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Hamoda H, Sharma A. Premature ovarian insufficiency, early menopause, and induced menopause. Best Pract Res Clin Endocrinol Metab 2024; 38:101823. [PMID: 37802711 DOI: 10.1016/j.beem.2023.101823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Premature ovarian insufficiency (POI) is a condition in which there is a decline in ovarian function in women who are younger than 40 years resulting in a hypo-oestrogenic state with elevated gonadotrophins and oligomenorrhoea/amenorrhoea. This leads to short term complications of menopausal symptoms and long-term effects on bone and cardiovascular health, cognition as well as the impact of reduced fertility and sexual function associated with this condition. It is managed by sex steroid replacement either with HRT or combined hormonal contraception until the age of natural menopause (51) and this can provide a beneficial role with both symptom control and minimising the long-term adverse effects associated with this condition. Women who undergo a menopause between 40 and 45 years are deemed to have an "early menopause". The limited data available for this group suggest that they also have an increased morbidity if not adequately treated with hormone therapy. As such, women who have an early menopause should be managed in a similar way to those with POI, with the recommendation that they should take HRT at least until the natural age of menopause. This is the same for induced menopause that is caused by medical or surgical treatment that impacts the ovaries. It is important to ensure early diagnosis and access to specialist care to help support and manage these patients to reduce the symptoms and risks of long-term complications. This review looks at the diagnosis, causes, short and long-term complications and management of POI, early and induced menopause.
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Affiliation(s)
- Haitham Hamoda
- Clinical Lead Menopause Service, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - Angela Sharma
- (GP Partner) Pembridge Villas Surgery, 45 Pembridge Villas, London W11 3EP, UK.
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2
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Lee GB, Nam GE, Kim W, Han B, Cho KH, Kim SM, Choi YS, Kim DH, Park Y, Jung J, Han K, Kim Y. Association Between Premature Menopause and Cardiovascular Diseases and All-Cause Mortality in Korean Women. J Am Heart Assoc 2023; 12:e030117. [PMID: 37947103 PMCID: PMC10727283 DOI: 10.1161/jaha.123.030117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
Background Mortality from cardiovascular diseases in Asian populations is considerable. Menopause is a risk-enhancing factor for cardiovascular disease, but it is unclear whether menopause is an independent risk factor for cardiovascular disease and mortality in Asian women. Methods and Results A total of 1 159 405 postmenopausal women, who had participated in the health examinations of the Korean National Health Insurance Service in 2009, were analyzed, and their reproductive histories were taken. A multivariable Cox proportional hazard model assessed the hazard ratios (HRs) of myocardial infarction (MI), ischemic stroke, and all-cause mortality, according to the history of premature menopause and age at menopause. After an average 10-year follow-up, there were 31 606, 45 052, and 77 680 new cases of MI, ischemic stroke, and all-cause mortality, respectively. The women with premature menopause exhibited increased risks of MI (HR, 1.40 [95% CI, 1.31-1.50]), ischemic stroke (HR, 1.24 [95% CI, 1.17-1.31]), and all-cause mortality (HR, 1.19 [95% CI, 1.14-1.24]) when compared with women with menopause aged ≥50 years. The highest risk was evident with menopause between the ages of 30 and 34 years (HR for MI, 1.52 [95% CI, 1.30-1.78]; HR for ischemic stroke, 1.29 [95% CI, 1.12-1.48]; HR for all-cause mortality, 1.33 [95% CI, 1.20-1.47]) when compared with women with menopause aged ≥50 years. Conclusions Earlier age at menopause was associated with increased risks for MI, ischemic stroke, and all-cause mortality. Future guidelines and risk assessment tools should consider menopause as an independent risk factor of cardiovascular disease in Korean women.
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Affiliation(s)
- Gyu Bae Lee
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Ga Eun Nam
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Wonsock Kim
- Department of Family MedicineUijeongbu Eulji Medical CenterUijeongbuKorea
| | - Byoungduck Han
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Kyung Hwan Cho
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Seon Mee Kim
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Youn Seon Choi
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Do Hoon Kim
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Yong‐Gyu Park
- Department of Medical StatisticsCatholic University College of MedicineSeoulKorea
| | - Jin‐Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of MedicineSuwonKorea
| | - Kyungdo Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Yang‐Hyun Kim
- Department of Family MedicineKorea University College of MedicineSeoulKorea
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Alinia T, Sabour S, Hashemipour M, Hovsepian S, Pour HR, Jahanfar S. Relationship between vitamin D levels and age of menopause and reproductive lifespan: Analysis based on the National health and nutrition examination survey (NHANES) 2001-2018. Eur J Obstet Gynecol Reprod Biol 2023; 289:183-189. [PMID: 37690281 DOI: 10.1016/j.ejogrb.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/01/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES To determine the association between serum vitamin D levels and age at menopause and reproductive lifespan in a group of US postmenopausal women. STUDY DESIGN Data from 6,326 postmenopausal US women in the National Health and Nutrition Examination Survey (NHANES) database 2001-2018 were obtained. Weighted multinomial logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI). Statistical analyzes were performed using SAS (version 9.4; SAS Institute), and complex survey designs were considered. RESULTS Vitamin D deficiency was associated with a higher likelihood of early menopause (OR = 1.34, 95% CI: 1.15, 1.58; p = 0.008) and lower odds of late menopause (OR = 0.79, 95% CI: 0.52, 0.95) in the unadjusted model but not in the adjusted model. Lower vitamin D levels were associated with a higher risk of a shorter reproductive lifespan. The strongest association was seen in the first tertile of vitamin D deficiency (OR = 1.54; 95% CI: 1:29-1:83). After adjustment, the associations were somewhat weakened but remained statistically significant. CONCLUSIONS The results of this study suggest that vitamin D deficiency and inadequacy might be associated with earlier age at menopause. It may also reduce the reproductive lifespan in women. Given the cross-sectional nature of the NHANES dataset, these results should be interpreted with caution due to temporality bias. Menopausal age is a multifactorial phenomenon, and the identification of factors and their interactions should be evaluated in future studies.
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Affiliation(s)
- Tahereh Alinia
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Mahin Hashemipour
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Silva Hovsepian
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Homeyra Rais Pour
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayesteh Jahanfar
- Tufts School of Medicine, Department of Public Health and Community Medicine, Boston, USA
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Biagetti B, Puig-Domingo M. Age-Related Hormones Changes and Its Impact on Health Status and Lifespan. Aging Dis 2023; 14:605-620. [PMID: 37191429 PMCID: PMC10187696 DOI: 10.14336/ad.2022.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 05/17/2023] Open
Abstract
The increase in life expectancy is accompanied with an increased consultation of age-related pathologies including endocrine disorders. Two main areas are focusing the attention of medical and social research in older population: the diagnosis and care of this heterogeneous population, and the interventional measures potentially useful to mitigate age-related functional declines and to increase health and quality of lifespan. Thus, better understanding the physiopathology of aging and establishing accurate diagnostic and personalized approaches are a priority and currently an unmet need of the medical community. The endocrine system plays a major role in survival and lifespan through regulating vital processes such as energy consumption and optimizing the stress response among others. The aim of this paper is to review the physiological evolution of the main hormonal functions in aging and its clinical translation to improve our approach to the aging patient.
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Affiliation(s)
- Betina Biagetti
- Endocrinology & Nutrition Service, Vall d’Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
| | - Manel Puig-Domingo
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Department of Medicine, Autonomous University of Barcelona, Badalona, Spain.
