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Lee J(S, Wasim AM, Karreman E, Al-Hayki M. Hormone therapy use among young cervical cancer patients in Southern Saskatchewan. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:757-761. [DOI: 10.1016/j.jogc.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
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Flores VA, Pal L, Manson JE. Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment. Endocr Rev 2021; 42:720-752. [PMID: 33858012 DOI: 10.1210/endrev/bnab011] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 12/22/2022]
Abstract
Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause. Randomized trials also demonstrate positive effects on bone health, and age-stratified analyses indicate more favorable effects on coronary heart disease and all-cause mortality in younger women (close proximity to menopause) than in women more than a decade past menopause. In the absence of contraindications or other major comorbidities, recently menopausal women with moderate or severe symptoms are appropriate candidates for HT. The Women's Health Initiative (WHI) hormone therapy trials-estrogen and progestin trial and the estrogen-alone trial-clarified the benefits and risks of HT, including how the results differed by age. A key lesson from the WHI trials, which was unfortunately lost in the posttrial cacophony, was that the risk:benefit ratio and safety profile of HT differed markedly by clinical characteristics of the participants, especially age, time since menopause, and comorbidity status. In the present review of the WHI and other recent HT trials, we aim to provide readers with an improved understanding of the importance of the timing of HT initiation, type and route of administration, and of patient-specific considerations that should be weighed when prescribing HT.
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Affiliation(s)
- Valerie A Flores
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ovarian tissue and oocyte cryopreservation prior to iatrogenic premature ovarian insufficiency. Best Pract Res Clin Obstet Gynaecol 2021; 81:119-133. [PMID: 34887172 DOI: 10.1016/j.bpobgyn.2021.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/21/2022]
Abstract
Gonadotoxic treatments like chemotherapy or radiotherapy and ovarian surgery may result in an accelerated depletion of the ovarian reserve and subsequent premature ovarian insufficiency. Important determinants of this severe risk that require fertility preservation strategies are patient age, ovarian reserve, type of treatment, and administered dose. Oocytes and ovarian tissue can both be cryopreserved, with encouraging results in terms of pregnancy and live birth rates according to recent publications. Moreover, since ovarian tissue transplantation also results in long-term endocrine resumption, it represents a potential future therapeutic option for complete ovarian function restoration in patients with premature ovarian insufficiency.
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Gernier F, Gompel A, Rousset-Jablonski C, Kalbacher E, Floquet A, Berton-Rigaud D, Tredan O, Alexandre J, Follana P, Zannetti A, Dohollou N, Grellard JM, Clarisse B, Licaj I, Ahmed-Lecheheb D, Fauvet R, Pautier P, Joly F. Menopausal symptoms in epithelial ovarian cancer survivors: a GINECO VIVROVAIRE2 study. Gynecol Oncol 2021; 163:598-604. [PMID: 34649724 DOI: 10.1016/j.ygyno.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We have previously shown that epithelial ovarian cancer (EOC) and its treatments have negative effects on long-term quality of life (QoL) and fatigue. The present multicenter study investigated the main menopausal symptoms and gynecological management of EOC survivors (EOCS). METHODS 166 patients with relapse-free ≥3 years after the end of treatment attended a consultation with a gynecologist, including a questionnaire related to vasomotor symptoms (VMS) and sexuality, a clinical examination, a blood sample and an osteodensitometry. QoL, fatigue, insomnia and mood disorders were measured with validated questionnaires and correlated to VMS. VMS and QoL were assessed according to natural menopause (NM) or surgical menopause (SM). RESULTS Mean age at the survey was 62 [21-83] years and stage III/IV (48%). Mean delay since the end of treatment was 6 years. Fifty-nine patients (36%) had SM. Half of patients reported VMS. Seventy-two percent of EOCS with SM had VMS compared to 41% with NM (P < .001). VMS were not associated with poor global QoL, fatigue, insomnia or mood disorders. Two-thirds of EOCS reported a decrease in libido. Patients with SM showed a greater decrease in libido than NM (P < .02). Fourteen percent of them had osteoporosis and 50% osteopenia. Among the 85 patients with VMS, 80 did not receive HRT after cancer treatment. At the time of the survey, only 7 (4%) patients were receiving hormone replacement therapy (HRT). CONCLUSIONS VMS and sexual disorders are frequently reported by EOCS, particularly among patients with SM. Most EOCS with menopausal symptoms could benefit from HRT to improve these symptoms.
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Affiliation(s)
- F Gernier
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; INSERM, U1086, Caen, France.
| | - A Gompel
- Université de Paris, Paris, France
| | | | - E Kalbacher
- Department of Oncology, CHU Jean Minjoz, Besançon, France
| | - A Floquet
- Department of Oncology, Institut Bergonie, Bordeaux, France
| | - D Berton-Rigaud
- Institut de Cancérologie de l'Ouest, Site René Gauducheau, Department of Oncology, Saint Herblain, France
| | - O Tredan
- Department of Oncology, Centre Léon Bérard, Lyon, France
| | - J Alexandre
- Department of Oncology, Hospital Cochin, Paris, France
| | - P Follana
- Department of Oncology, Centre Antoine Lacassagne, Nice, France
| | - A Zannetti
- Department of Oncology, Centre Hospitalier de Cholet, Cholet, France
| | - N Dohollou
- Polyclinique Bordeaux Nord Aquitaine, Department of Oncology, Bordeaux, France
| | - J-M Grellard
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France
| | - B Clarisse
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France
| | - I Licaj
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway; Clinipace Biostatistics, Morrisville, NC 27560, USA
| | - D Ahmed-Lecheheb
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; INSERM, U1086, Caen, France
| | - R Fauvet
- INSERM, U1086, Caen, France; Department of Gynecology and Obstetrics, Caen University Hospital, Caen, France; University of Caen Normandy, INSERM U1199, BIOTICLA, France
| | - P Pautier
- Department of Oncology, Gustave Roussy, Villejuif, France
| | - F Joly
- Clinical Research Department, Centre François Baclesse, av general Harris, Caen, France; INSERM, U1086, Caen, France; University of Caen Normandy, UMR-S1077, Caen, France; Department of Oncology, CHU de Caen, Caen, France
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Chakrabarti R, Holloway D, Bruce D, Rymer J. The management of menopausal symptoms in women following treatment for cancer at a specialist menopause service. Post Reprod Health 2021; 27:137-144. [PMID: 33823682 DOI: 10.1177/20533691211000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to identify prescribing patterns at a specialist menopause service in a central London teaching hospital for women following treatment for a malignancy. STUDY DESIGN This was a prospective cohort study with data collected over a seven-month period from December 2019 to June 2020. All women reviewed at the specialist menopause services following treatment of a malignancy, BRCA carriers and Lynch syndrome were included in the study, with management options divided into three categories: hormonal, non-hormonal and no treatment. MAIN OUTCOME MEASURES The primary outcome of this study was to identify prescribing patterns for all women reviewed following a diagnosis of a malignancy, as well as those with genetic mutations necessitating risk-reducing prophylactic bilateral salpingo-oopherectomy (BSO). RESULTS Altogether 71 women were included in this study, with the majority of women post management of a non-gynaecological malignancy (51/71, 72%), of which breast cancer was the most common (37/71, 52%). While non-hormonal treatment was the most popular among those treated for breast cancer, for all other malignancies, hormonal treatment was more widespread. Fourteen women also had genetic mutations, with all of these women commencing hormonal treatment post risk reducing surgery. CONCLUSION With the exception of those with a history of hormone-sensitive breast cancer, the use of hormonal treatment for menopausal symptoms remained widespread. While this was a relatively small study, the need for long-term follow-up across specialist menopause services, to assess the risk of recurrence is vital.
