 20), or (3) conjugated equine estrogens 0.625 mg/d plus medroxyprogesterone acetate of 5 mg/d (EPT group, n = 20). The primary endpoint was the intensity of menopausal symptoms as measured using the Menopause-Specific Quality of Life Questionnaire (global and domain scores). The Menopause-Specific Quality of Life Questionnaire uses a 7-point scale to rate the symptom intensity, with higher scores indicating severity. The secondary endpoints were hormonal, lipid, and safety profiles. RESULTS Fifty-four participants (n = 54) completed the study. The mean, model-estimated, and global menopausal symptom scores at 3 months were 85.8 in the EPT group, 61.3 in G1, and 62.5 in G2. Participants treated with the herbal compound had lower global (13.7 [6.9-20.4], P < 0.001) and physical symptom scores (6.6 [1.6-11.5], P = 0.002) on the second month and lower psychosocial symptom scores (3.8 [1.3 to 6.3], P < 0.001) on the third month of follow-up, compared with EPT. Conversely, participants receiving EPT showed better outcomes on vasomotor symptoms since the first month of treatment (-6.1 [-8.3 to -4.0], P < 0.001). The EPT group exhibited higher values of estradiol and lower follicle-stimulating hormone and luteinizing hormone since the first month of follow-up. Also, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were significantly higher in this group than in G2. CONCLUSIONS In this small single-blind exploratory trial, the oral herbal supplement was more efficacious in reducing global, physical, and psychosocial menopausal symptoms in the short term than EPT. However, further studies are needed to adequately assess the efficacy and safety of this herbal supplement in the treatment of menopausal symptoms.
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Affiliation(s)
| | | | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú
| | | | | | | | - Percy A Rojas
- Universidad Peruana Cayetano Heredia, Laboratorios de Investigación y Desarrollo, Unidad de Biotecnología Molecular, Lima, Perú
| | - Gabriela Lugo-Martínez
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Sección de Estudios de Posgrado e Investigación, Ciudad de México, México
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Morgan LL. Consideration of Gender on Hormone Therapy Management. Nurs Clin North Am 2023; 58:627-637. [PMID: 37833004 DOI: 10.1016/j.cnur.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Hormone therapy is a common treatment method for adult males, females, and transgender and gender-diverse individuals. Both men, women, and transgender and gender-diverse people may use hormone therapy at some point in their lives. There are notable differences and similarities in risk factors related to hormone therapy use based on genetics, sex, gender, personal history, and the type of hormone therapy used. Provider awareness in gender-inclusive hormone therapy management with the consideration of nonmodifiable and modifiable risk factors, prevention of complications, and monitoring parameters is essential in clinical practice.
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Affiliation(s)
- Lindsay L Morgan
- University of Wisconsin Oshkosh, College of Nursing, 800 Algoma Boulevard, Oshkosh, WI 54901, USA.
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17
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Abstract
Hormonal fluctuations in the perimenopause are associated with an array of physical and psychological symptoms. Those with pre-existing mental disorders may experience changes to their symptoms and response to treatment during the perimenopausal and postmenopausal periods and may also be at risk of poorer longer-term physical health outcomes in menopause. The transition towards menopause may be compounded by the oestradiol-suppressing effect of many psychotropics on the hypothalamopituitary-gonadal axis. A collaborative approach between primary care and secondary mental health services is an opportunity for proactive discussion of symptoms and support with management of the perimenopause. This may involve lifestyle measures and/or hormone replacement therapy, which can both lead to improvements in well-being and mental and physical health.
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Macías-Cortés E. Menopause: Questions and Answers for Improving Homeopathic Clinical Practice. HOMEOPATHY 2023; 112:214-225. [PMID: 36413987 DOI: 10.1055/s-0042-1755362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medical attention for menopausal women is frequently delivered by health care providers (general practitioners, gynecologists or homeopathic physicians) who are not specialized in post-reproductive care. Homeopathy has been used for treating menopausal complaints for more than two centuries. Therefore, it is important to improve clinical knowledge in this field among homeopathic physicians. Nowadays, there is a special interest in the study of menopause-related chronic conditions due to the impact on women's quality of life. The aim of this review is to address the important key points of the menopause, clinical assessment, and available tests for evaluating menopausal women, as well as some general topics regarding homeopathic clinical practice for menopause. METHODS AND RESULTS A literature search regarding menopause and current guidelines and recommendations was performed. To be practical and concise, the information is presented in the form of questions and answers. Currently, there is an international classification of woman's reproductive aging that can be useful for clinical and research purposes in homeopathy. A comprehensive homeopathic approach is mandatory for evaluating women with a healthy menopause, but also for those experiencing co-morbidities. In an integrative health care system, several assessment resources can be incorporated into the homeopathic consultations. Clinical and laboratory examinations for detecting metabolic disorders (dyslipidemia, insulin resistance, diabetes and hypertension, among others), mood disorders, cognitive impairment and osteoporosis are available in many clinical settings. Screening for gynecological cancers is an international recommendation at this stage. All data obtained from homeopathic consultations would help to integrate well-documented case reports. This would give the possibility to generate hypotheses to design high-quality clinical research. CONCLUSION Improving homeopathic clinical practice for menopause is useful for both clinical and research purposes. The international recommendations for evaluating menopausal women should be incorporated in homeopathic clinical practice, mainly in clinical settings where homeopathy is integrated in outpatient services.
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Affiliation(s)
- Emma Macías-Cortés
- Outpatient Homeopathy Service, Hospital Juárez de México, Mexico City, Mexico
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Chiu HY, Chang HT, Chan PC, Chiu PY. Cholesterol Levels, Hormone Replacement Therapy, and Incident Dementia among Older Adult Women. Nutrients 2023; 15:4481. [PMID: 37892556 PMCID: PMC10610485 DOI: 10.3390/nu15204481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Previous studies revealed that hormone replacement therapy (HRT) probably has a protective effect for preventing dementia in post-menopausal women. However, the results were still controversial. The association between cholesterol levels and incident dementia in older women is not fully understood either. We conducted a retrospective analysis on a cohort of non-demented women aged older than 50 years, which was registered in the History-based Artificial Intelligence Clinical Dementia Diagnostic System database from September 2015 to August 2021. We followed this cohort longitudinally to examine the rates of conversion to dementia. Using a Cox regression model, we investigated the impact of the quartile of total cholesterol (TC) levels on incident dementia, adjusting for age, sex, education, neuropsychiatric symptoms, neuropsychological assessments, HRT, as well as various vascular risk factors and medications. We examined a cohort of 787 participants, comprising 539 (68.5%) individuals who did not develop dementia (non-converters). Among these non-converters, 68 individuals (12.6%) were treated with HRT. By contrast, there were 248 (31.5%) who did develop dementia (converters). Among the converters, 28 individuals (11.3%) were treated with HRT. The average follow-up durations were 2.9 ± 1.5 and 3.3 ± 1.6 years for non-converters and converters, respectively. Compared to the lowest quartile of TC levels (<153), the hazard ratios (HR) for converting to dementia were 0.61, 0.58, and 0.58 for the second (153-176), third (177-201), and highest (>201) quartiles, respectively (all p < 0.05). However, the low-density lipoprotein cholesterol (LDL-C) level and HRT did not alter the rate of conversion to dementia. In conclusion, the lowest quartile of TC increased incident dementia in post-menopausal women without dementia; however, HRT did not contribute to conversion to dementia. Some studies suggest that post-menopausal women who have reduced estrogen levels might have an increased risk of Alzheimer's disease if they also have high cholesterol. Nonetheless, the evidence is inconclusive, as not all studies support this finding. The "Lower LDL-C is better" strategy for preventing cardiac vascular disease should be re-examined for the possible serial adverse effects of new onset dementia due to very low cholesterol levels.
