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Memi E, Pavli P, Papagianni M, Vrachnis N, Mastorakos G. Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord 2024; 25:751-772. [PMID: 38652231 PMCID: PMC11294403 DOI: 10.1007/s11154-024-09882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
Progesterone is a natural steroid hormone, while progestins are synthetic molecules. In the female reproductive system, progesterone contributes to the control of luteinizing hormone and follicle-stimulating hormone secretion and their pulsatility, via its receptors on the kisspeptin, neurokinin B, and dynorphin neurons in the hypothalamus. Progesterone together with estradiol controls the cyclic changes of proliferation and decidualization of the endometrium; exerts anti-mitogenic actions on endometrial epithelial cells; regulates normal menstrual bleeding; contributes to fertilization and pregnancy maintenance; participates in the onset of labor. In addition, it exerts numerous effects on other endocrine systems. Micronized progesterone (MP) is natural progesterone with increased bioavailability, due to its pharmacotechnical micronized structure, which makes it an attractive diagnostic and therapeutic tool. This critical literature review aims to summarize and put forward the potential diagnostic and therapeutic uses of MP in the field of endocrinology. During reproductive life, MP is used for diagnostic purposes in the evaluation of primary or secondary amenorrhea as a challenge test. Moreover, it can be prescribed to women presenting with amenorrhea or oligomenorrhea for induction of withdrawal bleeding, in order to time blood-sampling for diagnostic purposes in early follicular phase. Therapeutically, MP, alone or combined with estrogens, is a useful tool in various endocrine disorders including primary amenorrhea, abnormal uterine bleeding due to disordered ovulation, luteal phase deficiency, premenstrual syndrome, polycystic ovary syndrome, secondary amenorrhea [functional hypothalamic amenorrhea, premature ovarian insufficiency], perimenopause and menopause. When administrated per os, acting as a neurosteroid directly or through its metabolites, it exerts beneficial effects on brain function such as alleviation of symptoms of anxiety and depression, asw well as of sleep problems, while it improves working memory in peri- and menopausal women. Micronized progesterone preserves full potential of progesterone activity, without presenting many of the side-effects of progestins. Although it has been associated with more frequent drowsiness and dizziness, it can be well tolerated with nocturnal administration. Because of its better safety profile, especially with regard to metabolic ailments, breast cancer risk and veno-thromboembolism risk, MP is the preferred option for individuals with an increased risk of cardiovascular and metabolic diseases and of all-cause mortality.
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Affiliation(s)
- Eleni Memi
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Polina Pavli
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Maria Papagianni
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100, Trikala, Greece
- Endocrine Unit, 3rd Department of Pediatrics, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642, Thessaloniki, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Chaidari, Athens, Greece
- St George's NHS Foundation Trust Teaching Hospitals, St George's University of London, London, UK
| | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece.
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Kuru O, Ozcivit Erkan IB, Turker Saricoban C, Akgor U, Gokmen Inan N, Ilvan S. The Role of Endometrial Sampling before Hysterectomy in Premenopausal Women with Abnormal Uterine Bleeding. J Clin Med 2024; 13:3709. [PMID: 38999275 PMCID: PMC11242146 DOI: 10.3390/jcm13133709] [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: 05/12/2024] [Revised: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: An endometrial sampling is recommended for patients experiencing abnormal uterine bleeding above the age of 40 or 45. Valid risk prediction models are needed to accurately assess the risk of endometrial cancer and avoid an unnecessary endometrial biopsy in premenopausal women. We aimed to assess the necessity and usefulness of preoperative endometrial sampling by evaluating premenopausal women who underwent hysterectomy for abnormal uterine bleeding after preoperative endometrial sampling at our clinic. Methods: A retrospective analysis was conducted on 339 patients who underwent preoperative endometrial sampling and subsequently underwent hysterectomy due to abnormal uterine bleeding. Detailed gynecologic examinations, patient histories, and reports of endometrial sampling and hysterectomy were recorded. Cohen's Kappa (κ) statistic was utilized to evaluate the concordance between histopathological results from an endometrial biopsy and hysterectomy. Results: The mean age of the cohort was 47 ± 4 years. Endometrial biopsies predominantly revealed benign findings, with 137 (40.4%) cases showing proliferative endometrium and 2 (0.6%) cases showing endometrial cancer. Following hysterectomy, final pathology indicated proliferative endometrium in 208 (61.4%) cases, with 7 (2.1%) cases showing endometrioid cancer. There was a statistically significant but low level of concordance between histopathological reports of endometrial biopsy and hysterectomy results (Kappa = 0.108; p < 0.001). Significant differences were observed only in the body mass index of patients based on hysterectomy results (p = 0.004). When demographic characteristics were compared with cancer incidence, smoking status and preoperative endometrial biopsy findings showed statistically significant differences (p = 0.042 and p = 0.010, respectively). Conclusions: The concordance between the pathological findings of a preoperative endometrial biopsy and hysterectomy is low. Body mass index is an important differentiating factor between benign histopathologic findings of endometrium and endometrial neoplasia. Moreover, adenomyosis was found to be associated with endometrial cancer cases. The current approach to premenopausal women with abnormal uterine bleeding, which includes a routine endometrial biopsy, warrants re-evaluation by international societies and experts.
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Affiliation(s)
- Oguzhan Kuru
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Türkiye;
| | - Ipek Betul Ozcivit Erkan
- Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Türkiye
| | - Cansu Turker Saricoban
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Türkiye; (C.T.S.); (S.I.)
| | - Utku Akgor
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara 06230, Türkiye;
| | - Neslihan Gokmen Inan
- Department of Computer Engineering, College of Engineering, Koc University, Istanbul 34450, Türkiye;
| | - Sennur Ilvan
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Türkiye; (C.T.S.); (S.I.)
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Arab M, Jafari Ashtiani A, Ghavami B, Nouri B, Noghabaei G, Raoufi M. Role of Bariatric Surgery in Patients With Endometrial Cancer: A Case Report and Review of Literature. J Family Reprod Health 2024; 18:140-145. [PMID: 39011410 PMCID: PMC11246739 DOI: 10.18502/jfrh.v18i2.15938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
Objective The standard surgery for endometrial cancer can be deferred in some situations, including morbid obesity, comorbidities, and the patient's desire for fertility. One of the options to improve patients' circumstances is bariatric surgery. Case report This study presented two patients with stage IA, grade I endometrioid endometrial adenocarcinoma. Both patients had morbid obesity and had comorbidities. In case 1, because of fertility preservation, and in case 2, because of severe comorbidities, hormone therapy was started, followed by bariatric surgery after counseling patients. Both patients had acceptable changes in body mass index during follow-up, so cancer surgery through laparoscopy was done. Both patients did not need adjuvant therapy; months after cancer surgery, there is no recurrence, and their body mass index is also decreasing. Conclusion Bariatric surgery can improve outcomes in patients with morbid obesity who suffer endometrial cancer.