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Wang Z, Yang Y, He X, Jiang X, Gao X, Liu P, He Z, Zhang L, Zhang M, Niu X, Liu B, Zhang L, Li Z. Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness. Clin Appl Thromb Hemost 2023; 29:10760296231160753. [PMID: 36855268 PMCID: PMC9986904 DOI: 10.1177/10760296231160753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
AIMS We investigated the incidence and clinical features of venous thromboembolism (VTE) in inpatients with mental illnesses. METHODS We retrospectively analyzed records of inpatients with mental illnesses and confirmed VTE at The First Hospital of Hebei Medical University between August 2018 and July 2022. We recorded demographic characteristics, psychosis-related conditions, and thrombus distribution. RESULTS Among 12939 patients diagnosed with mental illness, 156 (1.21%) presented with VTE at the first visit or during the disease course. Crude VTE incidence varied significantly across mental illnesses, being highest in patients with organic mental disorders (5.20%), followed by emotional disorders (1.10%), and others (P < 0.001). Distal and proximal deep venous thromboses (DVT) occurred in 79.17% and 20.84% of patients, respectively. The Hamilton Depression Scale (HAMD) score was higher in patients with proximal DVT than in those with distal DVT (P < 0.001). On multivariate analysis, the HAMD score (odds ratio [OR] 1.173, confidence interval [CI] 1.100-1.251, P<0.001) was a risk factor and the Hamilton Anxiety Scale (HAMA) (OR 0.862, CI 0.796-0.934, P<0.001), a protective factor against DVT progression. CONCLUSION VTE is not rare in patients with mental illnesses and is most commonly associated with organic mental disorders. Psychosis-related DVT typically shows a significantly high incidence of distal DVT. Prevention and early treatment in patients with severe depression and distal DVT can prevent DVT aggravation.
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Affiliation(s)
- Zibin Wang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Yang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinqi He
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xia Jiang
- Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Gastrointestinal Surgery and General Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xian Gao
- Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Gastrointestinal Surgery and General Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Liu
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhaopeng He
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Like Zhang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Miao Zhang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xupeng Niu
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Boyu Liu
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Zhang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongxin Li
- Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Gastrointestinal Surgery and General Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
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6
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Watanabe M, Tomiyama C, Nikaido T, Takeda T, Mandai N. Factors associated with hie (chilly sensation): an analysis among Japanese women. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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7
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Gartlehner G, Patel SV, Reddy S, Rains C, Schwimmer M, Kahwati L. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1747-1765. [PMID: 36318128 DOI: 10.1001/jama.2022.18324] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
IMPORTANCE It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers. OBJECTIVE To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions. DATA SOURCES PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022. STUDY SELECTION English-language randomized clinical trials and prospective cohort studies of fair or good quality. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available. MAIN OUTCOMES AND MEASURES Morbidity and mortality related to chronic conditions; health-related quality of life. RESULTS Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year. CONCLUSIONS AND RELEVANCE Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.
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Affiliation(s)
- Gerald Gartlehner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
| | - Sheila V Patel
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| | - Shivani Reddy
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| | - Caroline Rains
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| | | | - Leila Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
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8
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The effect of micronized progesterone and medroxyprogesterone acetate in combination with transdermal estradiol on hemostatic biomarkers in postmenopausal women diagnosed with POI and early menopause. Menopause 2022; 29:580-589. [DOI: 10.1097/gme.0000000000001944] [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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9
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Alinia T, Khodakarim S, Tehrani FR, Sabour S. Age at Natural Menopause; A Data Mining Approach (Data from the National Health and Nutrition Examination Survey 2013-2014). Int J Prev Med 2021; 12:180. [PMID: 37663399 PMCID: PMC10472079 DOI: 10.4103/ijpvm.ijpvm_647_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background The timing of the age at which menopause occurs varies among female populations. This variation is attributed to genetic and environmental factors. This study aims to investigate the determinants of early and late-onset menopause. Methods We used data from the National Health and Nutrition Examination Survey 2013-2014 for 762 naturally menopause women. Data on sociodemographic, lifestyle, examination, and laboratory characteristics were examined. We used random forest (RF), support vector machine (SVM), and logistic regression (LR) to identify important determinants of early and late-onset menopause. We compared the performance of models using sensitivity, specificity, Brier score, and area under the receiver operating characteristic (AUROC). The top determinants were assessed by using the best performing models, using the mean decease in Gini. Results Random forest outperformed LR and SVM with overall AUROC 99% for identifying related factors of early and late-onset menopause (Brier score: 0.051 for early and 0.005 for late-onset menopause). Vitamin B12 and age at menarche were strongly related to early menopause. Also, methylmalonic acid (MMA), vitamin D, body mass index (BMI) were among the top highly ranked factors contributing to early menopause. Features such as age at menarche, MMA, sex hormone-binding globulin (SHBG), BMI, vitamin B12 were the most important covariate for late-onset menopause. Conclusions Menarche age and BMI are among the important contributors of early and late-onset menopause. More research on the association between vitamin D, vitamin B12, SHBG, and menopause timing is required which will produce invaluable information for better prediction of menopause timing.
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Affiliation(s)
- Tahereh Alinia
- Student Research Committee, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Epidemiology, School of Allied Medical Sciences, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Tehran, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran
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10
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Gianesini S, Menegatti E, Bottini O, Chi YW. Review on Disasters and Lower Limb Venous Disease. Ann Vasc Dis 2021; 14:315-322. [PMID: 35082935 PMCID: PMC8752912 DOI: 10.3400/avd.ra.21-00026] [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: 03/01/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
As per the World Health Organization, a disaster is defined as “an event that occurs in most cases suddenly and unexpectedly, causing severe disturbances to people or objects affected by it, resulting in the loss of life and harm to the health of the population.” A number of health issues are often reported following disasters, such as physical and psychological trauma, infections, malnutrition, and cardiovascular events. Among these, venous thromboembolism is deemed serious and thus should be taken into consideration. Indeed, its risk has been demonstrated to increase following earthquakes, floods, burns, and intoxications. The recent coronavirus pandemic summarizes some of the main triggering factors involved in acute and chronic venous disease development in a disaster setting: inflammation, infection, lockdown-induced reduced mobility, potential malnutrition, and overweight. Proper venous risk assessment and guideline application have been determined to be essential in disaster management, particularly in the current time in which sheltering could lead to a potential exacerbation of the pandemic, which can only increase the risk for venous thrombotic diseases. Global scientific teamwork is needed to make the recommendations as evidence-based and as homogeneous as possible among continents. In this present review, we focus on how earthquakes impact venous thromboembolism, including an analysis of other disaster-related conditions, such as burns and intoxication. (This is a review article based on the informative seminar of the 40th Annual Meeting of Japanese Society of Phlebology.)
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Affiliation(s)
- Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Erica Menegatti
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Oscar Bottini
- Phlebology and Lymphology Service, German Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Yung-Wei Chi
- Department of Internal Medicine, University of California Davis, CA, USA
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11
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Vasiltseva OY, Vitt KN, Cherniavsky AM. [Features of pulmonary thromboembolism in women]. KARDIOLOGIIA 2021; 61:89-97. [PMID: 34882082 DOI: 10.18087/cardio.2021.11.n1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/10/2020] [Accepted: 07/29/2020] [Indexed: 06/13/2023]
Abstract
Pulmonary artery embolism (PAE) is usually a diagnosis of exclusion. Verification of a more common pathology takes time, which may become critical for treatment of pulmonary embolism and saving the patient's life. Since PAE is an acute disease, the time window for medical care largely determines the prognosis. Therefore, the differential diagnostic process should include thromboembolism already at the first visit. It is important to determine risk factors for PAE taking into account the patient's personality and gender. Obtained data may help the physician to determine quickly the expedience of visualizing studies, such as ventilation/perfusion scintigraphy, angiopulmonography, computed tomographic angiopulmonography. For women, it is important to collect specific information, such as the presence of large uterine fibroids, use of combined oral contraceptives or hormonal replacement therapy; to ask how long ago the patient had pregnancy and delivery, whether she has thrombophilia or oncological diseases.