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Affiliation(s)
| | | | - D Bruce
- King's College London, London, UK
| | - J Rymer
- King's College London, London, UK
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Brzozowska M, Lewinski A. Hormonal replacement therapy in women with a history of internal genital organ malignancy. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:34-39. [PMID: 33935618 PMCID: PMC8077805 DOI: 10.5114/pm.2021.104572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
Sudden cessation of ovary activity as a result of bilateral oophorectomy or chemo- or radiotherapy in premenopausal women is linked with more serious consequences that bear no comparison to natural menopause - to name just a few: higher rate of mortality, higher rate of colorectal and lung cancer, circulatory system diseases, cognitive disorders, Parkinson's disease, psychological disorders, osteoporosis, and sexual disorders. The prolonged period of estrogens deficit in premenopausal age is connected with worsened quality of life. The progress in oncological care means that in many malignant diseases, also in the case of gynaecological malignancies, the percentage of survivors increases. This makes improving the quality of life more and more important. The purpose of this review is to establish, based on EBM data, the answer to whether replacement hormonal therapy, being the most effective treatment of menopause symptoms, can be recommended for women who have undergone bilateral oophorectomy because of gynaecological cancer. On the basis of collected data, derived from meta-analysis, and studies which have been published within the last 20 years, it seems that the use of the appropriate type of hormonal replacement therapy (HRT) in properly selected gynaecological cancer survivors (epithelial ovarian cancer - EOC, endometrial cancer, squamous cell carcinoma of the cervix) is safe and effective. It seems that benefits connected with better quality of life that stem from the use of appropriate HRT in gynaecological cancer survivors predominate the unfounded fear of disease recurrence in selected patients' groups.
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Affiliation(s)
- Maria Brzozowska
- Department of Endocrinology and Metabolic Diseases, Medical University, Lodz, Poland Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Andrzej Lewinski
- Department of Endocrinology and Metabolic Diseases, Medical University, Lodz, Poland Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
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Vargiu V, Amar ID, Rosati A, Dinoi G, Turco LC, Capozzi VA, Scambia G, Villa P. Hormone replacement therapy and cervical cancer: a systematic review of the literature. Climacteric 2020; 24:120-127. [PMID: 33236658 DOI: 10.1080/13697137.2020.1826426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gynecological tumor treatment, including cervical cancer (CC) treatment, often leads to iatrogenic premature menopause. This highlights the critical importance of investigating indications for hormone replacement therapy (HRT), as most patients, thanks to the improvement in diagnosis and treatment, have to deal with the sequelae of their cancer treatments for many years. This systematic review aims to provide an overview of the current knowledge regarding the risks of HRT and CC. In particular, we aim to investigate whether the use of HRT can increase CC incidence, and evaluate its risk in CC survivors. A systematic review, in agreement with PRISMA guidelines, of the English literature present in PubMed and SCOPUS has been performed. A total of 2805 articles have been screened, of which 10 were considered eligible. Several studies reported a significantly reduced risk of developing cervical squamous cell carcinoma in postmenopausal women treated with HRT, while a weak increase in the incidence of adenocarcinoma has been shown. No evidence reports a harmful effect of HRT on CC oncological outcome, while several benefits, in terms of reduced metabolic risk and increased quality of life, have been described, thus concluding that HRT should be offered to young CC survivors for the management of early menopause.
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Affiliation(s)
- V Vargiu
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - I D Amar
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Rosati
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Dinoi
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L C Turco
- Gynecology and Breast Care Unit, Mater Olbia spa, Olbia, Italy.,Division of Gynecologic Oncology, Gemelli Molise spa, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - V A Capozzi
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - G Scambia
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Women's and Children's Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Villa
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Women's and Children's Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Silva Filho ALD, Carvalho GM, Sena LCD, Gomes LPG, Valério MFH, Martins RIL, Cândido EB. Hormone therapy after risk-reducing surgery in patients with BRCA1/BRCA2 mutation: evaluation of potential benefits and safety. ACTA ACUST UNITED AC 2020; 66:1134-1138. [PMID: 32935810 DOI: 10.1590/1806-9282.66.8.1134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
Women with mutations in the BRCA 1 and 2 genes are at increased risk for ovarian and breast cancer and therefore candidates for risk-reducing surgery, including salpingo-oophorectomy and mastectomy. Risk-reducing salpingo-oophorectomy (RRSO) is considered the most effective prophylactic measure for ovarian cancer prevention in this group of patients. This procedure involves loss of ovarian function and induced menopause. Estrogen therapy is the most effective treatment for controlling vasomotor symptoms and improving the quality of life of climacteric women. However, the potential hormonal stimulation of these tumors and the risk of breast cancer are a concern regarding the safety of hormone replacement therapy (HRT) in this population. This article aims to review the current evidence regarding the potential benefits and safety of HRT after RRSO.
