1
|
Skaribas EE, Tschen J. Growth of a Nipple Adenoma After Estrogen Replacement Therapy. Cureus 2023; 15:e50843. [PMID: 38249210 PMCID: PMC10798381 DOI: 10.7759/cureus.50843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
A nipple adenoma is an epithelial tumor of the lactiferous ducts, typically affecting women aged 50-60 years old. This case report discusses a 52-year-old woman who developed a papillary adenoma of the right nipple after initiating oral estrogen replacement therapy (ERT) for perimenopausal symptoms. A 4 mm punch biopsy and subsequent immunohistochemistry stain revealed the proliferation of ductal structures consistent with a papillary adenoma and tumor cells expressing estrogen receptors (ER) and progesterone receptors (PR). Despite their benign nature, nipple adenomas may exhibit alterations in immunophenotype, including ER and PR expression, which could lead to potential tumor growth in women undergoing these treatments. This case describes the first reported growth of a nipple adenoma in the context of estrogen replacement therapy, highlighting a potential risk of hormone therapy in promoting hyperproliferation of benign tumors such as nipple adenomas. When utilizing ERT, it is important to weigh the potential advantages and risks, as its application in the management of vasomotor symptoms during menopause may increase the risk of both breast cancer and benign proliferative breast diseases. These considerations underscore the need for individualized therapy when approaching perimenopausal and postmenopausal care.
Collapse
Affiliation(s)
| | - Jaime Tschen
- Dermatology, Saint Joseph Dermatopathology, Houston, USA
| |
Collapse
|
2
|
Szybiak W, Kujawa B, Miedziaszczyk M, Lacka K. Effect of Growth Hormone and Estrogen Replacement Therapy on Bone Mineral Density in Women with Turner Syndrome: A Meta-Analysis and Systematic Review. Pharmaceuticals (Basel) 2023; 16:1320. [PMID: 37765128 PMCID: PMC10536543 DOI: 10.3390/ph16091320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Osteoporosis is a serious implication of Turner syndrome (TS). Common methods for the treatment of TS are growth hormone (GHT) and estrogen replacement therapy (ERT). We examined the relationship between the treatment of TS and bone mineral density (BMD) of the lumbar spine. The purpose of our study was to show the currency of BMD states among patients with TS for treatment with GHT and ERT. We searched databases for studies published from inception to April 2023. The articles were related to TS, osteoporosis, ERT, GHT, BMD and treatment patients with TS. We applied the selection criteria: lumbar spine values at L1-L4; dual-energy X-ray absorptiometry (DXA); treatment which was applied: one group of articles: ERT and two group of articles: GHT; results performed as means ± SD. In total, 79 articles were analyzed, of which 20 studies were included and 5 were considered for meta-analysis. The total number of women in the articles selected was 71. Based on the results of the meta-analysis, the effect of ERT on BMD demonstrated a significant increase in BMD (the standardized mean difference in the random model was 0.593 g/cm2, 95% CI: 0.0705 to 1.116; p = 0.026), which showed that treatment with estrogen particularly increases bone mass during treatment, which contributes to reducing the risk of fractures. The effect of GHT on BMD demonstrated a non-significant decrease in BMD in patients with TS. The results for growth hormone show that this therapy does not improve bone density. However, our review emphasizes the beneficial effect of supplementing growth hormone (GH) on the clinical presentation of TS.
Collapse
Affiliation(s)
- Weronika Szybiak
- Students’ Scientific Section at the Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland; (W.S.); (B.K.)
| | - Barbara Kujawa
- Students’ Scientific Section at the Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland; (W.S.); (B.K.)
| | - Miłosz Miedziaszczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland;
| | - Katarzyna Lacka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Science, 60-355 Poznan, Poland
| |
Collapse
|
3
|
Haavisto A, Wettergren L, Lampic C, Lähteenmäki PM, Jahnukainen K. Premature ovarian insufficiency and chance of pregnancy after childhood cancer: A population-based study (the Fex-Can study). Int J Cancer 2023. [PMID: 37078589 DOI: 10.1002/ijc.34541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
Endocrine complications are a common late effect after childhood cancer. Our study assessed the prevalence and predictors of premature ovarian insufficiency (POI) and prospects of pregnancy in young female survivors. This nationwide study combined registry and survey data for female childhood cancer survivors aged 19 to 40 years, identified through the National Quality Registry for Childhood Cancer in Sweden. Of 1989 approached young women, 1333 (67%) participated by completing a survey. Median age at diagnosis 1981 to 2017 was 6 (range 0-17) and at study 28 (19-40) years. There were two indicators of POI, induced puberty reported in 5.3% and estrogen replacement therapy (ERT) in 9.3% at assessment. In separate logistic regression analyses (P < .001), induced puberty and ERT were significantly predicted by hematopoietic stem cell transplantation (HSCT), abdominal irradiation, central nervous system irradiation and chemotherapy. ERT was also associated with older age at diagnosis. Of the 626 women (48% of responders) who had tried to become pregnant, 25% had undergone fertility investigations and 72% reported having a biological child. Treatment with HSCT was associated with 5.4 times the odds of needing fertility investigations (P < .001). Having a biological child was associated with non-HSCT treatment, but also with ever having had a partner and older age at the time of study (all P < .001). In conclusion, the majority of those female childhood cancer survivors who had tried to conceive were able to successfully give birth. However, a small identifiable group of female survivors are at risk of subfertility and early menopause.
Collapse
Affiliation(s)
- Anu Haavisto
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Päivi M Lähteenmäki
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
- FICANWEST, University of Turku, Turku, Finland
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Cambray S, Dubreuil S, Tejedor I, Dulon J, Touraine P. Family building after diagnosis of premature ovarian insufficiency: a cross-sectional survey in 324 women. Eur J Endocrinol 2023; 188:7034158. [PMID: 36763040 DOI: 10.1093/ejendo/lvad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The diagnosis of premature ovarian insufficiency (POI) is a traumatic event for many patients that involves poor fertility prognosis. After such diagnosis, spontaneous pregnancies are rare. The alternatives for building a family are oocyte donation, embryo donation, and adoption. However, we have few information on how many women with POI finally built a family after the diagnosis and which alternative they chose. DESIGN We performed a cross-sectional, descriptive study. METHODS We conducted a survey of all the women who consulted for POI in the department of endocrinology and reproductive medicine at la Pitié Salpêtrière between May 31, 1991, and January 12, 2021. We included patients who continued to be followed up regularly by our department or were contacted by mail or phone between June and September 2021. We excluded patients with Turner syndrome and POI secondary to oncological treatment and patients under 18 at the time of the survey. RESULTS 985 patients were referred to the department for POI, and 324 patients were finally analyzed. 41% of the women who wanted to build a family had children after the diagnosis: 53.9% by oocyte donation, 1 woman by embryo donation, 5.6% after ovarian stimulation, 13.5% by adoption, and 25.8% who had spontaneous pregnancy after a mean time of 2.5 years. Spontaneous pregnancy rate was 8.6% in the whole cohort. CONCLUSIONS Having children after a diagnosis of POI is not uncommon but more often results from oocyte donation. This study will provide enlightened information for newly diagnosed women on the possibilities to build a family after POI diagnosis.
Collapse
Affiliation(s)
- Solange Cambray
- Pitié Salpêtrière Hospital, Sorbonne Université Médecine, Department of Endocrinology and Reproductive Medicine, 75651 Paris cedex 13, France
| | - Sophie Dubreuil
- Pitié Salpêtrière Hospital, Sorbonne Université Médecine, Department of Endocrinology and Reproductive Medicine, 75651 Paris cedex 13, France
| | - Isabelle Tejedor
- Center for Rare Gynecologial Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
| | - Jérôme Dulon
- Center for Endocrine Rare Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
| | - Philippe Touraine
- Pitié Salpêtrière Hospital, Sorbonne Université Médecine, Department of Endocrinology and Reproductive Medicine, 75651 Paris cedex 13, France
- Center for Rare Gynecologial Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
- Center for Endocrine Rare Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
| |
Collapse
|
5
|
Wang L, Wang J, Shan Q, Shu H, Guo JM. Involvement of baroreflex deficiency in the age-related loss of estrogen efficacy against cerebral ischemia. Front Aging Neurosci 2023; 15:1167170. [PMID: 37205058 PMCID: PMC10186347 DOI: 10.3389/fnagi.2023.1167170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/03/2023] [Indexed: 05/21/2023] Open
Abstract
For post-menopausal women, stroke is complicated by the variable effects of estrogen therapy and the age-related therapeutic consequences involved. Estrogen therapy has been shown to have an age-dimorphic effect, which is neuroprotective in young females, but non-neuroprotective, even neurotoxic in acyclic females. We hypothesized that arterial baroreflex (ABR) and its downstream acetylcholine-α7 nicotinic acetylcholine receptor (α7nAChR) anti-inflammatory pathways are involved in estrogen efficacy toward cerebral ischemic damage. Our data showed that estrogen supplements contributed to ABR improvement and neuroprotection in adult, not aged, ovariectomized (OVX) rats. In adult rats, OVX-induced estrogen deficiency aggravated middle cerebral artery occlusion (MCAO), which induced brain infarction and reduced ABR function, with decreased α7nAChR expression of the brain and exaggerated inflammation following MCAO; these effects were significantly prevented by supplementation with estrogen. ABR impairment by sinoaortic denervation partly attenuated the estrogen effect on baroreflex sensitivity (BRS) and ischemic damage in adult rats, as well as α7nAChR expression and inflammatory response. These data suggested that ABR and acetylcholine-α7nAChR anti-inflammatory pathways are involved in the neuroprotection of estrogen in adult OVX rats. In contrast, aged rats exhibited more severe ischemic damage and inflammatory response than adult rats, as well as poorer baroreflex function and lower α7nAChR expression. Estrogen supplements did not improve BRS or confer neuroprotection in aged rats without affecting brain α7nAChR and post-ischemic inflammation. Most importantly, ketanserin restored ABR function and significantly postponed the onset of stroke in aged female strokeprone spontaneously hypertensive rats, whereas estrogen treatment failed to delay the development of stroke. Our findings reveal that estrogen is protective against ischemic stroke (IS) in adult female rats and that ABR played a role in this beneficial action. Dysfunction of ABR and unresponsiveness to estrogen in aged female rats may contribute to a reduced estrogen efficacy against cerebral ischemia.