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Affiliation(s)
- O Ya Vasiltseva
- National Medical Research Center named after acad. E.N. Meshalkin, Novosibirsk
| | - K N Vitt
- Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk
| | - A M Cherniavsky
- National Medical Research Center named after acad. E.N. Meshalkin, Novosibirsk
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12
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Tison GH, Avram R, Nah G, Klein L, Howard BV, Allison MA, Casanova R, Blair RH, Breathett K, Foraker RE, Olgin JE, Parikh NI. Predicting Incident Heart Failure in Women With Machine Learning: The Women's Health Initiative Cohort. Can J Cardiol 2021; 37:1708-1714. [PMID: 34400272 PMCID: PMC8642266 DOI: 10.1016/j.cjca.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a leading cause of cardiac morbidity among women, whose risk factors differ from those in men. We used machine-learning approaches to develop risk- prediction models for incident HF in a cohort of postmenopausal women from the Women's Health Initiative (WHI). METHODS We used 2 machine-learning methods-Least Absolute Shrinkage and Selection Operator (LASSO) and Classification and Regression Trees (CART)-to perform variable selection on 1227 baseline WHI variables for the primary outcome of incident HF. These variables were then used to construct separate Cox proportional hazard models, and we compared these results, using receiver-operating characteristic (ROC) curve analysis, against a comparator model built using variables from the Atherosclerosis Risk in Communities (ARIC) HF prediction model. We analyzed 43,709 women who had 2222 incident HF events; median follow-up was 14.3 years. RESULTS LASSO selected 10 predictors, and CART selected 11 predictors. The highest correlation between selected variables was 0.46. In addition to selecting well-established predictors such as age, myocardial infarction, and smoking, novel predictors included physical function, number of pregnancies, number of previous live births and age at menopause. In ROC analysis, the CART-derived model had the highest C-statistic of 0.83 (95% confidence interval [CI], 0.81-0.85), followed by LASSO 0.82 (95% CI, 0.81-0.84) and ARIC 0.73 (95% CI, 0.70-0.76). CONCLUSIONS Machine-learning approaches can be used to develop HF risk-prediction models that can have better discrimination compared with an established HF risk model and may provide a basis for investigating novel HF predictors.
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Affiliation(s)
- Geoffrey H Tison
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA; Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA.
| | - Robert Avram
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gregory Nah
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Liviu Klein
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbara V Howard
- Medstar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Washington DC, USA
| | - Matthew A Allison
- Division of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Ramon Casanova
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rachael H Blair
- State University of New York at Buffalo, Buffalo, New York, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona, Tucson Arizona, USA
| | - Randi E Foraker
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nisha I Parikh
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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13
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Hagen-Lillevik S, Rushing JS, Appiah L, Longo N, Andrews A, Lai K, Johnson J. Pathophysiology and management of classic galactosemic primary ovarian insufficiency. REPRODUCTION AND FERTILITY 2021; 2:R67-R84. [PMID: 35118398 PMCID: PMC8788619 DOI: 10.1530/raf-21-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022] Open
Abstract
Classic galactosemia is an inborn error of carbohydrate metabolism associated with early-onset primary ovarian insufficiency (POI) in young women. Our understanding of the consequences of galactosemia upon fertility and fecundity of affected women is expanding, but there are important remaining gaps in our knowledge and tools for its management, and a need for continued dialog so that the special features of the condition can be better managed. Here, we review galactosemic POI and its reproductive endocrinological clinical sequelae and summarize current best clinical practices for its management. Special consideration is given to the very early-onset nature of the condition in the pediatric/adolescent patient. Afterward, we summarize our current understanding of the reproductive pathophysiology of galactosemia, including the potential action of toxic galactose metabolites upon the ovary. Our work establishing that ovarian cellular stress reminiscent of endoplasmic reticulum (ER) stress is present in a mouse model of galactosemia, as well as work by other groups, are summarized. LAY SUMMARY Patients with the condition of classic galactosemia need to maintain a strict lifelong diet that excludes the sugar galactose. This is due to having mutations in enzymes that process galactose, resulting in the buildup of toxic metabolic by-products of the sugar. Young women with classic galactosemia often lose the function of their ovaries very early in life (termed 'primary ovarian insufficiency'), despite adherence to a galactose-restricted diet. This means that in addition to the consequences of the disease, these women also face infertility and the potential need for hormone replacement therapy. This article summarizes current strategies for managing the care of galactosemic girls and women and also what is known of how the condition leads to early primary ovarian insufficiency.
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Affiliation(s)
- Synneva Hagen-Lillevik
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, Utah, USA
| | - John S Rushing
- Divisions of Reproductive Sciences, Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Aurora, Colorado, USA
| | - Leslie Appiah
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Anschutz Outpatient Pavilion, Aurora, Colorado, USA
| | - Nicola Longo
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, Utah, USA
| | - Ashley Andrews
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kent Lai
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, Utah, USA
| | - Joshua Johnson
- Divisions of Reproductive Sciences, Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Aurora, Colorado, USA
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14
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Stevenson JC, Collins P, Hamoda H, Lambrinoudaki I, Maas AHEM, Maclaran K, Panay N. Cardiometabolic health in premature ovarian insufficiency. Climacteric 2021; 24:474-480. [PMID: 34169795 DOI: 10.1080/13697137.2021.1910232] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.
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Affiliation(s)
- J C Stevenson
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - P Collins
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - H Hamoda
- Department of Gynaecology, King's College Hospital, London, UK
| | - I Lambrinoudaki
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Maclaran
- Department of Gynaecology, Chelsea & Westminster Hospital, London, UK
| | - N Panay
- Department of Gynaecology, Queen Charlotte's and Chelsea & Westminster Hospitals, Imperial College London, London, UK
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15
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Zucker R, Reisman T, Safer JD. Minimizing Venous Thromboembolism in Feminizing Hormone Therapy: Applying Lessons From Cisgender Women and Previous Data. Endocr Pract 2021; 27:621-625. [PMID: 33819637 DOI: 10.1016/j.eprac.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review he impact of estrogen-containing feminizing hormone regimens on transgender individuals' risk for VTE. METHODS We evaluated VTE risk by screening 1170 relevant studies published from 1994 to 2020, focusing on meta-analysis data. RESULTS The type of oral estrogen, route of administration, patient demographics, and comorbidities may affect the risk of VTE. Venous thrombosis is the most common vascular complication associated with HT. CONCLUSION Conjugated equine estrogens and 17-β estradiol appear to be safer than oral ethinyl estradiol. Transdermal estrogen formulations appear to be the least thrombogenic estrogens. Estrogens used concomitantly with progestins increase the risk of VTE compared to estrogens alone. To date, there are no data to demonstrate the benefit of holding HT prior to vaginoplasty or other gender affirming surgeries. For most young, healthy transgender women, there is little risk of VTE with HT, while older patients with risk factors should be discussed case by case.