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Affiliation(s)
- Huei-Ying Chiu
- Department of Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua 500, Taiwan;
| | - Hsin-Te Chang
- Department of Psychology, College of Science, Chung Yuan Christian University, Taoyuan 320, Taiwan;
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua 500, Taiwan;
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua 500, Taiwan;
- Department of Applied Mathematics, Tunghai University, Taichung 407, Taiwan
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Wang Z, Li J. Lipoprotein(a) in patients with breast cancer after chemotherapy: exploring potential strategies for cardioprotection. Lipids Health Dis 2023; 22:157. [PMID: 37736722 PMCID: PMC10515253 DOI: 10.1186/s12944-023-01926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
Developments in neoadjuvant and adjuvant chemotherapy (CHT) have led to an increase in the number of breast cancer survivors. The determination of an appropriate follow-up for these patients is of increasing importance. Deaths due to cardiovascular disease (CVD) are an important part of mortality in patients with breast cancer.This review suggests that chemotherapeutic agents may influence lipoprotein(a) (Lp(a)) concentrations in breast cancer survivors after CHT based on many convincing evidence from epidemiologic and observational researches. Usually, the higher the Lp(a) concentration, the higher the median risk of developing CVD. However, more clinical trial results are needed in the future to provide clear evidence of a possible causal relationship. This review also discuss the existing and emerging therapies for lowering Lp(a) concentrations in the clinical setting. Hormone replacement therapy, statins, proprotein convertase subtilisin/kexin-type 9 (PCSK9) inhibitors, Antisense oligonucleotides, small interfering RNA, etc. may reduce circulating Lp(a) or decrease the incidence of CVD.
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Affiliation(s)
- Ziqing Wang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, No.1677 Wutai Mountain Road, Qingdao, 266000, China
| | - Jian Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, No.1677 Wutai Mountain Road, Qingdao, 266000, China.
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Prokai L, Nguyen V, Urbanski HF. Effect of estradiol replacement on hippocampal concentrations of estrogens in aged rhesus macaques maintained on an obesogenic diet. Biochem Biophys Rep 2023; 35:101548. [PMID: 37745986 PMCID: PMC10511332 DOI: 10.1016/j.bbrep.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
Replacement involving estrogens has proven efficacy at treating a wide range of disorders that develop with menopause or after surgical removal of the ovaries. Here, we tested whether an estradiol (E2) replacement paradigm that recapitulates physiological E2 levels in the circulation also recapitulates physiological E2 levels within the hippocampus. E2 was delivered continuously to old ovariectomized (OVX) rhesus macaques, maintained on a high-fat, high-sugar Western-style diet (WSD) for ∼30 months, via subcutaneous implants; this resulted in physiological concentrations of both estrone (E1) and E2 in the circulation (determined by LC-MS/MS). Surprisingly, however, hippocampal concentrations of E2 were markedly (P < 0.01) higher than in ovary-intact animals maintained on a regular chow diet. The data suggest that E2 replacement paradigms that appear to recapitulate physiological E2 concentrations in the circulation may produce hyper-physiological E2 levels within some brain areas, especially when individuals are maintained on a WSD.
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Affiliation(s)
- Laszlo Prokai
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center at Fort Worth, TX, 76063, USA
| | - Vien Nguyen
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center at Fort Worth, TX, 76063, USA
| | - Henryk F. Urbanski
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, 97006, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, 97239, USA
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Yu WX, Tang HH, Ye JJ, Xiao HH, Lam CY, Shum TF, Sun ZK, Li YZ, Zang XY, Du WC, Zhang JP, Kong TH, Zhou LP, Chiou JC, Kung CF, Mok KW, Hu J, Wong MS. Identification of the Microbial Transformation Products of Secoisolariciresinol Using an Untargeted Metabolomics Approach and Evaluation of the Osteogenic Activities of the Metabolites. Molecules 2023; 28:5742. [PMID: 37570714 PMCID: PMC10420892 DOI: 10.3390/molecules28155742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Secoisolariciresinol (SECO) is one of the major lignans occurring in various grains, seeds, fruits, and vegetables. The gut microbiota plays an important role in the biotransformation of dietary lignans into enterolignans, which might exhibit more potent bioactivities than the precursor lignans. This study aimed to identify, synthesize, and evaluate the microbial metabolites of SECO and to develop efficient lead compounds from the metabolites for the treatment of osteoporosis. SECO was fermented with human gut microbiota in anaerobic or micro-aerobic environments at different time points. Samples derived from microbial transformation were analyzed using an untargeted metabolomics approach for metabolite identification. Nine metabolites were identified and synthesized. Their effects on cell viability, osteoblastic differentiation, and gene expression were examined. The results showed that five of the microbial metabolites exerted potential osteogenic effects similar to those of SECO or better. The results suggested that the enterolignans might account for the osteoporotic effects of SECO in vivo. Thus, the presence of the gut microbiota could offer a good way to form diverse enterolignans with bone-protective effects. The current study improves our understanding of the microbial transformation products of SECO and provides new approaches for new candidate identification in the treatment of osteoporosis.
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Affiliation(s)
- Wen-Xuan Yu
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
| | - Hok-Him Tang
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
| | - Jun-Jie Ye
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Hui-Hui Xiao
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), Shenzhen Research Institute of the Hong Kong Polytechnic University, Shenzhen 518057, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
| | - Chung-Yan Lam
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
| | - Tim-Fat Shum
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
| | - Zhi-Kang Sun
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Yuan-Zhen Li
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Xin-Yu Zang
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Wen-Chao Du
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Jian-Ping Zhang
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Tsz-Hung Kong
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
| | - Li-Ping Zhou
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
| | - Jia-Chi Chiou
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Chun-Fai Kung
- Increasepharm (HK) Limited, Hong Kong Science Park, Shatin, Hong Kong, China;
| | - Kam-Wah Mok
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), Shenzhen Research Institute of the Hong Kong Polytechnic University, Shenzhen 518057, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
| | - Jing Hu
- Increasepharm (Tianjin) Innovative Medicine Institute Limited, Tianjin 300382, China; (J.-J.Y.); (Z.-K.S.); (Y.-Z.L.); (X.-Y.Z.); (W.-C.D.); (J.-P.Z.)
| | - Man-Sau Wong
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (W.-X.Y.); (H.-H.T.); (H.-H.X.); (C.-Y.L.); (T.-F.S.); (T.-H.K.); (J.-C.C.); (M.-S.W.)
