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Xiang X, Palasuberniam P, Pare R. The Role of Estrogen across Multiple Disease Mechanisms. Curr Issues Mol Biol 2024; 46:8170-8196. [PMID: 39194700 DOI: 10.3390/cimb46080483] [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: 06/13/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Estrogen is a significant hormone that is involved in a multitude of physiological and pathological processes. In addition to its pivotal role in the reproductive system, estrogen is also implicated in the pathogenesis of a multitude of diseases. Nevertheless, previous research on the role of estrogen in a multitude of diseases, including Alzheimer's disease, depression, cardiovascular disease, diabetes, osteoporosis, gastrointestinal diseases, and estrogen-dependent cancers, has concentrated on a single disease area, resulting in a lack of comprehensive understanding of cross-disease mechanisms. This has brought some challenges to the current treatment methods for these diseases, because estrogen as a potential therapeutic tool has not yet fully developed its potential. Therefore, this review aims to comprehensively explore the mechanism of estrogen in these seven types of diseases. The objective of this study is to describe the relationship between each disease and estrogen, including the ways in which estrogen participates in regulating disease mechanisms, and to outline the efficacy of estrogen in treating these diseases in clinical practice. By studying the role of estrogen in a variety of disease mechanisms, it is hoped that a more accurate theoretical basis and clinical guidance for future treatment strategies will be provided, thus promoting the effective management and treatment of these diseases.
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Affiliation(s)
- Xiuting Xiang
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Praneetha Palasuberniam
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Rahmawati Pare
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
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Broni EK, Echouffo-Tcheugui JB, Palatnik A, Graham EM, Turkson-Ocran RA, Commodore-Mensah Y, Ndumele CE, Michos ED. Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis. Am J Obstet Gynecol 2024:S0002-9378(24)00561-1. [PMID: 38703940 DOI: 10.1016/j.ajog.2024.04.035] [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: 08/09/2023] [Revised: 03/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Metabolic syndrome is linked to an increased risk of incident cardiovascular disease and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term cardiovascular disease risk. OBJECTIVE To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multiethnic cohort. STUDY DESIGN We studied 3367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy, and metabolic syndrome at baseline (2000-2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy and or oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from examinations 2 (2002-2004) to 6 (2016-2018). RESULTS The mean age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy (hazard ratio, 1.32 [95% confidence interval, 1.01-1.73]) and hystero-oophorectomy (hazard ratio, 1.40 [95% confidence interval, 1.13-1.74]) were both associated with incident metabolic syndrome compared with having neither hysterectomy nor oophorectomy. CONCLUSION Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomies and the mechanisms underpinning these associations may be explored.
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Affiliation(s)
- Eric K Broni
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Anna Palatnik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Ernest M Graham
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD
| | - Ruth-Alma Turkson-Ocran
- General Medicine, Research; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
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Hassan H, Allen I, Sofianopoulou E, Walburga Y, Turnbull C, Eccles DM, Tischkowitz M, Pharoah P, Antoniou AC. Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:44-57. [PMID: 37364803 DOI: 10.1016/j.ajog.2023.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study aimed to provide an up-to-date systematic review of "the long-term outcomes of bilateral salpingo-oophorectomy at the time of hysterectomy" and perform a meta-analysis for the reported associations. DATA SOURCES Our study updated a previous systematic review by searching the literature using PubMed, Web of Science, and Embase for publications between January 2015 and August 2022. STUDY ELIGIBILITY CRITERIA Our study included studies of women who had a hysterectomy with bilateral salpingo-oophorectomy vs women who had a hysterectomy with ovarian conservation or no surgery. METHODS The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations. Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates. RESULTS Compared with hysterectomy or no surgery, hysterectomy with bilateral salpingo-oophorectomy in young women was associated with decreased risk of breast cancer (hazard ratio, 0.78; 95% confidence interval, 0.73-0.84) but with an increased risk of colorectal cancer (hazard ratio, 1.27; 95% confidence interval, 1.10-1.47). In addition, it was associated with an increased risk of total cardiovascular diseases, coronary heart disease, and stroke with hazard ratios of 1.18 (95% confidence interval, 1.11-1.25), 1.17 (95% confidence interval, 1.10-1.25), and 1.20 (95% confidence interval, 1.10-1.31), respectively. Compared with no surgery, hysterectomy with bilateral salpingo-oophorectomy before the age of 50 years was associated with an increased risk of hyperlipidemia (hazard ratio, 1.44; 95% confidence interval, 1.25-1.65), diabetes mellitus (hazard ratio, 1.16; 95% confidence interval, 1.09-1.24), hypertension (hazard ratio, 1.13; 95% confidence interval, 1.06-1.20), dementia (hazard ratio, 1.70; 95% confidence interval, 1.07-2.69), and depression (hazard ratio, 1.39; 95% confidence interval, 1.22-1.60). The evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2=85%; P<.01). CONCLUSION Hysterectomy with bilateral salpingo-oophorectomy was associated with multiple long-term outcomes. The benefits of the addition of bilateral salpingo-oophorectomy to hysterectomy should be balanced against the risks.