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Affiliation(s)
- Roy Zucker
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tamar Reisman
- Icahn School of Medicine at Mount Sinai, New York, New York; Center for Transgender Medicine and Surgery, Mount Sinai Health System, New York, New York
| | - Joshua D Safer
- Icahn School of Medicine at Mount Sinai, New York, New York; Center for Transgender Medicine and Surgery, Mount Sinai Health System, New York, New York.
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16
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Lambrinoudaki I, Paschou SA, Lumsden MA, Faubion S, Makrakis E, Kalantaridou S, Panay N. Premature ovarian insufficiency: a toolkit for the primary care physician. Climacteric 2021; 24:425-437. [PMID: 33434082 DOI: 10.1080/13697137.2020.1859246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: (1) the diagnostic approach to POI, (2) the investigation of the etiology of this condition, (3) the therapeutic strategy regarding both hormone replacement therapy and fertility, and (4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal of this article is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine.HIGHLIGHTSPremature ovarian insufficiency occurs in 1% of the female population of reproductive age, yet the diagnosis is often delayed, with severe physical and emotional consequences for the patient.Primary care physicians should be aware of the possibility of premature ovarian insufficiency in young women presenting with menstrual irregularity.Prompt initiation of hormone replacement therapy ensures quality of life and prevents osteoporosis and cardiovascular disease.Women seeking fertility should be referred to specialists to discuss assisted reproduction options.
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Affiliation(s)
- I Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S A Paschou
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Lumsden
- Gynaecology and Medical Education, University of Glasgow, Glasgow, UK
| | - S Faubion
- Mayo Clinic Center for Women's Health, Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - E Makrakis
- 3rd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Kalantaridou
- 3rd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Panay
- Queen Charlotte's & Chelsea and Chelsea and Westminster Hospitals, Imperial College, London, UK
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17
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Premature ovarian insufficiency: A toolkit for the primary care physician. Maturitas 2021; 147:53-63. [PMID: 33451805 DOI: 10.1016/j.maturitas.2020.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhoea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: 1) the diagnostic approach to POI, 2) the investigation of the etiology of this condition, 3) the therapeutic strategy regarding both hormone replacement therapy (HRT) and fertility and 4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine.
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18
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The Impact of Premature Menopause on Future Risk of Cardiovascular Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Panay N, Anderson RA, Nappi RE, Vincent AJ, Vujovic S, Webber L, Wolfman W. Premature ovarian insufficiency: an International Menopause Society White Paper. Climacteric 2020; 23:426-446. [PMID: 32896176 DOI: 10.1080/13697137.2020.1804547] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.
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Affiliation(s)
- N Panay
- Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, Imperial College, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A J Vincent
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
| | - S Vujovic
- Faculty of Medicine, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - L Webber
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - W Wolfman
- Department of Obstetrics and Gynaecology, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
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20
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Honigberg MC, Natarajan P. Premature Menopause and Risk for Cardiovascular Disease-Reply. JAMA 2020; 323:1617-1618. [PMID: 32343325 PMCID: PMC7574161 DOI: 10.1001/jama.2020.2536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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21
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22
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Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, Januzzi JL, Scott NS, Natarajan P. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. JAMA 2019; 322:2411-2421. [PMID: 31738818 PMCID: PMC7231649 DOI: 10.1001/jama.2019.19191] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Recent guidelines endorse using history of menopause before age 40 years to refine atherosclerotic cardiovascular disease risk assessments among middle-aged women. Robust data on cardiovascular disease risk in this population are lacking. OBJECTIVE To examine the development of cardiovascular diseases and cardiovascular risk factors in women with natural and surgical menopause before age 40 years. DESIGN, SETTING, AND PARTICIPANTS Cohort study (UK Biobank), with adult residents of the United Kingdom recruited between 2006 and 2010. Of women who were 40 to 69 years old and postmenopausal at study enrollment, 144 260 were eligible for inclusion. Follow-up occurred through August 2016. EXPOSURES Natural premature menopause (menopause before age 40 without oophorectomy) and surgical premature menopause (bilateral oophorectomy before age 40). Postmenopausal women without premature menopause served as the reference group. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of incident coronary artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. Secondary outcomes included individual components of the primary outcome, incident hypertension, hyperlipidemia, and type 2 diabetes. RESULTS Of 144 260 postmenopausal women included (mean [SD] age at enrollment, 59.9 [5.4] years), 4904 (3.4%) had natural premature menopause and 644 (0.4%) had surgical premature menopause. Participants were followed up for a median of 7 years (interquartile range, 6.3-7.7). The primary outcome occurred in 5415 women (3.9%) with no premature menopause (incidence, 5.70/1000 woman-years), 292 women (6.0%) with natural premature menopause (incidence, 8.78/1000 woman-years) (difference vs no premature menopause, +3.08/1000 woman-years [95% CI, 2.06-4.10]; P < .001), and 49 women (7.6%) with surgical premature menopause (incidence, 11.27/1000 woman-years) (difference vs no premature menopause, +5.57/1000 woman-years [95% CI, 2.41-8.73]; P < .001). For the primary outcome, natural and surgical premature menopause were associated with hazard ratios of 1.36 (95% CI, 1.19-1.56; P < .001) and 1.87 (95% CI, 1.36-2.58; P < .001), respectively, after adjustment for conventional cardiovascular disease risk factors and use of menopausal hormone therapy. CONCLUSIONS AND RELEVANCE Natural and surgical premature menopause (before age 40 years) were associated with a small but statistically significant increased risk for a composite of cardiovascular diseases among postmenopausal women. Further research is needed to understand the mechanisms underlying these associations.
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Affiliation(s)
- Michael C. Honigberg
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Seyedeh Maryam Zekavat
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
- Yale University School of Medicine, New Haven,
Connecticut
| | - Krishna Aragam
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Phoebe Finneran
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Derek Klarin
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Division of Vascular Surgery and Endovascular
Therapy, University of Florida College of Medicine, Gainesville
| | - Deepak L. Bhatt
- Cardiovascular Division, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - James L. Januzzi
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
| | - Nandita S. Scott
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
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Goldstein Z, Khan M, Reisman T, Safer JD. Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy. J Blood Med 2019; 10:209-216. [PMID: 31372078 PMCID: PMC6628137 DOI: 10.2147/jbm.s166780] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/26/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Venous thromboembolism (VTE) is a potential risk of estrogen therapy. However, data show an improvement in the quality of life for transgender people who use feminizing hormone therapy. With few transgender-specific data, guidance may be drawn from cisgender (nontransgender) data, with a focus on hormonal birth control and postmenopausal hormone replacement therapy (HRT). The aim of this review is to examine the degree to which routes of administration, patient comorbidities, and type of hormone utilized affect the safety of estrogen therapy. Methods: We identified 6,349 studies by searching PubMed with the terms "transgender", "estrogen", "VTE", and "HRT". Of these, there were only 13 studies between 1989 and 2018 that investigated the effects of hormone therapy, including types of estrogens used, in transgender women and men. Results: The data suggest that the route of hormone administration, patient demographics, and patient comorbidities all affect estrogen's link with VTE. For example, avoiding ethinyl estradiol might make the use of hormone therapy in trans feminine individuals safer than oral birth control. Data from both cis and trans groups suggest additional VTE risk associated with the use of progestins. While transdermal estrogens dosed up to 0.1 mg/day or below appear lower risk for VTE than other forms of estrogen, it is unclear whether this is related to the delivery method or a dose effect. Finally, even if the risk from exogenous estrogen use remains significant statistically, the absolute clinical risk remains low. Conclusion: Clinicians should avoid the use of ethinyl estradiol. Additionally, data suggest that progestins should be avoided for transgender individuals. Further study of the relationship between estrogen use and the risk of VTE will serve to inform the safest care strategies for transgender individuals.