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Affiliation(s)
| | | | | | | | | | | | - Eduardo Batista Cândido
- . Professor Adjunto do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da UFMG, Belo Horizonte, MG, Brasil
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Sinno A, Pinkerton J, Febbraro T, Jones N, Khanna N, Temkin S, Iglesias D, Pothuri B. Hormone therapy (HT) in women with gynecologic cancers and in women at high risk for developing a gynecologic cancer: A Society of Gynecologic Oncology (SGO) clinical practice statement. Gynecol Oncol 2020; 157:303-306. [DOI: 10.1016/j.ygyno.2020.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
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10
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Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors. J Cancer Surviv 2020; 14:607-613. [PMID: 32323140 DOI: 10.1007/s11764-020-00857-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study sought to evaluate the prevalence of menopausal symptoms in a population of reproductive-aged women remote from cancer therapy compared with a group of healthy similar-aged controls and with a cohort of late reproductive-aged (LR) controls. METHODS Participants were assessed for symptoms of menopause, early follicular phase hormones, and ultrasound examinations. Menopausal symptoms were analyzed in exposed participants and controls using χ2 analyses, Wilcoxon-Mann Whitney tests, and multivariable logistic regression models. RESULTS One hundred seventy cancer survivors, 135 similar-aged controls, and 71 LR controls were followed prospectively for an average of 38 months. Compared with similar-aged controls, a greater proportion of survivors reported vasomotor symptoms at some point over the study period (35% vs 19%, p < 0.01), and this proportion was similar to LR controls (44%, p = 0.22). Survivors were more likely to be bothered by vaginal dryness (27%) than similar-aged controls (16%, p = 0.02) or LR controls (14%, p = 0.02). FSH levels were 38.4% higher in those with vasomotor symptoms compared with those without symptoms (p = 0.021). CONCLUSIONS Reproductive-aged cancer survivors have a higher prevalence of vasomotor symptoms and vaginal dryness than their similar-aged peers. IMPLICATIONS FOR CANCER SURVIVORS Providers should be attuned to the high prevalence of menopausal symptoms in cancer survivors.
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Svanström Röjvall A, Buchli C, Bottai M, Ahlberg M, Flöter-Rådestad A, Martling A, Segelman J. Effect of radiotherapy for rectal cancer on female sexual function: a prospective cohort study. Br J Surg 2019; 107:525-536. [DOI: 10.1002/bjs.11373] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/15/2019] [Accepted: 08/25/2019] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Clinical experience and limited data show that female sexual function is influenced negatively by preoperative radiotherapy (RT) for rectal cancer. The aim of this prospective study was to investigate the impact of RT on sexual function and ovarian reserve measured by levels of anti-Müllerian hormone (AMH).
Methods
Women with stage I–III rectal cancer scheduled for surgery with or without preoperative (chemo)RT were included and followed for 2 years. Female Sexual Function Index (FSFI) questionnaire responses and blood samples for hormone analyses, including AMH in women aged 45 years or less, were collected at baseline and during follow-up.
Results
In the group of 109 women who received preoperative RT, median scores in all FSFI domains decreased over time, as did the total FSFI score (from 18·5 (range 2·0–36·0) at baseline to 10·8 (2·0–34·8) at 2 years; P < 0·001). In the group of 30 women who did not receive preoperative RT, only satisfaction declined over time (from 3·2 (0·8–6·0) to 1·8 (0·8–6·0); P = 0·012). In longitudinal regression analysis, the mean decline in FSFI total score was –9·33 (95 per cent c.i. –16·66 to –1·99; P = 0·013) for women who had preoperative RT compared with those who did not, with adjustment for age, Psychological General Well-being Index score and relationship with partner. A corresponding association was seen for arousal, lubrication, orgasm and pain. Five of six women aged 45 years or less with detectable serum levels of AMH at baseline had undetectable levels after RT.
Conclusion
Preoperative RT was associated with impairment in sexual function in women with rectal cancer. This needs to be considered when discussing choice of treatment and rehabilitation. In younger women, undetectable AMH levels after RT indicate an irreversible loss of ovarian follicles.
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Affiliation(s)
- A Svanström Röjvall
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Department of Surgery, St Göran's Hospital, Stockholm, Sweden
| | - C Buchli
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - M Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Stockholm, Sweden
| | - M Ahlberg
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - A Flöter-Rådestad
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - J Segelman
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Department of Surgery, Ersta Hospital, Stockholm, Sweden
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Shi J, Wu L, Li B, Lu Y, Guo X, Cai Q, Long J, Wen W, Zheng W, Shu XO. Transcriptome-Wide Association Study Identifies Susceptibility Loci and Genes for Age at Natural Menopause. Reprod Sci 2018; 26:496-502. [PMID: 29848177 DOI: 10.1177/1933719118776788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify novel susceptibility genes for age at natural menopause (ANM). METHODS Using transcription data generated in tissues from normal hypothalami (n = 73) and ovaries (n = 68) and high-density genotyping data provided by the Genotype-Tissue Expression (GTEx) database, we built 16 164 genetic models to predict gene expression across the transcriptome in these tissues. We used these models and summary statistics data from genome-wide association studies (GWAS) of ANM generated in 69 360 women of European ancestry to identify genes with their predicted expression related to ANM. RESULTS We found the predicted expression of 34 genes to be significantly associated with ANM at a Bonferroni-corrected threshold of P < 3.09 ×10-6. These include 4 genes located more than 1 Mb away from any previously GWAS-identified ANM-associated variants, 24 genes that reside in known GWAS-identified loci but have not been previously implicated, and 6 genes previously implicated as ANM-associated genes. CONCLUSION Results from this transcriptome-wide association study, which integrated Expression quantitative trait loci (eQTL) data with summary statistics of GWAS of ANM, improves our understanding of the genetics and biology of female reproductive aging.