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Affiliation(s)
- Hend Hassan
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom.
| | - Isaac Allen
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Eleni Sofianopoulou
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Yvonne Walburga
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Clare Turnbull
- Translational Genetics Team, Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
| | - Diana M Eccles
- Faculty of Medicine, Department of Cancer Sciences, University of Southampton, Southampton, United Kingdom
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Paul Pharoah
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
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Li B, Zhang Y, Zhang L, Zhang L. Association between endometriosis and metabolic syndrome: a cross-sectional study based on the National Health and Nutrition Examination Survey data. Gynecol Endocrinol 2023; 39:2254844. [PMID: 37673102 DOI: 10.1080/09513590.2023.2254844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Endometriosis has been reported to be associated with metabolism-related diseases, such as hypercholesterolemia and diabetes, while no studies have reported the association between endometriosis and metabolic syndrome. OBJECTIVE This study aims to explore the association between endometriosis and metabolic syndrome. Also, the association between endometriosis and single metabolic syndrome indicator was explored. METHODS This was a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). A total of 2389 participants were finally included for analysis, with 2212 in the non-endometriosis group and 177 in the endometriosis group. Association between endometriosis and metabolic syndrome was explored using multivariate logistic regression analysis, with results shown as odds ratio (OR) with 95% confidence intervals (95%CI). Association between endometriosis and single metabolic syndrome indicator was explored using multivariate liner regression analysis. RESULTS After adjusting age, race, education level, family poverty to income ratio (PIR), smoking, age at menarche, gravidity, menopause, female hormones use, and dyslipidemia drug use, endometriosis was associated with the higher odds of metabolic syndrome (OR = 1.55, 95%CI: 1.01-2.35). Further adjusting hysterectomy or oophorectomy, we found the similar association despite no statistical significance (OR = 1.47, 95%CI: 0.96-2.25). Moreover, we found endometriosis was associated with the high level of triglyceride (TG) (β = 0.38, 95%CI: 0.06-0.70). CONCLUSIONS Our study found the association between endometriosis and metabolic conditions, indicating that metabolic conditions of endometriosis women should be focused, and monitoring the blood lipid levels may be significant in decreasing the risk of metabolic syndrome.
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Affiliation(s)
- Baijia Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, P.R. China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, P.R. China
| | - Yuxue Zhang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, P.R. China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, P.R. China
| | - Liuhang Zhang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, P.R. China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, P.R. China
| | - Lingyan Zhang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, P.R. China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, P.R. China
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Lin SJ, Wu CY, Tsai CF, Yang HY. Hysterectomy and risk of osteoarthritis in women: a nationwide nested case-control study. Scand J Rheumatol 2023; 52:556-563. [PMID: 36644967 DOI: 10.1080/03009742.2022.2153985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Hysterectomy is the most common gynaecological surgery, performed mainly for benign uterine pathologies in women. Studies have suggested that hysterectomy is associated with osteoarthritis (OA); however, the association remains controversial. This study aimed to investigate the association between hysterectomy and the risk of OA. METHOD We performed a population-based nested case-control study using the National Health Insurance programme database from 2000 to 2016 in Taiwan. All medical conditions for each case and control were categorized using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10. A multiple conditional logistic regression model was applied to analyse the adjusted odds ratio (aOR) and 95% confidence interval (CI) for the association between hysterectomy and OA. RESULTS Our analyses included 16 592 patients with OA and 66 368 matched controls. After adjustment for possible confounders, hysterectomy had a significant association with OA (aOR = 1.19, 95% CI = 1.09-1.30), especially knee OA (aOR = 1.25, 95% CI = 1.13-1.38). Furthermore, women who received oestrogen therapy (ET) alone and patients who underwent hysterectomy without ET showed a greater risk of OA development compared to women who did not receive ET (aOR = 1.14, 95% CI = 1.07-1.23, and aOR = 1.19, 95% CI = 1.08-1.31, respectively). CONCLUSION Our findings indicate that hysterectomy is associated with OA, especially knee OA. We also found that women who received ET alone and patients who underwent hysterectomy without ET had an increased risk of OA.
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Affiliation(s)
- S-J Lin
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - C-Y Wu
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chia-Yi, Taiwan
| | - C-F Tsai
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - H-Y Yang
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
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Interaction between gut microbiota and sex hormones and their relation to sexual dimorphism in metabolic diseases. Biol Sex Differ 2023; 14:4. [PMID: 36750874 PMCID: PMC9903633 DOI: 10.1186/s13293-023-00490-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Metabolic diseases, such as obesity, metabolic syndrome (MetS) and type 2 diabetes (T2D), are now a widespread pandemic in the developed world. These pathologies show sex differences in their development and prevalence, and sex steroids, mainly estrogen and testosterone, are thought to play a prominent role in this sexual dimorphism. The influence of sex hormones on these pathologies is not only reflected in differences between men and women, but also between women themselves, depending on the hormonal changes associated with the menopause. The observed sex differences in gut microbiota composition have led to multiple studies highlighting the interaction between steroid hormones and the gut microbiota and its influence on metabolic diseases, ultimately pointing to a new therapy for these diseases based on the manipulation of the gut microbiota. This review aims to shed light on the role of sexual hormones in sex differences in the development and prevalence of metabolic diseases, focusing on obesity, MetS and T2D. We focus also the interaction between sex hormones and the gut microbiota, and in particular the role of microbiota in aspects such as gut barrier integrity, inflammatory status, and the gut-brain axis, given the relevance of these factors in the development of metabolic diseases.