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Affiliation(s)
- Zil Goldstein
- Center for Transgender Medicine and Surgery at Mount Sinai, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Tamar Reisman
- Center for Transgender Medicine and Surgery at Mount Sinai, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery at Mount Sinai, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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24
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Swee DS, Javaid U, Quinton R. Estrogen Replacement in Young Hypogonadal Women-Transferrable Lessons From the Literature Related to the Care of Young Women With Premature Ovarian Failure and Transgender Women. Front Endocrinol (Lausanne) 2019; 10:685. [PMID: 31681164 PMCID: PMC6798086 DOI: 10.3389/fendo.2019.00685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/20/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Du Soon Swee
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- *Correspondence: Du Soon Swee
| | - Usman Javaid
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Richard Quinton
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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25
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Liu X, Fu X, Du R, Chen Z, Sun J, Ding Y. Epidemiology and Risk Factors of Menopause Syndrome Among Uyghur, Han, and Kazak Women in Xinjiang, China. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018; 24:8950-8958. [PMID: 30531683 PMCID: PMC6298176 DOI: 10.12659/msm.909954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study analyzed the epidemiology and the risk factors of menopause syndrome (MPS) among Uyghur, Han, and Kazak women in Xinjiang. MATERIAL AND METHODS This was a cross-sectional study. The stratified-cluster random-sampling method was used. A total of 3382 women aged 40 to 60 years of age were included from Urumqi City, Kashgar City, Altay City, Ili Kazakh Autonomous Prefecture, Künes County, Mongolkure County, Tekes County,Talede town, Alemale Township, and Ulugchat County (Kashgar Prefecture) in Xinjiang Province. A questionnaire was used to survey the clinical characteristics of MPS. Logistic regression analysis was used to analyze the MPS risk factors among Uyghur, Han, and Kazak women. RESULTS Oral contraceptives, negative life events, and menopause stages can influence MPS in Han women. In addition, occupation, body weight, mental illness, drug or alcohol abuse, and income level also affect the MPS of Uyghur women. In contrast to Han and Uyghur participants, education, menopausal pattern (natural or artificial), reproductive factors, and smoking are risk factors of MPS in Kazakh women. CONCLUSIONS The menopausal stages and the risk factors for MPS are different among Uyghur, Han, and Kazak women.
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Affiliation(s)
- Xinlian Liu
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xi Fu
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Rong Du
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Zhifang Chen
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jialin Sun
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yan Ding
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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26
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Cortés YI, Parikh N, Allison MA, Criqui MH, Suder N, Barinas-Mitchell E, Wassel CL. Women's Reproductive History and Pre-Clinical Peripheral Arterial Disease in Late Life: The San Diego Population Study. J Womens Health (Larchmt) 2018; 28:1105-1115. [PMID: 30508411 DOI: 10.1089/jwh.2018.7080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: Reproductive events have been linked with increased cardiovascular risk in women, but whether they are associated with pre-clinical peripheral arterial disease (PAD) has been understudied. We evaluated associations between reproductive factors and later-life ankle-brachial index (ABI), femoral artery intima-media thickness (fIMT), and femoral plaques. Methods: Cross-sectional analysis of 707 multiethnic women who participated in a follow-up exam of the San Diego Population Study in 2007-2011. To assess associations between reproductive factors (age at menarche, parity, age at menopause, surgical menopause, hormone therapy) with ABI, and Doppler ultrasound measurements of common and superficial fIMT, linear regression was used; for femoral plaque presence, logistic regression was used. Models were adjusted for age, race/ethnicity, and cardiometabolic factors. We tested interactions of reproductive factors with menopause type (natural vs. surgical). Results: Women were on average 71 years old, and 56% were non-Hispanic White. Reproductive factors were not associated with fIMT, femoral plaque presence, or ABI. There were significant interactions between menopause type (surgical vs. natural) and oral contraceptive use (-β: 0.04, p = 0.03) for ABI, as well as between menopause type and parity (β: 0.11, p = 0.05) and age at menopause (β: 0.001, p = 0.05) for fIMT. Among women with natural menopause, oral contraceptive use was associated with higher ABI (β: 0.03, p = 0.007) and older age at natural menopause was related to greater fIMT (β: 0.009, p = 0.06). Among women with surgical menopause, nulliparity was marginally associated with greater fIMT (β: 0.33, p = 0.07). Conclusions: Reproductive history may not be independently associated with later-life lower extremity atherosclerosis in women. Studies are necessary to confirm findings and examine pregnancy-related exposures in relation to pre-clinical PAD.
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Affiliation(s)
- Yamnia I Cortés
- 1School of Nursing, PhD Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nisha Parikh
- 2Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Matthew A Allison
- 3Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California
| | - Michael H Criqui
- 3Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California
| | - Natalie Suder
- 4Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emma Barinas-Mitchell
- 4Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Richardson A, Haridass SA, Ward E, Ayres J, Baskind NE. Investigation and treatment of premature ovarian insufficiency: A multi-disciplinary review of practice. Post Reprod Health 2018; 24:155-162. [PMID: 30392440 DOI: 10.1177/2053369118811233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess compliance with the European Society for Human Reproduction and Embryology (ESHRE) guidelines on the investigation and management of women with premature ovarian insufficiency at the Leeds Teaching Hospitals NHS Trust (LTHT) and to determine whether this varies depending on the clinical setting in which the women present. STUDY DESIGN A retrospective review of all females diagnosed with premature ovarian insufficiency between 1 July 2016 and 30 June 2017, presenting to one of the following clinics: reproductive medicine, specialist menopause, general gynaecology, oncology long-term follow-up, general endocrinology or paediatric endocrinology. MAIN OUTCOME MEASURES Proportion of patients who had the necessary investigations performed and relevant treatment options discussed. RESULTS 103 women were included in the study. Overall, 40.6% had a karyotype. Screening for the Fragile-X pre-mutation, thyroid peroxidase and 21-hydroxylase antibodies occurred in 7.4%, 11.1% and 13.6% of women, respectively. Only 35.9% had their bone mineral density measured. There was significant variation in the performance of a karyotype (p < 0.001) and thyroid peroxidase antibodies (p < 0.01) between the different clinical settings. Overall, lifestyle advice was offered to 30.1%. Estrogen replacement, contraception, fertility options and bone protection were discussed with 76.0%, 38.4%, 59.0% and 75.0%, respectively. Psychological support was offered to 25.2%. There was significant variation for all apart from contraception. CONCLUSION The investigation and treatment of women with premature ovarian insufficiency at the LTHT is not consistent with the ESHRE guidelines and requires improvement. Furthermore, there is significant variation in management depending on the department to which the patient initially presents.