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Affiliation(s)
- Jiajun Shi
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Lang Wu
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bingshan Li
- 2 Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA.,3 Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Yingchang Lu
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Xingyi Guo
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Qiuyin Cai
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jirong Long
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Wanqing Wen
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Wei Zheng
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Xiao-Ou Shu
- 1 Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Abstract
The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updates the 2012 Hormone Therapy Position Statement of The North American Menopause Society and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2012 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees.Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use, using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing or discontinuing HT.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome VMS and for those at elevated risk for bone loss or fracture. For women who initiate HT more than 10 or 20 years from menopause onset or are aged 60 years or older, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS or bone loss, with shared decision making and periodic reevaluation. For bothersome GSM symptoms not relieved with over-the-counter therapies and without indications for use of systemic HT, low-dose vaginal estrogen therapy or other therapies are recommended.This NAMS position statement has been endorsed by Academy of Women's Health, American Association of Clinical Endocrinologists, American Association of Nurse Practitioners, American Medical Women's Association, American Society for Reproductive Medicine, Asociación Mexicana para el Estudio del Climaterio, Association of Reproductive Health Professionals, Australasian Menopause Society, Chinese Menopause Society, Colegio Mexicano de Especialistas en Ginecologia y Obstetricia, Czech Menopause and Andropause Society, Dominican Menopause Society, European Menopause and Andropause Society, German Menopause Society, Groupe d'études de la ménopause et du vieillissement Hormonal, HealthyWomen, Indian Menopause Society, International Menopause Society, International Osteoporosis Foundation, International Society for the Study of Women's Sexual Health, Israeli Menopause Society, Japan Society of Menopause and Women's Health, Korean Society of Menopause, Menopause Research Society of Singapore, National Association of Nurse Practitioners in Women's Health, SOBRAC and FEBRASGO, SIGMA Canadian Menopause Society, Società Italiana della Menopausa, Society of Obstetricians and Gynaecologists of Canada, South African Menopause Society, Taiwanese Menopause Society, and the Thai Menopause Society. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool, June 2017. The British Menopause Society supports this Position Statement.
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Abstract
OBJECTIVE Women with gynecologic malignancies will be cured or may become long-term survivors. Management of menopausal symptoms is important in addressing their quality of life. We review the benefit and safety of hormone therapy use in these patients. METHODS MEDLINE was searched for studies on menopause management published in English through December of 2016. RESULTS Available data suggest that short-term use of hormone therapy in gynecologic cancer patients who do not have an estrogen-dependent malignancy do not adversely impact oncologic outcome and results in improvement of menopausal vasomotor and genitourinary symptoms. Evidence regarding safety of hormone therapy use in women with estrogen-dependent gynecologic malignances is currently lacking. CONCLUSIONS Candidates for hormone therapy in gynecologic oncology include women with menopausal symptoms diagnosed with low-grade, early-stage endometrial cancer, cervical, vulvar and vaginal cancer, and ovarian cancer.
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Affiliation(s)
- Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Laurel W Rice
- Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, WI, United States
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Yang X, Wang C, He X, Wei J, Wang Y, Li X, Xu LP. Hormone therapy for premature ovarian insufficiency patients with malignant hematologic diseases. Climacteric 2017; 20:268-273. [PMID: 28399661 DOI: 10.1080/13697137.2017.1309382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The current usage of hormone therapy (HT) among perimenopausal women is low in China, especial in women with premature ovarian insufficiency (POI) with malignant hematologic diseases. This study investigated the efficacy and safety of HT in POI patients with malignant hematologic diseases who have received myeloablative chemotherapy and hemopoietic stem cell transplantation (HSCT). METHODS Patients who had POI after myeloablative chemotherapy and HSCT for malignant hematologic diseases were enrolled. Questionnaires with information about characteristics, menstrual status, sex hormone levels and menopausal symptoms were used to evaluate the relief from menopausal symptoms and safety of HT. RESULTS Among 130 cases, 103 (79.2%) patients had perimenopausal symptoms. The mean total Kupperman menopausal index score changed significantly from 13.50 ± 7.128 to 6.13 ± 5.97 after HT for 24 months. Among the 118 patients who received estrogen/progestin cyclic sequential therapy, 89 (75.4%) had withdrawal bleeding. CONCLUSION Myeloablative chemotherapy against leukemia may cause POI. HT may relieve perimenopausal symptoms after myeloablative chemotherapy and HSCT. HT was safe and no excessive recurrences or mortality were seen in the hormone-treated group for patients who survived from malignant hematologic diseases and who received HSCT.
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Affiliation(s)
- X Yang
- a Department of Obstetrics and Gynecology , Peking University People's Hospital , Beijing , China
| | - C Wang
- a Department of Obstetrics and Gynecology , Peking University People's Hospital , Beijing , China
| | - X He
- b Department of Obstetrics and Gynecology , The Second Hospital of Hebei Medical University , Shijiazhuang , Hebei Province , China
| | - J Wei
- b Department of Obstetrics and Gynecology , The Second Hospital of Hebei Medical University , Shijiazhuang , Hebei Province , China
| | - Y Wang
- c Department of Obstetrics and Gynecology , Peking University Third Hospital , Beijing , China
| | - X Li
- b Department of Obstetrics and Gynecology , The Second Hospital of Hebei Medical University , Shijiazhuang , Hebei Province , China
| | - L-P Xu
- d Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Peking University Institute of Hematology, People's Hospital , Beijing , China
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Zhang YL, Chen JH, Lu W, Li BL, Zhu QY, Wan XP. Efficacy of Postoperative Hormone Replacement Therapy on Prognosis of Patients with Serous Ovarian Carcinoma. Chin Med J (Engl) 2017; 129:1316-21. [PMID: 27231169 PMCID: PMC4894042 DOI: 10.4103/0366-6999.182835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Ovarian cancer is the most common cause of gynecological cancer-associated death. Iatrogenic menopause might adversely affect the quality of life and health outcomes in young female cancer survivors. We evaluated whether postoperative hormone replacement therapy (HRT) had a negative influence on the progression-free survival (PFS) of patients with papillary serous ovarian cancer (SOC). Methods: We retrospectively reviewed the medical records of patients with papillary SOC, treated from January 1980 to December 2009, who suffered from menopause with or without HRT. Clinical characteristics of patients were compared between the two groups (HRT and non-HRT). Blood samples were collected from all the participants to detect serum cancer antigen (CA) 125. Hazard ratios with 95% confidential intervals for each variable were calculated by univariable and multivariable conditional Logistic regression analyses. Results: Among 112 identified patients, 31 were HRT users and 81 were not. The two groups did not significantly differ in median age at diagnosis (t = 0.652, P = 0.513), International Federation of Gynecology and Obstetrics (FIGO) stage (χ2 = 0.565, P = 0.754), differentiation (χ2 = 1.728, P = 0.422), resection status (χ2 = 0.070, P = 0.791), relapse (χ2 = 0.109, P = 0.741), chemotherapy course (t = −1.079, P = 0.282), follow-up interval (t = 0.878, P = 0.382), or PFS (t = 0.580, P = 0.562). Median Kupperman score at the onset of HRT was 30.81 and 12.19 after the therapy (t = 3.302, P = 0.001). According to the analysis, the strongest independent variables in predicting PFS were FIGO stage and disease that was not optimally debulked. Conclusions: Postoperative HRT is not a prognostic factor for PFS of patients with papillary SOC. However, multicenter studies are needed to verify and extend our findings.