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Affiliation(s)
- Maliheh Arab
- Department of Gyneco-oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Jafari Ashtiani
- Department of Gyneco-oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Ghavami
- Obstetrics and Gynecology Department, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Nouri
- Department of Obstetrics and Gynecology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti Noghabaei
- Imam Hossein Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Raoufi
- Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dinicola S, Unfer V, Soulage CO, Margarita Yap-Garcia MI, Bevilacqua A, Benvenga S, Barbaro D, Wdowiak A, Nordio M, Dewailly D, Appetecchia M, Aragona C, Bezerra Espinola MS, Bizzarri M, Cavalli P, Colao A, D’Anna R, Vazquez-Levin MH, Marin IH, Kamenov Z, Laganà AS, Monastra G, Oliva MM, Özay AC, Pintaudi B, Porcaro G, Pustotina O, Pkhaladze L, Prapas N, Roseff S, Salehpour S, Stringaro A, Tugushev M, Unfer V, Vucenik I, Facchinetti F. <sc>d</sc>-Chiro-Inositol in Clinical Practice: A Perspective from the Experts Group on Inositol in Basic and Clinical Research (EGOI). Gynecol Obstet Invest 2024; 89:284-294. [PMID: 38373412 PMCID: PMC11309080 DOI: 10.1159/000536081] [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: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND d-Chiro-inositol is a natural molecule that, in association with its well-studied isomer myo-inositol, may play a role in treating various metabolic and gynecological disorders. OBJECTIVES This perspective seeks to explore the mechanisms and functions of d-chiro-inositol, laying the foundations to discuss its use in clinical practice, across dysmetabolism, obesity, and hormonal dysregulation. METHODS A narrative review of all the relevant papers known to the authors was conducted. OUTCOME d-Chiro-inositol acts through a variety of mechanisms, acting as an insulin sensitizer, inhibiting the transcription of aromatase, in addition to modulating white adipose tissue/brown adipose tissue transdifferentiation. These different modes of action have potential applications in a variety of therapeutic fields, including PCOS, dysmetabolism, obesity, hypoestrogenic/hyperandrogenic disorders, and bone health. CONCLUSIONS d-Chiro-inositol mode of action has been studied in detail in recent years, resulting in a clear differentiation between d-chiro-inositol and its isomer myo-inositol. The insulin-sensitizing activities of d-chiro-inositol are well understood; however, its potential applications in other fields, in particular obesity and hyperestrogenic/hypoandrogenic disorders in men and women, represent promising avenues of research that require further clinical study.
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Affiliation(s)
- Simona Dinicola
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Systems Biology Group Lab, Rome, Italy
| | - Vittorio Unfer
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- UniCamillus – Saint Camillus International University of Health Sciences, Rome, Italy
| | - Christophe O. Soulage
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- INSERM U1060, INSA de Lyon, University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Maria Isidora Margarita Yap-Garcia
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- St. Luke’s Medical Center College of Medicine, William H. Quasha Memorial, Quezon, Philippines
| | - Arturo Bevilacqua
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Dynamic, Clinical Psychology and Health, Sapienza University of Rome, Rome, Italy
| | - Salvatore Benvenga
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Daniele Barbaro
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Director of U.O. Endocrinology in Livorno Hospital, Livorno, Italy
| | - Artur Wdowiak
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Faculty of Medicine and Dentistry, Medical University of Lublin, Lublin, Poland
| | - Maurizio Nordio
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- A.S.L. RMF, Civitavecchia, Italy
| | - Didier Dewailly
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Faculty of Medicine Henri Warembourg, University of Lille, Lille Cedex, France
| | - Marialuisa Appetecchia
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Oncological Endocrinology Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Cesare Aragona
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Systems Biology Group Lab, Rome, Italy
| | - Maria Salomè Bezerra Espinola
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Systems Biology Group Lab, Rome, Italy
| | - Mariano Bizzarri
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Systems Biology Group Lab, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Pietro Cavalli
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Annamaria Colao
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Italian Society of Endocrinology, Federico II University of Naples, Naples, Italy
| | - Rosario D’Anna
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Mónica Hebe Vazquez-Levin
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- National Council of Scientific and Technical Research, Instituto de Biología y Medicina Experimental (IBYME), Buenos Aires, Argentina
| | - Imelda Hernàndez Marin
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Human Reproduction Department, Hospital Juárez de México, and Universidad Nacional Autónoma de México (UNAM), México, Mexico
| | - Zdravko Kamenov
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Internal Medicine, University Hospital “Alexandrovska”, Clinic of Endocrinology and Metabolism, Medical University, Sofia, Bulgaria
| | - Antonio Simone Laganà
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giovanni Monastra
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
| | - Mario Montanino Oliva
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Obstetrics and Gynecology, Santo Spirito Hospital, Rome, Italy
| | - Ali Cenk Özay
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cyprus International University, Nicosia, Cyprus
| | - Basilio Pintaudi
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Porcaro
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Women's Health Centre, USL UMBRIA 2, Terni, Italy
| | - Olga Pustotina
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Obstetrics and Gynecology with Reproductive Medicine, F.I. Inozemtsev Academy of Medical Education, Saint Petersburg, Russia
| | - Lali Pkhaladze
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Zhordania and Khomasuridze Institute of Reproductology, Tbilisi, Georgia
| | - Nikos Prapas
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Third Department of OB-GYNAE, Aristotle University of Thessaloniki, and IVF Laboratory, IAKENTRO Fertility Centre, Thessaloniki, Greece
| | - Scott Roseff
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Reproductive Endocrinology and Infertility, South Florida Institute for Reproductive Medicine (IVFMD), Jupiter, FL, USA
| | - Saghar Salehpour
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Annarita Stringaro
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy
| | - Marat Tugushev
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Reproductive Medicine, Clinical Embryology and Genetics of Samara State Medical University, Samara, Russia
| | - Virginia Unfer
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- A.G.Un.Co. Obstetrics and Gynecology Center, Rome, Italy
| | - Ivana Vucenik
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- Department of Medical and Research Technology and Pathology, University of Maryland School of Medicine in Baltimore, Baltimore, MD, USA
| | - Fabio Facchinetti
- The Experts Group on Inositol in Basic and Clinical Research (EGOI) Rome, Italy
- University of Modena and Reggio Emilia, Modena, Italy
- President Italian Society of Perinatal Medicine (SIMP), Modena, Italy
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Winkler I, Tolkachov A, Lammers F, Lacour P, Daugelaite K, Schneider N, Koch ML, Panten J, Grünschläger F, Poth T, Ávila BMD, Schneider A, Haas S, Odom DT, Gonçalves Â. The cycling and aging mouse female reproductive tract at single-cell resolution. Cell 2024; 187:981-998.e25. [PMID: 38325365 DOI: 10.1016/j.cell.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/21/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
The female reproductive tract (FRT) undergoes extensive remodeling during reproductive cycling. This recurrent remodeling and how it shapes organ-specific aging remains poorly explored. Using single-cell and spatial transcriptomics, we systematically characterized morphological and gene expression changes occurring in ovary, oviduct, uterus, cervix, and vagina at each phase of the mouse estrous cycle, during decidualization, and into aging. These analyses reveal that fibroblasts play central-and highly organ-specific-roles in FRT remodeling by orchestrating extracellular matrix (ECM) reorganization and inflammation. Our results suggest a model wherein recurrent FRT remodeling over reproductive lifespan drives the gradual, age-related development of fibrosis and chronic inflammation. This hypothesis was directly tested using chemical ablation of cycling, which reduced fibrotic accumulation during aging. Our atlas provides extensive detail into how estrus, pregnancy, and aging shape the organs of the female reproductive tract and reveals the unexpected cost of the recurrent remodeling required for reproduction.