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), Shenzhen Research Institute of the Hong Kong Polytechnic University, Shenzhen 518057, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
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Dróżdż W, Wiciński M, Szota AM, Szambelan M, Radajewska I, Popławski I, Wojciechowski P. Augmentation Therapies as Treatments for Coexisting Somatic Problems in Schizophrenia-A Systematic Review. J Clin Med 2023; 12:4012. [PMID: 37373704 DOI: 10.3390/jcm12124012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this review is to appraise the data from available randomized clinical trials (RCT) regarding the possible combinations of neuroleptic and non-antipsychotic treatment which could enhance antipsychotic therapy efficacy whilst simultaneously addressing somatic symptoms in individuals with schizophrenia. A systematic search of the PubMed database up to February 2022 was conducted. Inclusion criteria: randomized controlled trials using augmentation therapy in chronic schizophrenia in adults, written in English, and only studies with psychometric assessments of schizophrenia were incorporated. Exclusion criteria: non-clinical, first episode of schizophrenia, patients on medication other than antipsychotics augmented, and not adjunctive therapy. Overall, 37 studies of 1931 patients with schizophrenia who received a combination of antipsychotic medication with other drugs were selected. A statistically significant reduction of negative and positive symptoms of schizophrenia, measured with the PANSS scale, when using a combination of antipsychotic treatment along with aspirin, simvastatin, N-acetylcysteine, or pioglitazone was found. A combination of antipsychotic medication with aspirin, simvastatin, N-acetylcysteine, or pioglitazone seems to be effective in the reduction of symptoms of schizophrenia in adults, but long-term studies are required to confirm this effect.
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Affiliation(s)
- Wiktor Dróżdż
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Michał Wiciński
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Anna Maria Szota
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Monika Szambelan
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Izabela Radajewska
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Igor Popławski
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
| | - Paweł Wojciechowski
- Department of Pharmacology and Therapy, Ludwig Rydygier Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń, Curie Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland
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Dothard MI, Allard SM, Gilbert JA. The effects of hormone replacement therapy on the microbiomes of postmenopausal women. Climacteric 2023; 26:182-192. [PMID: 37051868 DOI: 10.1080/13697137.2023.2173568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The sex steroid hormone estrogen plays a number of regulatory roles in female development. During menopause, estrogen synthesis in the ovaries decreases, which results in adverse physiological remodeling and increased risk of disease. Reduced bone density, changes in the community composition profiles of the gut and vaginal microbiome, mood swings and changes in the vaginal environment are to be expected during this time. To alleviate these changes, postmenopausal women can be prescribed hormone replacement therapy (HRT) through the use of exogenous estradiol, often in conjunction with progestin treatment, which re-induces estrogenic action throughout the body. The microbiome and estrogen have a bidirectional, regulatory relationship in the gut, while in the vaginal environment estrogen works indirectly on the microbiome through restoring the vaginal tissue environment that leads to microbial homeostasis. This review discusses what is known about how the gut and vaginal microbiomes of postmenopausal women are responding to HRT, and the potential future of microbe-based therapeutics for symptoms of menopause.
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Affiliation(s)
- M I Dothard
- Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - S M Allard
- Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - J A Gilbert
- Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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25
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Chlebowski RT, Aragaki AK. The Women's Health Initiative randomized trials of menopausal hormone therapy and breast cancer: findings in context. Menopause 2023; 30:454-461. [PMID: 36727752 DOI: 10.1097/gme.0000000000002154] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE AND OBJECTIVE The menopausal hormone therapy (MHT) association with breast cancer has been controversial for more than 40 years. Most recently, findings from cohort studies have been discordant compared with those from the Women's Health Initiative (WHI) randomized trials. In cohort studies, both estrogen therapy and estrogen plus progestin were associated with higher breast cancer incidence. In contrast, in the WHI randomized trials, findings for estrogen plus progestin are concordant with cohort study reports, whereas estrogen therapy significantly reduced breast cancer incidence. In addition, concerns have been raised regarding the WHI findings from both trials. In this report, we briefly summarize findings for MHT on breast cancer from cohort studies and the WHI randomized trials. The report focus is addressing, point-by-point, concerns raised regarding the WHI findings. METHODS For cohort studies, we relied on the latest findings from (1) the meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer and (2) the Million Women's Study. To identify commentaries and editorials, "Menopause" and "Climacteric" were searched from 2002 to present; PubMed and Google Scholar were searched for commentaries, editorials, and breast cancer, MHT, estrogen, conjugated equine estrogen, estradiol, "hormone replacement therapy," and "HRT." DISCUSSION AND CONCLUSIONS Thirty commentaries challenging WHI findings were identified. All were reviewed, and issues needing response were identified. Findings from the meta-analysis from the Collaborative Group on Hormonal Factors in Breast Cancer and the Million Women Study were summarized and compared with finding in the two WHI randomized trials evaluating estrogen therapy and estrogen plus progestin. Based on the randomized clinical trials, estrogen therapy, for women with prior hysterectomy, decreases breast cancer incidence and mortality. In contrast, estrogen plus progestin increases breast cancer incidence, which persists through two decades. Women considering estrogen plus progestin use for vasomotor symptoms should understand the breast cancer risk.
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Vanden Noven ML, Larson M, Lee E, Reilly C, Tracy MF, Keller-Ross ML. Perceptions, Benefits, and Use of Complementary and Integrative Therapies to Treat Menopausal Symptoms: A Pilot Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:136-147. [PMID: 37008184 PMCID: PMC10061331 DOI: 10.1089/whr.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
Background Menopause symptoms can be debilitating, and the use of menopausal hormone therapy (MHT) has declined significantly since the Women's Health Initiative. Materials and Methods We surveyed 508 peri- and postmenopausal females to determine (1) the use of complementary and integrative therapies (CIT), MHT; and pharmacotherapies; (2) the perceptions, perceived benefits/risks of CIT, MHT; and pharmacotherapy use; and (3) factors associated with CIT and MHT use for menopause symptom treatment. Results The majority of respondents used CIT to treat menopause symptoms based on physician recommendation and research studies. Treatments that were perceived as most beneficial included exercise, mind-body therapies, diet, and spiritual practices, with exercise and mind-body therapies chosen to treat the most common symptoms of sleep disturbances, depressive mood, and anxiety. Higher education level was the main predictive variable for choosing exercise (odds ratio [OR] = 1.27, p = 0.02) and mind-body therapies (OR = 1.57, p = 0.02) to treat menopausal symptoms. Perceptions, beliefs, and use of different CIT by primarily white, affluent, and educated peri- and postmenopausal females to treat menopause symptoms, including sleep disturbances, depression, and anxiety, are driven by conversations with physicians and evidence-based research. Conclusion These findings reinforce the necessity for both additional research in more diverse populations, as well as comprehensive, individualized personalized care from an interdisciplinary team that considers the best options available for all female patients.
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Affiliation(s)
- Marnie L. Vanden Noven
- Department of Exercise Science, College of Health Sciences and Nursing, Belmont University, Nashville, Tennessee, USA
| | - Mia Larson
- Medical Specialists of Kentuckiana, Owensboro, Kentucky, USA
| | - Emma Lee
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Fran Tracy
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Manda L. Keller-Ross
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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Blumenfeld Z, Leiba R, Stam T. What may be the best menopausal hormone treatment? Arch Gynecol Obstet 2023; 307:659-662. [PMID: 36574008 DOI: 10.1007/s00404-022-06889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology, Ob/Gyn, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 3 Ehud St, 3455205, Haifa, Israel. .,Meuhedet Health Services, Haifa, Israel.
