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Jackson SS, Graubard BI, Gabbi C, Koshiol J. Association with menopausal hormone therapy and asymptomatic gallstones in US women in the third National Health and Nutrition Examination Study. Sci Rep 2024; 14:191. [PMID: 38168135 PMCID: PMC10761940 DOI: 10.1038/s41598-023-50509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
15% of US adults have gallstones, most of which are clinically "silent". Several studies show that menopausal hormone therapy (MHT) increases symptomatic gallstones and cholecystectomy risk. MHT use may be contraindicated in women with gallstones and population studies may be biased by "confounding by contraindication" while the true association between MHT and gallstones remains underestimated. We sought to examine whether MHT use was associated with asymptomatic gallstones using instrumental variable (IV) analysis to account for confounding by contraindication. We used 2018 postmenopausal women from the Third National Health and Nutrition Examination Survey to estimate associations of MHT use with asymptomatic gallstones. A traditional logistic regression analysis was compared to instrumental variable (IV) analysis to account for confounding by contraindication. 12% of women with asymptomatic gallstones and 25% of women without gallstones were current MHT users (P < 0.001). The traditional analysis suggested a decreased odds of asymptomatic gallstones in current versus never users (OR 0.58, 95% CI 0.37, 0.89), but increased odds (OR 1.51, 95% CI 0.44, 5.16) in the IV analysis. The traditional analysis consistently underestimated the odds of asymptomatic gallstones with MHT use compared to the IV analysis. Accounting for confounding by contraindication, we found a suggestive, though imprecise, positive association between MHT use and asymptomatic gallstones among postmenopausal women. Failure to consider contraindication can produce incorrect results.
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Affiliation(s)
- Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20879, USA.
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20879, USA
| | - Chiara Gabbi
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Jill Koshiol
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20879, USA
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Wong KC, Lee KS, Luk HK, Wan HY, Ho CK, Zhang Y, Wong MS. Er-xian Decoction exerts estrogen-like osteoprotective effects in vivo and in vitro. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2014; 42:409-26. [PMID: 24707871 DOI: 10.1142/s0192415x1450027x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Er-xian Decoction (EXD), containing Herba epimedii Maxim (HEP) and Curculigo orchioides Gaertn (XM) as principal drugs, is a traditional Chinese medicine (TCM) formula prescribed for the treatment of postmenopausal osteoporosis. In the present study, the in vivo anti-osteoporosis effects of EXD, HEP and XM on four-month-old ovariectomized (OVX) Sprague-Dawley rats were investigated. Micro-computed tomography analysis showed that EXD could significantly improve the micro-architectural parameters (BMD, BV/TV, Tb.N, Tb.Th, and Tb.Sp) of trabecular bone in the distal femur and proximal tibia in OVX rats (p < 0.05). The biomechanical parameters of the distal femur in rats treated with EXD were also improved significantly (p < 0.05 vs. OVX group). The in vivo efficacy of EXD was found to be superior to HEP or XM alone in improving the bone properties of OVX rats. Treatment of rat osteoblastic-like UMR-106 cells with EXD, HEP, and XM significantly promoted the cell proliferation rate (p < 0.05) with the most promising effects observed in cells treated with EXD (p < 0.001). The proliferative effect in UMR-106 cells induced by EXD, HEP, and XM were abolished in the presence of the estrogen antagonist, ICI182780, suggesting that their effects were mediated by estrogen receptor (ER). Additionally, EXD could activate ER-α and ER-β mediated estrogen-response element (ERE)-dependent luciferase activity as well as phosphorylate ER-α at serine 118 in UMR-106 cells. Taken together, EXD offered better osteoprotective effects than its single principal herb, and the beneficial effects of EXD in preventing bone deteriorations are, at least partially, through the ER signaling pathway.