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Affiliation(s)
- A Richardson
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S A Haridass
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Ward
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Ayres
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N E Baskind
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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El Khoudary SR, Thurston RC. Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms. Obstet Gynecol Clin North Am 2018; 45:641-661. [PMID: 30401548 DOI: 10.1016/j.ogc.2018.07.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The menopause transition (MT) is a critical period of women's lives marked by several physiologic changes and menopause-related symptoms that have implications for health. Risk for cardiovascular disease, the leading cause of death in women, increases after menopause, suggesting a contribution of the MT to its development. This article focuses on the relationship between 2 main features of the MT and women's cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discussed.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, USA.
| | - Rebecca C Thurston
- Departments of Psychiatry and Epidemiology, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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Hamoda H. The British Menopause Society and Women's Health Concern recommendations on the management of women with premature ovarian insufficiency. Post Reprod Health 2018; 23:22-35. [PMID: 28381102 DOI: 10.1177/2053369117699358] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tairova MS, Graciolli LO, Tairova OS, De Marchi T. Analysis of Cardiovascular Disease Risk Factors in Women. Open Access Maced J Med Sci 2018; 6:1370-1375. [PMID: 30159059 PMCID: PMC6108803 DOI: 10.3889/oamjms.2018.274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/06/2022] Open
Abstract
AIM: Study the cardiovascular risk factors in a feminine population vulnerable to cardiovascular events particularly to evaluate the principal factors or possible confounding variables. METHODS: This is a cross-sectional descriptive study. Were analysed all the female patients from the Cardiovascular Rehabilitation Institute of Sports Medicine of Caxias do Sul who had the complete information on cardiovascular disease history, comorbidities and habits and who knew the complete gynaecological history by a phone interview. RESULTS: A group of 91 patients were analysed. About the comorbidities and habits, 45.2% of these patients presented some tobacco load, 82.4% are hypertensive, 61.5% are dyslipidemic, 25.3% are diabetic and the BMI average was 29.27 (overweight). Between the patients who undergone a hysterectomy and had an episode of the acute coronary syndrome (10 patients), 70% had the event after the procedure. Between the post-menopause women with at least one episode of the acute coronary syndrome, 80.5% (33 patients) had the first event after the menopause. CONCLUSION: We found multiple lifetime risk factors that predisposed the women of the sample to have cardiovascular disease. Between the women with specific to women risk factors and without, the prevalence of cardiovascular disease was very similar. This information supports the idea that these are just confounding factors of CVD and the principals involved are the genetic factors and habits. For this reason, the focus of CVD prevention and treatment should be directed towards these aspects.
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Affiliation(s)
| | - Lucas Odacir Graciolli
- Cardiovascular Rehabilitation Institute of Sports Medicine of Caxias do Sul, Caxias do Sul, Brazil
| | - Olga Sergueevna Tairova
- Cardiovascular Rehabilitation Institute of Sports Medicine of Caxias do Sul, Caxias do Sul, Brazil
| | - Thiago De Marchi
- Faculdade Cenecista of Bento Gonçalves, Rio Grande do Sul, Brazil
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Soleimani A, Pourmoghaddas A, Sadeghi M, Roohafza H, Talaei M, Dianatkhah M, Oveisgharan S, Soleimani M, Sarrafzadegan N. Risk and Age of Cardiovascular Event in Women with Metabolic Syndrome: Menopause Age in Focus. Metab Syndr Relat Disord 2018; 16:127-134. [DOI: 10.1089/met.2017.0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Azam Soleimani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Pourmoghaddas
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Talaei
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Minoo Dianatkhah
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Oveisgharan
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Maryam Soleimani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Shreibati JB, Manson JE, Margolis KL, Chlebowski RT, Stefanick ML, Hlatky MA. Impact of hormone therapy on Medicare spending in the Women's Health Initiative randomized clinical trials. Am Heart J 2018; 198:108-114. [PMID: 29653631 PMCID: PMC5901884 DOI: 10.1016/j.ahj.2017.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Randomized trials can compare economic as well as clinical outcomes, but economic data are difficult to collect. Linking clinical trial data with Medicare claims could provide novel information on health care utilization and cost. METHODS We linked data from Medicare claims of women ≥65 years old who had Medicare fee-for-service coverage with their clinical data from the Women's Health Initiative trials of conjugated equine estrogens plus medroxyprogesterone acetate (CEE+MPA) versus placebo and of CEE-alone versus placebo. The primary outcome was total Medicare spending during the intervention phase of the trial, and the secondary outcomes were spending on diseases hypothesized a priori to be sensitive to the effects of hormone therapy. RESULTS In the CEE+MPA trial, 4,557 participants ≥65 years old were included. Women randomly assigned to CEE+MPA had 4% higher mean Medicare spending overall ($45,690 vs $43,920, P = .08) but 0.5% lower spending for hormone-sensitive diseases ($3,526 vs $3,547, P = .07), with 73% higher spending for coronary heart disease (P = .045) and 122% higher spending for pulmonary embolism (P = .026). In the CEE-alone trial, 3,107 participants were included. Total spending among women randomly assigned to CEE was 3.3% higher ($75,411 vs $72,997, P = .16), and 1.7% higher spending for hormone-sensitive diseases ($5,213 vs $5,127, P = .57), but with 39% lower spending for hip fracture (p<0.03). CONCLUSIONS Menopausal hormone therapy increased spending for some diseases, but decreased spending for others. These offsetting effects led to modest (3%-4%), nonsignificant increases in overall spending among women aged 65 years and older.
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Affiliation(s)
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Mark A Hlatky
- Stanford University School of Medicine, Stanford, CA.
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Webber L, Anderson RA, Davies M, Janse F, Vermeulen N. HRT for women with premature ovarian insufficiency: a comprehensive review. Hum Reprod Open 2017; 2017:hox007. [PMID: 30895225 PMCID: PMC6276684 DOI: 10.1093/hropen/hox007] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/24/2017] [Accepted: 06/08/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Premature ovarian insufficiency (POI), often and misleadingly referred to as ‘premature menopause’, is defined as a loss of ovarian activity before the age of 40 years and is characterized by irregular or absent periods and reduced fertility. Symptoms include those associated with the natural menopause (night sweats and vaginal dryness), and with the long-term adverse effects of estrogen deficiency (osteoporosis and cardiovascular disease): the latter is believed to explain the shorter life expectancy associated with POI. OBJECTIVE AND RATIONALE The objective of the current review was to collect all relevant studies supporting recommendations on the indications, treatment options, and risks of hormone replacement therapy (HRT) (estrogen, progestogens and androgens) for women with POI. SEARCH METHODS The current review was written based on the best available evidence on the topic collected for the recently published ESHRE guideline on the management of women with POI. PUBMED/MEDLINE and the Cochrane library were searched in a stepwise approach. Relevant references were summarized in evidence tables, with assessment of the quality. OUTCOMES HRT is strongly recommended for women with POI, mainly for vasomotor and genito-urinary symptom relief. In addition, HRT has been shown to have a role in bone protection and probably also in primary prevention of cardiovascular disease. There is little evidence on the optimal type, regimen and dose of HRT; patient preference for route and method of administration of each component of HRT must be considered when prescribing, as should contraceptive needs. In women with POI, physiological replacement of estrogen (and progesterone) is essential for their health, and the controversies that surround the use of HRT in postmenopausal women do not apply. LIMITATIONS, REASONS FOR CAUTION N/A. WIDER IMPLICATIONS New areas of study on HRT for women with POI should focus on life expectancy, quality of life and neurological function. Furthermore, randomized controlled trials comparing transdermal estradiol with oral estrogens with regard to efficacy, patient satisfaction and side effects are urgently needed. STUDY FUNDING/COMPETING INTERESTS The authors received no funding for the review. The costs for the development of the ESHRE guideline were covered by ESHRE. The authors have no conflicts of interest to disclose.