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The Current Strategy in Hormonal and Non-Hormonal Therapies in Menopause—A Comprehensive Review. Life (Basel) 2023; 13:life13030649. [PMID: 36983805 PMCID: PMC10053935 DOI: 10.3390/life13030649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
Menopause is a natural stage of hormonal aging in women, accompanied by a series of symptoms that reduce the quality of life of a fully active person. As no therapy is entirely satisfactory, the race for a better option is in full swing. Our study objective is to investigate the most recent menopause studies on pharmacological resources, emerging therapies, and the particularities of hormonal replacement therapy (HRT). For this purpose, a comprehensive search was conducted in two main databases (PubMed and Web of Science) guided by the specific keywords “menopause” and “therapy” or “estrogen” or “progesterone” or “hormone replacement” during the last ten years period. Studies were eligible if they met certain criteria: randomized controlled trials (RCT) in adult women with menopause and hormonal or non-hormonal therapies. We selected 62 RCTs, which are focused on four main topics: (a) epidemiology of menopause-related symptoms, (b) hormonal replacement therapy (HRT) selective estrogen receptor modulators, (c) emerging therapies, and (d) menopause. HRT has proven a real health benefit for menopausal women; besides, complementary interventions must be considered. Further studies are needed on menopause and menopause-related therapies. The continuous updating of clinical experience will strengthen the therapeutic benefit and the decision to treat patients safely. This goal will fully access all therapeutic resources to address an unresolved health issue of active adult women.
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Lee C, Han KD, Yoo J, Park KA, Oh SY. Hormone Replacement Therapy and the Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy: a Nationwide Population-Based Study (2009-2018). Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05976-8. [PMID: 36680611 DOI: 10.1007/s00417-023-05976-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This study aimed to assess the association between hormone replacement therapy (HRT) and the prevalence of nonarteritic anterior ischemic optic neuropathy (NAION) in menopausal women using national data from the entire Korean population. METHODS The health screening data of 1,381,605 women between 40 and 90 years of age collected by the National Health Insurance Service (NHIS) of Korea between January 1, 2009, and December 31, 2018, were retrospectively reviewed. Before data analysis, the potential cofounders were adjusted for among all participants. Based on HRT use and its duration (classified into four groups), the hazard ratio (HR) and 95% confidence interval (CI) of NAION development were calculated via a Cox proportional hazards regression analysis using the nonuser group as a reference. RESULTS Overall, 7824 NAION diagnoses were made during the mean follow-up of 8.22 years (standard deviation: 1.09 years) in 1,381,605 post-menopausal women. NAION was more common in the HRT group than in the non-HRT group (HR [95% CI]: 1.268 [1.197-1.344]). Furthermore, the risk of NAION increased along with increased HRT duration (p < 0.0001). In the multivariate analysis, the adjusted HRs of the < 2-year HRT group, the 2-5-year HRT group, and the ≥ 5-year HRT group were 1.19 (95% CI: 1.10-1.28), 1.3 (95% CI: 1.17-1.45), and 1.473 (95% CI: 1.31-1.65), respectively. Compared to women younger than 65 years, the HR of HRT for NAION was significantly higher than that of women older than 65 years (p < 0.0001). CONCLUSION Our population-based cohort study found that HRT was significantly associated with increased incidence of NAION. The incidence of NAION also increased with the duration of HRT.
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Affiliation(s)
- Chaeyeon Lee
- Department of Ophthalmology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, Korea
| | - Juhwan Yoo
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
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Ronchetti S, Labombarda F, Roig P, De Nicola AF, Pietranera L. Beneficial effects of the phytoestrogen genistein on hippocampal impairments of spontaneously hypertensive rats (SHR). J Neuroendocrinol 2023; 35:e13228. [PMID: 36690381 DOI: 10.1111/jne.13228] [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] [Received: 07/05/2022] [Revised: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
Hippocampal neuropathology is a recognized feature of the spontaneously hypertensive rat (SHR). The hippocampal alterations associate with cognitive impairment. We have shown that hippocampal abnormalities are reversed by 17β-estradiol, a steroid binding to intracellular receptors (estrogen receptor α and β subtypes) or the membrane-located G-protein coupled estradiol receptor. Genistein (GEN) is a neuroprotective phytoestrogen which binds to estrogen receptor β and G-protein coupled estradiol receptor. Here, we investigated whether GEN neuroprotection extends to SHR. For this purpose, we treated 5-month-old SHR for 2 weeks with 10 mg kg-1 daily s.c injections of GEN. We analyzed the expression of doublecortin+ neuronal progenitors, glial fibrillary acidic protein+ astrocytes and ionized calcium-binding adapter molecule 1+ microglia in the CA1 region and dentate gyrus of the hippocampus using immunocytochemistry, whereas a quantitative real-time polymerase chain reaction was used to measure the expression of pro- and anti-inflammatory factors tumor necrosis factor α, cyclooxygenase-2 and transforming growth factor β. We also evaluated hippocampal dependent memory using the novel object recognition test. The results showed a decreased number of doublecortin+ neural progenitors in the dentate gyrus of SHR that was reversed with GEN. The number of glial fibrillary acidic protein+ astrocytes in the dentate gyrus and CA1 was increased in SHR but significantly decreased by GEN treatment. Additionally, GEN shifted microglial morphology from the predominantly activated phenotype present in SHR, to the more surveillance phenotype found in normotensive rats. Furthermore, treatment with GEN decreased the mRNA of the pro-inflammatory factors tumor necrosis factor α and cyclooxygenase-2 and increased the mRNA of the anti-inflammatory factor transforming growth factor β. Discrimination index in the novel object recognition test was decreased in SHR and treatment with GEN increased this parameter. Our results indicate important neuroprotective effects of GEN at the neurochemical and behavioral level in SHR. Our data open an interesting possibility for proposing this phytoestrogen as an alternative therapy in hypertensive encephalopathy.
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Affiliation(s)
- Santiago Ronchetti
- Laboratory of Neuroendocrine Biochemistry, Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina
| | - Florencia Labombarda
- Laboratory of Neuroendocrine Biochemistry, Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina
- Department of Human Biochemistry, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Paulina Roig
- Laboratory of Neuroendocrine Biochemistry, Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina
| | - Alejandro F De Nicola
- Laboratory of Neuroendocrine Biochemistry, Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina
- Department of Human Biochemistry, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Luciana Pietranera
- Laboratory of Neuroendocrine Biochemistry, Instituto de Biología y Medicina Experimental, Buenos Aires, Argentina
- Department of Human Biochemistry, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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Renke G, Kemen E, Scalabrin P, Braz C, Baêsso T, Pereira MB. Cardio-Metabolic Health and HRT in Menopause: Novel Insights in Mitochondrial Biogenesis and RAAS. Curr Cardiol Rev 2023; 19:e060223213459. [PMID: 36748220 PMCID: PMC10494270 DOI: 10.2174/1573403x19666230206130205] [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] [Received: 08/08/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Recent evidence shows the cardiometabolic effects of estrogen administration in postmenopausal women. Women have a cardiometabolic advantage during their reproductive years, which is lost at menopause due to declining estradiol (E2). E2, also known as 17-beta-estradiol, has diverse effects in its target tissues, including the cardiovascular (CV) system, through genomic and non-genomic signaling. Metabolic changes characteristic of menopause include a worsening lipid profile, changes in body fat distribution, epicardial and pericardial fat deposition, increased susceptibility to weight gain, and increased blood pressure, resulting in an increased risk of accelerated cardiovascular disease (CVD) development. E2 mediates its cardioprotective actions by increasing mitochondrial biogenesis, angiogenesis, and vasodilation, decreasing reactive oxygen species (ROS) and oxidative stress, and modulating the renin-angiotensin-aldosterone system (RAAS). In this review, we assess whether it is prudent to develop an approach to managing postmenopausal women based on modifying the patient's CV risk that includes human-identical hormone replacement therapy (HRT), modulation of RAAS, and stimulating mitochondrial biogenesis. Further research is needed to assess the safety and benefit of HRT to reduce cardiometabolic risk.