Collapse
Affiliation(s)
- Lei Wang
- Department of Orthopedics, 960th Hospital of PLA, Jinan, Shandong, China
| | - Jia Wang
- Health Service Department, 960th Hospital of PLA, Jinan, Shandong, China
| | - Qing Shan
- Department of Clinical Pharmacy, Weifang Medical University, Weifang, Shandong, China
| | - He Shu
- Department of Clinical Pharmacy, 960th Hospital of PLA, Jinan, Shandong, China
| | - Jin-Min Guo
- Department of Clinical Pharmacy, 960th Hospital of PLA, Jinan, Shandong, China
- *Correspondence: Jin-Min Guo,
| |
Collapse
|
6
|
Renke G, Kemen E, Scalabrin P, Braz C, Baêsso T, Pereira MB. Cardio-Metabolic Health and HRT in Menopause: Novel Insights in Mitochondrial Biogenesis and RAAS. Curr Cardiol Rev 2023; 19:e060223213459. [PMID: 36748220 PMCID: PMC10494270 DOI: 10.2174/1573403x19666230206130205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Recent evidence shows the cardiometabolic effects of estrogen administration in postmenopausal women. Women have a cardiometabolic advantage during their reproductive years, which is lost at menopause due to declining estradiol (E2). E2, also known as 17-beta-estradiol, has diverse effects in its target tissues, including the cardiovascular (CV) system, through genomic and non-genomic signaling. Metabolic changes characteristic of menopause include a worsening lipid profile, changes in body fat distribution, epicardial and pericardial fat deposition, increased susceptibility to weight gain, and increased blood pressure, resulting in an increased risk of accelerated cardiovascular disease (CVD) development. E2 mediates its cardioprotective actions by increasing mitochondrial biogenesis, angiogenesis, and vasodilation, decreasing reactive oxygen species (ROS) and oxidative stress, and modulating the renin-angiotensin-aldosterone system (RAAS). In this review, we assess whether it is prudent to develop an approach to managing postmenopausal women based on modifying the patient's CV risk that includes human-identical hormone replacement therapy (HRT), modulation of RAAS, and stimulating mitochondrial biogenesis. Further research is needed to assess the safety and benefit of HRT to reduce cardiometabolic risk.
Collapse
Affiliation(s)
- Guilherme Renke
- National Institute of Cardiology, Brazilian Ministry of Health, Rio de Janeiro, Brazil
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Elaine Kemen
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Priscila Scalabrin
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Cleibe Braz
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | - Thomáz Baêsso
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro, Brazil
| | | |
Collapse
|
7
|
Zhou R, Wang Z, Zhou B, Yu Z, Wu C, Hou J, Cheng K, Liu TC. Estrogen receptors mediate the antidepressant effects of aerobic exercise: A possible new mechanism. Front Aging Neurosci 2022; 14:1040828. [PMID: 36570542 PMCID: PMC9780551 DOI: 10.3389/fnagi.2022.1040828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to examine whether aerobic exercise exerts mood-modulating effects through an estrogen signaling mechanism. Method The experiment was divided into two parts. The first part is to compare the three modeling methods to obtain the most obvious method of depression-like phenotype for further study in the second part. The first part of ovariectomized rats (age, 13 weeks) was tested when rats were 14 or 22 weeks old or in the sixth week after 3 weeks of chronic restraint stress. The second part was to treat the animals with the most obvious depression-like phenotype in different ways, placebo treatment or estradiol (E2) replacement therapy was administered, aerobic training, or estrogen receptor antagonist treatment. The cognitive (Barnes maze and 3-chamber social tests), anxiety-like (open-field and elevated plus maze tests) and depression-like (sucrose preference and forced swim tests) behaviors of rats in both parts were analyzed to study the effects of estrogen depletion and aerobic exercise. Results Rats did not develop depressive symptoms immediately after ovariectomy, however, the symptoms became more pronounced with a gradual decrease in ovarian hormone levels. Compared with the placebo or control groups, the exercise and E2 groups showed improved performance in all behavioral test tasks, and the antidepressant effects of aerobic exercise were comparable to those of estrogen. Moreover, the estrogen receptor antagonist has markedly inhibited the antidepressant effects of aerobic exercise. Conclusion Estrogen receptors may mediate the antidepressant effects of aerobic exercise. In addition, an increasingly fragile ovarian hormonal environment may underlies chronic restraint stress-induced depression.
Collapse
|
8
|
Kim H, Lee E. Association between Menopausal Hormone Therapy and Frailty: Cross-Sectional Study Using National Survey Data in Korea. Healthcare (Basel) 2022; 10:healthcare10112121. [PMID: 36360462 PMCID: PMC9690075 DOI: 10.3390/healthcare10112121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Frailty is a multidimensional clinical syndrome that increases the risk of adverse health outcomes. Previous studies have reported a close link between menopause and frailty. Combined estrogen−progestin therapy (or estrogen-only therapy in women who have undergone a hysterectomy) is currently approved as a menopausal hormone therapy (MHT) to treat menopausal symptoms. Despite increasing evidence of the importance of sex hormones in the development of frailty, very few studies have investigated the association between MHT and frailty. A cross-sectional evaluation was conducted using population-based survey data known as the Korea National Health and Nutrition Examination Survey (KNHANES IV-V, 2008−2012). The KNHANES data provided variables that were used to construct a 51-item frailty index (FI). The number of study population, only including postmenopausal women, was 7823 women, and their mean age was 62.51 years (range 32−80 years). Approximately 40% of them had graduated from middle school or higher, 45% lived in metropolitan statistical areas, and 5% were recipients of the national Medical Aid. The mean age at menopause was 48.66 years (range 30−62 years). Overall, the mean FI value was 0.15, and the prevalence of MHT was 13.23%. Findings from multiple regression analysis using the inverse probability of treatment weighting showed that a treatment duration of more than 2 years and up to 5 years, age at first treatment between 50 and 59 years, and MHT initiation 3 to 6 years after menopause were all negatively associated with frailty (p < 0.05). Further studies are needed to confirm these findings using prospective data.
Collapse
|
9
|
Baristaite G, Gurwitz D. Estradiol reduces ACE2 and TMPRSS2 mRNA levels in A549 human lung epithelial cells. Drug Dev Res 2022; 83:961-966. [PMID: 35103351 PMCID: PMC9015589 DOI: 10.1002/ddr.21923] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 02/06/2023]
Abstract
Epidemiologic studies suggest slightly higher risk of severe Covid‐19 symptoms and fatalities following SARS‐CoV‐2 infection in men compared with women from similar age groups. This bias was suggested to reflect differences in the male and female immune system regulation, driven by different sex hormone levels in men and women, in particular, higher plasma estradiol in women. SARS‐CoV‐2 infects respiratory tract epithelial cells by binding to their cell membrane ACE2, followed by priming for cell entry by the host cell membrane serine protease TMPRSS2. The cell protease FURIN facilitates cell exit of mature SARS‐CoV‐2 virions. Our study examined the effects of in vitro treatment of A549 human lung epithelial cells with 17‐β‐estradiol on mRNA expression of genes coding for these proteins. Treatment of A549 human lung epithelial cells with 17‐β‐estradiol reduced the cellular mRNA levels of ACE2 and TMPRSS2 mRNA, while not affecting FURIN expression. Our findings suggest that 17‐β‐estradiol may reduce SARS‐CoV‐2 infection of lung epithelial cells, which may in part explain the reduced incidence of severe Covid‐19 and fatalities among women compared with men of similar age. Studies into the molecular pathways by which 17‐β‐estradiol reduces ACE2 and TMPRSS2 mRNA expression in lung epithelial cells are needed for assessing its potential protective value against severe Covid‐19.
Collapse
Affiliation(s)
- Gabriele Baristaite
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Gurwitz
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Radovick S, Misra M. Editorial: Insights in pediatric Endocrinology: 2021. Front Endocrinol (Lausanne) 2022; 13:977912. [PMID: 35957814 PMCID: PMC9359621 DOI: 10.3389/fendo.2022.977912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sally Radovick
- Department of Pediatrics, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Madhusmita Misra,
| |
Collapse
|
11
|
Ma Y, Niu E, Xie F, Liu M, Sun M, Peng Y, Guo H. Electroacupuncture reactivates estrogen receptors to restore the neuroprotective effect of estrogen against cerebral ischemic stroke in long-term ovariectomized rats. Brain Behav 2021; 11:e2316. [PMID: 34473429 PMCID: PMC8553307 DOI: 10.1002/brb3.2316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Stroke is a sexually dimorphic disease and a leading cause of death and disability. Estrogen replacement therapy (ERT) confers beneficial neuroprotective effects if administered within a widely accepted time window called the "critical period." However, very few studies have explored the idea of modulating the critical period to enable long-term post-menopausal women to regain more benefits from estrogen therapy. Here, motivated by previous findings that electroacupuncture could both alter estrogen metabolism and induce significant tolerance against stroke, it was explored whether EA could restore estrogen's neuroprotection against cerebral ischemia in long-term ovariectomized (OVX) rats. METHODS We implemented 1 week(w)-EA pretreatment on OVX-10w or OVX-20w rats, and tested the expression of estrogen receptors, and detected the ERT's neuroprotection against stroke induced by middle cerebral artery occlusion (MCAO). RESULTS We found that the expression levels of phospho-ERα-S118 and estrogen receptor β (ERβ) in the striatum of OVX-10w rats were significantly decreased and ERT's neuroprotection was abolished in the OVX-10w rats. However, EA-1w pretreatment could significantly recover the expression levels of phospho-ERα-S118 and ERβ, and also restored the neuroprotective effects of ERT in OVX-10w rats. However, EA-1w pretreatment could not restore the expression of estrogen receptors and ERT's neuroprotection in OVX-20w rats. CONCLUSION Taken together, our study indicates that EA may be an easy intervention that can restore the efficacy of estrogen therapy during the "critical period," which has the potential to improve the stroke outcomes of an enormous number of long-term post-menopausal women. However, the time-sensitive influences for how EA and estrogen metabolism interact with each other should be considered.