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Affiliation(s)
- Yong-Li Zhang
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Jin-Hong Chen
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Wen Lu
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Bi-Lan Li
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Qin-Yi Zhu
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Xiao-Ping Wan
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
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Shi J, Zhang B, Choi JY, Gao YT, Li H, Lu W, Long J, Kang D, Xiang YB, Wen W, Park SK, Ye X, Noh DY, Zheng Y, Wang Y, Chung S, Lin X, Cai Q, Shu XO. Age at menarche and age at natural menopause in East Asian women: a genome-wide association study. AGE (DORDRECHT, NETHERLANDS) 2016; 38:513-523. [PMID: 27629107 PMCID: PMC5266214 DOI: 10.1007/s11357-016-9939-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/14/2016] [Indexed: 06/06/2023]
Abstract
Age at menarche (AM) and age at natural menopause (ANM) are complex traits with a high heritability. Abnormal timing of menarche or menopause is associated with a reduced span of fertility and risk for several age-related diseases including breast, endometrial and ovarian cancer, cardiovascular disease, and osteoporosis. To identify novel genetic loci for AM or ANM in East Asian women and to replicate previously identified loci primarily in women of European ancestry by genome-wide association studies (GWASs), we conducted a two-stage GWAS. Stage I aimed to discover promising novel AM and ANM loci using GWAS data of 8073 women from Shanghai, China. The Stage II replication study used the data from another Chinese GWAS (n = 1230 for AM and n = 1458 for ANM), a Korean GWAS (n = 4215 for AM and n = 1739 for ANM), and de novo genotyping of 2877 additional Chinese women. Previous GWAS-identified loci for AM and ANM were also evaluated. We identified two suggestive menarcheal age loci tagged by rs79195475 at 10q21.3 (beta = -0.118 years, P = 3.4 × 10-6) and rs1023935 at 4p15.1 (beta = -0.145 years, P = 4.9 × 10-6) and one menopausal age locus tagged by rs3818134 at 22q12.2 (beta = -0.276 years, P = 8.8 × 10-6). These suggestive loci warrant a further validation in independent populations. Although limited by low statistical power, we replicated 19 of the 98 menarche loci and 5 of the 20 menopause loci previously identified in women of European ancestry in East Asian women, suggesting a shared genetic architecture for these two traits across populations.
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Affiliation(s)
- Jiajun Shi
- Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 600, IMPH, Nashville, Tennessee, 37203, USA
| | - Ben Zhang
- Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 600, IMPH, Nashville, Tennessee, 37203, USA
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huaixing Li
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, China
| | - Wei Lu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jirong Long
- Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 600, IMPH, Nashville, Tennessee, 37203, USA
| | - Daehee Kang
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Yong-Bing Xiang
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wanqing Wen
- Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 600, IMPH, Nashville, Tennessee, 37203, USA
| | - Sue K Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Xingwang Ye
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, China
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ying Zheng
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yiqin Wang
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, China
| | - Seokang Chung
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Xu Lin
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, China
| | - Qiuyin Cai
- Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 600, IMPH, Nashville, Tennessee, 37203, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt Epidemiology Center and Division of Epidemiology, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 600, IMPH, Nashville, Tennessee, 37203, USA.
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Moss E, Taneja S, Munir F, Kent C, Robinson L, Potdar N, Sarhanis P, McDermott H. Iatrogenic Menopause After Treatment for Cervical Cancer. Clin Oncol (R Coll Radiol) 2016; 28:766-775. [DOI: 10.1016/j.clon.2016.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023]
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Role of Hormone Replacement Therapy (HRT) in Gynecological Cancers: Endocrinologist’s Perspective. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Kushtagi P, Narayanan A. Ovarian Hormone Replacement Therapy in Gynecological Cancer Survivors. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Serum Androgen Levels and Sexual Function Before and One Year After Treatment of Uterine Cervical Cancer: A Pilot Study. J Sex Med 2016; 13:413-24. [DOI: 10.1016/j.jsxm.2015.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
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Hormone replacement therapy after treatment for a gynaecological malignancy. Curr Opin Obstet Gynecol 2016; 28:32-41. [DOI: 10.1097/gco.0000000000000238] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Lost workdays in uterine cervical cancer survivors compared to the general population: impact of treatment and relapse. J Cancer Surviv 2015; 10:514-23. [DOI: 10.1007/s11764-015-0496-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/02/2015] [Indexed: 01/03/2023]
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Faubion SS, MacLaughlin KL, Long ME, Pruthi S, Casey PM. Surveillance and Care of the Gynecologic Cancer Survivor. J Womens Health (Larchmt) 2015; 24:899-906. [PMID: 26208166 PMCID: PMC4649722 DOI: 10.1089/jwh.2014.5127] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling. METHODS This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience. RESULTS Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception. CONCLUSIONS A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health.
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Affiliation(s)
- Stephanie S. Faubion
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic, Rochester, Minnesota
| | | | - Margaret E. Long
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Sandhya Pruthi
- Division of General Internal Medicine, Breast Diagnostic Clinic, Women's Health Clinic, Mayo Clinic, Rochester, Minnesota
| | - Petra M. Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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Perrone AM, Pozzati F, Santini D, Rossi M, Procaccini M, Casalini L, Santi E, Tesei M, Zamagni C, Iaco PD. Gynecological malignancies and hormonal therapies: Clinical management and recommendations. World J Obstet Gynecol 2014; 3:162-170. [DOI: 10.5317/wjog.v3.i4.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/15/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Every year in the world a large number of women receive a diagnosis of gynecological cancer and undergo a therapy such as surgery, chemotherapy and radiotherapy to the pelvic region. A large portion of these patients are already in menopause, but for younger patients therapies are responsible of early menopause. The physical and psychological symptoms due to iatrogenic menopause significantly reduce the quality of life; however hormone replacement therapy (HRT) has a high efficacy in reducing menopausal symptoms. The prescription of HRT in patients with story of gynecological cancer is debated because its safety has not been completely proven. The main criticism is based on the theory that the hormone replacement could stimulate growth of residual cancer cells increasing the risk of recurrence.