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Affiliation(s)
- Lisa Webber
- Department of Women's Health, University College London Hospitals, London NW1 2PG, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Melanie Davies
- Department of Women's Health, University College London Hospitals, London NW1 2PG, UK
| | - Femi Janse
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE), Grimbergen B-1852, Belgium
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Gentry-Maharaj A, Glazer C, Burnell M, Ryan A, Berry H, Kalsi J, Woolas R, Skates SJ, Campbell S, Parmar M, Jacobs I, Menon U. Changing trends in reproductive/lifestyle factors in UK women: descriptive study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMJ Open 2017; 7:e011822. [PMID: 28264823 PMCID: PMC5353253 DOI: 10.1136/bmjopen-2016-011822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE There has been considerable interest in the impact of reproductive factors on health but there are little data on how these have varied over time. We explore trends in reproductive/lifestyle factors of postmenopausal British women by analysing self-reported data from participants of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). DESIGN Prospective birth cohort analysis. SETTING Population cohort invited between 2001 and 2005 from age-sex registers of 27 Primary Care Trusts in England, Wales and Northern Ireland and recruited through 13 National Health Service Trusts. PARTICIPANTS 202 638 postmenopausal women aged 50-74 years at randomisation to UKCTOCS between April 2001 and October 2005. INTERVENTIONS Women were stratified into the following six birth cohorts (1925-1929, 1930-1934, 1935-1939, 1940-1944, 1945-1949, 1950-1955) based on year of birth. Self-reported data on reproductive factors provided at recruitment were explored using tabular and graphical summaries to examine for differences between the birth cohorts. OUTCOME MEASURES Trends in mean age at menarche and menopause, use of oral contraceptives, change in family size, infertility treatments, tubal ligation and hysterectomy rates. RESULTS Women born between 1935 and 1955 made up 86% of the cohort. Median age at menarche decreased from 13.4 for women born between 1925 and 1929 to 12.8 for women born between 1950 and 1955. Increased use of the oral contraceptives, infertility treatments and smaller family size was observed in the younger birth cohorts. Tubal ligation rates increased for those born between 1925 and 1945, but this increase did not persist in subsequent cohorts. Hysterectomy rates (17-20%) did not change over time. CONCLUSIONS The trends seen in this large cohort are likely to reflect the reproductive history of the UK female postmenopausal population of similar age. Since these are risk factors for hormone-related cancers, these trends are important in understanding the changing incidence of these cancers. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trial Number: 22488978.
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Affiliation(s)
| | - Clara Glazer
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
- Department of Occupational and Environmental Medicine, Frederiksberg-Bispebjerg University Hospital, Copenhagen, Denmark
| | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Hannah Berry
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Steve J Skates
- Massachusetts General Hospital Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
- Centre for Women's Health, Institute of Human Development, University of Manchester, Manchester, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
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Farge D, Bounameaux H, Bauersachs RM, Brenner B. Women, thrombosis, and cancer: A gender-specific analysis. Thromb Res 2017; 151 Suppl 1:S21-S29. [DOI: 10.1016/s0049-3848(17)30062-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martin RC, Burgin WS, Schabath MB, Kirby B, Chae SH, Fradley MG, Rose DZ, Labovitz AJ. Gender-Specific Differences for Risk of Disability and Death in Atrial Fibrillation-Related Stroke. Am J Cardiol 2017; 119:256-261. [PMID: 27846983 DOI: 10.1016/j.amjcard.2016.09.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
In the latest American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation (AF) guidelines, CHA2DS2-VASc replaced the CHADS2 stroke risk assessment to determine prophylactic anticoagulation, reflecting female gender's association with stroke incidence in AF. However, little investigation has been pursued of potential risk factors associated with worsened stroke severity. In this study, we examined patients with AF with ischemic stroke patient characteristics associated with increased stroke severity. Using the Get With The Guidelines-Stroke database, we retrospectively identified 221 consecutive patients with AF diagnosed with acute ischemic stroke and performed in depth chart review, evaluating demographics, labs, and co-morbidities. We analyzed the modified Rankin Scale (mRS) at discharge as a surrogate for stroke severity, defining severe stroke as fatal (mRS of 6) or disabling (mRS 4 to 5), requiring max assistance with ambulation or activities of daily living. Female gender, advanced age, and decreased body surface area were associated with disabling or fatal stroke (68.3% of patients with mRS 4 to 6 vs 50% with mRS 0 to 3, 78.4 vs 71.1 year, and 1.83 vs 1.92, respectively). Using a backward elimination approach revealed a logistic regression model with statistically significant odds ratios (ORs) for female gender (OR 1.99) and age (OR 1.04), and borderline significant for a history of coronary artery disease (OR 1.89). In conclusion, female gender is associated in the AF population with a twofold risk of severe disabling or fatal ischemic stroke, a finding that persists after controlling for potential confounders. This finding highlights the potential benefit from appropriate anticoagulation use for stroke prophylaxis in the AF population.
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Affiliation(s)
- Ryan C Martin
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida
| | - W Scott Burgin
- Department of Neurology, University of South Florida College of Medicine, Tampa, Florida
| | - Matthew B Schabath
- Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Florida; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bonnie Kirby
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida
| | - Sanders H Chae
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida
| | - Michael G Fradley
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida
| | - David Z Rose
- Department of Neurology, University of South Florida College of Medicine, Tampa, Florida
| | - Arthur J Labovitz
- Department of Cardiovascular Sciences, University of South Florida College of Medicine, Tampa, Florida.
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Zhong GC, Liu Y, Chen N, Hao FB, Wang K, Cheng JH, Gong JP, Ding X. Reproductive factors, menopausal hormone therapies and primary liver cancer risk: a systematic review and dose-response meta-analysis of observational studies. Hum Reprod Update 2016; 23:126-138. [PMID: 27655589 DOI: 10.1093/humupd/dmw037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A striking gender disparity in the incidence and outcome of primary liver cancer (PLC) has been well recognized. Mounting evidence from basic research suggests that hormonal factors may be involved in the gender disparity of PLC. Whether hormonal exposures in human subjects are associated with PLC risk is largely unknown. OBJECTIVE AND RATIONALE Whether reproductive factors and use of menopausal hormone therapies (MHTs) in women are associated with PLC risk remains controversial. We conducted this study to clarify this issue. SEARCH METHODS PubMed and EMBASE were searched to July, 2016 for studies published in English or Chinese. Observational studies (cohort, nested case-control and case-control) that provided risk estimates of reproductive factors, MHTs and PLC risk were eligible. The quality of included studies was determined based on the Newcastle-Ottawa quality assessment scale. Summary risk ratios (RRs) were calculated using a random-effects model. Dose-response analysis was conducted where possible. OUTCOMES Fifteen peer-reviewed studies, involving 1795 PLC cases and 2 256 686 women, were included. Overall meta-analyses on parity and PLC risk did not find any significant associations; however, when restricting to studies with PLC cases ≥100, increasing parity was found to be significantly associated with a decreased risk of PLC [RR for the highest versus lowest parity 0.67, 95% CI 0.52, 0.88; RR for parous versus nulliparous 0.71, 95% CI 0.53, 0.94; RR per one live birth increase 0.93, 95% CI 0.88, 0.99]. A J-shaped relationship between parity and PLC risk was identified (Pnon-linearity < 0.01). Compared with never users, the pooled RRs of PLC were 0.60 (95% CI 0.37, 0.96) for ever users of MHT, 0.73 (95% CI 0.46, 1.17) for ever users of estrogen-only therapy (ET) and 0.67 (95% CI 0.45, 1.02) for ever users of estrogen-progestin therapy (EPT). The pooled RR of PLC for the oldest versus youngest category of menarcheal age was 0.50 (95% CI 0.32, 0.79). Oophorectomy was significantly associated with an increased risk of PLC (RR 2.23, 95% CI 1.46, 3.41). No significant association of age at first birth, and spontaneous or induced abortion with PLC risk was found. No meta-analysis was performed for the association of age at menopause, breastfeeding, hysterectomy, menopausal status and stillbirth with PLC risk owing to huge methodological heterogeneity and/or very limited studies. WIDER IMPLICATIONS Parity is associated with PLC risk in a J-shaped dose-response pattern. Late age at menarche and ever use of MHT are associated with a reduced risk of PLC, whereas there is no association of ever use of ET and EPT, age at first birth, or spontaneous and induced abortion with PLC risk. Compared to women with no history of oophorectomy, those with a history of oophorectomy are at an increased risk of PLC. Our findings provide some epidemiological support for a role of hormonal exposures in the development of PLC in women. However, these findings should be interpreted with much caution because of the limited number of studies and potential biases, and need to be validated by studies with good design and large sample size.