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Affiliation(s)
- Ivana Winkler
- German Cancer Research Center (DKFZ), Division of Somatic Evolution and Early Detection, 69120 Heidelberg, Germany
| | - Alexander Tolkachov
- German Cancer Research Center (DKFZ), Division of Regulatory Genomics and Cancer Evolution, 69120 Heidelberg, Germany
| | - Fritjof Lammers
- German Cancer Research Center (DKFZ), Division of Regulatory Genomics and Cancer Evolution, 69120 Heidelberg, Germany
| | - Perrine Lacour
- German Cancer Research Center (DKFZ), Division of Somatic Evolution and Early Detection, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Biosciences, 69117 Heidelberg, Germany
| | - Klaudija Daugelaite
- German Cancer Research Center (DKFZ), Division of Regulatory Genomics and Cancer Evolution, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Biosciences, 69117 Heidelberg, Germany
| | - Nina Schneider
- German Cancer Research Center (DKFZ), Division of Somatic Evolution and Early Detection, 69120 Heidelberg, Germany
| | - Marie-Luise Koch
- German Cancer Research Center (DKFZ), Division of Regulatory Genomics and Cancer Evolution, 69120 Heidelberg, Germany
| | - Jasper Panten
- German Cancer Research Center (DKFZ), Division of Regulatory Genomics and Cancer Evolution, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Biosciences, 69117 Heidelberg, Germany; German Cancer Research Center (DKFZ), Division of Computational Genomics and Systems Genetics, 69120 Heidelberg, Germany
| | - Florian Grünschläger
- Heidelberg University, Faculty of Biosciences, 69117 Heidelberg, Germany; German Cancer Research Center (DKFZ) and DKFZ-ZMBH Alliance, Division of Stem Cells and Cancer, 69120 Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), 69120 Heidelberg, Germany
| | - Tanja Poth
- CMCP - Center for Model System and Comparative Pathology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Augusto Schneider
- Universidade Federal de Pelotas, Faculdade de Nutrição, 96010-610 Pelotas, RS, Brazil
| | - Simon Haas
- German Cancer Research Center (DKFZ) and DKFZ-ZMBH Alliance, Division of Stem Cells and Cancer, 69120 Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), 69120 Heidelberg, Germany; Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany; Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 10115 Berlin, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; Charité - Universitätsmedizin Berlin, Department of Hematology, Oncology and Cancer Immunology, 10115 Berlin, Germany
| | - Duncan T Odom
- German Cancer Research Center (DKFZ), Division of Regulatory Genomics and Cancer Evolution, 69120 Heidelberg, Germany; Cancer Research UK - Cambridge Institute, University of Cambridge, Cambridge, UK.
| | - Ângela Gonçalves
- German Cancer Research Center (DKFZ), Division of Somatic Evolution and Early Detection, 69120 Heidelberg, Germany.
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Matina SS, Mendenhall E, Cohen E. Women´s experiences of menopause: A qualitative study among women in Soweto, South Africa. Glob Public Health 2024; 19:2326013. [PMID: 38497205 DOI: 10.1080/17441692.2024.2326013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
Women today are experiencing menopause for decades more than in previous generations. This 'change of life' is defined by an entire stage of physical, hormonal, and emotional changes that accompany menstrual irregularity and the cessation of fertility, although limited medical research has focused on it. Yet, the inevitability of menopause is universal for all human females around 50 years old. In this article, we conducted twenty-five 20-60 min semi-structured qualitative interviews. Most women marked menopause by fertility cessation and social transition to old age, pushing back against a medical framework of menopause that emphasises hormonal deficiency and becoming disordered. In contrast, women frame menopause as a natural process that contributes to a critical social role transition, which they perceive as deeply private in part because it is associated with a reduction in femininity, sexuality, and power. On the other hand, menopause was also described as a liberating process through which women no longer needed to purchase pads or manage blood loss. Recognising how women may perceive menopause not as a deficit or disorder but as a social role transition that has both costs and benefits is useful for medical practitioners when discussing clinical options.
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Affiliation(s)
- Sostina Spiwe Matina
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Emmanuel Cohen
- Eco-Anthropologie (EA), Museum National d'Histoire Naturelle, CNRS, Université Paris-Cité, Musée de l'Homme, Paris, France
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Lange C, Brüggemann J, Thüner T, Jauckus J, Strowitzki T, Germeyer A. Changes in the expression of cancer- and metastasis-related genes and proteins after metformin treatment under different metabolic conditions in endometrial cancer cells. Heliyon 2023; 9:e16678. [PMID: 37313172 PMCID: PMC10258389 DOI: 10.1016/j.heliyon.2023.e16678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
Research question Hyperinsulinemia and elevated estrogen levels are known risk factors for endometrial cancer (EC) development and are associated with obesity, type 2 diabetes mellitus (T2DM), insulin resistance, among others. Metformin, an insulin-sensitizing drug, displays anti-tumor effects in cancer patients, including EC, but the mechanism of action is still not completely understood. In the present study, the effects of metformin on gene and protein expression were investigated in pre- and postmenopausal EC in vitro models in order to identify candidates that are potentially involved in the drug's anti-cancer mechanism. Design After treating the cells with metformin (0.1 and 1.0 mmol/L), changes in the expression of >160 cancer- and metastasis-related gene transcripts were evaluated with RNA arrays. A total of 19 genes and 7 proteins were selected for a follow-up expression analysis, including further treatment conditions, in order to evaluate the influence of hyperinsulinemia and hyperglycemia on metformin-induced effects. Results Changes in the expression of BCL2L11, CDH1, CDKN1A, COL1A1, PTEN, MMP9 and TIMP2 were analyzed on gene and protein level. The consequences resulting from the detected expression changes as well as the influence of varying environmental influences are discussed in detail. With the presented data, we contribute to a better understanding of the direct anti-cancer activity of metformin as well as its underlying mechanism of action in EC cells. Conclusions Although further research will be necessary to confirm the data, the influence of different environmental settings on metformin-induced effects could be highlighted with the presented data. Additionally, gene and protein regulation were not similar in the pre- and postmenopausal in vitro models.
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Merhej T, Zein JG. Epidemiology of Asthma: Prevalence and Burden of Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:3-23. [PMID: 37464114 DOI: 10.1007/978-3-031-32259-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma, a common airway disease, results in a significant burden to both patients and society worldwide. Yet, despite global political commitment backed by the United Nations, progress to reduce the burden of asthma remains inadequate. This is particularly true in low-income countries. To date, progress has been delayed by the lack of uniform data collection, imperfect surveillance methods, inadequate resources, poor access to effective therapies, substandard asthma education, ineffective governmental policies, rapid urbanization, progressive increase in asthma prevalence, increased life expectancy and obesity rates worldwide, asthma heterogeneity and disease complexity, smoking, and environmental exposures to allergens and pollution. A thorough understanding of the challenges facing the international community is essential to define future strategies to improve the burden of asthma.
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Affiliation(s)
| | - Joe G Zein
- Respiratory Institute. Cleveland Clinic, Cleveland, OH, USA.
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Farooq S, Khatri S. Life Course of Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:43-76. [PMID: 37464116 DOI: 10.1007/978-3-031-32259-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma is a heterogeneous chronic airway disease that can vary over a lifetime. Although broad categories of asthma by severity and type have been constructed, there remains a tremendous opportunity to discover an approach to managing asthma with additional factors in mind. Many in the field have suggested and are pursuing a novel paradigm shift in how asthma might be better managed, considering the life course of exposures, management priorities, and predicted trajectory of lung function growth. This approach will require a more holistic view of prenatal, postnatal, adolescence, hormonal and gender aspects, and the aging process. In addition, the environment, externally and internally, including in one's genetic code and epigenetic changes, are factors that affect how asthma progresses or becomes more stable in individuals. This chapter focuses on the various influences that may, to differing degrees, affect people with asthma, which can develop at any time in their lives. Shifting the paradigm of thought and strategies for care and advocating for public policies and health delivery that focus on this philosophy is paramount to advance asthma care for all.
