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Newman MS, Mayfield BP, Saltiel D, Stanczyk FZ. Assessing estrogen exposure from transdermal estradiol patch therapy using a dried urine collection and a GC-MS/MS assay. Steroids 2023; 189:109149. [PMID: 36414155 DOI: 10.1016/j.steroids.2022.109149] [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: 09/20/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transdermal estradiol patch therapy is often dosed based on patient reported symptoms. Although dosing based on serum estradiol concentrations has been considered, serum sampling is too invasive and inconvenient to use in real-world settings. The primary aim of this study was to determine if a dried urine assay could be used to assess estrogen exposure resulting from transdermal estradiol patch therapy at increasing doses. METHODS This was a retrospective analysis of clinical laboratory data. Urinary estrogen profiles of postmenopausal women being treated with transdermal estradiol patches at differing doses (age = 56.8 ± 7.5) were selected from the database along with the profiles of women on no therapy for comparison (age = 55.1 ± 9.5). Metabolite concentrations were obtained using a multi-spot dried urine collection and a gas chromatography-tandem mass spectrometry assay. The Jonckheere-Terpstra test was used to assess for ordered differences across dose groups to determine if dose-dependent increases in urinary estrogens occurred with increasing doses. RESULTS Median concentrations of estradiol and other estrogen metabolites increased with increasing doses of transdermal estradiol patch therapy (p < 0.001; Jonckheere-Terpstra test). For women who collected samples before and after initiating therapy, there were significant differences between before and after concentrations of estradiol and other estrogen metabolites. CONCLUSION This large study conducted using real-world data demonstrated that a dried urine assay offers a viable method of assessing estrogen exposure differences that occur with the use of differing doses of transdermal estradiol patches. Further studies with prospective designs that include outcome measures are needed to confirm the findings of this study.
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Affiliation(s)
- Mark S Newman
- Precision Analytical, Inc 3138 NE Rivergate St., Suite 301C, McMinnville, OR 97128, USA
| | - Bryan P Mayfield
- Precision Analytical, Inc 3138 NE Rivergate St., Suite 301C, McMinnville, OR 97128, USA; Department of Pharmacy Practice, Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy, 5920 Forest Park Road, Dallas, TX 75235, USA.
| | - Doreen Saltiel
- Precision Analytical, Inc 3138 NE Rivergate St., Suite 301C, McMinnville, OR 97128, USA
| | - Frank Z Stanczyk
- Departments of Obstetrics and Gynecology, and Population and Public Health Sciences, University of Southern California, LRB 1321 N. Mission Road, Los Angeles, CA, USA
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Alpert AB, Scout NFN, Schabath MB, Adams S, Obedin-Maliver J, Safer JD. Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology. Am Soc Clin Oncol Educ Book 2022; 42:1-17. [PMID: 35658501 DOI: 10.1200/edbk_350175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.
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Affiliation(s)
- Ash B Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - N F N Scout
- National LGBT Cancer Network, Providence, RI
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Spencer Adams
- School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, MI
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY.,Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
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Dixit A, Carden N, Stephens E, Chadwick M, Tamblyn J, Robinson L. Hormone replacement therapy subcutaneous implants for refractory menopause symptoms; the patient's perspective. Post Reprod Health 2022; 28:79-91. [PMID: 35599571 DOI: 10.1177/20533691221097042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE For women with menopause symptoms refractory to standard hormone replacement therapy (HRT) preparations, HRT implants offer an alternative. The primary objective of this study was to evaluate women's perceptions regarding efficacy, tolerability, satisfaction and safety of implant therapy. STUDY DESIGN A single centre service evaluation study performed at Birmingham Women's & Children's Foundation Hospital Trust. An anonymised semi-structured survey link was posted to all women (n = 397) recorded to have received HRT implant(s) at a tertiary Menopause clinic (May 1982 and Dec 2018). Women attending clinic (June 2020 to Sept 2020) were opportunistically invited to complete a written version of the survey. MAIN OUTCOME MEASURES Data collected included demographics, medical and surgical history, therapy duration, type, indication and complications. Climacteric symptoms were assessed using the Greene Climacteric Scale. RESULTS Data was obtained for 119 women. The written survey yielded higher response rates (n = 73, 61.3%). Most respondents were 51-60 years old (n = 51 42.9%) and 87.4% (n = 104) were 'White British'. 70 women used estradiol only implants. 30.1%% (n = 34) of patients reported a low Greene Climacteric Scale score (0-5). Subgroup analysis showed prevalence of sexual dysfunction and vasomotor symptoms across ages. There was a lower prevalence of psychological symptoms amongst ≥51 year olds. High satisfaction rates were reported. CONCLUSIONS Data from a large cohort is presented. Good symptom control, satisfaction and long-term efficacy was demonstrated. This study supports the value of HRT implants for refractory menopause symptoms. A national database of implant users would be a useful tool to record satisfaction scores and adverse events.
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Affiliation(s)
- Anushka Dixit
- College of Medical and Dental Sciences, 150183University of Birmingham, Birmingham, UK
- 2379Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Nikkita Carden
- Specialist Menopause Service, 1729Birmingham Women's & Children's Foundation Hospital Trust, Birmingham, UK
| | - Elaine Stephens
- Specialist Menopause Service, 1729Birmingham Women's & Children's Foundation Hospital Trust, Birmingham, UK
| | - Mark Chadwick
- Specialist Menopause Service, 1729Birmingham Women's & Children's Foundation Hospital Trust, Birmingham, UK
| | - Jennifer Tamblyn
- Specialist Menopause Service, 1729Birmingham Women's & Children's Foundation Hospital Trust, Birmingham, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, 150183University of Birmingham, Birmingham, UK
- Seacroft Hospital, 1729Leeds Teaching Hospitals NHS Trust, Seacroft, Leeds
| | - Lynne Robinson
- Specialist Menopause Service, 1729Birmingham Women's & Children's Foundation Hospital Trust, Birmingham, UK
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Yoon BK, Sung J, Song YM, Kim SM, Son KA, Yoo JH, Park SJ, Kim DK. Effects of menopausal hormone therapy on ambulatory blood pressure and arterial stiffness in postmenopausal Korean women with grade 1 hypertension: a randomized, placebo-controlled trial. Clin Hypertens 2021; 27:18. [PMID: 34521477 PMCID: PMC8442403 DOI: 10.1186/s40885-021-00175-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 06/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background Estrogen therapy in early menopausal women decreases the risk of coronary heart disease and parenteral, but not oral, estrogen is reported to reduce blood pressure (BP). Progestogens are typically added to estrogens to prevent unopposed endometrial stimulation. The effects of progestogen on BP have been less well studied to date. This study was conducted to explore the impacts of micronized progesterone (MP4) combined with percutaneous estradiol gel (PEG) on hemodynamics in postmenopausal Korean women with grade 1 hypertension. Methods Fifty-two postmenopausal women (aged 49–75 years) with systolic BP (SBP) of 140–160 mmHg or diastolic BP (DBP) of 90–100 mmHg were randomly assigned for 12 weeks to placebo (n = 16), estrogen therapy (ET) (n = 19) with PEG (0.1 %, 1 g./d), or estrogen + progestogen therapy (EPT, n = 17) with PEG and MP4 (100 mg/d). The primary endpoint was ambulatory BP and the secondary endpoints were arterial stiffness as brachial–ankle pulse-wave velocity (baPWV) and aortic parameters on applanation tonometry. Results One woman in the ET group dropped out, so 51 participants were finally analyzed. Outcome measures for ambulatory BP and arterial stiffness were not different between groups. Within-group comparisons showed that EPT significantly decreased daytime heart rate and baPWV: the changes from baseline (mean ± standard deviation) were − 2.5 ± 5.7 bpm (P = 0.03) and − 0.6 ± 1.4 m/s (P = 0.04), respectively. After adjusting for baseline, linear regression analysis revealed a significant difference in the relationship between baseline and 12-week baPWV among groups (P = 0.02). The relationship was significantly different between placebo and ET (P = 0.03) and EPT (P = 0.01), respectively, but not between ET and EPT. Additionally, pooled results of active treatments disclosed that SBP, DBP, PWV, and augmentation index at the aorta were significantly reduced relative to baseline. Conclusions There was no difference in ambulatory BP between ET and EPT in postmenopausal Korean women with grade 1 hypertension. Further, ET and EPT similarly decreased baPWV from baseline as compared with placebo. MP4 might not adversely influence estrogen effects on ambulatory BP and arterial stiffness. Trial registration Clinical Research Information Registry, KCT0005405, Registered 22 September 2020 - Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do?all_type=Y&search_page=L&pageSize=10&page=1&seq=17608&search_lang=E. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00175-1.