Collapse
Affiliation(s)
- Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Erlong Niu
- Department of Orthopedics, 305 Hospital of PLA, Beijing, China
| | - Fei Xie
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Min Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Miao Sun
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ye Peng
- Department of Orthopaedics, Air Force Medical Center, PLA, Beijing, China
| | - Hang Guo
- Department of Anesthesiology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
12
|
de Azeredo Siqueira R, Carlos AS, d'Avila JC, Moreno AM, Alves EL, de Farias MLF, Mendonça LMC, Guimarães MM. Body composition, but not insulin resistance, influences postprandial lipemia in patients with Turner's syndrome. Arch Endocrinol Metab 2021; 64:758-763. [PMID: 34033286 PMCID: PMC10528628 DOI: 10.20945/2359-3997000000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/12/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of the present study was to examine the influence of body composition and insulin resistance on the magnitude of postprandial lipemia in patients with Turner's syndrome receiving oral versus transdermal estrogen replacement. METHODS Twenty-five patients with Turner's syndrome receiving oral or transdermal estrogen replacement were evaluated for body mass index, waist-to-hip and waist-to-height ratios, fasting glycemia, insulin, body composition (dual-energy X-ray absorptiometry), and postprandial lipid metabolism. For statistical analysis, we used parametric tests to compare numeric variables between the two subgroups. RESULTS We observed no difference in postprandial triglyceride levels between patients receiving oral versus transdermal hormone replacement therapy. The postprandial triglycerides increment correlated positively with the percentage of total fat mass (p=0.02) and android fat mass (p=0.02) in the transdermal group. In the oral estrogen group, a positive correlation was observed between the increment in postprandial triglycerides and waist-to-hip (p=0.15) and waist-to-height (p=0.009) ratios. No association was observed between the estrogen replacement route and insulin resistance evaluated by the homeostatic model assessment-insulin resistance (HOMA-IR) index (p=0.19 and p=0.65 for the oral and transdermal groups, respectively). CONCLUSION We concluded that body composition and anthropometric characteristics possibly affect the extent of postprandial lipemia independently from the route of estrogen replacement.
Collapse
Affiliation(s)
- Rodrigo de Azeredo Siqueira
- Laboratório de Pesquisa Pré-Clínica, Faculdade de Medicina, Universidade de Nova Iguaçu, Nova Iguaçu, RJ, Brasil,
| | - Aluana Santana Carlos
- Laboratório de Pesquisa Pré-Clínica, Faculdade de Medicina, Universidade de Nova Iguaçu, Nova Iguaçu, RJ, Brasil
| | - Joana Costa d'Avila
- Laboratório de Pesquisa Pré-Clínica, Faculdade de Medicina, Universidade de Nova Iguaçu, Nova Iguaçu, RJ, Brasil,
| | - Adalgiza Mafra Moreno
- Laboratório de Pesquisa Pré-Clínica, Faculdade de Medicina, Universidade de Nova Iguaçu, Nova Iguaçu, RJ, Brasil
| | - Estela Luz Alves
- Departamento de Endocrinologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Laura Maria C Mendonça
- Departamento de Reumatologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | |
Collapse
|
13
|
Abstract
In this invited review, we discuss some unresolved and controversial issues concerning premature (<40 years) or early (40-45 years) bilateral oophorectomy. First, we clarify the terminology. Second, we summarize the long-term harmful consequences of bilateral oophorectomy. Third, we discuss the restrictive indications for bilateral oophorectomy in premenopausal women to prevent ovarian cancer that are justified by the current scientific evidence. Fourth, we explain the importance of estrogen replacement therapy when bilateral oophorectomy is performed. Hormone replacement therapy is indicated after bilateral oophorectomy until the age of expected natural menopause like in premature or early primary ovarian insufficiency. Fifth, we discuss the relationship between adverse childhood experiences, adverse adult experiences, mental health, gynecologic symptoms and bilateral oophorectomy. The acceptance and popularity of bilateral oophorectomy over several decades, and its persistence even in the absence of supporting scientific evidence, suggest that non-medical factors related to sex, gender, reproduction, cultural beliefs and socioeconomic structure are involved. We discuss some of these non-medical factors and the need for more research in this area.
Collapse
Affiliation(s)
- W A Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
| | - M M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
| | - L Gazzuola Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - E A Stewart
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
14
|
Chiarito M, Brunetti G, D'Amato G, Faienza MF. Monitoring and maintaining bone health in patients with Turner syndrome. Expert Rev Endocrinol Metab 2020; 15:431-438. [PMID: 33074770 DOI: 10.1080/17446651.2020.1834846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Subjects affected with Turner Syndrome (TS) suffer low bone mineral density and high risk of fracture from a young age. Estrogen deficiency is considered the main risk factor but other factors, such as intrinsic bone abnormalities, enhanced osteoclastogenesis, vitamin D deficiency and other comorbidities may contribute to the exalted bone fragility. AREAS COVERED The authors performed a literature search in PubMed and EMBASE, using selected key words. They focused their search on pathogenetic mechanisms of osteoporosis in TS and updated the diagnosis, prevention and therapeutic interventions. EXPERT OPINION Bone health is a concern in subjects with TS, and strategies to prevent osteoporosis and fractures should be considered from childhood. Advice on how to live a healthy lifestyle, including physical activity and correct nutrition, should be given during childhood in order to prevent bone impairment later in life. The screening for vitamin D deficiency should be performed between the ages of 9 and 11, and every 2-3 years thereafter. Early initiation of estrogen replacement therapy (ERT) between 11-12 years of age, prompt titration to the adult dose after 2 years, and long-term follow-up to guarantee compliance with ERT, are the key points of osteoporosis prevention in women with TS.
Collapse
Affiliation(s)
- Mariangela Chiarito
- Department of Biomedical Sciences and Human Oncology, University "A.Moro" , Bari, Italy
| | - Giacomina Brunetti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, University "A. Moro" , Bari, Italy
| | - Gabriele D'Amato
- Department of Women's and Children's Health, ASL Bari, Neonatal Intensive Care Unit, Di Venere Hospital , Bari, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, University "A.Moro" , Bari, Italy
| |
Collapse
|
15
|
Abstract
The genitourinary syndrome of menopause (GSM) is a relatively new term for the condition previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. The term was first introduced in 2014. GSM is a chronic, progressive, vulvovaginal, sexual, and lower urinary tract condition characterized by a broad spectrum of signs and symptoms. Most of these symptoms can be attributed to the lack of estrogen that characterizes menopause. Even though the condition mainly affects postmenopausal women, it is seen in many premenopausal women as well. The hypoestrogenic state results in hormonal and anatomical changes in the genitourinary tract, with vaginal dryness, dyspareunia, and reduced lubrication being the most prevalent and bothersome symptoms. These can have a great impact on the quality of life (QOL) of the affected women, especially those who are sexually active. The primary goal of the treatment of GSM is to achieve the relief of symptoms. First-line treatment consists of non-hormonal therapies such as lubricants and moisturizers, while hormonal therapy with local estrogen products is generally considered the “gold standard’’. Newer therapeutic approaches with selective estrogen receptor modulators (SERMs) or laser technologies can be employed as alternative options, but further research is required to investigate the viability and scope of their implementation in day-to-day clinical practice.
Collapse
Affiliation(s)
- Kyveli Angelou
- Urogynecology Unit, Alexandra Hospital-National and Kapodistrian University of Athens, Athens, GRC
| | - Themos Grigoriadis
- Urogynecology Unit, Alexandra Hospital-National and Kapodistrian University of Athens, Athens, GRC
| | - Michail Diakosavvas
- Urogynecology Unit, Alexandra Hospital-National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitris Zacharakis
- Urogynecology Unit, Alexandra Hospital-National and Kapodistrian University of Athens, Athens, GRC
| | - Stavros Athanasiou
- Urogynecology Unit, Alexandra Hospital-National and Kapodistrian University of Athens, Athens, GRC
| |
Collapse
|
16
|
Cattoni A, Rovelli A, Prunotto G, Bonanomi S, Invernizzi P, Perego R, Mariani AM, Balduzzi A. Hepatic focal nodular hyperplasia after pediatric hematopoietic stem cell transplantation: The impact of hormonal replacement therapy and iron overload. Pediatr Blood Cancer 2020; 67:e28137. [PMID: 31889398 DOI: 10.1002/pbc.28137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The advent of techniques for the assessment of iron overload (liver T2*-MRI) has led to the awareness that focal nodular hyperplasia (FNH) represents a possible incidental finding after hematopoietic stem cell transplantation (HSCT), though its pathogenesis is still unclear. METHODS We performed a retrospective analysis of the liver T2*-MRI scans performed between 2013 and 2018 in a single pediatric HSCT Unit and recorded the number of patients with FNH (group A). Patients incidentally diagnosed with FNH at imaging performed for different clinical indications were included in group B. RESULTS Nine of 105 (8.6%) patients from group A were diagnosed with FNH. Group B included three patients. Overall, 12 patients were diagnosed 4.4 ± 3.1 years after HSCT. At univariate analysis, female gender (odds ratio [OR] 3.77, P = .03), moderate-to-severe iron overload (OR 6.97, P = .01), and hormone replacement therapy (HRT) administered for at least 6 months (OR 18.20, P = .0002) exposed patients to a higher risk of developing FNH. The detrimental effect of HRT was significant also at multivariate analysis (OR 7.93, P = .024). MRI-T2* values in affected patients were statistically lower than healthy controls (P < .001). CONCLUSIONS We confirm the high incidence of FNH among transplanted pediatric patients and demonstrate the potential pathogenic role of HRT and iron overload.