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Affiliation(s)
- Guilherme Renke
- National Institute of Cardiology, Brazilian Ministry of Health, Rio de Janeiro, Brazil
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Elaine Kemen
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Priscila Scalabrin
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Cleibe Braz
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Thomáz Baêsso
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
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Bermingham KM, Linenberg I, Hall WL, Kadé K, Franks PW, Davies R, Wolf J, Hadjigeorgiou G, Asnicar F, Segata N, Manson JE, Newson LR, Delahanty LM, Ordovas JM, Chan AT, Spector TD, Valdes AM, Berry SE. Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study. EBioMedicine 2022; 85:104303. [PMID: 36270905 PMCID: PMC9669773 DOI: 10.1016/j.ebiom.2022.104303] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The menopause transition is associated with unfavourable alterations in health. However, postprandial metabolic changes and their mediating factors are poorly understood. METHODS The PREDICT 1 UK cohort (n=1002; pre- n=366, peri- n=55, and post-menopausal females n=206) assessed phenotypic characteristics, anthropometric, diet and gut microbiome data, and fasting and postprandial (0-6 h) cardiometabolic blood measurements, including continuous glucose monitoring (CGM) data. Differences between menopausal groups were assessed in the cohort and in an age-matched subgroup, adjusting for age, BMI, menopausal hormone therapy (MHT) use, and smoking status. FINDINGS Post-menopausal females had higher fasting blood measures (glucose, HbA1c and inflammation (GlycA), 6%, 5% and 4% respectively), sugar intakes (12%) and poorer sleep (12%) compared with pre-menopausal females (p<0.05 for all). Postprandial metabolic responses for glucose2hiauc and insulin2hiauc were higher (42% and 4% respectively) and CGM measures (glycaemic variability and time in range) were unfavourable post- versus pre-menopause (p<0.05 for all). In age-matched subgroups (n=150), postprandial glucose responses remained higher post-menopause (peak0-2h 4%). MHT was associated with favourable visceral fat, fasting (glucose and insulin) and postprandial (triglyceride6hiauc) measures. Mediation analysis showed that associations between menopause and metabolic health indicators (visceral fat, GlycA360mins and glycaemia (peak0-2h)) were in part mediated by diet and gut bacterial species. INTERPRETATION Findings from this large scale, in-depth nutrition metabolic study of menopause, support the importance of monitoring risk factors for type-2 diabetes and cardiovascular disease in mid-life to older women to reduce morbidity and mortality associated with oestrogen decline. FUNDING Zoe Ltd.
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Affiliation(s)
- Kate M. Bermingham
- Department of Twins Research and Genetic Epidemiology, King's College London, London, UK
| | | | - Wendy L. Hall
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Paul W. Franks
- Department of Clinical Sciences, Lund University, Malmö, Sweden,Department of Nutrition, Harvard Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Linda M. Delahanty
- Diabetes Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Jose M. Ordovas
- JM-USDA-HNRCA at Tufts University, Boston, MA, USA,IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain,UCJC, Madrid, Spain
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Tim D. Spector
- Department of Twins Research and Genetic Epidemiology, King's College London, London, UK
| | - Ana M. Valdes
- School of Medicine, University of Nottingham, Nottingham, UK,Nottingham NIHR Biomedical Research Centre, Nottingham, UK
| | - Sarah E. Berry
- Department of Nutritional Sciences, King's College London, London, UK,Corresponding author.
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Deng Y, Huang H, Shi J, Jin H. Identification of Candidate Genes in Breast Cancer Induced by Estrogen Plus Progestogens Using Bioinformatic Analysis. Int J Mol Sci 2022; 23:ijms231911892. [PMID: 36233194 PMCID: PMC9569986 DOI: 10.3390/ijms231911892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Menopausal hormone therapy (MHT) was widely used to treat menopause-related symptoms in menopausal women. However, MHT therapies were controversial with the increased risk of breast cancer because of different estrogen and progestogen combinations, and the molecular basis behind this phenomenon is currently not understood. To address this issue, we identified differentially expressed genes (DEGs) between the estrogen plus progestogens treatment (EPT) and estrogen treatment (ET) using the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) data. As a result, a total of 96 upregulated DEGs were first identified. Seven DEGs related to the cell cycle (CCNE2, CDCA5, RAD51, TCF19, KNTC1, MCM10, and NEIL3) were validated by RT-qPCR. Specifically, these seven DEGs were increased in EPT compared to ET (p < 0.05) and had higher expression levels in breast cancer than adjacent normal tissues (p < 0.05). Next, we found that estrogen receptor (ER)-positive breast cancer patients with a higher CNNE2 expression have a shorter overall survival time (p < 0.05), while this effect was not observed in the other six DEGs (p > 0.05). Interestingly, the molecular docking results showed that CCNE2 might bind to 17β-estradiol (−6.791 kcal/mol), progesterone (−6.847 kcal/mol), and medroxyprogesterone acetate (−6.314 kcal/mol) with a relatively strong binding affinity, respectively. Importantly, CNNE2 protein level could be upregulated with EPT and attenuated by estrogen receptor antagonist, acolbifene and had interactions with cancer driver genes (AKT1 and KRAS) and high mutation frequency gene (TP53 and PTEN) in breast cancer patients. In conclusion, the current study showed that CCNE2, CDCA5, RAD51, TCF19, KNTC1, MCM10, and NEIL3 might contribute to EPT-related tumorigenesis in breast cancer, with CCNE2 might be a sensitive risk indicator of breast cancer risk in women using MHT.
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Affiliation(s)
- Yu Deng
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China
| | - He Huang
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China
| | - Jiangcheng Shi
- School of Life Sciences, Tiangong University, Tianjin 300387, China
| | - Hongyan Jin
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China
- Correspondence:
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Sommer IE, Brand BA, Gangadin S, Tanskanen A, Tiihonen J, Taipale H. Women with Schizophrenia-Spectrum Disorders After Menopause: A Vulnerable Group for Relapse. Schizophr Bull 2022; 49:136-143. [PMID: 36198044 PMCID: PMC9810004 DOI: 10.1093/schbul/sbac139] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Throughout the life stages of women with schizophrenia-spectrum disorders (SSD), lower estrogen levels are associated with more severe disease course. At perimenopause in the mid-forties, estrogen levels decline to remain persistently low after menopause. This period is hypothesized to increase relapse risk and reduce antipsychotic effectiveness in preventing relapse. STUDY DESIGN The cohort of persons with schizophrenia/schizoaffective disorder was identified from Finnish nationwide registers (N = 61 889) and stratified by sex and age <45 vs. ≥45 years. Hospitalizations for psychosis were defined per 5-year age group during the follow-up 1996-2017. Risk of psychosis hospitalization (Adjusted Hazard Ratio, aHR) was assessed using within-individual design, by comparing antipsychotic monotherapy use to nonuse periods in the same individuals for seven dose categories in defined daily doses (DDDs/day). RESULTS Starting at age 45-50, women were consistently more often hospitalized for psychosis than their male peers. Women ≥45 had significantly higher aHRs than women <45 at antipsychotic monotherapy >0.6 DDDs/day, and than men at >1.1 DDDs/day. This female-specific age-dependent decrease in effectiveness was present for clozapine doses >0.6 DDDs/day, olanzapine doses >1.4 DDDs/day, and for specific doses of quetiapine (0.9-1.1 DDDs/day) and risperidone (0.6-0.9 DDDs/day). CONCLUSIONS While younger women have a lower risk of relapse and generally need a lower antipsychotic dose to prevent rehospitalization than men, antipsychotic effectiveness declines in women after the age of 45. Starting in mid-forties, older women with SSD should be regarded as a vulnerable group that deserve special attention.