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Affiliation(s)
- Byung-Koo Yoon
- Department of Obstetrics, Gynecology, and Women's Health, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jidong Sung
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Min Kim
- Department of Obstetrics, Gynecology, and Women's Health, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-A Son
- Department of Obstetrics, Gynecology, and Women's Health, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Hyun Yoo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk-Kyung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Park CW, Lim SJ, Moon YW, Choi SH, Shin MH, Min YK, Yoon BK, Park YS. Fracture recurrence in hip fracture with menopausal hormone therapy versus risedronate: a clinical trial. Climacteric 2021; 24:408-414. [PMID: 34240673 DOI: 10.1080/13697137.2021.1915271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES An open-label, randomized trial was conducted to examine the effects of risedronate versus menopausal hormone therapy (MHT) in postmenopausal women with recent hip fracture. METHODS Among 1165 eligible women, 281 were recruited and randomly assigned to receive oral risedronate (35 mg/week) or percutaneous estradiol gel (1.5 mg/day) plus oral micronized progesterone (100 mg/day) for 4 years. The primary end point was recurrent fracture and the secondary end points were mortality and bone mineral density (BMD). RESULTS Kaplan-Meier analyses showed no significant differences in fracture recurrence and mortality between the two groups. The incidence of any new fracture per 100 person-years (PY) was 8.63 in the risedronate group and 12.86 in the MHT group (p = 0.180); that of clinical fracture was 4.75 and 6.99, respectively (p = 0.265); and that of asymptomatic vertebral fracture was 4.87 and 5.58, respectively (p = 0.764). The respective incidence of death per 100 PY was 3.58 and 4.40 (p = 0.503). BMD increased comparably at the lumbar spine in both groups. BMD at the total hip did not change in the risedronate group, but increased significantly by 2.8% in the MHT group. CONCLUSIONS MHT might not differ from risedronate in the prevention of secondary fractures and death among postmenopausal women with recent hip fracture.
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Affiliation(s)
- C-W Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S-J Lim
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-W Moon
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S-H Choi
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M-H Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-K Min
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - B-K Yoon
- Department of Obstetrics, Gynecology and Women's Health, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-S Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim YJ, Soto M, Branigan GL, Rodgers K, Brinton RD. Association between menopausal hormone therapy and risk of neurodegenerative diseases: Implications for precision hormone therapy. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12174. [PMID: 34027024 PMCID: PMC8118114 DOI: 10.1002/trc2.12174] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/18/2021] [Accepted: 03/12/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The impact of menopausal hormone therapy (HT) on age-associated Alzheimer's and neurodegenerative diseases (NDDs) remains unresolved. To determine the effect of HT, formulation, type, and duration on risk of NDDs, a retrospective analysis was performed using a 10-year Humana claims dataset. METHODS Study population included women aged 45 years or older with or without claim records of HT medications. Patients diagnosed with NDDs including Alzheimer's disease (AD), Parkinson's disease (PD), dementia, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS) were identified. Relative risk (RR) ratios and 95% confidence intervals (CI) for combined NDDs, or AD, PD, dementia, MS, and ALS were determined. Cumulative hazard ratios were determined to investigate the association between HT and NDDs at different age groups. RESULTS In 379,352 women with or without claim records of HT, use of HT was associated with significantly reduced risk for combined NDDs (RR 0.42, 95% CI 0.40-0.43, P < 0.001). Average follow-up time was 5.1 [2.3] years. Formulations containing natural steroids 17β-estradiol and/or progesterone were associated with greater reduction in NDD risk. Oral- HT users showed significantly reduced RRs (0.42, 0.41-0.44, P < 0.001) for combined NDDs compared to non-HT users. The RRs for transdermal-HT users were significantly decreased for all-cause dementia (0.73, 0.60-0.88, P = 0.001) and MS (0.55, 0.36-0.84, P = 0.005). Greatest reduction in risk of NDD, AD, and dementia emerged in patients aged 65 years or older. Further, the protective effect of long-term therapy (>1 year) on combined NDDs, AD, PD, and dementia was greater compared to short-term therapy (≤1 year). DISCUSSION HT was associated with reduced risk of all NDDs including AD and dementia, with greater duration of therapy and natural steroid formulations associated with greater efficacy. These findings advance precision HT to prevent NDDs including AD.
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Affiliation(s)
- Yu Jin Kim
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
| | - Maira Soto
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- College of Medicine, Department of PharmacologyUniversity of ArizonaTucsonArizonaUSA
| | - Gregory L Branigan
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- College of Medicine, Department of PharmacologyUniversity of ArizonaTucsonArizonaUSA
- College of MedicineMD‐PhD Training ProgramUniversity of ArizonaTucsonArizonaUSA
| | - Kathleen Rodgers
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- College of Medicine, Department of PharmacologyUniversity of ArizonaTucsonArizonaUSA
| | - Roberta Diaz Brinton
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- College of Medicine, Department of PharmacologyUniversity of ArizonaTucsonArizonaUSA
- College of Medicine, Department of NeurologyUniversity of ArizonaTucsonArizonaUSA
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Clinical impact of estradiol/testosterone ratio in patients with acute ischemic stroke. BMC Neurol 2021; 21:91. [PMID: 33632142 PMCID: PMC7908649 DOI: 10.1186/s12883-021-02116-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/19/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS). METHODS Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients. RESULTS The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003). CONCLUSIONS These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.
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Abstract
With the growing number of transgender and gender-nonbinary individuals who are becoming visible, it is clear that there is a need to develop a rigorous evidence base to inform care practice. Transgender health research is often limited to HIV/AIDS or mental health research and is typically subsumed in larger studies with general LGBTQ focus. Although the number of knowledgeable health care providers remains modest, the model for the medical approach to transgender health is shifting owing to growing social awareness and an appreciation of a biological component. Gender-affirming medicine facilitates aligning the body of the transgender person with the gender identity; typical treatment regimens include hormone therapy and/or surgical interventions. While broadly safe, hormone treatments require some monitoring for safety. Exogenous estrogens are associated with a dose-dependent increase in venous thromboembolic risk, and androgens stimulate erythropoiesis. The degree to which progressing gender-affirming hormone treatment changes cancer risk, cardiac heart disease risk, and/or bone health remains unknown. Guidelines referencing the potential exacerbation of cancer, heart disease, or other disease risk often rely on physiology models, because conclusive clinical data do not exist. Dedicated research infrastructure and funding are needed to address the knowledge gap in the field.