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Wang J, Hu F, Luo Y, Luo H, Huang N, Cheng F, Deng Z, Deng W, Zou K. Estrogenic and anti-estrogenic activities of hispolon from Phellinus lonicerinus (Bond.) Bond. et sing. Fitoterapia 2014; 95:93-101. [PMID: 24637110 DOI: 10.1016/j.fitote.2014.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/06/2014] [Accepted: 03/09/2014] [Indexed: 01/25/2023]
Abstract
Hispolon was the main antitumor active ingredient in Phellinus sensu lato species. In order to confirm the dual regulating estrogenic ingredient and obtain more effective natural estrogen replacement drugs, hispolon was separated from Phellinus lonicerinus (Bond.) Bond. et sing. Hispolon exhibited significant anti-proliferative effect against estrogen-sensitive ER (+) MCF-7 cells in the absence of estrogen, and exhibits antagonistic effects on 17β-estradiol (E2)-induced MCF-7 cell proliferation when E2 and the different concentrations of hispolon were treated simultaneously. Hispolon also inhibited the proliferation of estrogen-negative ER (-) MDA-MB-231 cells at the concentration of 5.00×10(-5) M. The yeast two-hybrid experiments showed that hispolon had strong and non-selective effects on the estrogen receptor (ER) α and ERβ at a concentration of 1.00×10(-6) M. The ERβ-binding ability of hispolon was larger than ERα in the concentration range of 1.00×10(-9) M and 1.00×10(-7) M. Hispolon could increase the body weight coefficient, serum E2 and progesterone contents in immature female mice at dose of 9.10×10(-6) mol/kg, and increase coefficient of thymus and spleen in mice. The Gscores of hispolon-ERα and hispolon-ERβ docked complexes were -7.93 kcal/mol and -7.79 kcal/mol in docking simulations. Hispolon presented dual regulating estrogenic activities, which showed estrogenic agonist activity at low concentration or lack of endogenous estrogen, and the estrogenic antagonistic effect was stimulated at high concentrations or too much endogenous estrogen. Hispolon could be used for treating the estrogen deficiency-related disease with the benefit of non-toxic to normal cells, good antitumor effects and estrogenic activity.
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Affiliation(s)
- Junzhi Wang
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China; Hubei Tujia Institute of Medicine, China Three Gorges University, Yichang 443002, China
| | - Fang Hu
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China
| | - Youcheng Luo
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China
| | - Huajun Luo
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China
| | - Nianyu Huang
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China.
| | - Fan Cheng
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China
| | - Zhangshuang Deng
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China
| | - Weiqiao Deng
- Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, China
| | - Kun Zou
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang 443002, China
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Zhou X, Chai Y, Chen K, Yang Y, Liu Z. A meta-analysis of reference values of leptin concentration in healthy postmenopausal women. PLoS One 2013; 8:e72734. [PMID: 24023638 PMCID: PMC3758328 DOI: 10.1371/journal.pone.0072734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 07/12/2013] [Indexed: 02/07/2023] Open
Abstract
Objective There are numerous reports about the leptin concentration (LC) in postmenopausal women (PW). Changes in LC can elicit different clinical outcomes. We systematically analyzed the LC in PW. Methods A search was conducted in original English-language studies published from 1994 to October 2012 in the following databases: Medline (78), Cochrane Center (123) Embase (505), Biological abstracts (108), Cochrane (53) and Science Finder Scholar (0). A meta-analysis was undertaken on the correction coefficient (r) between the serum LC and body mass index (BMI) for healthy PW across studies containing a dataset and sample size. Pre-analytical and analytical variations were examined. Pre-analytical variables included fasting status (FS) and sampling timing. Analytical variation comprised assay methodology, LC in those undertaking hormone replacement therapy (HRT) and those not having HRT as well as LC change according to age. Results Twenty-seven studies met the inclusion criteria. Eighteen studies detected LC in the morning in a FS, 15 studies denoted the r between leptin and the BMI. A combined r was counted for the 15 studies (r = 0.51 [95% confidence interval (CI), 0.46–0.54], P = 0.025), and if sampling collection was in the FSat morning, a combined r was form 10 studies (r = 0.54 [95% CI, 0.45–0.54], P = 0.299) and heterogeneity was diminished. LC did not change between HRT users and non-users in 7 studies. Five studies analyzed changes in LC according to age. Conclusion Based on all studies that investigated both LC and BMI, LC was positively correlated with the BMI. No studies established reference ranges according to the Clinical and Laboratory Standards Institute (CLSI) in healthy PW, and there was a wide variation in LC values. These differences suggest that caution should be used in the interpretation and comparison between studies.