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Affiliation(s)
- Sobia Farooq
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA
| | - Sumita Khatri
- National Heart, Lung, and Blood Institute, CMO Division of Lung Diseases, Bethesda, MD, USA.
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Keestra SM, Male V, Salali GD. Out of balance: the role of evolutionary mismatches in the sex disparity in autoimmune disease. Med Hypotheses 2021; 151:110558. [PMID: 33964604 DOI: 10.1016/j.mehy.2021.110558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/07/2021] [Accepted: 03/02/2021] [Indexed: 12/28/2022]
Abstract
Over the past century autoimmune disease incidence has increased rapidly in (post-) industrialised, affluent societies, suggesting that changes in ecology and lifestyle are driving this development. Epidemiological studies show that (i) 80% of autoimmune disease patients are female, (ii) autoimmune diseases co-occur more often in women, and (iii) the incidence of some autoimmune diseases is increasing faster in women than in men. The female preponderance in autoimmunity is most pronounced between puberty and menopause, suggesting that diverging sex hormone levels during the reproductive years are implicated in autoimmune disease development. Using an evolutionary perspective, we build on the hypotheses that female immunity is cyclical in menstruating species and that natural selection shaped the female immune system to optimise the implantation and gestation of a semi-allogeneic foetus. We propose that cyclical immunomodulation and female immune tolerance mechanisms are currently out of balance because of a mismatch between the conditions under which they evolved and (post-)industrialised, affluent lifestyles. We suggest that current changes in autoimmune disease prevalence may be caused by increases in lifetime exposure to cyclical immunomodulation and ovarian hormone exposure, reduced immune challenges, increased reproductive lifespan, changed reproductive patterns, and enhanced positive energy balance associated with (post-)industrialised, affluent lifestyles. We discuss proximate mechanisms by which oestrogen and progesterone influence tolerance induction and immunomodulation, and review the effect of the menstrual cycle, pregnancy, and contraceptive use on autoimmune disease incidence and symptoms.
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Affiliation(s)
- Sarai M Keestra
- Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK.
| | - Victoria Male
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, UK
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Lange C, Machado Weber A, Schmidt R, Schroeder C, Strowitzki T, Germeyer A. Changes in protein expression due to metformin treatment and hyperinsulinemia in a human endometrial cancer cell line. PLoS One 2021; 16:e0248103. [PMID: 33690729 PMCID: PMC7943011 DOI: 10.1371/journal.pone.0248103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/21/2021] [Indexed: 12/18/2022] Open
Abstract
The incidence of endometrial cancer (EC) has increased over the past years and mainly affects women above the age of 45 years. Metabolic diseases such as obesity and type II diabetes mellitus as well as associated conditions like polycystic ovary syndrome (PCOS), insulin resistance and hyperinsulinemia lead to elevated levels of circulating estrogens. Increased estrogen concentrations, in turn, further trigger the proliferation of endometrial cells and thus promote EC development and progression, especially in the absence of progesterone as seen in postmenopausal women. Elevated blood glucose levels in diabetic patients further contribute to the risk of EC development. Metformin is an insulin-sensitizing biguanide drug, commonly used in the treatment of type II diabetes mellitus, especially in obese patients. Besides its effects on glucose metabolism, metformin displayed anti-cancer effects in various cancer types, including EC. Direct anti-cancer effects of metformin target signaling pathways that are involved in cellular growth and proliferation, e.g. the AKT/PKB/mTOR pathway. Further proteins and pathways have been suggested as potential targets, but the underlying mechanism of action of metformin's anti-cancer activity is still not completely understood. In the present study, the effects of metformin on protein expression were investigated in the human EC cell line HEC-1A using an affinity proteomic approach. Cells were treated with 0.5 mmol/L metformin over a period of 7 days and changes in the expression pattern of 1,300 different proteins were compared to the expression in untreated control cells as well as insulin-treated cells. Insulin treatment (100 ng/mL) was incorporated into the study in order to implement a model for insulin resistance and associated hyperinsulinemia, conditions that are often observed in obese and diabetic patients. Furthermore, the culture medium was supplemented with 10 nmol/L ß-estradiol (E2) during treatments to mimic increased estrogen levels, a common risk factor for EC development. Based on the most prominent and significant changes in expression, a set of 80 proteins was selected and subjected to a more detailed analysis. The data revealed that metformin and insulin targeted similar pathways in the present study and mostly acted on proteins related to proliferation, migration and tumor immune response. These pathways may be affected in a tumor-promoting as well as a tumor-suppressing way by either metformin treatment or insulin supplementation. The consequences for the cells resulting from the detected expression changes were discussed in detail for several proteins. The presented data helps identify potential targets affected by metformin treatment in EC and allows for a better understanding of the mechanism of action of the biguanide drug's anti-cancer activity. However, further investigations are necessary to confirm the observations and conclusions drawn from the presented data after metformin administration, especially for proteins that were regulated in a favorable way, i.e. AKT3, CCND2, CD63, CD81, GFAP, IL5, IL17A, IRF4, PI3, and VTCN1. Further proteins might be of interest, where metformin counteracted unfavorable effects that have been induced by hyperinsulinemia.
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Affiliation(s)
- Carsten Lange
- Department of Gynecologic Endocrinology and Fertility Disorders, Women’s Hospital, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Amanda Machado Weber
- Department of Gynecologic Endocrinology and Fertility Disorders, Women’s Hospital, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | | | | | - Thomas Strowitzki
- Department of Gynecologic Endocrinology and Fertility Disorders, Women’s Hospital, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecologic Endocrinology and Fertility Disorders, Women’s Hospital, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
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Zein JG, Denson JL, Wechsler ME. Asthma over the Adult Life Course: Gender and Hormonal Influences. Clin Chest Med 2018; 40:149-161. [PMID: 30691709 DOI: 10.1016/j.ccm.2018.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asthma is a common disorder that affects genders differently across the life span. Earlier in life, it is more common in boys. At puberty, asthma becomes more common and often more severe in girls and women. The effect of sex hormones on asthma incidence and its severity is difficult to differentiate from other asthma severity risk factors, such as racial background, socioeconomic factors, obesity, atopy, environmental exposure, and, in particular, lung aging. Recognizing gender-associated and age-associated differences is important to understanding the pathobiology of asthma and to providing effective education and personalized care for patients with asthma across the life course.
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Affiliation(s)
- Joe G Zein
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44106, USA
| | - Joshua L Denson
- National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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Gilbert EW, Tay CT, Hiam DS, Teede HJ, Moran LJ. Comorbidities and complications of polycystic ovary syndrome: An overview of systematic reviews. Clin Endocrinol (Oxf) 2018; 89:683-699. [PMID: 30099747 DOI: 10.1111/cen.13828] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting reproductive-aged women with adverse reproductive, metabolic and psychological outcomes. It has a complex pathophysiology and therefore requires a multidiscipline clinical approach. However, there remains limited research synthesizing the broad clinical implications of PCOS which would assist clinicians in the management of PCOS. OBJECTIVE To summarize and appraise methodological quality of systematic reviews and meta-analyses evaluating complications and comorbidities associated with PCOS. METHODS A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed until 15 September 2017. Article selection, data extraction and quality appraisal of included reviews using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. A narrative synthesis of the findings was conducted. RESULTS Twenty-three reviews were included. All reviews were of low (n = 2) to moderate quality (n = 21). PCOS was associated with adverse pregnancy outcomes (n = 2), impaired glucose tolerance (n = 6), insulin resistance (n = 6), increased risk of type 2 diabetes (n = 1), cardiovascular disease (n = 10), metabolic syndrome (n = 2), psychological stress (n = 7), endometrial cancer (n = 1) and vitamin D deficiency (n = 1). Obesity exacerbates many of these outcomes. CONCLUSIONS There is a large body of reliable evidence for adverse metabolic outcomes and smaller, but consistent evidence for psychological issues in PCOS. We identified a shortage of systematic reviews regarding pregnancy outcomes of PCOS and significant gaps in knowledge of the association between PCOS and subclinical hyperthyroidism, vitamin D levels and cancers which future studies could aim to address.