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Yare K, Woodward M. Hormone Therapy and Effects on Sporadic Alzheimer’s Disease in Postmenopausal Women: Importance of Nomenclature. J Alzheimers Dis 2020; 73:23-37. [DOI: 10.3233/jad-190896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Katrine Yare
- Austin Health, Heidelberg Repatriation Hospital, Victoria, Australia
| | - Michael Woodward
- Austin Health, Heidelberg Repatriation Hospital, Victoria, Australia
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10
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Boskey ER, Taghinia AH, Ganor O. Association of Surgical Risk With Exogenous Hormone Use in Transgender Patients: A Systematic Review. JAMA Surg 2019; 154:159-169. [PMID: 30516808 DOI: 10.1001/jamasurg.2018.4598] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance A growing number of transgender patients are receiving gender-affirming hormone treatments. It is unclear whether the evidence supports the current practice of routinely discontinuing these hormones prior to surgery. Objective To determine how medications used in cross-sex hormone treatment (CSHT) affect perioperative risk. Evidence Review A series of searches were carried out in PubMed and Excerpta Medica Database to identify articles using each of the terms testosterone, estrogen, estradiol, oral contraceptive, spironolactone, cyproterone acetate, finasteride, dutasteride, leuprolide, goserelin, and histrelin, in combination with the terms surgery, perioperative, thrombosis, thromboembolism, and operative. The search was not restricted to perioperative outcomes in transgender populations because many surgeons routinely discontinue hormone use prior to surgery in this population, which makes it impossible to study how hormones affect outcomes. Additional sources were also identified from the texts of reviewed articles. Articles were excluded if they were animal studies or case reports, did not explicitly discuss surgical outcomes, or were restricted to removal of hormonally sensitive tissues. Findings Eighteen articles addressing perioperative outcomes were identified by this systematic review, including 1 on CSHT, 12 on estrogens and progesterones, 1 on testosterone, and 4 on spironolactone and antiandrogens. Data were limited, but use of exogenous testosterone was not found to be associated with an increased risk of venous thromboembolism or other complications during surgery. Moderate evidence suggests that spironolactone is not associated with negative surgical outcomes. The data linking estrogen use and thrombosis is inconsistent in the perioperative period and does not address the types of estrogens most often used for CSHT. Conclusions and Relevance Current evidence does not support routine discontinuation of all CSHT prior to surgery, particularly given the lack of information on risks associated with resuming these medications after they have been stopped. Evidence suggests there is no need to discontinue either testosterone or spironolactone, although their association with perioperative outcome quality has not been studied in depth. Most of the evidence that supports discontinuation of estrogen prior to surgery is based on oral estrogen regimens that are not typically used in transgender patients, and even with those formulations, there are conflicting reports on perioperative risk. Further research is needed to determine the safety of continuing hormone treatment and elucidate risks of short-term discontinuation.
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Affiliation(s)
- Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Amir H Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
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Kim T, Chelluboina B, Chokkalla AK, Vemuganti R. Age and sex differences in the pathophysiology of acute CNS injury. Neurochem Int 2019; 127:22-28. [PMID: 30654116 PMCID: PMC6579702 DOI: 10.1016/j.neuint.2019.01.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/11/2019] [Indexed: 12/21/2022]
Abstract
Despite the immeasurable burden on patients and families, no effective therapies to protect the CNS after an acute injury are available yet. Furthermore, the underlying mechanisms that promote neuronal death and functional deficits after injury remain to be poorly understood. The prevalence, age of onset, pathophysiology, and symptomatology of many CNS insults differ significantly between males and females. In the case of stroke, younger males tend to show a higher risk than younger females, while this trend reverses with age. Accumulating evidence from preclinical studies have shown that sex hormones play a crucial role in providing neuroprotection following ischemic stroke and other acute CNS injuries. Estrogen, in particular, exerts a neuroprotective effect by modulating the immune responses after injury. In addition, there exists a sexual dimorphism in cell death pathways between males and females that are independent of hormones. Meanwhile, recent studies suggest that microRNAs are critically involved in the sex-specific mechanisms of cell death. This review discusses the current knowledge on the contribution of sex and age to outcome after stroke. Implication of the interplay between these two factors on other CNS injuries (spinal cord injury and traumatic brain injury) from the experimental evidence were also discussed.
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Affiliation(s)
- TaeHee Kim
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Anil K Chokkalla
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; Cellular and Molecular Pathology Program, University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; Cellular and Molecular Pathology Program, University of Wisconsin, Madison, WI, USA; William S. Middleton Veterans Administration Hospital, Madison, WI, USA.
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No Author. Chapitre 1 : Évaluation et gestion des risques chez les femmes ménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S36-S48. [DOI: 10.1016/j.jogc.2019.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Because clinical trial data assessing more than 10 years of hormone therapy (HT) use are not available, providing guidance to menopausal women regarding duration of systemic HT is controversial. However, clinicians routinely encounter this issue in practice. Using available evidence and clinical experience, this chapter provides guidance for clinicians who care for patients who may be candidates for extended use of systemic HT.
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Gonzalez J, Bryant S, Hermes-DeSantis ER. Transdermal estradiol for the management of refractory uremic bleeding. Am J Health Syst Pharm 2019; 75:e177-e183. [PMID: 29691259 DOI: 10.2146/ajhp170241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The efficacy and thrombogenicity of transdermal estradiol in the management of refractory uremic bleeding in adults are examined. SUMMARY Platelet dysfunction from chronic kidney disease may induce uremic bleeding. This type of bleeding may involve the skin, oral and nasal mucosa, gingivae, respiratory system, and gastrointestinal or urinary tract. While the mainstay of treatment for uremic bleeding primarily involves dialysis and use of prohemostatic agents such as desmopressin and erythropoiesis-stimulating agents, certain patients may experience bleeding refractory to these interventions. In this clinical scenario, a weak conditional recommendation (grade 2C) supporting transdermal estradiol as a therapy of last resort exists. Limited data suggest that transdermal estradiol may reduce bleeding time and transfusion requirements in dialysis patients with recurrent episodes of hematochezia, gastrointestinal telangiectasia, and hematomas. The management of uremic bleeding will require long-term therapy, and case reports have documented the safe use of transdermal estradiol for up to 25 months. Oral conjugated estrogens increase the risk of deep vein thrombosis in women; however, the transdermal route of administration has been associated with a lower incidence of venous thromboembolism and stroke relative to oral estrogen and, in some studies, its associated risk of thrombosis is not significantly different when compared with placebo. CONCLUSION Patients who are refractory to routine interventions for uremic bleeding may benefit from transdermal estrogen despite the limited data. Extended therapy with low-dose transdermal estrogen (≤50 μg daily) may provide a hemostatic benefit that outweighs thrombotic risk.
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Affiliation(s)
- Jimmy Gonzalez
- Western New England University, College of Pharmacy and Health Sciences, Springfield, MA .,Cooley Dickinson Hospital, Northampton, MA
| | - Samantha Bryant
- Division of Drug Information, Food and Drug Administration, Silver Spring, MD
| | - Evelyn R Hermes-DeSantis
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ.,Robert Wood Johnson University Hospital, New Brunswick, NJ
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Thaung Zaw JJ, Howe PRC, Wong RHX. Postmenopausal health interventions: Time to move on from the Women's Health Initiative? Ageing Res Rev 2018; 48:79-86. [PMID: 30355506 DOI: 10.1016/j.arr.2018.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/25/2018] [Accepted: 10/17/2018] [Indexed: 11/15/2022]
Abstract
Menopause is a critical period during which, without timely interventions, increased risks of cardiovascular and metabolic diseases, osteoporosis, sexual dysfunction and premature cognitive decline will contribute to diminished quality-of-life in women. Hormone therapy (HT) used to be the standard of care for managing vasomotor symptoms and prevention of chronic diseases until publication of the Women's Health Initiative (WHI) in 2002. Concerned about risks highlighted in WHI publications, many symptomatic women promptly ceased HT which resulted in increased vasomotor symptoms, osteoporosis-related-fractures and insomnia. Data from post-hoc WHI analyses and newer clinical trials consistently show reductions in coronary heart disease and mortality when estrogen therapy is initiated soon after menopause, whereas administration in later years and/or in combination with progesterone carries increased risks. However, no validated primary preventive strategies are available for younger postmenopausal women (<60 years), highlighting the need to re-evaluate the use of estrogen alone for which the risk-benefit balance appears positive. In contrast, in older women (>60 years), risks associated with oral HT exceed benefits; however transdermal estrogen may offer a safer alternative and should be further evaluated. Alternative therapies such as phytoestrogens and non-hormonal prescriptions may be beneficial for older women or those who are unsuitable for HT. Long-term head-to-head comparisons of HT with alternative interventions are warranted to confirm their efficacy for chronic disease prevention.