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Affiliation(s)
- Iris E Sommer
- To whom correspondence should be addressed; Antonius Deusinglaan 2, Groningen, Netherlands; tel: +31-625647485, e-mail:
| | - Bodyl A Brand
- Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Groningen, Netherlands
| | - Shiral Gangadin
- Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Groningen, Netherlands
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
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Amin MA, Mozid NE, Ahmed SB, Sharmin S, Monju IH, Jhumur SS, Sarker W, Dalal K, Hawlader MDH. Status of female sexual dysfunction among postmenopausal women in Bangladesh. BMC Womens Health 2022; 22:401. [PMID: 36195886 PMCID: PMC9533598 DOI: 10.1186/s12905-022-01991-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women's sexual health and physical desire for sex are most important for their emotional and physical well-being. This study aimed to examine the status of sexual dysfunction among postmenopausal women in Bangladesh and assess the significant risk factors behind this. METHODS A cross-sectional study was conducted among 45-55 years in four public and private hospitals in Bangladesh from April 2021 to June 2021 using a multi-stage sampling technique to enroll the study participants. The female sexual function index (FSFI) scale measured the prevalence of FSD, and the relationship of independent risk factors were assessed using a multivariate logistic regression model. RESULTS The total score of FSFI among postmenopausal Bangladeshi women was 18.07 ± 8.51. Among 260 participants, the prevalence of FSD was 56.9%. Out of all the significant risk factors, increasing age, urban population group, multiparous, homemakers, duration of menopause, and postmenopausal women with no hormone therapy were significantly associated with FSD. In contrast, those with regular physical activity were protective of FSD. CONCLUSION In conclusion, a significant proportion of postmenopausal Bangladeshi women are enduring sexual dysfunction. Proper hormonal therapy and non-hormonal therapies such as physical activity and pelvic floor muscle (Kegel) exercise with adequate counseling are helpful to cope in this distressing situation.
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Affiliation(s)
- Mohammad Ashraful Amin
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Nusrat-E Mozid
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh ,Public Health Professional Developmental Society (PPDS), Dhaka, 1205 Bangladesh
| | - Sanjana Binte Ahmed
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Shakila Sharmin
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Imran Hossain Monju
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Shirin Shahadat Jhumur
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Wharesha Sarker
- grid.443020.10000 0001 2295 3329Department of Public Health, North South University, Dhaka, 1229 Bangladesh
| | - Koustuv Dalal
- grid.29050.3e0000 0001 1530 0805Division of Public Health Science, Institution for Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Citalopram improves vasomotor syndrome and urogenital syndrome of menopause in Mexican women: a randomized clinical trial. Arch Gynecol Obstet 2022; 306:2035-2045. [PMID: 35997971 DOI: 10.1007/s00404-022-06732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed to determine the efficacy of non-hormonal therapy with citalopram vs fluoxetine for treating vasomotor syndrome (VMS) and urogenital syndrome of menopause (GSM) in Mexican women. METHODS A parallel prospective randomized clinical trial was conducted in 91 postmenopausal women with a total score on the Menopause Rating Scale (MRS) ≥ 17 and with the clinical diagnosis of VSM and GSM. Patients were randomly assigned to receive citalopram (n = 49) or fluoxetine (n = 42). Follow-up was carried out at 3 and 6 months. RESULTS The citalopram group experienced a significant improvement compared to the fluoxetine group in the MRS total score (p < 0.01), as well as in the psychological (p < 0.001) and somatic (p < 0.0001) domains at 3 and 6 months of follow-up. After 6 months of follow-up, the group that received citalopram decreased the relative risk (RR) to present VMS symptoms (RR = 0.30, CI 0.19-0.5, p = 0.0001), depressed mood (RR = 0.31, CI 0.15-0.6, p = 0.0002), irritability (RR = 0.40, CI 0.22-0.73, p = 0.002), anxiety (RR = 0.30, CI 0.13-0.69, p = 0.003), physical and mental exhaustion (RR = 0.35, CI 0.18-0.67, p = 0.001), sexual problems (RR = 0.18, CI 0.06-0.48, p = 0.0001), vaginal dryness (RR = 0.34, CI 0.14-0.80, p = 0.01), and urinary problems (RR = 0.36, CI 0.14-0.92, p = 0.043). CONCLUSION We conclude that citalopram tends to improve VSM and GSM symptoms in postmenopausal Mexican women. Thus, we recommend the daily use of citalopram 20 mg. However, further studies will be required to support the results of the present work. These should include a larger number of patients and a placebo group. CLINICAL TRIAL REGISTRATION This clinical trial was retrospectively registered by the United States National Library of Medicine in the www. CLINICALTRIALS gov database on 04/20/2022. The given test Registration Number is NCT05346445.
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Female Sexual Dysfunction. Clin Plast Surg 2022; 49:495-504. [DOI: 10.1016/j.cps.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Manwani B, Finger C, Lisabeth L. Strategies for Maintaining Brain Health: The Role of Stroke Risk Factors Unique to Elderly Women. Stroke 2022; 53:2662-2672. [PMID: 35652344 PMCID: PMC10911965 DOI: 10.1161/strokeaha.121.036894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke risk and prevalence increase with advanced age and women tend to be older than men at the time of their first stroke. Advanced age in women confers unique stroke risks that are beyond reproductive factors. Previous reviews and guidelines have largely focused on risk factors specific to women, with a predominant focus on reproductive factors and, therefore, younger to middle-aged women. This review aims to specifically describe stroke risk factors in elderly women, the population of women where the majority of strokes occur, with a focus on atrial fibrillation, hormone therapy, psychosocial risk factors, and cognitive impairment. Our review suggests that prevention and management of stroke risks that are unique or more prevalent in elderly women needs a coordinated system of care from general physicians, general neurologists, vascular and cognitive neurologists, psychologists, cardiologists, patients, and their caretakers. Early identification and management of the elderly woman-specific and traditional stroke risk factors is key for decreasing stroke burden in elderly women. Increased education among elderly women regarding stroke risk factors and their identification should be considered, and an update to the guidelines for prevention of stroke in women is strongly encouraged.
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Affiliation(s)
- Bharti Manwani
- Department of Neurology, University of Texas Health Science Center at Houston (B.M., C.F.)
| | - Carson Finger
- Department of Neurology, University of Texas Health Science Center at Houston (B.M., C.F.)
| | - Lynda Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor (L.L.)