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Affiliation(s)
- Emily W Gilbert
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Chau T Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Danielle S Hiam
- Institute of Health, Exercise and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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Santoro N, Crawford SL, El Khoudary SR, Allshouse AA, Burnett-Bowie SA, Finkelstein J, Derby C, Matthews K, Kravitz HM, Harlow SD, Greendale GA, Gold EB, Kazlauskaite R, McConnell D, Neal-Perry G, Pavlovic J, Randolph J, Weiss G, Chen HY, Lasley B. Menstrual Cycle Hormone Changes in Women Traversing Menopause: Study of Women's Health Across the Nation. J Clin Endocrinol Metab 2017; 102:2218-2229. [PMID: 28368525 PMCID: PMC5505186 DOI: 10.1210/jc.2016-4017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/17/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Menstrual cycle hormone patterns in women approaching menopause are inadequately studied. OBJECTIVE To describe day-to-day menstrual cycle hormones in women as they approach menopause from the Study of Women's Health Across the Nation Daily Hormone Study (DHS). DESIGN DHS enrollees collected daily urine for one entire menstrual cycle or up to 50 days, whichever came first, annually, up to the final menstrual period (FMP) or for up to 10 years. SETTING Seven sites across the United States. PARTICIPANTS A total of 511 premenopausal or early perimenopausal women at enrollment, within 10 years before menopause. INTERVENTION Time-to-FMP measurement. MAIN OUTCOME MEASURES Evidence of luteal activity (ELA), determined using objective algorithms. Menstrual cycle/segment length; whole cycle, and segment integrated urinary luteinizing hormone, follicle-stimulating hormone, estrone conjugates, and pregnanediol glucuronide (Pdg) for each year, organized around the FMP. RESULTS Mean menstrual cycle length was remarkably preserved at 26 to 27 days in ELA cycles; non-ELA cycles had greater variability. The percentage of cycles that were ELA remained high until 5 years before the FMP (87.9%); only 22.8% of cycles within 1 year of the FMP were ELA. Whole cycle hormones remained relatively stable up to 3 years before the FMP, when gonadotropins began to increase. Pdg excretion declined slowly with progress to the FMP, but Pdg patterns of ELA cycles remained distinguishable from non-ELA. CONCLUSIONS Menstrual cycle hormone patterns in perimenopausal women resemble those of midreproductive-aged women until 5 years before menopause, and presumably ovulatory cycles retain a potentially fertile pattern up to the end of reproductive life.
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Affiliation(s)
- Nanette Santoro
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Sybil L. Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Amanda A. Allshouse
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado 80045
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado 80045
| | | | - Joel Finkelstein
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Carol Derby
- Departments of Neurology and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York 10461
| | - Karen Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Howard M. Kravitz
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | - Sioban D. Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | - Gail A. Greendale
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California 90095
| | - Ellen B. Gold
- Department of Public Health Sciences, University of California Davis Health, Davis, California 95817
| | - Rasa Kazlauskaite
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | - Dan McConnell
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | | | - Jelena Pavlovic
- Departments of Neurology and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York 10461
| | - John Randolph
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109-5624
| | - Gerson Weiss
- Department of Obstetrics and Gynecology, Rutgers-New Jersey Medical School, Newark, New Jersey 07103
| | - Hsiang-Yu Chen
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Bill Lasley
- Department of Public Health Sciences, University of California Davis Health, Davis, California 95817
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Alpizar-Rodriguez D, Mueller RB, Möller B, Dudler J, Ciurea A, Zufferey P, Kyburz D, Walker UA, von Mühlenen I, Roux-Lombard P, Mahler M, Lamacchia C, Courvoisier DS, Gabay C, Finckh A. Female hormonal factors and the development of anti-citrullinated protein antibodies in women at risk of rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1579-1585. [DOI: 10.1093/rheumatology/kex239] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 12/13/2022] Open
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Onstad MA, Schmandt RE, Lu KH. Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. J Clin Oncol 2016; 34:4225-4230. [PMID: 27903150 DOI: 10.1200/jco.2016.69.4638] [Citation(s) in RCA: 332] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In sharp contrast to many other cancer types, the incidence and mortality of endometrial cancer continue to grow. This unfortunate trend is, in no small part, a result of the worldwide obesity epidemic. More than half of endometrial cancers are currently attributable to obesity, which is recognized as an independent risk factor for this disease. In this review, we identify the molecular mechanisms by which obesity and adipose tissue contribute to the pathogenesis of endometrial cancer. We further discuss the impact of obesity on the clinical management of the disease and examine the development of rational behavioral and pharmaceutical interventions aimed at reducing endometrial cancer risk, improving cancer outcomes, and preserving fertility in an increasingly younger population of patients with endometrial cancer.
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Affiliation(s)
- Michaela A Onstad
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Karen H Lu
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
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Vanden Brink H, Robertson DM, Lim H, Lee C, Chizen D, Harris G, Hale G, Burger H, Baerwald A. Associations Between Antral Ovarian Follicle Dynamics and Hormone Production Throughout the Menstrual Cycle as Women Age. J Clin Endocrinol Metab 2015; 100:4553-62. [PMID: 26465392 DOI: 10.1210/jc.2015-2643] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The physiological origins of age-related changes in hormone production during the menstrual cycle are uncertain. OBJECTIVE The objective of the study was to test the hypothesis that changes in antral follicle dynamics are associated with changes in hormone production as women age. METHODS A prospective, observational study was conducted in ovulatory women of midreproductive age (MRA; 18-35 y; n = 10) and advanced reproductive age (ARA; 45-55 y; n = 20). The numbers and diameters of all follicles of 2 mm or greater were quantified ultrasonographically every 1-3 days for one interovulatory interval; the growth profiles of individually identified follicles of 4 mm or greater were tabulated. Blood samples were assayed for FSH, LH, estradiol, progesterone, inhibin A and B, and anti-Mullerian hormone. RESULTS Fifty percent of women in both the MRA and ARA groups developed one to two luteal-phase dominant follicles (LPDFs). MRA women with typical LPDFs had greater luteal-phase inhibin B (44.2 vs 17.0 ng/L) and estradiol (91.3 vs 51.7 ng/L) compared with those without LPDFs (P < .05). Luteal-phase estradiol was greater (184 vs 79 ng/L), inhibin B was greater (25.3 vs 12.7 ng/L), and progesterone was lower (6.98 vs 13.8 μg/L) in ARA women with atypical vs no LPDFs (P < .01). CONCLUSION Changes in antral follicle dynamics are associated with changes in hormone production as women age. The development of LPDFs in women of MRA was associated with elevated luteal-phase estradiol. A similar but exaggerated elevation in late luteal-early follicular-phase estradiol, accompanied by lower progesterone, was observed in ARA women with atypically large and persistent LPDFs.