Collapse
Affiliation(s)
- Alessandro Cattoni
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Attilio Rovelli
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Giulia Prunotto
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Sonia Bonanomi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Pietro Invernizzi
- Gastroenterologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Rosangela Perego
- Radiologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Anna Maria Mariani
- Radiologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| |
Collapse
|
17
|
Song YJ, Li SR, Li XW, Chen X, Wei ZX, Liu QS, Cheng Y. The Effect of Estrogen Replacement Therapy on Alzheimer's Disease and Parkinson's Disease in Postmenopausal Women: A Meta-Analysis. Front Neurosci 2020; 14:157. [PMID: 32210745 PMCID: PMC7076111 DOI: 10.3389/fnins.2020.00157] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Estrogen replacement therapy (ERT) is a common treatment method for menopausal syndrome; however, its therapeutic value for the treatment of neurological diseases is still unclear. Epidemiological studies were performed, and the effect of postmenopausal ERT on treating neurodegenerative diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD), was summarized through a meta-analysis. Methods: Twenty-one articles were selected using a systematic searching of the contents listed on PubMed and Web of Science before June 1, 2019. Epidemiological studies were extracted, and relevant research data were obtained from the original articles based on the predefined inclusion criteria and data screening principles. The Comprehensive Meta-Analysis Version 2 software was used to pool effective size, test heterogeneity, conduct meta-regression and subgroup analysis, and to calculate publication bias. Results: Our results showed that ERT significantly decreased the risk of onset and/or development of AD [odds ratio (OR): 0.672; 95% CI: 0.581–0.779; P < 0.001] and PD (OR: 0.470; 95% CI: 0.368–0.600; P < 0.001) compared with the control group. A subgroup and meta-regression analysis showed that study design and measure of effect were the source of heterogeneity. Age, sample size, hormone therapy ascertainment, duration of the treatment, or route of administration did not play a significant role in affecting the outcome of the meta-analysis. Conclusion: We presented evidence here to support the use of estrogen therapy for the treatment of AD and PD.
Collapse
Affiliation(s)
- Yu-Jia Song
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Shu-Ran Li
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Xiao-Wan Li
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Xi Chen
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Ze-Xu Wei
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Qing-Shan Liu
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yong Cheng
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| |
Collapse
|
18
|
Bahri N, Sajjadi M, Sadeghmoghadam L. The relationship between management strategies for menopausal symptoms and women's decision making styles during menopausal transition. Prz Menopauzalny 2019; 18:174-9. [PMID: 31975985 DOI: 10.5114/pm.2019.90378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/18/2019] [Indexed: 12/02/2022]
Abstract
Introduction Considering the importance of identifying the factors affecting women’s decision making process about the management of menopausal symptoms, this study was conducted with the aim of investigating the relation between decision making styles and women’s chosen options for management of menopausal symptoms. Material and methods This cross-sectional study was conducted from May 2016 to July 2018 in Gonabad, north east of Iran.Using the cluster sampling method 473 women between 45 and 60 years old were recruited to the study. Data were collected using a demographic questionnaire, a menopause symptom treatment options questionnaire, the Menopause Rating Scale and the Decision Making Styles Questionnaire. The data analysis was conducted using SPSS software version 16 as well as descriptive and analytical statistics; a p-value of< 0.05 was considered as statistically significant. Results The mean age of participants was 51.6 ±4.6 years old and the majority of them (85.5%) were housewives. The most popular menopause symptom treatment option was hormone replacement therapy. The majority of participants (45.4%, 228 people) used an avoidant decision making style. There was no statistically significant difference between menopausal symptom treatment options and decision making styles type(p = 0.525). There was a statistically significant difference between severity of menopausal symptoms and type of decision making style (p = 0.003). Conclusions The findings showed that there was no significant relation between the selected method to manage menopausal symptoms and women’s decision making styles. It is recommended that this study be conducted on a population that has greater access to all menopausal symptom treatment options.
Collapse
|
19
|
Poudou C, Fritel X. [Menopause and HRT]. Rev Prat 2019; 69:e208. [PMID: 31626443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Caroline Poudou
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU La Milétrie, 86000 Poitiers, France
| | - Xavier Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU La Milétrie, 86000 Poitiers, France
| |
Collapse
|
20
|
Anno T, Kawasaki F, Shigemoto R, Irie S, Mune T, Kaku K, Kaneto H. Alteration of ACTH and Cortisol Levels After Estradiol Valerate Treatment in a Male Subject With Gender Dysphoria: A Case Report. Front Endocrinol (Lausanne) 2019; 10:751. [PMID: 31827460 PMCID: PMC6849494 DOI: 10.3389/fendo.2019.00751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The number of subjects with gender dysphoria has been increasing. In general, male-to-female transsexual subjects are treated with estradiol valerate therapy. In this report, we showed the time course of ACTH and cortisol levels after estradiol valerate injection in a male subject with gender dysphoria. It seemed that alteration of estradiol levels influenced ACTH and cortisol levels via some pathway. Case presentation: A 31-year-old man with estradiol valerate therapy for gender dysphoria was referred due to an elevation of serum cortisol levels. She started hormone therapy at 26 years old. Her laboratory analyses showed an elevation of plasma ACTH and cortisol levels. There were no remarkable changes in the adrenal gland and pituitary gland. Her estradiol levels were elevated 7 days after estradiol valerate injection, but they were not detected 18 days after such treatment. Interestingly, plasma ACTH and serum cortisol levels were moderately decreased 7 days after estradiol valerate injection, but both were markedly elevated 18 days after such treatment. Conclusions: We should bear in mind the possibility of elevation in plasma ACTH and serum cortisol levels when we start estradiol valerate injection in subjects with gender dysphoria. In addition, we may need to check ACTH and cortisol levels when we use estrogen replacement therapy for a long period of time in subjects with gender dysphoria.
Collapse
Affiliation(s)
- Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
- *Correspondence: Takatoshi Anno
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Ryo Shigemoto
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Shintaro Irie
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Tomoatsu Mune
- Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
21
|
Speth RC, D'Ambra M, Ji H, Sandberg K. A heartfelt message, estrogen replacement therapy: use it or lose it. Am J Physiol Heart Circ Physiol 2018; 315:H1765-H1778. [PMID: 30216118 PMCID: PMC6336974 DOI: 10.1152/ajpheart.00041.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022]
Abstract
The issue of cardiovascular and cognitive health in women is complex. During the premenopausal phase of life, women have healthy blood pressure levels that are lower than those of age-matched men, and they have less cardiovascular disease. However, in the postmenopausal stage of life, blood pressure in women increases, and they are increasingly susceptible to cardiovascular disease, cognitive impairments, and dementia, exceeding the incidence in men. The major difference between pre- and postmenopausal women is the loss of estrogen. Thus, it seemed logical that postmenopausal estrogen replacement therapy, with or without progestin, generally referred to as menopausal hormone treatment (MHT), would prevent these adverse sequelae. However, despite initially promising results, a major randomized clinical trial refuted the benefits of MHT, leading to its falling from favor. However, reappraisal of this study in the framework of a "critical window," or "timing hypothesis," has changed our perspective on the benefit-to-risk ratio of MHT, and this review discusses the historical, current, and future approaches to MHT.
Collapse
Affiliation(s)
- Robert C Speth
- College of Pharmacy, Nova Southeastern University , Fort Lauderdale, Florida
- Department of Pharmacology and Physiology, College of Medicine, Georgetown University , Washington, District of Columbia
| | | | - Hong Ji
- Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University , Washington, District of Columbia
| | | |
Collapse
|
22
|
Olatunji LA, Adeyanju OA, Michael OS, Usman TO, Tostes RC, Soladoye AO. Ameliorative effect of low-dose spironolactone on obesity and insulin resistance is through replenishment of estrogen in ovariectomized rats. Can J Physiol Pharmacol 2018; 97:65-74. [PMID: 30422674 DOI: 10.1139/cjpp-2018-0416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Women have a lower incidence of cardiovascular diseases (CVD) than men at a similar age but the reverse is the case after menopause, indicating a possible protective effect of estrogen on cardiometabolic function. Although various hormonal therapies have been formulated to combat the CVD risks in postmenopausal state, the beneficial effects have not been consistent. Obesity with insulin resistance (IR) is closely linked to CVD risks while ovariectomized rodents have been shown to mimic a state of obesity and IR. We therefore hypothesized that low-dose spironolactone would ameliorate obesity and IR in estrogen-deprived rats by replenishing estrogen and suppressing elevated glycogen synthase kinase-3 (GSK-3). Ten-week-old female Wistar rats were divided into 4 groups: sham-operated (SHM), spironolactone (SPL; 0.25 mg/kg), and ovariectomized (OVX) rats treated with or without spironolactone daily for 8 weeks. Results showed that estrogen deprivation through ovariectomy caused increased body mass gain and visceral adiposity that are accompanied by increased HOMA-IR, HOMA-β, 1-hour postload glucose, glucose intolerance, platelet/lymphocyte ratio, plasma insulin, atherogenic dyslipidemia, uric acid, GSK-3, corticosterone, and aldosterone and depressed 17β-estradiol. However, treatment of OVX rats with spironolactone ameliorated all these effects. Taken together, the results demonstrate that treatment with low-dose spironolactone improves obesity and IR, which appears to involve replenishment of estrogen and suppression of GSK-3 along with circulating mineralocorticoid and glucocorticoid. The findings imply a positive cardiometabolic effect of low-dose spironolactone usage in estrogen-deprived conditions.