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Affiliation(s)
- Ka-Chun Wong
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, P. R. China
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Aljarrah A, Miller WR. Trends in the distribution of breast cancer over time in the southeast of Scotland and review of the literature. Ecancermedicalscience 2014; 8:427. [PMID: 24834122 PMCID: PMC4019459 DOI: 10.3332/ecancer.2014.427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Breast cancer is the most common form of malignancy in Scottish women, and its incidence appears to be increasing with time. It is therefore important to identify factors associated with risk and outcome. Whilst breast cancer occurs equally in the right and left breasts, tumours most commonly affect the upper outer quadrant (UOQ) of the breast. However, there is only limited information as to whether the incidence has changed over time. MATERIALS AND PATIENTS We investigated two cohorts of women diagnosed with breast cancer in the south-east of Scotland between either 1957-1959 or 1997-1999 (i.e., 40 years apart). The earlier cohorts represent 1158 of 1207 women referred to radiation oncologists in the region and the latter group comprised 1477 of about 1600 women referred to the Edinburgh Breast Unit. RESULTS Whilst the mean age, menopausal status, and laterality of the patients were similar in both groups, the tumour size and tumour location within the breast were significantly different in the two groups. Thus, there was significant reduction in T stage with year of diagnosis (p < 0.0001), the incidence of T1, T2, and T3/4 being 15.6%, 51.9%, and 25.6% in the earlier cohort compared with 49.3%, 36.8%, and 13.7% in the later cohort. The overall distribution within the breast was significantly different by chi-squared analysis ( p < 0.0001). In terms of individual quadrants 469 of 1158 (40.5%) tumours were located in the UOQ, whereas in the more recent cohort it was 788 of 1477 (53.4%), this increase in proportion being statistically significant ( p < 0.0001). Occurrence in the lower outer quadrant also significantly increased (p < 0.028) but was significantly reduced in the upper inner quadrant and centrally (both p < 0.0001). CONCLUSION Analysing data on location for each T stage separately showed that the increased incidence in the UOQ with time was apparent for each subgroup. The increased incidence in UOQ tumours over time is therefore not a simple reflection of decreased size between the two time groups. The underlying reason(s) for this change in distribution with time requires further study.
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Affiliation(s)
- A Aljarrah
- Breast Unit, Department of Surgery, Sultan Qaboos University Hospital, Al khoud, PO Box 912 PC 111, Muscat, Oman ; Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
| | - W R Miller
- Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
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Taylor AW, MacLennan AH, Avery JC. Postmenopausal hormone therapy: who now takes it and do they differ from non-users? Aust N Z J Obstet Gynaecol 2006; 46:128-35. [PMID: 16638035 DOI: 10.1111/j.1479-828x.2006.00542.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Considerable changes in hormone therapy use have taken place in the last few years. AIMS To determine current usage of postmenopausal hormone therapy and assess the trend and rate of change in hormone therapy usage over the last 13 years. Additionally, to assess differences between current users and non-users for health-related and risk factor variables. METHODS Questions regarding hormone therapy use have been included in an annual face to face population health survey of South Australians eight times since 1991. In 2004, additional questions on health status and quality of life were included. RESULTS In 2004, current use of hormone therapy was 15.4, 19.8 and 31.2% in all women over 40, 50 and 50-59 years, respectively. Ever use of hormone therapy among all women over 50 years was 46.5% with a mean duration of use of 7.46 years. Hormone therapy users did not differ from non-users in chronic disease indicators, body mass index, complementary medicine or therapist use, other health service use, socioeconomic status or quality of life. Increased hormone therapy use was associated with higher income, better educated, employed and married women in their sixth decade. Current use has varied over the years, with an increase to 2000, but a drop in 2003 and 2004. CONCLUSION Apart from menopausal symptoms, there is no evidence to support differences between users and non-users in terms of quality of life or health characteristics, requiring more appropriate selection of women for hormone therapy.
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Affiliation(s)
- Anne W Taylor
- Population Research and Outcome Studies, South Australian Department of Health, Adelaide, South Australia.