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Affiliation(s)
- Guo-Chao Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Yan Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China.,Department of Gastroenterology, The Fifth People's Hospital of Chengdu, 33 Mashi Street, Wenjiang District, Chengdu 611130, China
| | - Nan Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Fa-Bao Hao
- Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Kang Wang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang District, Chongqing 400016, China
| | - Jia-Hao Cheng
- Department of Urinary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Jian-Ping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Xiong Ding
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China
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Arterial Remodeling in B-Type Natriuretic Peptide Knock-Out Females. Sci Rep 2016; 6:25623. [PMID: 27162120 PMCID: PMC4861904 DOI: 10.1038/srep25623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/19/2016] [Indexed: 12/12/2022] Open
Abstract
Sexual dimorphisms are recognized in cardiovascular conditions such as hypertension, stroke, thrombosis and vasculitis. B-type natriuretic peptide (BNP) is a guanylyl cyclase A (GC-A) agonist. The anti-hypertensive, vasodilatory, anti-fibrotic, and anti-hypertrophic properties of BNP are well established in male animal models. Although circulating BNP levels are higher in women, when compared to age-matched men, the cardiovascular protective propensity of BNP in females is poorly understood. We assessed the cardiovascular consequences of BNP deletion in genetically null (Nppb−/−) female rat lines. Throughout the study, blood pressure (BP) remained uninfluenced by genotype, and cardiorenal consequences of BNP knock out remained minor. Unexpectedly, approximately 60% of Nppb−/− females developed mesenteric polyarteritis-nodosa (PAN)-like vasculitis in their life span, some as early as 4 months of age. Mesenteric lesions involved intense arterial remodeling, progressive inflammation, occluded lumens, and less frequently intestinal necrosis and multiple visceral arterial aneurysms. Cumulative pathologies resulted in a significant decline in survival of the Nppb−/− female. This study highlights BNP’s vasoprotective propensity, bringing to light a possible sex specific difference in the cardiovascular protection provided by BNP. Defects in the BNP/GC-A/cGMP pathway may play a role in arteriopathies in women, while GC-A agonists may provide effective therapy for arteritis.
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Abstract
PURPOSE OF REVIEW Cardiovascular disease considerations are associated with the menopause. Despite a misconception that women have a minimal risk for coronary heart disease (CHD), it is the major cause of female deaths. This review highlights issues of hormone replacement therapy (HRT) and CHD in women. RECENT FINDINGS A woman under age 60, who suffers a myocardial infarction (MI), has a 2-year post-MI mortality of 28.9%; it is 19.6% in men. CHD and MI in women are subtle. In addition, female mortality from CHD increases after the menopause. The increased inflammatory risk factor status of women plays a role in development of atherosclerosis, before and after the menopause. Until after the menopause, women overall have a lower CHD mortality rate. Menopause is associated with unique symptoms, especially vasomotor ones; preexisting cardiovascular disease further exacerbates problems associated with the menopause. Use of HRT after the menopause is a major issue. Early menopause at age 39 years or younger and late menopause at age 56 years or older increase cardiovascular risk. HRT should not be prescribed for cardiovascular risk prevention, but when less than 10 years from menopause at a normal age, women can be reassured that cardiovascular risk from HRT is very low. SUMMARY Prescription of HRT should never be made only for cardiovascular risk reduction. However, when symptom-related and other indications are present, HRT is appropriate and well tolerated in the early years after menopause with onset at a normal age.
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Prior hysterectomy and oophorectomy and incident venous thrombosis risk among postmenopausal women: a population-based, case-control study. Menopause 2016; 23:143-9. [PMID: 26757272 DOI: 10.1097/gme.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hysterectomy and bilateral salpingo-oophorectomy (BSO) are associated with changes in endogenous hormone levels, yet the risk of venous thrombosis (VT) associated with hysterectomy and BSO is incompletely characterized. This study evaluated the risk of incident VT among postmenopausal women associated with combined prior hysterectomy/oophorectomy status and current use of hormone therapy (HT). METHODS In a case-control study, we identified incident VT cases (n = 1,623) among postmenopausal Group Health Cooperative enrollees without reproductive cancer, defining their "index date" as their VT diagnosis date (1995-2010). Matched controls had not experienced a prior VT (n = 4,480). Multiple logistic regression models estimated adjusted relative risks for VT associated with combinations of prior hysterectomy/oophorectomy status and HT use at the index date. RESULTS Compared with women with an intact uterus who were not using HT, there was no suggestion of greater VT risk in women with prior hysterectomy without BSO, whether they were (adjusted odds ratio [aOR] = 0.80 [95% CI: 0.57, 1.12]) or were not using HT (aOR = 1.09 [95% CI: 0.89, 1.35]). Women with prior hysterectomy and BSO who were using HT were not at a greater VT risk (OR = 1.00 [95% CI: 0.78, 1.27]), but there was evidence of a 25% greater risk associated with prior hysterectomy with BSO and no current HT use (OR = 1.25 [95% CI: 1.05, 1.49]). CONCLUSIONS Collectively, these and prior data do not suggest a substantial impact of hysterectomy, with or without BSO, on the risk of VT among postmenopausal women.
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Bińkowska M. Menopausal hormone therapy and venous thromboembolism. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2014; 13:267-72. [PMID: 26327865 PMCID: PMC4520375 DOI: 10.5114/pm.2014.46468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 10/02/2014] [Accepted: 10/10/2014] [Indexed: 11/24/2022]
Abstract
Menopausal hormone therapy (MHT) is the most effective method of treating vasomotor symptoms and other climacteric symptoms related to estrogen deficiency in peri- and postmenopausal period. In addition to estrogen replacement, women with preserved uterus require the addition of progestagen in order to ensure endometrial safety. One of rare but severe complications of MHT is venous thromboembolism (VTE). The incidence of VTE rises in parallel to women's age and body weight. The condition is also linked to hereditary and acquired risk factors. Oral estrogens increase the risk of venous thromboembolic complications to varying extents, probably depending on their type and dose used. Observational studies have not found an association between an increased risk of VTE and transdermal estrogen treatment regardless of women's age and body mass index (BMI). Micronized progesterone and pregnanes, including dydrogesterone, have no effect on the risk of VTE, whereas norpregnane progestagens cause an additional increase in risk. Among hormonal preparations which are commercially available in Poland, the combination of transdermal estradiol with oral dydrogesterone appears to be the optimum choice, as it does not elevate the risk of VTE (compared to patients not using MHT), and dydrogesterone seems to be the progestagen of choice.
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Affiliation(s)
- Małgorzata Bińkowska
- First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
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