Collapse
Affiliation(s)
- Lawrence A Olatunji
- a HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Oluwaseun A Adeyanju
- a HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.,b Cardiometabolic Research Unit, Department of Physiology, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Olugbenga S Michael
- a HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.,c Cardiometabolic Research Unit, Department of Physiology, College of Health Sciences, Bowen University, Iwo, Nigeria
| | - Taofeek O Usman
- a HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.,d Cardiometabolic Research Unit, Department of Physiology, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Rita C Tostes
- e Department of Pharmacology, University of São Paulo, Ribeirao Preto Medical School, Ribeirao Preto, São Paulo, Brazil
| | - Ayodele O Soladoye
- a HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.,c Cardiometabolic Research Unit, Department of Physiology, College of Health Sciences, Bowen University, Iwo, Nigeria
| |
Collapse
|
23
|
Park HK, Ilango S, Charriez CM, Checkoway H, Riley D, Standaert DG, Bordelon Y, Shprecher DR, Reich SG, Hall D, Kluger B, Marras C, Jankovic J, Dubinsky R, Litvan I. Lifetime exposure to estrogen and progressive supranuclear palsy: Environmental and Genetic PSP study. Mov Disord 2018; 33:468-472. [PMID: 29460982 PMCID: PMC5840026 DOI: 10.1002/mds.27336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/10/2017] [Accepted: 01/11/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Studies suggesting a protective effect of estrogen in neurodegenerative diseases prompted us to investigate this relationship in progressive supranuclear palsy (PSP). METHODS This case-control study evaluated the self-reported reproductive characteristics and estrogen of 150 women with PSP and 150 age-matched female controls who participated in the Environmental Genetic-PSP study. Conditional logistic regression models were generated to examine associations of PSP with estrogen. RESULTS There was no association between years of estrogen exposure duration and PSP. There was a suggestion of an inverse association between composite estrogen score and PSP that did not reach statistical significance (P = .06). Any exposure to estrogen replacement therapy halved the risk of PSP (odds ratio = 0.52; 95% confidence interval = 0.30-0.92; P = .03). Among PSP cases, earlier age at menarche was associated with better performance on Hoehn and Yahr stage (β = -0.60; SE = 0.26; P = .02) and Unified Parkinson's Disease Rating Scale II score (β = -5.19; SE = 2.48; P = .04) at clinical examination. CONCLUSIONS This case-control study suggests a protective role of lifetime estrogen exposure in PSP. Future studies will be needed to confirm this association. © 2018 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Hee Kyung Park
- Department of Neurology, Inje University Ilsan-Paik Hospital, Goyang, Korea
- Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Sindana Ilango
- Graduate School of Public Health, San Diego State University
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Christina M. Charriez
- Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Harvey Checkoway
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | | | - David G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - David R. Shprecher
- Banner Sun Health Research Institute, Sun City, AZ
- Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Stephen G. Reich
- Department of Neurology, University of Maryland, Baltimore, Maryland, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Chicago, Illinois, USA
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Benzi Kluger
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Connie Marras
- Morto and Gloria Shulman Movement Disorders Centre and the Edmond J. Saftra Program in Parkinson’s Research, Toronto Western Hospital, University of Toronto, Toronto, Ontario, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine
| | | | - Irene Litvan
- Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
- Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| |
Collapse
|
24
|
He Q, Luo Y, Lv F, Xiao Q, Chao F, Qiu X, Zhang L, Gao Y, Xiu Y, Huang C, Tang Y. Effects of estrogen replacement therapy on the myelin sheath ultrastructure of myelinated fibers in the white matter of middle-aged ovariectomized rats. J Comp Neurol 2017; 526:790-802. [PMID: 29205359 DOI: 10.1002/cne.24366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/17/2022]
Abstract
The effects of estrogen replacement therapy (ORT) on white matter and the myelin sheath ultrastructure in the white matter of middle-aged ovariectomized (OVX) rats were investigated in this study. Middle-aged rats were ovariectomized and divided into a placebo replacement (OVX + O) group and an estrogen replacement (OVX + E) group. Then, the Morris water maze, electron microscope techniques, and stereological methods were used to investigate the effects of ORT on spatial learning capacity, white matter volume and the myelin sheath ultrastructure in the white matter. We found that the spatial learning capacity of the OVX + E rats was significantly improved compared with that of the OVX + O rats. When compared with that of OVX + O rats, the total volume of the myelin sheaths in the white matter of the OVX + E rats was significantly increased by 27%, and the difference between the outer perimeter and inner perimeter of the myelin sheaths of the white matter in the OVX + E rats increased significantly by 12.6%. The myelinated fibers with mean diameters of 1.2-1.4 μm were significantly longer (46.1%) in the OVX + E rats; the difference between the mean diameter of myelinated fibers and the mean diameter of axons (0-0.4 μm) was significantly increased by 21.6% in the OVX + E rats. These results suggested that ORT had positive protective effects on the spatial learning ability and on the myelin sheath ultrastructure in the white matter of middle-aged OVX rats.
Collapse
Affiliation(s)
- Qi He
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| | - Yanmin Luo
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| | - Fulin Lv
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| | - Qian Xiao
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| | - Fenglei Chao
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| | - Xuan Qiu
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China.,Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine, Ministry of Education, Chongqing Medical University, Chongqing, P. R. China
| | - Lei Zhang
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| | - Yuan Gao
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China.,Department of Geriatrics, The First Affiliated Hospital, Chongqing Medical University, Chongqing, P. R. China
| | - Yun Xiu
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Institute of Life Science, Chongqing Medical University, Chongqing, P. R. China
| | - Chunxia Huang
- Department of Physiology, Chongqing Medical University, Chongqing, P. R. China
| | - Yong Tang
- Department of Histology and Embryology, Chongqing Medical University, Chongqing, P. R. China.,Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing, P. R. China
| |
Collapse
|
25
|
da Silva LHA, Panazzolo DG, Marques MF, Souza MGC, Paredes BD, Nogueira Neto JF, Leão LMCSM, Morandi V, Bouskela E, Kraemer-Aguiar LG. Low-dose estradiol and endothelial and inflammatory biomarkers in menopausal overweight/obese women. Climacteric 2016; 19:337-43. [PMID: 27170466 DOI: 10.1080/13697137.2016.1180676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to investigate the effects of low-dose transdermal estrogen on endothelial and inflammatory biomarkers in menopausal overweight/obese women. METHODS We recruited 44 menopausal women (47-55 years; body mass index 27.5-34.9 kg/m(2)) and divided them into estradiol (1 mg/day; n = 22) or placebo groups (n = 22). They were double-blinded, followed and treated for 3 months. At baseline and post-intervention, inflammatory biomarkers (hs-CRP, IL-1β, IL-6, MCP-1 and TNF-α) and of vascular injury (activated circulating endothelial cells, CEC-a) and repair (endothelial progenitor cells, EPC) were quantified. Resting CECs (CEC-r) were also assessed. Microvascular reactivity and vasomotion were analyzed by laser-Doppler flowmetry. RESULTS Volunteers (51.8 ± 2.3 years; mean body mass index 31.5 ± 2.5 kg/m(2)) had been menopausal for 3 (range 2-5) years. After treatment, no changes were observed in the placebo group, while levels of CEC-r and EPC increased in the estradiol group. In this group, no changes in inflammatory biomarkers were observed but it required a lower cumulative dose of acetylcholine to achieve peak velocity during endothelial-dependent vasodilatation and there was increased endothelial-independent vasodilatation. CONCLUSIONS The short-term use of low-dose transdermal estradiol therapy in overweight/obese menopausal women increased markers of vascular repair and improved microvascular reactivity without changing the inflammatory biomarkers. CLINICAL TRIAL REGISTRATION NCT01295892 at www.clinicaltrials.gov .
Collapse
Affiliation(s)
- L H A da Silva
- a Clinical and Experimental Research Laboratory on Vascular Biology , Biomedical Center, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - D G Panazzolo
- a Clinical and Experimental Research Laboratory on Vascular Biology , Biomedical Center, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - M Ferreira Marques
- b Angiogenesis and Endothelial Cell Biology Laboratory, Department of Cell Biology , Institute of Biology Roberto Alcântara Gomes, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - M G C Souza
- a Clinical and Experimental Research Laboratory on Vascular Biology , Biomedical Center, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - B Dias Paredes
- c Molecular and Cellular Cardiology Laboratory , Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - J F Nogueira Neto
- d Lipids Laboratory , Policlínica Piquet Carneiro, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - L M C S M Leão
- e Endocrinology, Department of Internal Medicine, Medical Sciences Faculty , State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - V Morandi
- b Angiogenesis and Endothelial Cell Biology Laboratory, Department of Cell Biology , Institute of Biology Roberto Alcântara Gomes, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - E Bouskela
- a Clinical and Experimental Research Laboratory on Vascular Biology , Biomedical Center, State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - L G Kraemer-Aguiar
- a Clinical and Experimental Research Laboratory on Vascular Biology , Biomedical Center, State University of Rio de Janeiro , Rio de Janeiro , Brazil ;,e Endocrinology, Department of Internal Medicine, Medical Sciences Faculty , State University of Rio de Janeiro , Rio de Janeiro , Brazil
| |
Collapse
|
26
|
Blondon M, van Hylckama Vlieg A, Wiggins KL, Harrington LB, McKnight B, Rice KM, Rosendaal FR, Heckbert SR, Psaty BM, Smith NL. Differential associations of oral estradiol and conjugated equine estrogen with hemostatic biomarkers. J Thromb Haemost 2014; 12:879-86. [PMID: 24628832 PMCID: PMC5371691 DOI: 10.1111/jth.12560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The risk of venous thrombosis (VT) associated with oral hormone therapy (HT) may differ by type of estrogen compound. OBJECTIVE To compare the thrombotic profile of women using oral conjugated equine estrogens (CEE) with that of women using oral estradiol (E2). METHODS In postmenopausal, female, health maintenance organization (HMO) members with no history of VT, we measured thrombin generation, levels of factor VII activity, antithrombin activity and total protein S antigen. Mean levels of hemostasis biomarkers were cross-sectionally compared by use and type of estrogen using multiple linear regressions. The type of estrogen used was determined primarily by the HMO formulary, which changed its preferred estrogen from CEE to E2 during the study period. RESULTS The sample included 92 E2 users and 48 CEE users, with a mean age of 64.1 years and mean BMI of 29.1 kg m(-2) . Twenty-seven per cent of HT contained medroxyprogesterone acetate. Compared with E2 users, CEE users had greater thrombin generation peak values and endogenous thrombin potential, and lower total protein S (multivariate adjusted differences of 49.8 nm (95% CI, 21.0, 78.6), 175.0 nm × Min (95% CI, 54.4, 295.7) and -13.4% (95% CI, -19.8, -6.9), respectively). Factor VII and antithrombin levels were not different between E2 and CEE users. Results were similar in subgroups of users of unopposed HT, opposed HT, low-dose estrogen and standard dose estrogen. CONCLUSION The hemostatic profile of women using CEE is more prothrombotic than that of women using E2. These findings provide further evidence for a different thrombotic risk for oral CEE and oral E2.