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Affiliation(s)
- Jay Jay Thaung Zaw
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, 2308, Australia; University of Southern Queensland, Institute for Resilient Regions, Springfield Central, Queensland, 4300, Australia
| | - Rachel Heloise Xiwen Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, 2308, Australia; University of Southern Queensland, Institute for Resilient Regions, Springfield Central, Queensland, 4300, Australia.
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16
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Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis. Thromb Res 2018; 168:83-95. [DOI: 10.1016/j.thromres.2018.06.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/22/2018] [Accepted: 06/16/2018] [Indexed: 11/19/2022]
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Beyer-Westendorf J, Bauersachs R, Hach-Wunderle V, Zotz RB, Rott H. Sex hormones and venous thromboembolism - from contraception to hormone replacement therapy. VASA 2018; 47:441-450. [PMID: 30008249 DOI: 10.1024/0301-1526/a000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The use of sex hormones such as combined oral contraceptives (COC) or hormone replacement therapy (HRT) increases the risk for venous thromboembolism (VTE) considerably, especially in patients with an increased intrinsic risk for thromboembolic complications. Despite public and media attention and increasing scientific evidence, prescription patterns seem to be hard to change. It is well recognized that the patient's baseline risk is the most relevant factor in the absolute risk for developing VTE. The relative risk increase associated with sex hormones, depends on the type and dosage of hormones, the route of application (oral, vaginal, transdermal), and for COC, on the specific combination of oestrogen and gestagen components. Consequently, a careful decision for or against any specific type of hormone treatment needs to be based on an assessment of the patient's risk profile (disposition) as well as on the treatment-associated risks and benefits (exposition). This review discusses the most common sex hormone treatments in contraception and HRT, the relevance for VTE risk patients, and strategies to counsel patients with regard to hormone use according to their risk profiles. Keywords: Oral contraceptives, hormonal contraception, hormone replacement therapy, venous thromboembolism.
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Affiliation(s)
- Jan Beyer-Westendorf
- 1 Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.,2 Kings Thrombosis Service, Department of Hematology, Kings College London, UK
| | | | | | - Rainer B Zotz
- 5 Institute for Laboratory Medicine, Blood Coagulation and Transfusion Medicine (LBT), Düsseldorf, Germany.,6 Department of Haemostasis, Haemotherapy and Transfusion Medicine, Heinrich Heine University Medical Centre, Düsseldorf, Germany
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18
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Groenewoud ER, Cohlen BJ, Macklon NS. Programming the endometrium for deferred transfer of cryopreserved embryos: hormone replacement versus modified natural cycles. Fertil Steril 2018; 109:768-774. [DOI: 10.1016/j.fertnstert.2018.02.135] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 12/01/2022]
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Abstract
Menopause predisposes women to osteoporosis due to declining estrogen levels. This results in a decrease in bone mineral density (BMD) and an increase in fractures. Osteoporotic fractures lead to substantial morbidity and mortality, and are considered one of the largest public health priorities by the World Health Organization (WHO). It is therefore essential for menopausal women to receive appropriate guidance for the prevention and management of osteoporosis. The Women's Health Initiative (WHI) randomized controlled trial first proved hormonal therapy (HT) reduces the incidence of all osteoporosis-related fractures in postmenopausal women. However, the study concluded that the adverse effects outweighed the potential benefits on bone, leading to a significant decrease in HT use for menopausal symptoms. Additionally, HT was not used as first-line therapy for osteoporosis and fractures. Subsequent studies have challenged these initial conclusions and have shown significant efficacy of HT in various doses, durations, regimens, and routes of administration. These studies support that HT improves BMD and reduces fracture risk in women with and without osteoporosis. Furthermore, the studies suggest that low-dose and transdermal HT are less likely associated with the adverse effects of breast cancer, endometrial hyperplasia, coronary artery disease (CAD), and venous thromboembolism (VTE) previously observed in standard-dose oral HT regimens. Given the need for estrogen in menopausal women and evidence supporting the cost effectiveness, safety, and efficacy of HT, we propose that HT should be considered for the primary prevention and treatment of osteoporosis in appropriate candidates. HT should be individualized and the once "lowest dose for shortest period of time" concept should no longer be used. This review will focus on the prior and current studies for various HT formulations used for the prevention and treatment of osteoporosis, exploring the safety profile of low-dose and transdermal HT that have been shown to be safer than oral standard-dose HT.
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Affiliation(s)
- V A Levin
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, USA
| | - X Jiang
- Department of ObGyn, The Reading Hospital of Tower Health, Reading, PA, USA
- Department of ObGyn, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - R Kagan
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco, CA, USA.
- Sutter East Bay Medical Foundation, 2500 Milvia Street, Berkeley, CA, 94704, USA.
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Scarabin PY. Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis. Climacteric 2018; 21:341-345. [PMID: 29570359 DOI: 10.1080/13697137.2018.1446931] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Postmenopausal hormone therapy (HT) is a modifiable risk factor for venous thromboembolism (VTE). While the route of estrogen administration is now well recognized as an important determinant of VTE risk, there is also increasing evidence that progestogens may modulate the estrogen-related VTE risk. This review updates previous meta-analyses of VTE risk in HT users, focusing on the route of estrogen administration, hormonal regimen and progestogen type. Among women using estrogen-only preparations, oral but not transdermal preparations increased VTE risk (relative risk (RR) 1.48, 95% confidence interval (CI) 1.39-1.58; RR 0.97, 95% CI 0.87-1.09, respectively). In women using opposed estrogen, results were highly heterogeneous due to important differences between the molecules of progestogen. In transdermal estrogen users, there was no change in VTE risk in women using micronized progesterone (RR 0.93, 95% CI 0.65-1.33), whereas norpregnane derivatives were associated with increased VTE risk (RR 2.42, 95% CI 1.84-3.18). Among women using opposed oral estrogen, there was higher VTE risk in women using medroxyprogesterone acetate (RR 2.77, 95% CI 2.33-3.30) than in those using other progestins. These clinical findings, together with consistent biological data, emphasize the safety advantage of transdermal estrogen combined with progesterone and support the current evidence-based recommendations on HT, especially in women at high VTE risk.
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Affiliation(s)
- P-Y Scarabin
- a Université Paris-Saclay, Université Paris-Sud, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations , INSERM UMRS1018 Villejuif , France
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21
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Venous thromboembolism and cardiovascular disease complications in menopausal women using transdermal versus oral estrogen therapy. Menopause 2018; 23:600-10. [PMID: 26953655 DOI: 10.1097/gme.0000000000000590] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the risk of venous thromboembolism (VTE) and cardiovascular disease (CVD) complications, and assess healthcare costs in menopausal women using an estradiol transdermal system versus oral estrogen therapy (ET). METHODS Health insurance claims from 60 self-insured US companies from 1999 to 2011 were analyzed. Women at least 50 years of age, newly initiated on transdermal or oral ET, were included. Cohorts were matched 1:1 based on exact factors and propensity score-matching methods. The incidence rate ratios (IRRs) of CVD complications, as well as VTE and other CVD events separately, were assessed through conditional Poisson models. Cohorts were also compared for healthcare costs using linear regression models to assess per-patient per-month cost differences. Confidence intervals (CIs) and P values were determined using a nonparametric method for cost outcomes. RESULTS From each cohort, 2,551 users were matched to form the study population. A total of 274 transdermal ET users developed CVD complications compared with 316 women in the oral ET cohort (adjusted IRR 0.81; 95% CI, 0.67-0.99). Transdermal ET users also incurred lower adjusted all-cause and VTE/CVD-related healthcare costs relative to oral ET users (all-cause per-patient per-month cost difference [95% CI] = $41 [-34; 137], P = 0.342). CONCLUSIONS This large matched-cohort study based on real-world data suggests that women receiving transdermal ET have significantly lower incidences of CVD events compared with those receiving oral ET, and that they also incur lower healthcare costs.