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Affiliation(s)
- Xi Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, China
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - YanLan Chai
- Department of Radiation Oncology, The First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, China
| | - Ke Chen
- Department of Physiology and Pathophysiology, Health Science Center, Xi'an Jiaotong University, China
| | - YunYi Yang
- Department of Radiation Oncology, The First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, China
| | - Zi Liu
- Department of Radiation Oncology, The First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, China
- * E-mail:
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Abstract
Treatment of gynecological cancer has significant impact on a woman's quality of life because it commonly includes removal of the uterus and ovaries, both being the core of a woman's femininity, whilst irradiation and chemotherapy, be they as primary therapy or when indicated as postoperative adjuvant therapy, will lead to ablation of ovarian function if the ovaries had not been removed. This will lead to an acute onset of menopausal symptoms, which may be more debilitating than those occurring as a result of natural aging, and of which hot flushes, night sweats, insomnia, mood swings, vaginal dryness, decreased libido, malaise and a general feeling of apathy are the most common. About 25% of gynecological cancers will occur in pre- and perimenopausal women, a large percentage of whom will become menopausal as a result of their treatment. There are also the gynecological cancer survivors who are not rendered menopausal as a result of the treatment strategy but who will become menopausal because of natural aging. Concern among the medical attendants of these women is whether use of estrogen therapy or estrogen and progestogens for their menopausal symptoms will reactivate tumor deposits and therefore increase the rate of recurrence and, as a result, decrease overall survival among these women. Yet the data that are available do not support this concern. There are eight retrospective studies and only one randomized study that have analyzed outcome in endometrial cancer survivors who used hormone therapy after their surgery, whilst, among ovarian cancer survivors, there are four retrospective studies and one randomized study. The studies do suffer from small numbers and, although the studies pertaining to endometrial cancer analyze mostly women with early-stage disease, a number of the studies in both the endometrial and ovarian cancer survivors do have a sizeable follow-up. These studies seem to support that estrogen therapy after the treatment for gynecological cancer does not impact negatively on outcome in endometrial and ovarian cancer survivors and that estrogen therapy can be considered as a plausible therapeutic option in survivors who are debilitated by their menopausal symptoms. It is prudent not to offer estrogen therapy to survivors of endometrial stromal sarcoma and women with granulosa cell tumors of the ovaries. Vulval, vaginal and cervical cancers are not considered hormone-dependent and therefore estrogen therapy can be given.
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Affiliation(s)
- F Guidozzi
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
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Salani R. Survivorship planning in gynecologic cancer patients. Gynecol Oncol 2013; 130:389-97. [DOI: 10.1016/j.ygyno.2013.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 01/01/2023]
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Hu WS, Lin YM, Ho TJ, Chen RJ, Li YH, Tsai FJ, Tsai CH, Day CH, Chen TS, Huang CY. Genistein suppresses the isoproterenol-treated H9c2 cardiomyoblast cell apoptosis associated with P-38, Erk1/2, JNK, and NFκB signaling protein activation. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2013; 41:1125-36. [PMID: 24117073 DOI: 10.1142/s0192415x13500766] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart disease (HD) is associated with estrogen and therefore gender and menopausal status. In addition, clinical evidence shows that increased serum norepinephrine is found in patients with HD. Therefore, this study aimed to investigate the cardio-protective effect of genistein, a selective estrogen receptor modulator (SERM) from soy bean extract, in H9c2 cardiomyoblast cells treated with isoproterenol (ISO), a norepinephrine analog. In this in vitro model, image data and results from western blotting shown that ISO treatment was capable of inducing cellular apoptosis, especially the mitochondrial dependent pathway. Treatment of genistein could suppress the expression of mitochondrial pro-apoptotic proteins including Bad, caspase-8, caspase-9, and caspase-3 in H9c2 treated with ISO. By contrast, several survival proteins were expressed in H9c2 treated with genistein, such as phosphor (p)-Akt, p-Bad, and p-Erk1/2. Furthermore, we confirmed that the protective role of genistein was partially mediated through the expression of Erk1/2, Akt, and NF κ B proteins by adding several pathway inhibitors. These in vitro data suggest that genistein may be a safe and natural SERM alternative to hormone therapy in cardio-protection.
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Affiliation(s)
- Wei-Syun Hu
- Division of Cardiology, Taipei Medical University, Shuang-Ho Hospital, Taipei, Taiwan , Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Lin CC, Chen TS, Lin YM, Yeh YL, Li YH, Kuo WW, Tsai FJ, Tsai CH, Yen SK, Huang CY. The p38 and NFκB signaling protein activation involved in glycitein protective effects on isoproterenol-treated H9c2 cardiomyoblast cells. J Funct Foods 2013. [DOI: 10.1016/j.jff.2012.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Drummond AE, Fuller PJ. Activin and inhibin, estrogens and NFκB, play roles in ovarian tumourigenesis is there crosstalk? Mol Cell Endocrinol 2012; 359:85-91. [PMID: 21839804 DOI: 10.1016/j.mce.2011.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 01/24/2023]
Abstract
Ovarian cancer may be the most frequently lethal gynaecological malignancy but the heterogeneous nature of the disease and the advanced stage at which it is usually diagnosed, have contributed to the paucity of information relating to its aetiology and pathogenesis. Members of the TGF-β superfamily, estrogen and NFκB have all been implicated in the development and progression of cancers from a wide range of tissues. In the ovary, TGF-β superfamily members and estrogen play key roles in maintaining normal function. To date, little is known about the capacity of NFκB to influence normal ovarian function except that it is ubiquitously expressed. In this review we will highlight the roles that inhibin/activin, estrogen and NFκB, have been attributed within carcinogenesis and examine the potential for crosstalk between these pathways in ovarian cancer pathogenesis.
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Affiliation(s)
- Ann E Drummond
- Prince Henry's Institute of Medical Research, PO Box 5152, Clayton, Victoria 3168, Australia.
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Li L, Pan Z, Gao K, Zhang W, Luo Y, Yao Z, Liang X, Tang B, Li QQ. Impact of post-operative hormone replacement therapy on life quality and prognosis in patients with ovarian malignancy. Oncol Lett 2011; 3:244-249. [PMID: 22740889 DOI: 10.3892/ol.2011.461] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/11/2011] [Indexed: 11/12/2022] Open
Abstract
The present study aimed to assess the impact of post-surgical hormone replacement therapy (HRT) on life quality and prognosis in women with ovarian malignancy. HRT (Premarin, Nilestriol and medroxyprogesterone) was administered following surgery in 31 patients with ovarian cancer. A total of 44 ovarian cancer patients of similar age, clinical stage and pathological features did not receive HRT following surgery. The expression of estrogen receptor (ER)-α, ERβ and progesterone receptor (PR) in cancer tissues was detected by immunohistochemical staining. Serum levels of calcitonin (CT) and transforming growth factor (TGF)-α were determined by radioimmunoassay and enzyme-linked immunosorbent assay, respectively. Data were analyzed using Kaplan-Meier survival curves, a log-rank test and a Cox scale risk model. Quality of life was assessed in the patient groups and in healthy post-menopausal women (control) based on a questionnaire developed by the European Organization of Research and Treatment of Cancer (EORTC-C30), as well as our own specific questionnaire. A log-rank test revealed no difference in survival between the patients with and without HRT (p>0.05), and a Cox model showed that HRT was not an independent prognostic factor. The accumulated survival rate did not differ significantly based on the expression of ERα, ERβ or PR in patients with or without HRT (p>0.05). The serum TGFα levels prior to and following surgery were not significantly different in either of the two patient groups (p>0.05). Serum CT levels were higher in patients without HRT at 1.5 years following surgery (p<0.05), but no significant difference was found in the serum CT levels of patients receiving HRT. The HRT and non-HRT groups differed significantly with regard to the body and emotional functional sub-scales of the EORTC-C30 (p<0.05) and the sex quality and autonomic nerve maladjustment categories of our specific questionnaire (p<0.05). Findings of this study showed that HRT administered following surgery exhibited no apparent negative effect on prognosis in patients with ovarian cancer, regardless of ERα, ERβ or PR expression in cancer tissues, and had no effect on serum transforming growth factor (TGF)-α levels. Post-surgical HRT aided in the stabilization of serum CT levels and improved the quality of life in these patients.