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Affiliation(s)
- Heidi Vanden Brink
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - David Mark Robertson
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Hyun Lim
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Chel Lee
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Donna Chizen
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Guy Harris
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Georgina Hale
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Henry Burger
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
| | - Angela Baerwald
- Department of Obstetrics, Gynecology, and Reproductive Sciences (H.V.B., D.C., A.B.) and Clinical Research Support Unit (H.L., C.L.), College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W8; Hudson Institute of Medical Research (formally Monash Institute of Medical Research-Prince Henry's Institute of Medical Research) (D.M.R., H.B.), Clayton, Victoria 3168, Australia; and Department of Obstetrics and Gynecology (G.H.), University of Sydney, Sydney 2006, New South Wales, Australia
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18
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Cahoon EK, Kitahara CM, Ntowe E, Bowen EM, Doody MM, Alexander BH, Lee T, Little MP, Linet MS, Freedman DM. Female Estrogen-Related Factors and Incidence of Basal Cell Carcinoma in a Nationwide US Cohort. J Clin Oncol 2015; 33:4058-65. [PMID: 26527779 PMCID: PMC4669591 DOI: 10.1200/jco.2015.62.0625] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose UV radiation exposure is the primary risk factor for basal cell carcinoma (BCC), the most common human malignancy. Although the photosensitizing properties of estrogens have been recognized for decades, few studies have examined the relationship between reproductive factors or exogenous estrogen use and BCC. Methods Using data from the US Radiologic Technologists Study, a large, nationwide, prospective cohort, we assessed the relationship between reproductive factors, exogenous estrogen use, and first primary BCC while accounting for sun exposure, personal sun sensitivity, and lifestyle factors for geographically dispersed women exposed to a wide range of ambient UV radiation. Results Elevated risk of BCC was associated with late age at natural menopause (hazard ratio [HR] for ≥ 55 years v 50 to 54 years, 1.50; 95% CI, 1.04 to 2.17) and any use of menopausal hormone therapy (MHT; HR, 1.16; 95% CI, 1.03 to 1.30; P for trend for duration = .001). BCC risk was most increased among women reporting natural menopause who used MHT for 10 or more years versus women who never used MHT (HR, 1.97; 95% CI, 1.35 to 2.87). Risk of BCC was not associated with age at menarche, parity, age at first birth, infertility, use of diethylstilbestrol by participant's mother, age at hysterectomy, or use of oral contraceptives. Conclusion These analyses confirm a previous finding of increased risk of BCC associated with MHT. Novel findings of increased BCC risk associated with MHT in women experiencing natural menopause and for late age at natural menopause warrant further investigation. Users of MHT may constitute an additional high-risk group in need of more frequent skin cancer screening.
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Affiliation(s)
- Elizabeth K Cahoon
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Cari M Kitahara
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Estelle Ntowe
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Emily M Bowen
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michele M Doody
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Bruce H Alexander
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Terrence Lee
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Mark P Little
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Martha S Linet
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
| | - D Michal Freedman
- Elizabeth K. Cahoon, Cari M. Kitahara, Estelle Ntowe, Emily M. Bowen, Michele M. Doody, Terrence Lee, Mark P. Little, Martha S. Linet, and D. Michal Freedman, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; and Bruce H. Alexander, School of Public Health, University of Minnesota, Minneapolis, MN
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Abstract
Gender differences in asthma incidence, prevalence and severity have been reported worldwide. After puberty, asthma becomes more prevalent and severe in women, and is highest in women with early menarche or with multiple gestations, suggesting a role for sex hormones in asthma genesis. However, the impact of sex hormones on the pathophysiology of asthma is confounded by and difficult to differentiate from age, obesity, atopy, and other gender associated environmental exposures. There are also gender discrepancies in the perception of asthma symptoms. Understanding gender differences in asthma is important to provide effective education and personalized management plans for asthmatics across the lifecourse.
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Gilbreath ET, MohanKumar SMJ, Balasubramanian P, Agnew DW, MohanKumar PS. Chronic exposures to low levels of estradiol and their effects on the ovaries and reproductive hormones: Comparison with aging. ACTA ACUST UNITED AC 2014; 2. [PMID: 26779558 DOI: 10.4161/23273739.2014.967127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aging in female rats is characterized by a state called "constant estrous" in which rats are unable to ovulate, have polycystic ovaries and moderately elevated estrogen levels. We hypothesized that chronic exposure of young animals to low levels of E2 can produce reproductive changes similar to that seen in aging animals. Adult female rats were sham-implanted (control) or implanted with slow-release E2 (20 ng/day) pellets for 30, 60, or 90 days. Old constant estrous (OCE) rats were used for comparison. Estrous cyclicity was monitored periodically. At the end of treatment, animals were sacrificed, trunk blood was collected for hormone measurements and ovaries for immunohistochemistry. Young animals became acyclic with increasing duration of E2 exposure while OCE rats were in a state of acyclicity. Ovaries became increasingly more cystic with E2 exposure, and were comparable to OCE rats; however, there was a marked reduction in interstitial tissue with exogenous E2 treatment. Exogenous E2 also decreased Mullerian inhibiting substance expression, increased infiltration of macrophages without much impact on apoptosis in the ovaries. Serum testosterone levels decreased in E2-treated young animals, while it increased significantly in OCE rats. There was a marked reduction in LH but not FSH levels with E2 exposure in both young and old animals. These results indicate that even very low doses of E2 are capable of inducing aging-like changes in young animals.
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Affiliation(s)
- Ebony T Gilbreath
- Department of Pathobiology, College of Veterinary Medicine, Nursing and Allied Health, Tuskegee University, Tuskegee, AL
| | - Sheba M J MohanKumar
- Department of Pharmacology and Toxicology, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Priya Balasubramanian
- Department of Pharmacology and Toxicology, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Dalen W Agnew
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - P S MohanKumar
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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21
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Age-related changes in major ovarian follicular wave dynamics during the human menstrual cycle. Menopause 2013; 20:1243-54. [DOI: 10.1097/gme.0b013e31828cfb62] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Timing hypothesis for postmenopausal hormone therapy: its origin, current status, and future. Menopause 2013; 20:342-53. [PMID: 23435033 DOI: 10.1097/gme.0b013e3182843aad] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This work aims to review preclinical/clinical cardiovascular studies that led to randomized trials of the risks and benefits of postmenopausal hormone therapy (HT), the pathobiological basis for the timing hypothesis, and subset analyses of randomized trials that tend to support the timing hypothesis; to elaborate experimental data that might inform the results of recent trials; and to summarize evidence regarding how early is early enough for the initiation of HT. METHODS This work used interpretive literature review. RESULTS Preclinical and large observational studies provided what was considered at the time to be convincing evidence that HT provided protection against progressing coronary artery atherosclerosis. Those findings prompted three randomized, placebo-controlled, prospective trials to determine the risks and benefits of HT. None provided any evidence that HT had any beneficial effects on preexisting coronary artery atherosclerosis. Monkey studies provided clear evidence that HT was effective in slowing the progression of coronary artery atherosclerosis only when administered soon after surgical menopause and that benefit was lost if estrogen therapy was delayed until the plaques had become complicated. The phenomenon was referred to as the "timing hypothesis," and evidence for its translation into postmenopausal women was sought in subset analyses of data from the Women's Health Initiative and from newly planned prospective trials. CONCLUSIONS Current data are both supportive and not supportive of the timing hypothesis. However, evidence indicating that estrogens administered in the perimenopausal transition or early in menopause are not harmful to the cardiovascular system and, when given for a few years for the treatment of menopausal symptoms, may slow the progression of atherosclerosis and reduce the postmenopausal cardiovascular disease burden seems convincing.