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Crandall CJ, Hovey KM, Andrews C, Cauley JA, Stefanick M, Shufelt C, Prentice RL, Kaunitz AM, Eaton C, Wactawski-Wende J, Manson JE. Comparison of clinical outcomes among users of oral and transdermal estrogen therapy in the Women's Health Initiative Observational Study. Menopause 2017; 24:1145-1153. [PMID: 28697036 PMCID: PMC5607093 DOI: 10.1097/gme.0000000000000899] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine associations of estrogen preparations with an index of health risks versus benefits. METHODS Using data from 45,112 participants of the Women's Health Initiative Observational Study (average follow-up 5.5 years), we examined associations of estrogen type and oral conjugated equine estrogen (CEE) dose with time to first global index event (GIE), defined as coronary heart disease, breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, or death. RESULTS Oral CEE less than 0.625 mg/d + progestogen (P) users had a lower risk of a GIE (adjusted hazard ratio 0.74, 95% confidence interval 0.56-0.97) than oral CEE 0.625 mg/d + P users. GIE risk in oral CEE 0.625 mg/d + P users was greater with at least 5-year use (adjusted hazard ratio 1.22, 95% confidence interval 1.06-1.41) than with less than 5-year use. In women with prior hysterectomy, compared with women taking oral CEE 0.625 mg/d for less than 5 years, GIE risk was similar with oral CEE below 0.625 mg/d, oral estradiol (E2), and transdermal E2, whether used for less than 5 years or for at least 5 years. There was no difference in GIE risk between users of the following: oral CEE + P versus oral E2 + P; oral CEE + P versus transdermal E2 + P; oral E2 + P versus transdermal E2 + P. Findings were similar among women with hysterectomy taking estrogen alone. CONCLUSIONS The summary index of risks versus benefits was similar for oral CEE versus oral or transdermal E2-containing regimens. CEE + P containing less than 0.625 mg/d of CEE (vs 0.625 mg/d) for less than 5 years appeared safer.
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Affiliation(s)
- Carolyn J Crandall
- 1Department of Medicine, University of California, Los Angeles, Los Angeles, CA 2Dept of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, NY 3Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 5Department of Medicine, Stanford University School of Medicine, Stanford, CA 6Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 7Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 8Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 9Department of Family Medicine and Epidemiology, Brown University Warren Alpert Medical School and School of Public Health, Pawtucket, RI 10Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY 11Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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The time has come for a safe, effective way to relieve menopausal symptoms. Menopause 2017; 24:1113-1115. [DOI: 10.1097/gme.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE Hormone therapy (HT) alleviates menopausal symptoms, but there is a lack of consensus regarding its use among premenopausal ovarian cancer survivors. METHODS We systematically reviewed the literature and searched the Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), and Cochrane Central Register of Controlled Trials CENTRAL (1999-2014) databases and the reference lists of electronically retrieved studies. Statistical meta-analysis was performed using RevMan 5.1 software. RESULTS Six studies were included in our systematic review, which involved 1,521 women. Among them, 451 women (29.6%) received HT, whereas the remaining 1,070 women (70.4%) did not receive any treatment. We noticed a statistically significant reduction of ovarian cancer-related deaths among women who received HT (odds ratio, 0.47; 95% CI, 0.28-0.80); however, disease recurrence rates did not differ between the two groups (odds ratio, 0.71; 95% CI, 0.45-1.14). Studies included in the present systematic review did not report a significant difference in overall survival and disease-free survival rates among women receiving HT and controls. CONCLUSIONS Based on the results of meta-analysis, HT does not influence the odds of ovarian cancer recurrence; however, this conclusion must be confirmed separately because of significant limitations in the methodological quality of the studies included.
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Ganderton C, Semciw A, Cook J, Pizzari T. Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial. BMC Womens Health 2016; 16:32. [PMID: 27312538 PMCID: PMC4910216 DOI: 10.1186/s12905-016-0311-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 06/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is pathology in the gluteus medius and minimus tendons and trochanteric bursa that causes debilitating tendon pain and dysfunction, particularly in post-menopausal women. Limited evidence in clinical studies suggests hormone changes after menopause may have a negative effect on tendon. This protocol describes a randomised controlled trial comparing the effectiveness of menopausal hormone therapy (MHT) and exercise therapy in reducing pain and dysfunction associated with GTPS in post-menopausal women. METHOD One hundred and sixteen post-menopausal women will be recruited and randomised to receive one of two exercise programs (sham or targeted intervention exercise) and transdermal creams (MHT cream containing oestradiol 50mcg and norethisterone acetate 140mcg or placebo cream). Interventions will be 12-weeks in duration and outcomes will be examined at baseline, 12-weeks and 52-weeks. The primary outcome measure will be the VISA-G questionnaire and secondary outcomes measures will include three hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, Lateral Hip Pain questionnaire), a global change in symptom questionnaire (using a 15-point Likert scale) and a quality of life measure (AQoL-8D questionnaire). Data will be analysed using the intention to treat principle. DISCUSSION This study is the first randomised controlled trial to compare the effectiveness of menopausal hormone therapy therapy alone, and with the combination of exercise therapy, to treat pain and dysfunction associated with GTPS. This study has been pragmatically designed to ensure that the interventions in this study can be integrated into policy and clinical practice if found to be effective in the treatment of GTPS in post-menopausal women. If successful, there is potential for this treatment regimen to be explored in future studies of other persistent tendon conditions in the post-menopausal population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001157662 Registered 31 October 2014.
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Affiliation(s)
- Charlotte Ganderton
- />School of Allied Health (Physiotherapy), College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
| | - Adam Semciw
- />School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072 Australia
| | - Jill Cook
- />School of Allied Health (Physiotherapy), College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
| | - Tania Pizzari
- />School of Allied Health (Physiotherapy), College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
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Ahmed SB, Ramesh S. Sex hormones in women with kidney disease. Nephrol Dial Transplant 2016; 31:1787-1795. [DOI: 10.1093/ndt/gfw084] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/19/2016] [Indexed: 12/21/2022] Open
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Feldman J, Brown GR, Deutsch MB, Hembree W, Meyer W, Meyer-Bahlburg HF, Tangpricha V, T’Sjoen G, Safer JD. Priorities for transgender medical and healthcare research. Curr Opin Endocrinol Diabetes Obes 2016; 23:180-7. [PMID: 26825469 PMCID: PMC4821501 DOI: 10.1097/med.0000000000000231] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Transgender individuals experience unique health disparities but are the subject of little focused health research. This manuscript reviews current literature on transgender medical and mental health outcomes and proposes research priorities to address knowledge gaps. RECENT FINDINGS Published research in transgender healthcare consists primarily of case reports, retrospective and cross-sectional studies, involving largely European settings. Challenges to US-based transgender health research include a diverse population where no single center has sufficient patient base to conduct clinical research with statistical rigor. Treatment regimens are heterogeneous and warrant study for best practices. Current research suggests increased mortality and depression in transgender individuals not receiving optimal care, and possibly a modest increase in cardiovascular risk related to hormone therapy. Current evidence does not support concerns for hormone-related malignancy risk. SUMMARY The priorities for transgender medical outcomes research should be to determine health disparities and comorbid health conditions over the life span, along with the effects of mental health, medical, and surgical interventions on morbidity and mortality. Specific outcomes of interest based on frequency in the literature, potential severity of outcome, and patient-centered interest, include affective disorders, cardiovascular disease, malignancies, fertility, and time dose-related responses of specific interventions.