Collapse
Affiliation(s)
- M Blondon
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Balakrishnan B, Indap MM, Singh SP, Krishna CM, Chiplunkar SV. Turbo methanol extract inhibits bone resorption through regulation of T cell function. Bone 2014; 58:114-25. [PMID: 24140785 DOI: 10.1016/j.bone.2013.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/10/2013] [Accepted: 10/11/2013] [Indexed: 11/24/2022]
Abstract
Marine organisms have bioactive potential which has tremendous pharmaceutical promise. Emerging evidence highlights the importance of the interplay between bone and the immune system of which T lymphocytes and their product act as key regulators of bone resorption. In the present investigation we have analyzed the anti-osteoporotic effect of turbo methanol extract (TME) in the reversal of bone resoprtion. Forty-two female Swiss albino mice were used and randomly assigned into sham-operated group (sham) and six ovariectomized (OVX) subgroups, i.e. OVX with vehicle (OVX) that received daily oral administration of water ad libitum; OVX with estradiol (2mg/kg/day); and OVX with different doses of TME i.e. TME 100mg/kg, TME 50mg/kg, TME 25mg/kg and TME 12.5mg/kg. Oral administration of TME or estradiol started on the second week after ovariectomy for a period of 4weeks. We observed that the administration of TME increased the trabeculation in tibia and reduced the atrophy in the uterus. TME significantly decreased the serum alkaline phosphatase (ALP) and acid phosphatase (ACP) activity in OVX mice. Micro CT analysis revealed that the TME administration preserved the bone volume, connectivity density, trabecular number, trabecular thickness and trabecular separation in OVX mice. Bone mineralization was measured in different groups of mice by Raman spectroscopy. Reversal of bone resorption was observed in TME treated group of mice. To further investigate the mechanism of action of TME, we analyzed the T lymphocyte proliferation and profiles of cytokine TNFα and sRANKL in TME treated ovariectomized mice. Decrease in the elevation of T cell subsets was observed after the supplementation with TME. The extract significantly lowered the T cell proliferation responses to mitogens, phorbol 12-myristate 13-acetate (PMA) and ionomycin (Io) and phytohemagglutinin (PHA). A marked reduction in TNFα and sRANKL secretion in serum and TNFα in cell free supernatants of activated T lymphocytes was observed upon TME administration. TME could significantly inhibit the in vitro osteoclastogenesis and the bone resorption observed using artificial calcium coated slides. Collectively, these results indicate that TME has the potential to inhibit bone resorption and may prove to be a potential candidate for the development of an anti-osteoporosis drug.
Collapse
Affiliation(s)
- Babita Balakrishnan
- Department of Zoology, The D. G. Ruparel College, Mahim, Mumbai 40016, India
| | | | | | | | | |
Collapse
|
28
|
O'Brien J, Jackson JW, Grodstein F, Blacker D, Weuve J. Postmenopausal hormone therapy is not associated with risk of all-cause dementia and Alzheimer's disease. Epidemiol Rev 2013; 36:83-103. [PMID: 24042430 DOI: 10.1093/epirev/mxt008] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The relationship of postmenopausal hormone therapy with all-cause dementia and Alzheimer's disease dementia has been controversial. Given continued interest in the role of hormone therapy in chronic disease prevention and the emergence of more prospective studies, we conducted a systematic review to identify all epidemiologic studies meeting prespecified criteria reporting on postmenopausal hormone therapy use and risk of Alzheimer's disease or dementia. A systematic search of Medline and Embase through December 31, 2012, returned 15 articles meeting our criteria. Our meta-analysis of any versus never use did not support the hypothesis that hormone therapy reduces risk of Alzheimer's disease (summary estimate = 0.88, 95% confidence interval: 0.66, 1.16). Exclusion of trial findings did not change this estimate. There were not enough all-cause dementia results for a separate meta-analysis, but when we combined all-cause dementia results (n = 3) with Alzheimer's disease results (n = 7), the summary estimate remained null (summary estimate = 0.94, 95% confidence interval: 0.71, 1.26). The limited explorations of timing of use-both duration and early initiation-did not yield consistent findings. Our findings support current recommendations that hormone therapy should not be used for dementia prevention. We discuss trends in hormone therapy research that could explain our novel findings and highlight areas where additional data are needed.
Collapse
Affiliation(s)
- Jacqueline O'Brien
- Abbreviations: CEE, conjugated equine estrogen; CEE+MPA, conjugated equine estrogen plus medroxyprogesterone acetate combined; CI, confidence interval; MPA, medroxyprogesterone acetate; RR, relative risk; WHI, Women's Health Initiative; WHIMS, Women's Health Initiative Memory Study
| | | | | | | | | |
Collapse
|
29
|
Shanmugan S, Epperson CN. Estrogen and the prefrontal cortex: towards a new understanding of estrogen's effects on executive functions in the menopause transition. Hum Brain Mapp 2012; 35:847-65. [PMID: 23238908 DOI: 10.1002/hbm.22218] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/25/2012] [Accepted: 10/03/2012] [Indexed: 01/03/2023] Open
Abstract
Midlife decline in cognition, specifically in areas of executive functioning, is a frequent concern for which menopausal women seek clinical intervention. The dependence of executive processes on prefrontal cortex function suggests estrogen effects on this brain region may be key in identifying the sources of this decline. Recent evidence from rodent, nonhuman primate, and human subject studies indicates the importance of considering interactions of estrogen with neurotransmitter systems, stress, genotype, and individual life events when determining the cognitive effects of menopause and estrogen therapy.
Collapse
Affiliation(s)
- Sheila Shanmugan
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Center for Women's Behavioral Wellness, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|
30
|
Abstract
Alzheimer's disease is one of the most devastating brain disorders of elderly humans. It is an undertreated and under-recognized disease that is becoming a major public health problem. The last decade has witnessed a steadily increasing effort directed at discovering the etiology of the disease and developing pharmacological treatment. Recent developments include improved clinical diagnostic guidelines and improved treatment of both cognitive disturbance and behavioral problems. Symptomatic treatment mainly focusing on cholinergic therapy has been clinically evaluated by randomized, double-blind, placebo-controlled, parallel-group studies measuring performance-based tests of cognitive function, activities of daily living, and behavior. Cholinesterase inhibitors, including donepezil, tacrine, rivastigmine, and galantamine are the recommended treatment of cognitive disturbance in patients with Alzheimer's disease. The role of estrogen replacement, anti-inflammatory agents, and antioxidants is controversial and needs further study. Antidepressants, antipsychotics, mood stabilizers, anxiolytics, and hypnotics are used for the treatment of behavioral disturbance. Future directions in the research and treatment of patients with Alzheimer's disease include: applying functional brain imaging techniques in early diagnosis and evaluation of treatment efficacy; development of new classes of medications working on different neurotransmitter systems (cholinergic, glutamatergic, etc), both for the treatment of the cognitive deficit and the treatment of the behavioral disturbances; and developing preventive methods (amyloid p-peptide immunizations and inhibitors of β-secretase and γ-secretase).
Collapse
Affiliation(s)
- A S Schachter
- Department of Psychiatry, Mount Sinai School of Medicine, Mount Sinai Hospital, Mount Sinai Medical Center; New York, NY, USA
| | | |
Collapse
|
31
|
Abstract
We now appreciate that estrogen is a pleiotropic gonadal steroid that exerts profound effects on the plasticity and cell survival of the adult brain. Over the past century, the life span of women has increased, but the age of the menopause remains constant. This means that women may now live over one third of their lives in a hypoestrogenic, postmenopausal state. The impact of prolonged hypoestrogenicity on the brain is now a critical health concern as we realize that these women may suffer an increased risk of cognitive dysfunction and neurodegeneration due to a variety of diseases. Accumulating evidence from both clinical and basic science studies indicates that estrogen exerts critical protective actions against neurodegenerative conditions such as Alzheimer's disease and stroke. Here, we review the discoveries that comprise our current understanding of estrogen action against neurodegeneration. These findings carry far-reaching possibilities for improving the quality of life in our aging population.
Collapse
Affiliation(s)
- Dena B Dubal
- Department of Physiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | |
Collapse
|
32
|
Abstract
BACKGROUND Evidence suggests a role for oestrogen in depression but the involvement of oestrogen receptor polymorphisms remains unknown. AIMS To determine the association between oestrogen receptor polymorphisms and late-life depression and the modifying effect of hormone treatment. METHOD Depression was assessed using the Mini-International Neuropsychiatric Interview, according to DSM-IV criteria and the Centre for Epidemiologic Studies - Depression Scale. The association between oestrogen receptor α and β (ER-α and ER-β) polymorphisms with severe depression was examined in 6017 community-dwelling elderly people using multivariate logistic regression. RESULTS In women, the ER-α rs2234693 and rs9340799 polymorphisms were significantly associated with the risk of late-life depression. The A allele of ER-β rs1256049 increased the risk of depression, but only for non-current users of hormone treatment. In men, only the ER-β rs4986938 polymorphism showed a weak association with depression risk. CONCLUSIONS Oestrogen receptor polymorphisms are associated with severe late-life depression risk in women only.