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23
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Kubota T. Update in polycystic ovary syndrome: new criteria of diagnosis and treatment in Japan. Reprod Med Biol 2013; 12:71-77. [PMID: 23874146 PMCID: PMC3695670 DOI: 10.1007/s12522-013-0145-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/26/2013] [Indexed: 11/02/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women of reproductive age. In 2006 the Japanese Society of Obstetrics and Gynecology (JSOG) proposed new, revised diagnostic criteria that in the future could also be valued internationally. Based on the new diagnostic criteria, the JSOG has also proposed the revised treatment criteria in 2008. In PCOS obese patients desiring children, weight loss and exercise is recommended. Nonobese patients, or those obese women who do not ovulate after lifestyle changes, are submitted to ovulation-induction therapy with clomiphene citrate (CC). Obese CC-resistant patients who have impaired glucose tolerance or insulin resistance are treated with a combination of metformin and CC. If these treatments options are unsuccessful, ovulation induction with exogenous gonadotropin therapy or laparoscopic ovarian drilling (LOD) is recommended. A low-dose step-up regimen is recommended with careful monitoring in order to reduce the risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. Alternatively, with LOD high successful pregnancy rates of around 60 % are expected with a low risk of multiple pregnancies. If ovulation induction is unsuccessful, IVF-ET treatment is indicated. In high OHSS-risk patients, systematic embryo freezing and subsequent frozen embryo transfer cycles are recommended. In nonobese, anovulatory PCOS patients not desiring children, pharmacological treatments such as Holmström, Kaufmann regimens or low-dose oral anticonceptives are used to induce regular withdrawal bleeding. These treatments are especially important for preventing endometrial hyperplasia and endometrial cancer. These new diagnostic and treatment criteria hopefully will contribute to an improved care of PCOS patients in Japan.
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Affiliation(s)
- Toshiro Kubota
- Comprehensive Reproductive Medicine, Graduate SchoolTokyo Medical and Dental University1‐5‐45, Bunkyo‐ku113‐8519TokyoJapan
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24
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Bove R. Autoimmune diseases and reproductive aging. Clin Immunol 2013; 149:251-64. [PMID: 23522436 DOI: 10.1016/j.clim.2013.02.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/08/2013] [Accepted: 02/11/2013] [Indexed: 11/29/2022]
Abstract
As the population ages, more individuals with autoimmune diseases are experiencing reproductive senescence. Understanding the impact of menopause and age-related androgen decline on disease onset and course, as well as the potential for hormonal interventions, is critically important. In men, lupus erythematosis (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS) are associated with lower androgen levels. However, the impact of age-related declines in testosterone, as well as of testosterone replacement, on disease course remains underexplored. In women, the course of all three diseases with onset after the age of menopause differs from that with onset before menopause. Early age at menopause is associated with increased disease risk, and after menopause, disease course changes in SLE and RA. Less is known about MS. This article summarizes what is known about the relationship between reproductive aging and autoimmune diseases in men and women, and highlights areas for further investigation.
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Affiliation(s)
- Riley Bove
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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25
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Hypoestrogenic "inactive phases" at the start of the menstrual cycle: changes with age and reproductive stage, and relationship to follicular depletion. Fertil Steril 2012; 98:1246-53.e1-3. [PMID: 22901850 DOI: 10.1016/j.fertnstert.2012.07.1101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/01/2012] [Accepted: 07/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate hypoestrogenic "inactive phases" (IP) in the follicular phase of the menstrual cycle, with respect to age, reproductive stage, and follicular depletion. DESIGN Analysis of prospectively collected menstrual bleed and estrone-3-glucuronide data. SETTING Center for Population and Health, Georgetown University. PATIENT(S) White women (n = 88, aged 25-59 years, mean = 44.7 years) from the population-based Biodemographic Models of Reproductive Aging (BIMORA) project. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The IP durations by age and reproductive stage. Estimated follicular depletion rate based on IP durations. RESULT(S) Mean IP duration and variability decreased and then increased with age/reproductive stage. The proportion of very short (≤ 1 day) IP durations increased and then decreased with age/stage. Long IPs occurred most, but not exclusively, in the oldest age/latest stage. Follicular depletion rate estimates were a plausible 2%-4% per year of age, but these models were a poor fit because IP durations did not consistently increase across ages/stages. CONCLUSION(S) Follicular depletion models alone do not explain the observed pattern of IPs. Our data suggest that IPs reflect both follicular depletion and hyperstimulation in premenopausal and perimenopausal women. Knowledge of underlying IP patterns in the menstrual cycle could inform decisions about hormone sampling and contraception during the perimenopause.
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26
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Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause 2012; 19:387-95. [PMID: 22343510 DOI: 10.1097/gme.0b013e31824d8f40] [Citation(s) in RCA: 459] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. METHODS Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. RESULTS STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. CONCLUSIONS STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
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27
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Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab 2012; 97:1159-68. [PMID: 22344196 PMCID: PMC3319184 DOI: 10.1210/jc.2011-3362] [Citation(s) in RCA: 723] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. METHODS Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. RESULTS STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. CONCLUSIONS STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
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Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor MI 48109, USA.
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28
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Santoro N, Randolph JF. Reproductive hormones and the menopause transition. Obstet Gynecol Clin North Am 2012; 38:455-66. [PMID: 21961713 DOI: 10.1016/j.ogc.2011.05.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The hormonal correlates of reproductive aging and the menopause transition reflect an initial loss of the follicle cohort, while a responsive ovary remains, and an eventual complete loss of follicle response, with persistent hypergonadotropic amenorrhea. The physiology of the process is described, along with key findings of relevant studies, with an emphasis on the Study of Women's Health Across the Nation. A clinical framework is provided to help clinicians to forecast the major milestones of the menopausal transition and to predict potential symptoms or disease.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA
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29
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Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Fertil Steril 2012; 97:843-51. [PMID: 22341880 DOI: 10.1016/j.fertnstert.2012.01.128] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. METHOD(S) Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. RESULT(S) STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. CONCLUSION(S) STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
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30
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Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Climacteric 2012; 15:105-14. [PMID: 22338612 DOI: 10.3109/13697137.2011.650656] [Citation(s) in RCA: 311] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW +10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period. METHODS Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus. RESULTS STRAW +10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics. CONCLUSIONS STRAW +10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW +10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.
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Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan 1415 Washington Heights, Ann Arbor, MI 48109, USA.