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Affiliation(s)
- Li Li
- Department of Gynecologic Oncology, Cancer Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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Gadducci A, Barsotti C, Cosio S, Domenici L, Riccardo Genazzani A. Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: a review of the literature. Gynecol Endocrinol 2011; 27:597-604. [PMID: 21438669 DOI: 10.3109/09513590.2011.558953] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
High-risk human papillomaviruses (HPVs) are involved in the etiopathogenesis of cervical intraepithelial neoplasia (CIN) and cervical cancer. After taking HPV into account, smoking habit appears to be the most significant environmental risk factor, and the risk of this malignancy increases significantly with intensity and duration of smoking. Women with human immunodeficiency virus (HIV) infection experience a higher incidence of CIN and invasive cervical cancer. Among HIV+ women, the highly active antiretroviral therapy increases the regression rate of CIN, but the majority of these lesions do not regress to normal. As far as oral contraceptives (OCs), a systematic review of 28 studies found that, compared with never pill users, the relative risk (RR) of cervical cancer increased with increasing duration of OC use. The results were similar for squamous cell carcinoma and adenocarcinoma, and the RRs decreased after pill discontinuation. However, by weighing risks and benefits, the World Health Organization does not recommend any change in OC practice. There is no correlation between hormone replacement therapy and cervical cancer. Experimental data have shown that estradiol and progesterone can modulate the host immune response to HPV16. Prophylactic vaccination in conjunction with cervical screening is the best prevention strategy for cervical cancer.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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Hormone replacement therapy and women with premature menopause--a cancer survivorship issue. Eur J Cancer 2011; 47:1623-32. [PMID: 21561765 DOI: 10.1016/j.ejca.2011.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/02/2011] [Accepted: 04/04/2011] [Indexed: 11/21/2022]
Abstract
The importance of addressing survivorship issues has been emphasised in recent years. As cancer therapies improve there is a growing population of cancer survivors, which includes many women with premature menopause. Women who are premenopausal at the time of their cancer diagnosis may have specific survivorship issues to be addressed, including infertility, early menopause and sexual dysfunction. These factors can continue have a significant impact on the quality of life of these patients at long term follow up. Data for this Review were identified by searches of MEDLINE, PubMed, and references from relevant articles using the search terms 'HRT', 'women/female cancer/tumour', 'menopause' and 'survivorship'. Abstracts and reports from meetings were excluded. Only papers published in English between 1980 and 2010 were included. The aims of this review are to: • Address the hormonal factors which impact on cancer survivorship for premenopausal women • Review the debate for the role of hormone replacement therapy (HRT) in cancer survivors • Provide information for physicians and patients regarding the management of hormonally driven survivorship issues (for different tumour types), based on current evidence The recommendations for practice are that HRT may be offered for the alleviation of vasomotor symptoms in cancer survivors who undergo premature menopause up to the age of natural menopause (51 years in the UK). HRT (including vaginal oestrogen preparations) is contraindicated in survivors of oestrogen receptor positive breast cancer and low grade endometrial leiomyosarcoma, where non-HRT alternatives should be considered to alleviate symptoms.
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Ibeanu O, Modesitt SC, Ducie J, von Gruenigen V, Agueh M, Fader AN. Hormone replacement therapy in gynecologic cancer survivors: why not? Gynecol Oncol 2011; 122:447-54. [PMID: 21474167 DOI: 10.1016/j.ygyno.2011.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/13/2011] [Accepted: 03/15/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE As a result of treatment, many women with gynecologic malignancies will go through menopause and display climacteric symptoms at an earlier age than occurs naturally. Iatrogenic menopause may adversely affect quality of life and health outcomes in young female cancer survivors. Hormone replacement therapy (HRT) has often been withheld from women with gynecologic cancer because of concern that it might increase the risk of relapse or the development of new primary cancers. The purpose of this review was to examine the published literature on menopause management in gynecologic cancer survivors and highlight the risks and benefits of conventional and alternative HRT in this population. METHODS A comprehensive literature search of English language studies on menopause management in gynecologic cancer survivors and women with a hereditary predisposition to a gynecologic malignancy was performed in MEDLINE databases through December 2010. RESULTS Both our review and a 2008 Cochrane review of randomized trials on the effects of long-term HRT demonstrate that for menopausal women in their 40s or 50s with and without gynecologic cancer, the absolute risks of estrogen-only HRT are low. Several prospective observational studies and randomized trials on HRT use in women with a genetic predisposition for or development of a gynecologic malignancy suggest benefits in quality of life with no proven adverse oncologic effects as a result of short-term HRT use. CONCLUSION In select women, it is reasonable to discuss and offer conventional HRT for the amelioration of menopausal symptoms and to improve quality of life. HRT does not appear to increase the risk of gynecologic cancer recurrences; however, this conclusion was largely based on observational data and smaller prospective studies.
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Affiliation(s)
- Okechukwu Ibeanu
- Division of Gynecologic Oncology, Greater Baltimore Medical Center and Johns Hopkins Medical Institutions, Baltimore, MD, USA
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MacLennan AH. HRT in difficult circumstances: are there any absolute contraindications? Climacteric 2011; 14:409-17. [DOI: 10.3109/13697137.2010.543496] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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