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Desai S, Singh RJ, Govil D, Nambiar D, Shukla A, Sinha HH, Ved R, Bhatla N, Mishra GD. Hysterectomy and women's health in India: evidence from a nationally representative, cross-sectional survey of older women. Womens Midlife Health 2023; 9:1. [PMID: 36609516 PMCID: PMC9825041 DOI: 10.1186/s40695-022-00084-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life. METHODS This analysis utilised the first wave of the Longitudinal Study on Aging in India, a nationally representative study of adults that included a module on health and well-being. We analysed data on 35,083 women ≥45 years in India. We estimated prevalence of hysterectomy and performed multivariable logistic regression to identify associated risk factors and to examine the association between hysterectomy status and eight self-reported chronic conditions, hospitalisation and mobility. RESULTS The prevalence of hysterectomy among women >=45 years was 11.4 (95% CI: 10.3, 12.6), with higher odds among urban women (aOR: 1.39; 1.17,1.64) and higher economic status (highest compared to lowest quintile: aOR: 1.95; 1.44, 2.63). Hysterectomy history was associated with four chronic conditions: hypertension (aOR: 1.51; 95% CI: 1.28, 1.79), high cholesterol (aOR: 1.43; 1.04, 1.97), diabetes (aOR: 1.69; 1.28, 2.24), and bone/joint disease (aOR: 1.54; 1.20, 1.97) and higher odds of any hospitalisation in the past year (aOR: 1.69; 1.36, 2.09). CONCLUSIONS In India, evidence suggests that hysterectomy is associated with major chronic conditions. The assessment for hysterectomy as a treatment option for gynaecological morbidity should consider potential health consequences in later life.
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Affiliation(s)
- Sapna Desai
- grid.510878.3Population Council Institute, Zone 5A India Habitat Centre, Lodhi Road, New Delhi, 110003 India
| | - Roopal Jyoti Singh
- grid.510878.3Population Council Institute, Zone 5A India Habitat Centre, Lodhi Road, New Delhi, 110003 India
| | - Dipti Govil
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
| | - Devaki Nambiar
- grid.464831.c0000 0004 8496 8261George Institute for Global Health, New Delhi, India
| | | | - Hemali Heidi Sinha
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, India
| | - Rajani Ved
- Bill & Melinda Gates Foundation, New Delhi, India
| | - Neerja Bhatla
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Gita D. Mishra
- grid.1003.20000 0000 9320 7537University of Queensland School of Public Health, Herston, Queensland Australia
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Association of age at menopause with type 2 diabetes mellitus in postmenopausal women in the United States: National Health and Nutrition Examination Survey 2011-2018. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2022; 21:229-235. [PMID: 36704768 PMCID: PMC9871996 DOI: 10.5114/pm.2022.123514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 01/20/2023]
Abstract
Introduction The present study aimed to examine the impact of age at menopause on the type 2 diabetes mellitus (T2DM) risk in postmenopausal women. Material and methods We included 4,968 postmenopausal women from the National Health and Nutrition Examination Survey 2011-2018. Age at menopause was measured by single year and categorically (< 40 years, 40-44 years, 45-54 years, 55 years and above). The outcome variable T2DM was measured with self-report and fasting blood glucose level. We performed logistic regression to estimate the odds ratio (OR) (95% confidence interval [CI]). Linear regression was used to examine the correlation between age at menopause and age at T2DM. Results Of the 4,968 postmenopausal women, 796 (16.0%) had T2DM after menopause. The mean age at menopause was 44.2 years. The mean age at T2DM was 57.2 years. Adjusting for potential confounders, the ORs for the association between age at menopause of < 40 years, 40-44 years and ≥ 55 years and T2DM were 1.97 (95% CI: 1.47-2.63), 1.27 (95% CI: 0.90-1.79) and 0.98 (95% CI: 0.66-1.45), respectively, compared to women having menopause at age 45 to 54 years. Each increase by 1 year in age at menopause was associated with a 3% reduction in the prevalence of T2DM (95% CI: 2-5). Age at menopause was significantly correlated with age at T2DM. Each 1-year increase in age at menopause might lead to a decrease of 0.39 years in age at T2DM. Conclusions Premature menopause was associated with increased T2DM risk in women. The earlier menopause occurs, the younger is the age at which T2DM may occur.
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Choi HG, Koh YS, Lee SW. Increased risk of coronary heart disease with hysterectomy in young women: A longitudinal follow-up study using a national health screening cohort. Maturitas 2022; 157:49-56. [DOI: 10.1016/j.maturitas.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023]
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