Collapse
Affiliation(s)
- Joanne Ryan
- Inserm U1061, Hôpital La Colombière, 39 Avenue Charles Flahault, BP 34493, 34093 Montpellier Cedex 5, France.
| | - Jacqueline Scali
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR
| | - Isabelle Carrière
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR
| | - Karine Peres
- Epidémiologie et Biostatistique
INSERM : U897Université Victor Segalen - Bordeaux IIInstitut de Santé Publique, d'Épidémiologie et de Développement (ISPED)146, rue Léo-Saignat 33076 Bordeaux, FR
| | - Olivier Rouaud
- Neuroépidémiologie
INSERM : U708Université Paris VI - Pierre et Marie Curie - GH Pitié-Salpetriere, Assistance publique - Hôpitaux de Paris (AP-HP)47, Boulevard de L'Hopital 75651 Paris Cedex 13, FR
| | - Pierre-Yves Scarabin
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations
INSERM : U1018Université Paris XI - Paris SudHôpital Paul BrousseAssistance publique - Hôpitaux de Paris (AP-HP)16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France, FR
| | - Karen A. Ritchie
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR,Epidemiology
Faculty of Medicine, St Mary's Hospital, Imperial College LondonSouth Kensington Campus, London SW7 2AZ, GB
| | - Marie-Laure Ancelin
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR
| |
Collapse
|
33
|
Scali J, Ryan J, Carrière I, Dartigues JF, Tavernier B, Ritchie K, Ancelin ML. A prospective study of hormone therapy and depression in community-dwelling elderly women: the Three City Study. J Clin Psychiatry 2010; 71:1673-9. [PMID: 20816026 PMCID: PMC3078521 DOI: 10.4088/jcp.09m05188blu] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 07/07/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The potential benefits of hormone therapy (HT) in treating depressed postmenopausal women are controversial, and data on depression (re)emergence in the context of HT discontinuation are lacking. OBJECTIVE To determine whether HT is associated with a modified risk of new-onset depressive symptoms in elderly women. METHOD Current depressive symptomatology was evaluated in 4,069 community-dwelling postmenopausal women aged 65 years and over who were randomly recruited from 3 French cities between 1999 and 2001. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression Scale at baseline and as part of the 2- and 4-year follow-up. RESULTS Over the follow-up period, multivariate logistic regression analyses adjusted for sociodemographic variables, measures of physical health, and cognitive impairment failed to find a significant association between HT at baseline and the incidence of depressive symptoms. However further analysis indicated an increased risk of incident depressive symptoms for women using transdermal estradiol treatment combined with synthetic progestin specifically (odds ratio [OR] = 1.59; 95% CI, 1.01-2.50; P = .046). In addition, while women taking HT continuously over the 4-year follow-up did not show an increased risk of depressive symptoms, women who stopped their treatment early after study inclusion, had a significantly higher risk (OR = 2.63; 95% CI, 1.52-4.55; P = .0005). CONCLUSIONS Hormone therapy was not associated with a protective effect against the emergence of depressive symptoms in elderly postmenopausal women. However, discontinuing treatment could increase the risk of depressive symptoms. Data on the appropriate management of depression in the context of HT discontinuation among postmenopausal women require further investigation.
Collapse
Affiliation(s)
- Jacqueline Scali
- Pathologies du système nerveux : recherche épidémiologique et clinique
INSERM : U888IFR76Université Montpellier IHôpital la colombiere 39, avenue charles flahault BP 34493 -pav 42 calixte cavalier 34093 MONTPELLIER CEDEX 5,FR
| | - Joanne Ryan
- Pathologies du système nerveux : recherche épidémiologique et clinique
INSERM : U888IFR76Université Montpellier IHôpital la colombiere 39, avenue charles flahault BP 34493 -pav 42 calixte cavalier 34093 MONTPELLIER CEDEX 5,FR
| | - Isabelle Carrière
- Pathologies du système nerveux : recherche épidémiologique et clinique
INSERM : U888IFR76Université Montpellier IHôpital la colombiere 39, avenue charles flahault BP 34493 -pav 42 calixte cavalier 34093 MONTPELLIER CEDEX 5,FR
| | - Jean-François Dartigues
- Centre épidémiologie et biostatistique
INSERM : U897Université Victor Segalen - Bordeaux IIFR
| | - Béatrice Tavernier
- Service de médecine interne gériatrie
CHU DijonCentre de Champmaillot Dijon,FR
| | - Karen Ritchie
- Pathologies du système nerveux : recherche épidémiologique et clinique
INSERM : U888IFR76Université Montpellier IHôpital la colombiere 39, avenue charles flahault BP 34493 -pav 42 calixte cavalier 34093 MONTPELLIER CEDEX 5,FR
| | - Marie-Laure Ancelin
- Pathologies du système nerveux : recherche épidémiologique et clinique
INSERM : U888IFR76Université Montpellier IHôpital la colombiere 39, avenue charles flahault BP 34493 -pav 42 calixte cavalier 34093 MONTPELLIER CEDEX 5,FR,* Correspondence should be adressed to: Marie-Laure Ancelin
| |
Collapse
|
34
|
Norman SA, Weber AL, Localio AR, Marchbanks PA, Ursin G, Strom BL, Weiss LK, Burkman RT, Bernstein L, Deapen DM, Folger SG, Simon MS, Nadel MR. Hormone therapy and fatal breast cancer. Pharmacoepidemiol Drug Saf 2010; 19:440-7. [PMID: 20336635 PMCID: PMC3098621 DOI: 10.1002/pds.1941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Among unanswered questions is whether menopausal use of estrogen therapy (ET) or estrogen-plus-progestin therapy (CHT) increases risk of developing fatal breast cancer i.e., developing and dying of breast cancer. Using a population-based case-control design, we estimated incidence rate ratios of fatal breast cancer in postmenopausal hormone therapy (HT) users compared to non-users by type, duration, and recency of HT use. METHODS HT use prior to breast cancer diagnosis in 278 women who died of breast cancer within 6 years of diagnosis (cases) was compared with use in 2224 controls never diagnosed with breast cancer using conditional logistic regression. Measures taken to address potential bias and confounding inherent in case-control studies included collecting and adjusting for detailed data on demographic and other factors potentially associated both with HT use and breast cancer. RESULTS Fifty-six per cent of cases and 68% of controls reported HT use. Among current 3+ year HT users, odds ratios and 95% confidence intervals for death were 0.83 (0.50, 1.38) and 0.69 (0.44, 1.09), respectively, for exclusive use of CHT or of ET, and were 0.94 (0.59, 1.48) and 0.70 (0.45, 1.07) for any use of CHT or of ET regardless of other hormone use. CONCLUSION Point estimates suggest no increased risk of fatal breast cancer with HT use, although 50% increases in risk in longer-term current CHT users cannot be ruled out.
Collapse
Affiliation(s)
- Sandra A Norman
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
A plethora of in vitro and in vivo studies have supported the neuroprotective role of estrogens and their impact on the neurotransmitter systems implicated in cognition. Recent hormonal replacement therapy (HRT) trials in non-demented postmenopausal women suggest a temporary positive effect (notably on verbal memory), and four meta-analyses converge to suggest a possible protective effect in relation to Alzheimer's disease (reducing risk by 29 to 44%). However, data from the only large randomized controlled trial published to date, the Women's Health Initiative Memory Study, did not confirm these observations and have even suggested an increase in dementia risk for women using HRT compared to controls. Apart from methodological differences, one key shortcoming of this trial has probably been the focus on late-onset (postmenopausal) hormonal changes, i.e. at a time when the neurodegenerative process has already begun and without taking into account individual lifetime exposure to hormone variability. Multifactorial models based on an exhaustive view of all hormonal events throughout the reproductive life (rather than on a specific exposure to a given steroid) together with other risk factors (notably genetic risk factors related to estrogen receptor polymorphisms) should be explored to clarify the role of hormonal risk factors, or protective factors for cognitive dysfunction and dementia.
Collapse
|
36
|
Tivis LJ, Ceballos NA, Chastain G, Tivis RD. Alcohol and estrogen replacement therapy in postmenopausal women. Direct and mediated effects on cognitive component processes. Neuropsychobiology 2008; 58:104-10. [PMID: 18843196 PMCID: PMC2723943 DOI: 10.1159/000162357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 08/03/2008] [Indexed: 02/04/2023]
Abstract
The literature remains contentious regarding the separate and combined effects of moderate drinking and estrogen replacement therapy (ERT) on cognition. In the current study, the authors sought to disentangle the predictive utility of alcohol use, ERT and their interaction on the episodic and semantic memory stores of postmenopausal women. It was predicted that relationships between moderate drinking, ERT and cognition would be attenuated by demographic and health-related factors. Postmenopausal women (n = 298) completed a battery of cognitive tests designed to assess speed and accuracy of episodic and knowledge-based cognitive processing. Potentially confounding variables were categorized and tested as mediators in hierarchical regression analyses. Moderate drinking was a weak predictor of episodic availability prior to removal of potential mediators. ERT use was a significant predictor of episodic and knowledge-based availability; no mediators were identified. Alcohol moderated ERT, as a combined alcohol/ERT variable was shown to be related to cognition. Neither moderate drinking nor ERT use was associated with cognitive speed. These findings suggest that positive relationships between alcohol and cognition are likely mediated by other variables, and should not be regarded as a benefit of drinking. Further, results support ERT as a predictor of knowledge-based and episodic availability, independent of mood stabilization or socioeconomic influences. Finally, alcohol and ERT appear to interact to impact both episodic and knowledge-based performance.