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Affiliation(s)
- Jamie Feldman
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - George R. Brown
- Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Mountain Home VAMC, Johnson City, TN
| | - Madeline B. Deutsch
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Wylie Hembree
- Program of Developmental Psychoendocrinology, Division of Gender, Sexuality, and Health, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY and NYS Psychiatric Institute, New York, NY
| | - Walter Meyer
- Department of Psychiatry, University of Texas, Medical Branch, Galveston, TX
| | - Heino F.L. Meyer-Bahlburg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, GA
| | - Guy T’Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Joshua D. Safer
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA
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Simonsen RK, Hald GM, Kristensen E, Giraldi A. Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death. Sex Med 2016; 4:e60-8. [PMID: 26944779 PMCID: PMC4822482 DOI: 10.1016/j.esxm.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/07/2016] [Accepted: 01/13/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. AIMS To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. METHODS Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. MAIN OUTCOME MEASURES Somatic morbidity and cause of death. RESULTS Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). CONCLUSION Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.
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Affiliation(s)
| | - Gert Martin Hald
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellids Kristensen
- Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark
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Bertonazzi A, Nelson B, Salvador J, Umland E. The Smallest Available Estradiol Transdermal Patch: A New Treatment Option for the Prevention of Postmenopausal Osteoporosis. WOMENS HEALTH 2015; 11:815-24. [DOI: 10.2217/whe.15.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Minivelle® (Noven Therapeutics, LLC, FL, USA) is an estradiol transdermal delivery system that has recently been approved in the USA for prevention of postmenopausal osteoporosis. The decline in estrogen during menopause leads to bone resorption, increasing the risk of fractures. Transdermal estradiol has been shown to increase bone mineral density. Safety studies of transdermal estradiol have shown a decreased risk in cardiovascular disease as compared with oral estrogen therapy. Minivelle is currently the smallest available transdermal estradiol patch, providing the lowest effective dose of estrogen.
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Affiliation(s)
- Abigail Bertonazzi
- Jefferson School of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107, USA
| | - Bridgette Nelson
- Jefferson School of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107, USA
| | - Jamie Salvador
- Jefferson School of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107, USA
| | - Elena Umland
- Jefferson School of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107, USA
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Reid RL, Magee BA. Confronting the challenges of the menopausal transition. Womens Midlife Health 2015; 1:7. [PMID: 30766694 PMCID: PMC6297993 DOI: 10.1186/s40695-015-0008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/06/2015] [Indexed: 12/24/2022] Open
Abstract
Canada’s Generation X is now entering the menopausal transition and pursuing effective therapy for bothersome vasomotor symptoms. They do so at a time when confusion about the safe and appropriate use of menopausal hormone therapy (MHT) has never been greater. Misplaced fears among women and their health care providers about MHT have, in many circumstances, led them to abandon this most effective therapy. This review discusses the physiology of the menopausal transition, the nature of symptoms related to withdrawal of ovarian estrogen production, and the potential benefits and risks of MHT. It is now clear that for most recently menopausal women the benefits of MHT outweigh the risks. The rationale for choosing different dosages, formulations, and regimens is reviewed.
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Affiliation(s)
- Robert L Reid
- Division of Reproductive Endocrinology and Infertility, Queen's University, Kingston, Ontario K7L 4 V1 Canada
| | - Bryden A Magee
- Division of Reproductive Endocrinology and Infertility, Queen's University, Kingston, Ontario K7L 4 V1 Canada
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Knowledge and personal use of menopausal hormone therapy among Chinese obstetrician-gynecologists: results of a survey. Menopause 2015; 21:1190-6. [PMID: 24736196 DOI: 10.1097/gme.0000000000000233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obstetrician-gynecologists' (ob-gyns) knowledge of the benefits and risks of-and attitude toward-menopausal hormone therapy (HT) have evolved since the publication of the Heart and Estrogen/progestin Replacement Study and the Women's Health Initiative. The survey investigated Chinese ob-gyns' perception and personal use of-and attitude toward-HT. METHODS A total of 2,000 self-administered questionnaires were sent to female ob-gyns who attended gynecological endocrinology workshops in 15 provinces and cities in China from February to May 2013. RESULTS A total of 904 eligible questionnaires were collected (response rate, 45.2%). Most of the respondents knew that HT could relieve menopausal symptoms (97.7%) and prevent osteoporosis (93.5%). Most (69.4%) of the respondents thought that HT would increase the risk of breast cancer, and 52.9% thought that HT would increase the risk of endometrial cancer. The most common concern regarding adverse effects of HT was risk of breast cancer, followed by risk of endometrial cancer, risk of venous thrombosis, and weight gain. One hundred twenty-three of 324 symptomatic respondents (38.0%) reported HT use, and a further 28 respondents (8.6%) had tried transdermal and vaginal estrogen creams. CONCLUSIONS These findings show better knowledge of HT among Chinese ob-gyns compared with the general Chinese population. However, HT use is relatively low, and ob-gyns seem to be overconcerned with the risks of HT. HT education must be promoted among Chinese ob-gyns to enhance the proper use of HT in the general population.
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Salgado IK, Torrado AI, Santiago JM, Miranda JD. Tamoxifen and Src kinase inhibitors as neuroprotective/neuroregenerative drugs after spinal cord injury. Neural Regen Res 2015; 10:385-90. [PMID: 25878585 PMCID: PMC4396099 DOI: 10.4103/1673-5374.153685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that produces significant changes in the lifestyle of patients. Many molecular and cellular events are triggered after the initial physical impact to the cord. Two major phases have been described in the field of SCI: an acute phase and late phase. Most of the therapeutic strategies are focused on the late phase because this provides an opportunity to target cellular events like apoptosis, demyelination, scar formation and axonal outgrowth. In this mini-review, we will focus on two agents (tamoxifen and a Src kinase family inhibitor known as PP2) that have been shown in our laboratory to produce neuroprotective (increase cell survival) and/or regenerative (axonal outgrowth) actions. The animal model used in our laboratory is adult female rat (~250 g) with a moderate contusion (12.5 mm) to the spinal cord at the T10 level, using the MASCIS impactor device. Tamoxifen or PP2 was administered by implantation of a 15 mg pellet (Innovative Research of America, Sarasota, FL, USA) or by intraperitoneal injections (1.5 mg/kg, every 3 days), respectively, to produce a long-term effect (28 days). Tamoxifen and the Src kinase inhibitor, PP2, are drugs that in rats with a moderate spinal cord injury promote functional locomotor recovery, increase spared white matter tissue, and stimulate axonal outgrowth. Moreover, tamoxifen reduces the formation of reactive oxygen species. Therefore, these drugs are possible therapeutic agents that have a neuroprotective/regenerative activity in vertebrates with SCI.
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Affiliation(s)
- Iris K Salgado
- Department of Physiology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
| | - Aranza I Torrado
- Department of Physiology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
| | - Jose M Santiago
- University of Puerto Rico Carolina Campus, Department of Natural Sciences, Carolina, PR 00984, USA
| | - Jorge D Miranda
- Department of Physiology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
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Abstract
Although providing guidance to patients regarding duration of hormone therapy represents a topic surrounded by controversy, clinicians often encounter this issue in practice. As pointed out in the NAMS 2012 Hormone Therapy (HT) Position Statement, determining the optimal duration of HT is challenging both for clinicians and for patients. This Practice Pearl addresses clinical situations for which long-term HT might be appropriate and provides practical guidance regarding prudent therapeutic choices for women using HT for an extended duration.