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31
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Prior JC. Progesterone for Symptomatic Perimenopause Treatment - Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn 2011; 3:109-20. [PMID: 24753856 PMCID: PMC3987489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Perimenopause, women's normal midlife reproductive transition, is highly symptomatic for about 20% of women who are currently inaccurately counseled and inappropriately treated with oral contraceptives, menopausal hormone therapy or hysterectomy. About 80% of perimenopausal women experience vasomotor symptoms (VMS), 25% have menorrhagia, and about 10% experience mastalgia. The majority of women describe varying intensities of sleep, -coping or mood difficulties. Women are more symptomatic because common knowledge inaccurately says that estradiol (E2) levels are dropping/deficient. Evidence shows that with disturbed brain-ovary feedbacks, E2 levels average 26% higher and soar erratically - some women describe feeling pregnant! Also, ovulation and progesterone (P4) levels become insufficient or absent. The most symptomatic women have higher E2 and lower P4 levels. Because P4 and E2 complement/counterbalance each other's tissue effects, oral micronized P4 (OMP4 300 mg at -bedtime) is a physiological therapy for treatment-seeking, symptomatic perimenopausal women. Given cyclically (cycle d 14-27, or 14 on/off) in menstruating midlife women, OMP4 decreases cyclic VMS, improves sleep and premenstrual mastalgia. Menorrhagia is treated with ibuprofen 200mg/6h plus OMP4 cycle d 4-28. For insulin resistance, metformin plus cyclic or daily OMP4 decreases insulin resistance and weight gain. Non-responsive migraines need daily OMP4 plus usual therapies. VMS and insomnia in late perimenopause respond to daily OMP4. In summary, OMP4 is a physiology-based therapy that improves sleep, treats VMS, does not increase breast proliferation or cancer risk, increases bone formation and has beneficial cardiovascular effects. A controlled trial is testing OMP4 for perimenopausal VMS - more evidence-based data are needed.
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Affiliation(s)
- J C Prior
- Endocrinology, University of British Columbia, and Vancouver Coastal Health Research. Institute, Vancouver, Canada V5Z 1M9. Scientific Director, Centre for Menstrual Cycle and Ovulation Research ( www.cemcor.ubc.ca )
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32
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Abstract
Human female reproductive aging consists of multiple processes and interacts with other physiological systems in unique ways. Here we discuss eight recent longitudinal, epidemiologic studies of female reproductive aging that include endocrine data to highlight their contributions to our understanding of these various aging processes and their interactions. Specifically, we review data on ovarian and nonovarian reproductive aging processes and reproductive staging. We consider these data in the context of longitudinal research design and research goals, identify limitations of the studies but also ways in which existing longitudinal data can further our understanding of aging processes, and make recommendations for future studies of female reproductive aging.
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Affiliation(s)
- Rebecca J Ferrell
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA.
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33
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Marks M, Hitchcock CL, Sathi P, Prior JC. Community Pharmacists' Therapeutic Recommendations for Heavy Flow, Androgen Excess, Fragility Fractures and Night Sweats in Menstruating Women. Can Pharm J (Ott) 2010. [DOI: 10.3821/1913-701x-143.2.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Physicians and menstruating women often ask pharmacists for recommendations about menstrual cycle–related problems. Progesterone and medroxyprogesterone may provide physiology-based treatment, but official indications in menstruating women in Canada are minimal. Objectives: To describe pharmacists' responses to vignette-based questions about the treatment of common clinical problems in menstruating women and review evidence-based therapies. Methods: A pharmacist interviewer administered an 11-item questionnaire to a random sample of community pharmacists. Questions were based on clinical vignettes in adolescent, pre- and perimenopausal women and related to heavy flow, polycystic ovary syndrome, premenopausal osteoporosis, perimenopausal night sweats and side effects/contraindications for estrogens and progesterone/progestins. Results: The participation rate was 58%, including equal numbers of male and female pharmacists. Seventy-two percent indicated that they would treat menorrhagia in an anemic 13-year-old with oral contraceptives — 21% would recommend ibuprofen and 86% iron. Half recommended that a 35-year-old smoker with heavy flow and acne stop oral contraceptives, but the other 50% recommended a switch to an oral contraceptive with cyproterone. For premenopausal osteoporosis, the majority recommended calcium and vitamin D, but 53% endorsed oral contraceptives — only 7% suggested cyclic medroxyprogesterone. For night sweats, the majority recommended progesterone/progestin in a regularly menstruating 42-year-old woman. Estrogens are contraindicated with past thrombosis and/or breast cancer family history, and they could cause nausea; 50% of pharmacists also attributed these adverse effects to progesterone/progestins. Conclusions: Community pharmacists vary widely in their treatment choices for common pre- and perimenopausal women's menstrual cycle–related problems. The evidence in support of most recommendations is minimal or lacking.
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Affiliation(s)
- Monterrey Marks
- MacDonald's Prescriptions (Marks), Vancouver, BC; the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Division of Endocrinology (Marks, Hitchcock, Sathi, Prior), University of British Columbia, and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Contact
| | - Christine L. Hitchcock
- MacDonald's Prescriptions (Marks), Vancouver, BC; the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Division of Endocrinology (Marks, Hitchcock, Sathi, Prior), University of British Columbia, and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Contact
| | - Poornima Sathi
- MacDonald's Prescriptions (Marks), Vancouver, BC; the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Division of Endocrinology (Marks, Hitchcock, Sathi, Prior), University of British Columbia, and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Contact
| | - Jerilynn C. Prior
- MacDonald's Prescriptions (Marks), Vancouver, BC; the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Division of Endocrinology (Marks, Hitchcock, Sathi, Prior), University of British Columbia, and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Contact
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Abstract
OBJECTIVE Detailed characterization of progesterone and ovulation across the menopausal transition provides insight into conception risk and mechanisms of reproductive aging. METHODS Participants (n = 108, aged 25-58 y) collected daily urine specimens for 6-month intervals in each of 5 consecutive years. Specimens were assayed for pregnanediol glucuronide (PDG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estrone glucuronide (E1G). Reproductive stage was determined using cycle length variance. A hierarchical algorithm was used to identify ovulation. Linear mixed-effects models estimated (1) the frequency and day of ovulation by age and stage; (2) differences in FSH, LH, and E1G levels between ovulatory (O) and anovulatory (AO) cycles; and (3) total PDG levels and PDG levels in O cycles by age and stage. RESULTS The probability of AO cycles increased across the perimenopause (P < 0.0001); reproductive stage was a stronger predictor than age of the probability of anovulation. Most cycles in late perimenopause were AO (>60%), but one quarter of cycles longer than 60 days were O. Average day of ovulation was later in the late perimenopause (mean [SD] cycle day, 27 [25] d) compared with the premenopause. FSH and LH levels were higher and E1G levels were lower in AO than O cycles (P < 0.0001 for each). Total PDG decreased in the late perimenopause, but 95th percentile PDG in O cycles declined steadily across the transition. CONCLUSIONS Exposure to the risk of conception in women experiencing cycles long enough to classify them as late perimenopausal is far from negligible. Reproductive stage is more informative than age about PDG levels and the likelihood of anovulation.
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Su HI, Freeman EW. Hormone changes associated with the menopausal transition. MINERVA GINECOLOGICA 2009; 61:483-489. [PMID: 19942836 PMCID: PMC3823936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The menopausal transition (MT) is the time in each woman's reproductive life that precedes the final menstrual period (FMP). MT is associated with changes in bleeding pattern and hormone profiles. In recent years, research efforts have characterized changes in reproductive hormones over MT in order to elucidate the process of late reproductive aging and potentially identify predictors of time to menopause. Follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B and estradiol represent the four primary hormone measures of these investigations. Current data show an increase in FSH and decreases in AMH, inhibin B and estradiol over MT. AMH appears to be the first marker to change, followed by FSH and inhibin B. Estradiol declines in late MT. To date, there are no validated hormone cutpoints that predict the length of MT or FMP. There are very preliminary data on AMH as a predictor of menopause. Until further evidence identifies clinically useful hormone levels for predicting MT or FMP, diagnosis of MT and FMP should be based on clinical signs and symptoms only.
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Affiliation(s)
- H. Irene Su
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA, USA
| | - Ellen W. Freeman
- Departments of Obstetrics and Gynecology and Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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