Collapse
|
37
|
Campagnoli C, Clavel-Chapelon F, Kaaks R, Peris C, Berrino F. Progestins and progesterone in hormone replacement therapy and the risk of breast cancer. J Steroid Biochem Mol Biol 2005; 96:95-108. [PMID: 15908197 PMCID: PMC1974841 DOI: 10.1016/j.jsbmb.2005.02.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 02/04/2005] [Indexed: 01/29/2023]
Abstract
Controlled studies and most observational studies published over the last 5 years suggest that the addition of synthetic progestins to estrogen in hormone replacement therapy (HRT), particularly in continuous-combined regimen, increases the breast cancer (BC) risk compared to estrogen alone. By contrast, a recent study suggests that the addition of natural progesterone in cyclic regimens does not affect BC risk. This finding is consistent with in vivo data suggesting that progesterone does not have a detrimental effect on breast tissue. The increased BC risk found with the addition of synthetic progestins to estrogen could be due to the regimen and/or the kind of progestin used. Continuous-combined regimen inhibits the sloughing of mammary epithelium that occurs after progesterone withdrawal in a cyclic regimen. More importantly, the progestins used (medroxyprogesterone acetate and 19-Nortestosterone-derivatives) are endowed with some non-progesterone-like effects, which can potentiate the proliferative action of estrogens. Particularly relevant seem to be the metabolic and hepatocellular effects (decreased insulin sensitivity, increased levels and activity of insulin-like growth factor-I, and decreased levels of SHBG), which contrast the opposite effects induced by oral estrogen.
Collapse
Affiliation(s)
- Carlo Campagnoli
- Unit of Endocrinological Gynecology, Sant'Anna Gynecological Hospital, Corso Spezia 60, 10126 Torino, Italy.
| | | | | | | | | |
Collapse
|
38
|
Nussmeier NA, Mora-Mangano C, Fontes M, Schwann NM, Mangano DT. Hormone replacement therapy is safe in women undergoing coronary artery bypass grafting. Tex Heart Inst J 2005; 32:507-14. [PMID: 16429894 PMCID: PMC1351821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In postmenopausal women, hormone replacement therapy (HRT) does not substantially reduce the incidence of cardiovascular disease and may produce a short-term increase in risk. Therefore, we investigated whether HRT increased risk in patients with severe coronary artery disease necessitating surgery We prospectively studied 4,782 patients undergoing coronary artery bypass grafting at 70 centers in 17 countries from November 1996 through June 2000. Patients were selected using a systematic sampling technique. Mortality, major morbidity, and transfusion requirements were compared among 3 groups: men (n=3,840), women receiving HRT (n= 144), and women not receiving HRT (n=798). Women actively receiving HRT, compared with women not receiving HRT or with men, were at no greater risk of developing the following fatal or non-fatal complications: death (2.8% vs 4.4% vs 2.8%, respectively; P=0.05), myocardial infarction (6.3% vs 7.0% vs 7.7%; P=0.67), central nervous system complication (2.1% vs 2.8% vs 2.9%; P=0.85), or renal dysfunction (0.7% vs 5.3% vs 4.8%; P=0.06). Incidence of postoperative congestive heart failure was significantly lower in men (7.7%) than in women receiving HRT (12.5%; P=0.04) and in women without HRT (12.8%; P <0.0001). Fewer men (61%) needed red blood cell transfusion than did women receiving HRT (79%) and women without HRT (88%) (P <0.0001 compared with both other groups). However, the need for fresh frozen plasma transfusions was significantly less in women receiving HRT (16%) than in women not receiving HRT (25%; P=0.01). We conclude that HRT administration before coronary artery bypass grafting does not increase women's risk of any adverse outcome.
Collapse
Affiliation(s)
- Nancy A Nussmeier
- Ischemia Research and Education Foundation, 1111 Bayhill Drive, Suite 480, San Bruno, CA 94066, USA.
| | | | | | | | | |
Collapse
|
39
|
Berkowitz GS, Wolff MS, Lapinski RH, Todd AC. Prospective study of blood and tibia lead in women undergoing surgical menopause. Environ Health Perspect 2004; 112:1673-8. [PMID: 15579412 PMCID: PMC1253658 DOI: 10.1289/ehp.7005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Despite the dramatic decline in environmental lead exposure in the United States during the past couple of decades, concern has been expressed regarding mobilization during menopause of existing lead stored in bone. To investigate whether bone lead concentrations decrease and blood lead levels increase, we conducted a prospective study of 91 women who were scheduled to undergo a bilateral oophorectomy for a benign condition at Mount Sinai Hospital in New York City during October 1994 through April 1999. We excluded women who were younger than 30 years of age or who were postmenopausal at the time of the surgery. We observed a small but significant increase in median blood lead levels between the baseline visit and the 6-month visit (0.4 microg/dL, p<0.0001), particularly for women who were not on estrogen replacement therapy (0.7 microg/dL, p=0.008). No significant change was observed in blood lead values between 6 and 18 months postsurgery, nor was there evidence of significant changes in tibia lead concentrations during the follow-up period. These findings do not point to substantial mobilization of lead from cortical bone during menopause.
Collapse
Affiliation(s)
- Gertrud S Berkowitz
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA.
| | | | | | | |
Collapse
|
40
|
Dubal DB, Wise PM. Estrogen and neuroprotection: from clinical observations to molecular mechanisms. Dialogues Clin Neurosci 2002; 4:149-61. [PMID: 22034440 PMCID: PMC3181675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
We now appreciate that estrogen is a pleiotropic gonadal steroid that exerts profound effects on the plasticity and cell survival of the adult brain. Over the past century, the life span of women has increased, but the age of the menopause remains constant. This means that women may now live over one third of their lives in a hypoestrogenic, postmenopausal state. The impact of prolonged hypoestrogenicity on the brain is now a critical health concern as we realize that these women may suffer an increased risk of cognitive dysfunction and neurodegeneration due to a variety of diseases. Accumulating evidence from both clinical and basic science studies indicates that estrogen exerts critical protective actions against neurodegenerative conditions such as Alzheimer's disease and stroke. Here, we review the discoveries that comprise our current understanding of estrogen action against neurodegeneration. These findings carry far-reaching possibilities for improving the quality of life in our aging population.
Collapse
Affiliation(s)
- Dena B Dubal
- Department of Physiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | |
Collapse
|
41
|
Abstract
BACKGROUND Evidence regarding the effect of postmenopausal estrogen therapy on mood is limited. METHODS To determine whether postmenopausal estrogen therapy is associated with fewer depressive symptoms in elderly women, we conducted a cross-sectional study of 6, 602 white women ages 71 years or older who were recruited from population-based listings in Baltimore, Md; Minneapolis, Minn; Portland, Ore; and the Monongahela Valley, Pa. Use of estrogen and progestin was determined by interview. Participants completed the Geriatric Depression Scale short form (GDS) and were considered depressed if they reported 6 or more of 15 possible symptoms of depression. RESULTS A total of 6.3% (72/1,150) of current estrogen users, 7.2% (142/1,964) of past estrogen users, and 9.0% (313/3,488) of never users reported 6 or more symptoms of depression (P =.004). Current estrogen users had a decreased risk of reporting 6 or more depressive symptoms, compared with not current (past or never) users of estrogen (odds ratio [OR], 0.7; 95% CI, 0.5 to 0.9; P =.01], adjusted for living alone, bilateral oophorectomy, current smoking, physical activity, social network, self-perceived health, cognitive function, functional status, and antidepressant use. However, excluding women who use estrogen or progestin alone, we were unable to find an association between current use of combined estrogen plus progestin therapy and depressive symptoms (adjusted OR, 0.8; 95% CI, 0.5 to 1.4; P =.5). CONCLUSIONS This cross-sectional study found that current use of unopposed estrogen was associated with a decreased risk of depressive symptoms in older women. Additional studies are needed to understand the effect of combined estrogen and progestin therapy on the prevalence of depressive symptoms in older women.
Collapse
Affiliation(s)
- M A Whooley
- Section of General Internal Medicine, San Francisco Department of Veterans Affairs Medical Center, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
| | | | | |
Collapse
|
42
|
Johnson RR, Sweeney ME. Debate: The potential role of estrogen in the prevention of heart disease in women after menopause. Curr Control Trials Cardiovasc Med 2000; 1:139-142. [PMID: 11714428 PMCID: PMC59620 DOI: 10.1186/cvm-1-3-139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2000] [Accepted: 11/06/2000] [Indexed: 11/10/2022]
Abstract
Large numbers of observational studies have described a decrease in the incidence of cardiovascular disease in women taking hormone replacement therapy (HRT). The potential mechanisms for this effect are numerous, including direct effects on lipid levels and lipid metabolism, cardiovascular dynamics, and endothelial reactivity. The beneficial effects of HRT are probably affected by various factors, including the age of onset of therapy, the presence of coronary artery disease, the type of estrogen and whether it is used in combination with progesterone, concurrent modification of other cardiac risk factors, and duration of therapy. Until further prospective clinical trials are done, HRT should be considered in those women for whom the potential benefits exceed the potential risks, on the basis of an individualized patient evaluation.
Collapse
|
43
|
Higgin JR. Estrogen replacement therapy. Can Fam Physician 1989; 35:1375-1377. [PMID: 21248975 PMCID: PMC2280414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The present status of estrogen replacement therapy suggests that its benefits far outweigh the risks; it is hoped that the incapacity related to fractures, coronary artery disease, and urinary incontinence may be reduced or prevented. Estrogen replacement therapy should provide for a healthier elderly population, increase the number who can remain in their homes, and therefore reduce the number that require institutionalization.
Collapse
|
44
|
Roberts JG, Webber CE, Woolever CA. Estrogen replacement therapy for postmenopausal osteoporosis. Can Fam Physician 1986; 32:883-891. [PMID: 21267140 PMCID: PMC2327642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In postmenopausal women, inevitable longitudinal loss of bone mass is increased in association with reduced levels of endogenous estrogen. A review of the health-care literature on therapy for postmenopausal osteoporosis provides strong evidence for prevention and treatment with estrogen/progestogen replacement therapy. This therapy was not associated with endometrial carcinoma.
Collapse
|