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Affiliation(s)
- Andrew M Kaunitz
- From the University of Florida College of Medicine-Jacksonville, Department of Obstetrics & Gynecology, Jacksonville, FL
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Corbelli J, Shaikh N, Wessel C, Hess R. Low-dose transdermal estradiol for vasomotor symptoms. Menopause 2015; 22:114-21. [DOI: 10.1097/gme.0000000000000258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Krause MS, Nakajima ST. Hormonal and nonhormonal treatment of vasomotor symptoms. Obstet Gynecol Clin North Am 2014; 42:163-79. [PMID: 25681847 DOI: 10.1016/j.ogc.2014.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article focuses on the cause, pathophysiology, differential diagnosis of, and treatment options for vasomotor symptoms. In addition, it summarizes important points for health care providers caring for perimenopausal and postmenopausal women with regard to health maintenance, osteoporosis, cardiovascular disease, and vaginal atrophy. Treatment options for hot flashes with variable effectiveness include systemic hormone therapy (estrogen/progestogen), nonhormonal pharmacologic therapies (selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, clonidine, gabapentin), and nonpharmacologic therapy options (behavioral changes, acupuncture). Risks and benefits as well as contraindications for hormone therapy are further discussed.
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Affiliation(s)
- Miriam S Krause
- Fertility and Endocrine Associates, 4121 Dutchman's Lane, Suite 414, Louisville, KY 40207, USA.
| | - Steven T Nakajima
- Stanford Fertility and Reproductive Medicine Center, 900 Welch Road, Suite 20, Palo Alto, CA 94304, USA
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Age at menopause, reproductive history, and venous thromboembolism risk among postmenopausal women: the Women's Health Initiative Hormone Therapy clinical trials. Menopause 2014; 21:214-20. [PMID: 23760439 DOI: 10.1097/gme.0b013e31829752e0] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aims to investigate venous thromboembolism (VTE) risk in relation to age at menopause, age at menarche, parity, bilateral oophorectomy, and time since menopause, as well as any interaction with randomized hormone therapy (HT) assignment, among postmenopausal women. METHODS Using pooled data from the Women's Health Initiative HT clinical trials including 27,035 postmenopausal women aged 50 to 79 years who had no history of VTE, we assessed the risk of VTE in relation to age at menopause, age at menarche, parity, bilateral oophorectomy, and time since menopause by Cox proportional hazards models. Linear trends, quadratic relationships, and interactions of reproductive life characteristics with HT on VTE risk were systematically tested. RESULTS During follow-up, 426 women reported a first VTE, including 294 non-procedure-related events. No apparent interaction of reproductive life characteristics with HT assignment on VTE risk was detected, and there was not a significant association between VTE and age at menarche, age at menopause, parity, oophorectomy, or time since menopause. However, analyses restricted to non-procedure-related VTE showed a U-shaped relationship between age at menopause and thrombotic risk that persisted after multivariable analysis (P < 0.01). Compared with women aged 40 to 49 years at menopause, those who had early menopause (age <40 y) or late menopause (age >55 y) had a significantly increased VTE risk (hazard ratio [95% CI]: 1.8 [1.2-2.7] and 1.5 [1.0-2.4], respectively). CONCLUSIONS Reproductive life characteristics have little association with VTE and do not seem to influence the effect of HT on thrombotic risk among postmenopausal women. Nevertheless, early and late onset of menopause might be newly identified risk factors for non-procedure-related VTE.
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Abstract
Many large trials in the past 15 years have proven an increased risk of vascular complications in women using oral, mostly non-bioidentical, hormone therapy. The risk of vascular complications depends on the route of administration (oral versus transdermal), age, duration of administration, and type of hormones (bioidentical versus non-bioidentical). Acquired and/or hereditary thrombophilias (eg, factor V Leiden, prothrombin mutation G20210A, and others) lead to a further increase of risk for venous thromboembolism, stroke, or myocardial infarction. Therefore, bioidentical hormone therapy via the transdermal route seems to be the safest opportunity for hormone replacement therapy, although large trials for bioidentical hormone therapy are needed.
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Managing Menopause Chapter 1 Assessment and Risk Management of Menopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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What if the Women’s Health Initiative had used transdermal estradiol and oral progesterone instead? Menopause 2014; 21:769-83. [DOI: 10.1097/gme.0000000000000169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Mosquera L, Colón JM, Santiago JM, Torrado AI, Meléndez M, Segarra AC, Rodríguez-Orengo JF, Miranda JD. Tamoxifen and estradiol improved locomotor function and increased spared tissue in rats after spinal cord injury: their antioxidant effect and role of estrogen receptor alpha. Brain Res 2014; 1561:11-22. [PMID: 24637260 DOI: 10.1016/j.brainres.2014.03.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/20/2014] [Accepted: 03/05/2014] [Indexed: 12/17/2022]
Abstract
17β-Estradiol is a multi-active steroid that imparts neuroprotection via diverse mechanisms of action. However, its role as a neuroprotective agent after spinal cord injury (SCI), or the involvement of the estrogen receptor-alpha (ER-α) in locomotor recovery, is still a subject of much debate. In this study, we evaluated the effects of estradiol and of Tamoxifen (an estrogen receptor mixed agonist/antagonist) on locomotor recovery following SCI. To control estradiol cyclical variability, ovariectomized female rats received empty or estradiol filled implants, prior to a moderate contusion to the spinal cord. Estradiol improved locomotor function at 7, 14, 21, and 28 days post injury (DPI), when compared to control groups (measured with the BBB open field test). This effect was ER-α mediated, because functional recovery was blocked with an ER-α antagonist. We also observed that ER-α was up-regulated after SCI. Long-term treatment (28 DPI) with estradiol and Tamoxifen reduced the extent of the lesion cavity, an effect also mediated by ER-α. The antioxidant effects of estradiol were seen acutely at 2 DPI but not at 28 DPI, and this acute effect was not receptor mediated. Rats treated with Tamoxifen recovered some locomotor activity at 21 and 28 DPI, which could be related to the antioxidant protection seen at these time points. These results show that estradiol improves functional outcome, and these protective effects are mediated by the ER-α dependent and independent-mechanisms. Tamoxifen׳s effects during late stages of SCI support the use of this drug as a long-term alternative treatment for this condition.
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Affiliation(s)
- Laurivette Mosquera
- Department of Physiology, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA
| | - Jennifer M Colón
- Department of Physiology, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA
| | - José M Santiago
- University of Puerto Rico Carolina Campus, Department of Natural Sciences, Carolina, PR 00984, USA
| | - Aranza I Torrado
- Department of Physiology, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA
| | | | - Annabell C Segarra
- Department of Physiology, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA
| | - José F Rodríguez-Orengo
- Department of Biochemistry, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA
| | - Jorge D Miranda
- Department of Physiology, University of Puerto Rico-School of Medicine, San Juan, PR 00936, USA.
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42
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Has the pendulum begun to swing back? Menopause 2014; 21:211-2. [DOI: 10.1097/gme.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Fantasia HC, Sutherland MA. Hormone Therapy for the Management of Menopause Symptoms. J Obstet Gynecol Neonatal Nurs 2014; 43:226-35; quiz E18-9. [DOI: 10.1111/1552-6909.12282] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gawlik A, Malecka-Tendera E. Transitions in endocrinology: treatment of Turner's syndrome during transition. Eur J Endocrinol 2014; 170:R57-74. [PMID: 24225028 DOI: 10.1530/eje-13-0900] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Transition in health care for young patients with Turner's syndrome (TS) should be perceived as a staged but uninterrupted process starting in adolescence and moving into adulthood. As a condition associated with high risk of short stature, cardiovascular diseases, ovarian failure, hearing loss and hypothyroidism, TS requires the attention of a multidisciplinary team. In this review paper, we systematically searched the relevant literature from the last decade to discuss the array of problems faced by TS patients and to outline their optimal management during the time of transfer to adult service. The literature search identified 233 potentially relevant articles of which 114 were analysed. The analysis confirmed that all medical problems present during childhood should also be followed in adult life. Additionally, screening for hypertension, diabetes mellitus, dyslipidaemia, and osteoporosis is needed. After discharge from the paediatric clinic, there is still a long way to go.