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Zakari-Jiya A, Frazzoli C, Obasi CN, Babatunde BB, Patrick-Iwuanyanwu KC, Orisakwe OE. Pharmaceutical and personal care products as emerging environmental contaminants in Nigeria: A systematic review. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2022; 94:103914. [PMID: 35738461 DOI: 10.1016/j.etap.2022.103914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/26/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
The increasingly broad and massive use of pharmaceuticals (human, veterinary) and personal care products in industrially developing nations makes their uncontrolled environmental and ecological impact a true concern. Focusing on Nigeria, this systematic literature search (databases: PubMed, ScienceDirect, Google Scholar, EMBASE, Scopus, Cochrane library and African Journals Online) aims to increase visibility to the issue. Among 275 articles identified, 7 were included in this systematic review. Studies indicated the presence of 11 personal care products (15.94 %) and 58 pharmaceutical products (84.06 %) in surface and ground water, leachates, runoffs, sludge, and sediments. The 42.86% (3/7) of reviewed studies reported 17 analgesics; 71.42 % (5/7) reported 16 antibiotics; 28.57 % (2/7) reported 5 lipid lowering drugs; 28.57% reported anti-malaria and fungal drugs; 14.29 % (1/7) reported estrogen drugs. Different studies report on sunscreen products, hormone, phytosterol, insect repellent, and β1 receptor. Gemfibrozil (<4-730 ng/L), Triclosan (55.1-297.7 ng/L), Triclocarban (35.6-232.4 ng/L), Trimethoprim (<1-388 ng/L) and Tramadol (<2-883 ng/L) had the highest range of concentrations. Findings confirm the need of i) legislation for environmental monitoring, including biota, ii) toxicological profiling of new market products, and iii) sensitization on appropriate use and disposal of pharmaceuticals and personal care products.
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Affiliation(s)
- Aliyu Zakari-Jiya
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323 Port Harcourt, Choba, Nigeria
| | - Chiara Frazzoli
- Department of Cardiovascular and Endocrine-Metabolic Diseases, and Ageing, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy
| | - Cecilia Nwadiuto Obasi
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria
| | - Bolaji Bernard Babatunde
- Department of Animal and Environmental Biology, Faculty of Science, University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria
| | - Kingsley C Patrick-Iwuanyanwu
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323 Port Harcourt, Choba, Nigeria; Department of Biochemistry, Faculty of Science, University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria
| | - Orish E Orisakwe
- African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB, 5323 Port Harcourt, Choba, Nigeria; Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria.
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Kang S, Park YM, Kwon DJ, Chung YJ, Namkung J, Han K, Ko SH. Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus. Diabetes Metab J 2022; 46:578-591. [PMID: 35067011 PMCID: PMC9353572 DOI: 10.4093/dmj.2021.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated. METHODS This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models. RESULTS During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30-34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35-39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse. CONCLUSION Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.
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Affiliation(s)
- Soyeon Kang
- Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Moon Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dong Jin Kwon
- Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Jee Chung
- Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Namkung
- Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ruan X, Mueck AO. Primary choice of estrogen and progestogen as components for HRT: a clinical pharmacological view. Climacteric 2022; 25:443-452. [PMID: 35638518 DOI: 10.1080/13697137.2022.2073811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Prescribing hormone replacement therapy (HRT) requires consideration of the selection of its two components, the estrogen and the progestogen. In terms of the estrogen, the decision is mainly whether to use estradiol (E2) or conjugated equine estrogens (CEE). These are the components needed to efficiently treat climacteric symptoms or/and prevent osteoporosis, currently the only labeled indications. There is still controversy regarding the adequate dosages comparing E2 and CEE; however, the consensus is that the differences in the efficacy of E2 and CEE are not a real issue. Therefore, other criteria have to be used. The first reason to add the progestogen is to avoid the development of endometrial cancer (i.e. to achieve 'endometrial safety'). Any available 'fixed-combined' HRT preparation has to be tested for sufficient endometrial efficacy, because the first question the health authorities ask before product registration relates to endometrial safety. We can generally rely on the endometrial safety of these fixed-combined products. However, it could be that we want to use 'free' combinations, which are necessary if we use transdermal E2 (patches, gel, spray), but also to individualize schedules, for example when treating bleeding problems. The question here is how to attain knowledge about the endometrial efficacy of the different progestogens and how to monitor therapy. We will try to answer these two questions from a 'clinical pharmacology' point of view, as a discipline which preferably considers pharmacological properties, but also relating to clinical practice, to achieve individualized therapy with optimal efficacy, best tolerability and minimal risks.
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Affiliation(s)
- X Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.,Department of Women's Health, Research Centre for Women's Health and University Women's Hospital of Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - A O Mueck
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.,Department of Women's Health, Research Centre for Women's Health and University Women's Hospital of Tuebingen, University of Tuebingen, Tuebingen, Germany
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Khattak H, Gallos I, Coomarasamy A, Topping AE. Why are women considering ovarian tissue cryopreservation to preserve reproductive and hormonal ovarian function? A qualitative study protocol. BMJ Open 2022; 12:e051288. [PMID: 35418423 PMCID: PMC9013984 DOI: 10.1136/bmjopen-2021-051288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Current fertility preservation options available to women are oocyte cryopreservation (egg freezing) or embryo cryopreservation. A newer procedure, ovarian tissue cryopreservation (OTC), has become available in some centres, which offers another option for women and girls considering fertility preservation. These procedures are commonly offered to women about to undergo treatments for cancer. OTC involves removing sections of ovarian tissue and cryopreserving it for future reimplantation, often several years later. OTC offers girls and women who may become infertile with optionality and the possibility of pregnancy. OTC has potential for other applications, including restoring ovarian endocrine function beyond biological menopause. This is not without controversy but has led to some women considering undergoing the procedure for purposes of ovarian hormonal preservation (conservation of ovarian endocrine function). OTC is invasive, involves two surgical procedures with concomitant risks and can be costly. Understanding why women may consider and ultimately undergo OTC is timely, so that evidence-based and women-centred care can be provided. METHODS A pragmatic narrative qualitative design will be used. A purposive sample of women aged 18-45 who are considering, or have sought, OTC will be recruited over 1-year period. Potential participants will be approached via a clinic that offers OTC on a private basis or via social media. ANALYSIS Participant interviews will be audio and, if consented, video recorded. These will be conducted face-to-face or virtually. The recordings will be transcribed verbatim and analysed using a thematic analysis approach supported by NVivo software. ETHICS AND DISSEMINATION Ethical approval has been granted by the Institutional Ethical Review ERN_19-1578A. We expect to disseminate the findings of this study through journal articles, conference presentations and multimedia to public.
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Affiliation(s)
- Hajra Khattak
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Ioannis Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - A E Topping
- Institute of Clinical Sciences, School of Nursing, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
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Zouboulis CC, Blume-Peytavi U, Kosmadaki M, Roó E, Vexiau-Robert D, Kerob D, Goldstein SR. Skin, hair and beyond: the impact of menopause. Climacteric 2022; 25:434-442. [PMID: 35377827 DOI: 10.1080/13697137.2022.2050206] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The skin is an endocrine organ and a major target of hormones such as estrogens, androgens and cortisol. Besides vasomotor symptoms (VMS), skin and hair symptoms often receive less attention than other menopausal symptoms despite having a significant negative effect on quality of life. Skin and mucosal menopausal symptoms include dryness and pruritus, thinning and atrophy, wrinkles and sagging, poor wound healing and reduced vascularity, whereas skin premalignant and malignant lesions and skin aging signs are almost exclusively caused by environmental factors, especially solar radiation. Hair menopausal symptoms include reduced hair growth and density on the scalp (diffuse effluvium due to follicular rarefication and/or androgenetic alopecia of female pattern), altered hair quality and structure, and increased unwanted hair growth on facial areas. Hormone replacement therapy (HRT) is not indicated for skin and hair symptoms alone due to the risk-benefit balance, but wider potential benefits of HRT (beyond estrogen's effect on VMS, bone, breast, heart and blood vessels) to include skin, hair and mucosal benefits should be discussed with women so that they will be able to make the best possible informed decisions on how to prevent or manage their menopausal symptoms.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences, Brandenburg, Germany
| | - U Blume-Peytavi
- Department of Dermatology, Venerology and Allergology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | | | - E Roó
- Clider Clínica Dermatológica Roó, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - D Kerob
- Laboratoires Vichy, Levallois-Perret, France
| | - S R Goldstein
- School of Medicine, New York University Grossman, New York, NY, USA
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Ruan X, Mueck AO. Optimizing menopausal hormone therapy: for treatment and prevention, menstrual regulation, and reduction of possible risks. GLOBAL HEALTH JOURNAL 2022. [DOI: 10.1016/j.glohj.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Affiliation(s)
- Annette M Bourgault
- Annette Bourgault is Editor of Critical Care Nurse. She is an Associate Professor at the University of Central Florida in Orlando and a Nurse Scientist with Orlando Health. Dr Bourgault can be reached at
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Natari RB, Hollingworth SA, Clavarino AM, Dingle KD, McGuire TM. Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre. BMC WOMENS HEALTH 2021; 21:348. [PMID: 34607596 PMCID: PMC8491426 DOI: 10.1186/s12905-021-01478-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms. METHODS In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods. RESULTS There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation. CONCLUSIONS Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.
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Affiliation(s)
- Rifani B Natari
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.,Department of Pharmacy, Jambi Regional Psychiatric Hospital, Jambi, 36129, Indonesia
| | - Samantha A Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.
| | - Alexandra M Clavarino
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.,School of Public Health, University of Queensland, Herston, QLD, 4006, Australia
| | - Kaeleen D Dingle
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.,Mater Pharmacy, Mater Health, Brisbane, QLD, 4101, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia
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Richardson A, Watson L, Persic M, Phillips A. Safety of hormone replacement therapy in women with a history of cervical adenocarcinoma. Post Reprod Health 2021; 27:167-173. [PMID: 34255590 DOI: 10.1177/20533691211028518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Studies investigating the safety of hormone replacement therapy in cervical cancer have predominantly included patients with squamous disease. Pathological studies have identified estrogen receptor positivity in cervical adenocarcinomas. A recent small case-control study suggested a trend towards reduced survival with hormone replacement therapy in cervical adenocarcinomas. Our objective was to determine if hormone replacement therapy use in patients treated for cervical adenocarcinomas is detrimental to survival. STUDY DESIGN A retrospective review of all women under the age of 50 with stage 1B-2B cervical adenocarcinomas diagnosed between 1 November 2000 and 24 September 2019. Women were categorised into three groups: ovaries conserved (OVCON); or iatrogenic menopause with (IM-HRT) or without (IM-NOHRT) hormone replacement therapy. Hormone replacement therapy use was defined on an intention to treat basis. Statistical analysis was performed using Kaplan-Meier and Cox proportional hazards methods. MAIN OUTCOME MEASURES Overall (OS), disease specific (DSS) and progression free (PFS) survival. RESULTS A total of 58 women (mean age 38.5 ± 6.6) were included in the study of whom 25 (43.1%) had OVCON, 20 (34.4%) had IM-HRT and 13 (22.4%) had IM-NOHRT. No menopause-associated deaths occurred. Although five-year DSS was 73% in IM-NOHRT compared to 95% in IM-HRT and 95% in OVCON, these differences were not statistically significant. Five-year PFS was 68% in IM-NOHRT compared to 90% in IM-HRT and 81% in OVCON but again, these differences were not statistically significant. CONCLUSION In this small study, hormone replacement therapy does not appear to be detrimental to survival in cervical adenocarcinomas. There is a trend towards improved survival with hormone replacement therapy. Larger studies are required to substantiate these findings.
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Affiliation(s)
- A Richardson
- Department of Gynaecology, 4490University Hospitals of Leicester NHS Trust, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L Watson
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - M Persic
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - A Phillips
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Bovbjerg ML. Current Resources for Evidence-Based Practice, July 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:485-495. [PMID: 34147485 DOI: 10.1016/j.jogn.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of how fetal monitoring may lead to overuse of birth-related interventions, commentaries on reviews focused on bedsharing, and women's lifetime estrogen exposure and risk of cardiovascular mortality.
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Langer RD. The role of medications in successful aging. Climacteric 2021; 24:505-512. [PMID: 33977831 DOI: 10.1080/13697137.2021.1911991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Successful aging includes good health and low levels of disability. To that end, primary prevention is far better than managing subsequent organ damage. When medication is needed to prevent or manage disease, the preferred choice should be associated with the greatest benefits and fewest adverse effects. Cardiovascular diseases are the leading cause of morbidity and mortality in postmenopausal women worldwide. Considering disease-adjusted life years, other leading causes are chronic obstructive pulmonary disease, diabetes mellitus, dementias, hearing loss, cancers of the breast, lung and bowel, osteoporosis, fractures and falls, depression, osteoarthritis, refractive errors of the eye and non-diabetic chronic kidney disease. This review explores the global prevalence of these diseases in women aged 50 years and older, and medications commonly used for them, and contrasts the effects of menopausal hormone therapy (MHT) with others. When initiated early, there is good evidence for MHT benefit in all-cause mortality and primary prevention of cardiovascular disease, diabetes and osteoporosis; fair evidence for benefit in dementias, depression and osteoarthritis; limited evidence for benefit in chronic obstructive pulmonary disease, hearing loss, non-diabetic chronic kidney disease and colorectal cancer; null effects on lung cancer and refractive errors; and varied effects on breast cancer and stroke. Relative benefits and adverse effects of other medications warrant consideration.
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Affiliation(s)
- R D Langer
- Jackson Hole Center for Preventive Medicine, Jackson, WY, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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Vandenberg LN. Endocrine disrupting chemicals: strategies to protect present and future generations. Expert Rev Endocrinol Metab 2021; 16:135-146. [PMID: 33973826 DOI: 10.1080/17446651.2021.1917991] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022]
Abstract
Introduction: Endocrine-disrupting chemicals (EDCs) are chemicals that alter the actions of hormones. In the 21st Century, numerous expert groups of clinicians, scientists, and environmental activists have called for action to protect present and future generations from the harm induced by EDC exposures. These demands for regulatory responses come because of the strong weight of the evidence from epidemiology, wildlife, and controlled laboratory studies.Areas covered: In this review, we examine the conclusions drawn by experts from different scientific and medical disciplines. We also address several areas where recent findings or work has changed the landscape of EDC work including new approaches to identify and evaluate the evidence for EDCs using a key characteristics approach, the need to expand our understanding of vulnerable periods of development, and the increasing concern that traditional methods used to evaluate toxicity of environmental chemicals are insufficient for EDCs and how collaborative science could help to address these gaps.Expert opinion: The science is clear: there is more than enough evidence to demonstrate that EDCs affect the health of humans and wildlife. Waiting to act is a decision that puts the health of current and future generations at risk.
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Affiliation(s)
- Laura N Vandenberg
- School of Public Health & Health Sciences, Department of Environmental Health Sciences, University of Massachusetts, Amherst, MA USA
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