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Affiliation(s)
- Aneta Gawlik
- Department of Paediatrics, Paediatric Endocrinology and Diabetes, Medical University of Silesia, ul Medykow 16, 40-752 Katowice, Poland
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45
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Sood R, Faubion SS, Kuhle CL, Thielen JM, Shuster LT. Prescribing menopausal hormone therapy: an evidence-based approach. Int J Womens Health 2014; 6:47-57. [PMID: 24474847 PMCID: PMC3897322 DOI: 10.2147/ijwh.s38342] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The constantly changing landscape regarding menopausal hormone therapy (MHT) has been challenging for providers caring for menopausal women. After a decade of fear and uncertainty regarding MHT, reanalysis of the Women’s Health Initiative data and the results of recent studies have provided some clarity regarding the balance of risks and benefits of systemic MHT. Age and years since menopause are now known to be important variables affecting the benefit-risk profile. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks. Systemic MHT initiated early in menopause appears to slow the progression of atherosclerotic disease, thereby reducing the risk of cardiovascular disease and mortality. During this window of opportunity, MHT might also provide protection against cognitive decline. In older women and women more than 10 years past menopause, the risk-benefit balance of MHT is less favorable, particularly with regard to cardiovascular risk and cognitive impairment. For women entering menopause prematurely (<40 years), MHT ameliorates the risk of cardiovascular disease, osteoporosis, and cognitive decline. Nonoral administration of estrogen offers advantages due to the lack of first-pass hepatic metabolism, which in turn avoids the increased hepatic synthesis of clotting proteins, C-reactive protein, triglycerides, and sex hormone-binding globulin. The duration of combined MHT use is ideally limited to less than 5 years because of the known increase in breast cancer risk after 3–5 years of use. Limitations to use of estrogen only MHT are less clear, since breast cancer risk does not appear to increase with use of estrogen alone. For women under the age of 60 years, or within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail.
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Affiliation(s)
- Richa Sood
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Carol L Kuhle
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Jacqueline M Thielen
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Lynne T Shuster
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, MN, USA
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46
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Alexander IM. The history of hormone therapy use and recent controversy related to heart disease and breast cancer arising from prevention trial outcomes. J Midwifery Womens Health 2013; 57:547-557. [PMID: 23217066 DOI: 10.1111/j.1542-2011.2012.00247.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The reasons for hormone therapy use have changed dramatically over time from being very popular for the purpose of preserving youth in women to menopause-related symptom management, disease prevention, and now back to menopause-related symptom management. Over time, several important risks associated with the use of hormone therapy have become evident, causing dramatic reductions in the use of hormone therapy for periods of time following identification of these risks. Most recently, randomized controlled prevention trials that evaluated hormone therapy for the purpose of reducing or preventing coronary heart disease among women have found that hormone therapy is associated with increased rather than decreased risks for coronary heart disease. The most recent of these trials again identified increased risks for breast cancer associated with estrogen plus progestogen therapy. The evolving evidence base from these randomized controlled prevention trials is complicated and in some cases contradictory. Specifically, the data suggest that the timing of when hormone therapy is initiated once a woman is postmenopausal may influence her risk for developing heart disease and breast cancer. In this article, contradictory evidence is carefully sifted so risks and benefits can be weighed by clinicians when partnering with women to individualize decisions about using hormone therapy.
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Wierckx K, Elaut E, Declercq E, Heylens G, De Cuypere G, Taes Y, Kaufman JM, T'Sjoen G. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol 2013; 169:471-8. [PMID: 23904280 DOI: 10.1530/eje-13-0493] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study evaluated the short- and long-term cardiovascular- and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons. SUBJECTS AND METHODS A specialist center cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) with an age- and gender-matched control population (1-3 matching). The participants were on cross-sex hormone therapy for an average of 7.4 years. We assessed physical health and possible treatment-related adverse events using questionnaires. RESULTS Five percent of trans women experienced venous thrombosis and/or pulmonary embolism during hormone therapy. Five of these adverse events occurred during the first year of treatment, while another three occurred during sex reassignment surgery. Trans women experienced more myocardial infarctions than the control women (P=0.001), but a similar proportion compared with control men. The prevalence of cerebrovascular disease (CVD) was higher in trans women than in the control men (P=0.03). The rates of myocardial infarction and CVD in trans men were similar to the control male and female subjects. The prevalence of type 2 diabetes was higher in both trans men and women than in their respective controls, whereas the rates of cancer were similar compared with the control men and women. CONCLUSION Morbidity rate during cross-sex hormone therapy was relatively low, especially in trans men. We observed a higher prevalence of venous thrombosis, myocardial infarction, CVD, and type 2 diabetes in trans women than in the control population. Morbidity rates in trans men and controls were similar, with the exception of the increased prevalence of type 2 diabetes.
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Ghazal S, Pal L. Perspective on hormone therapy 10 years after the WHI. Maturitas 2013; 76:208-12. [PMID: 24094493 DOI: 10.1016/j.maturitas.2013.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/31/2013] [Indexed: 12/28/2022]
Abstract
The Women's Health Initiative (WHI) hormone trials are among the most influential and debated research studies in women's health in recent medical history. This year (2013) marked the 10th anniversary of the publication of the WHI results and this past decade has been nothing less than revolutionary. We have witnessed a transformative evolution in our understanding of, and in the practice of, menopause management and herein summarize the strides the field has traversed over the past 10 years.
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Affiliation(s)
- Sanaz Ghazal
- Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, 333 Cedar Street, New Haven, CT 06477, United States
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49
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L’Hermite M. HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT. Climacteric 2013; 16 Suppl 1:44-53. [DOI: 10.3109/13697137.2013.808563] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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50
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Sedlak T, Shufelt C, Iribarren C, Lyon LL, Bairey Merz CN. Oral contraceptive use and the ECG: evidence of an adverse QT effect on corrected QT interval. Ann Noninvasive Electrocardiol 2013; 18:389-98. [PMID: 23879279 DOI: 10.1111/anec.12050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A prolonged corrected QT (QTc) interval is a marker for an increased risk of sudden cardiac death. We evaluated the relationship between oral contraceptive (OC) use, type of OC, and QTc interval. METHODS We identified 410,782 ECGs performed at Northern California Kaiser Permanente on female patients between 15 and 53 years from January, 1995 to June, 2008. QT was corrected for heart rate using log-linear regression. OC generation (first, second and third) was classified by increasing progestin androgenic potency, while the fourth generation was classified as antiandrogenic. RESULTS Among 410,782 women, 8.4% were on OC. In multivariate analysis after correction for comorbidities, there was an independent shortening effect of OCs overall (slope = -0.5 ms; SE = 0.12, P < 0.0002). Users of first and second generation progestins had a significantly shorter QTc than nonusers (P < 0.0001), while users of fourth generation had a significantly longer QTc than nonusers (slope = 3.6 ms, SE = 0.35, P < 0.0001). CONCLUSION Overall, OC use has a shortening effect on the QTc. Shorter QTc is seen with first and second generation OC while fourth generation OC use has a lengthening effect on the QTc. Careful examination of adverse event rates in fourth generation OC users is needed.
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Affiliation(s)
- Tara Sedlak
- Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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