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Abstract
CONTEXT Research has suggested that use of combined estrogen and progestin hormone replacement therapy (CHRT) increases breast cancer risk and that CHRT use is more strongly associated with the risk of invasive lobular breast carcinoma than that of invasive ductal carcinoma. Lobular carcinoma is less common than ductal carcinoma but can be more difficult to diagnose because of its subtle elusive infiltrative pattern. OBJECTIVE To evaluate trends in invasive lobular and ductal carcinoma incidence rates from 1987 through 1999, during which time use of CHRT increased in the United States. DESIGN Descriptive epidemiologic study. SETTING Nine cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute and that cover Atlanta, Ga; Detroit, Mich; San Francisco-Oakland, Calif; Seattle, Wash; and Connecticut, Hawaii, Iowa, New Mexico, and Utah. POPULATION Women 30 years of age and older residing in the areas covered by the 9 SEER registries. MAIN OUTCOME MEASURES Proportional changes in incidence rates of invasive lobular and ductal carcinoma among women with no prior history of breast cancer. RESULTS A total of 190 458 women were included in this analysis who were identified through the registries as having invasive breast cancer; 7682 of the 198 140 potentially eligible women (ie, those identified as not having in situ breast cancer) were excluded from this analysis because stage of cancer was unknown. Invasive breast cancer incidence rates adjusted for age and for SEER historic stage increased 1.04-fold (95% confidence interval [CI], 1.004-1.07) from 1987-1999 (206.7/100 000 to 214.1/100 000, age-adjusted). However, incidence rates of tumors classified as lobular increased 1.52-fold (95% CI, 1.42-1.63), and those classified as mixed ductal-lobular increased 1.96-fold (95% CI, 1.80-2.14); rates of these types combined increased 1.65-fold (95% CI, 1.55-1.78) (19.8/100 000 to 33.4/100 000, age-adjusted). In contrast, ductal carcinoma rates remained largely constant (153.8/100 000 to 155.3/100 000, age-adjusted; proportional change, 1.03 [95% CI, 0.99-1.06]). The proportion of breast cancers with a lobular component increased from 9.5% in 1987 to 15.6% in 1999. CONCLUSIONS Ductal carcinoma incidence rates remained essentially constant from 1987-1999 while lobular carcinoma rates increased steadily. This increase presents a clinical challenge given that lobular carcinoma is more difficult to detect than ductal carcinoma by both physical examination and mammography.
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Affiliation(s)
- Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, MP 381, PO Box 19024, Seattle, Wash 98109-1024, USA.
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Cummings JA, Brizendine L. Comparison of physical and emotional side effects of progesterone or medroxyprogesterone in early postmenopausal women. Menopause 2002; 9:253-63. [PMID: 12082361 DOI: 10.1097/00042192-200207000-00006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the mood and somatic effects during the initial 2 months of medroxyprogesterone acetate (MPA) or progesterone combined with conjugated equine estrogen (CEE) in early postmenopausal women. DESIGN Twenty-three nondepressed, early postmenopausal women (average age, 52.5 years) completed a 91-day, single-blind pilot study with the following sequence of treatments: 1 week of no substance; 2 weeks of placebo; 2 weeks of progestogen only; 1 week of placebo; and 2 months of "standard hormone replacement therapy cycles," which consisted of (in order) 2 weeks of 0.625 mg CEE, 2 weeks of CEE plus progestogen, 2 weeks of CEE, and 2 weeks of CEE plus progestogen. Ten women who completed the study received MPA (5 mg/day) as their progestogen, and 13 who completed the study received micronized, oil-suspended progesterone (200 mg/day) as their progestogen. All participants made daily assessments of mood using the Profile of Mood States and daily recordings of somatic symptoms. All subjects had plasma follicle-stimulating hormone of greater than 35 IU/L and had not had spontaneous vaginal bleeding for more than 1 year. RESULTS None of the hormone treatments had a detectable effect on mood. MPA users reported more vaginal bleeding and breast tenderness than progesterone users. CONCLUSIONS In contrast with the widely held belief among psychiatrists that progesterone depresses mood, neither of the progestogens we used in normal, nondepressed and nonanxious women showed this effect. Absence of an effect on mood was also found when the results of the two progestogens were combined. The lesser side effects of the micronized progesterone-containing regimen suggest that some women may prefer it to an MPA-containing regimen.
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Affiliation(s)
- Jennifer A Cummings
- School of Medicine, University of California, San Francisco, California 94143, USA
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Maki PM, Resnick SM. Effects of estrogen on patterns of brain activity at rest and during cognitive activity: a review of neuroimaging studies. Neuroimage 2001; 14:789-801. [PMID: 11554798 DOI: 10.1006/nimg.2001.0887] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Animal and human studies provide evidence of systematic effects of estrogen on cerebral activity and cognitive function. In this article, we review studies of the activational effects of estrogen on cerebral activity during rest and during the performance of cognitive tasks in pre- and postmenopausal women. The goal is twofold--to better understand evidence suggesting that estrogen influences brain functioning and argue for the importance of considering hormone effects when designing neuroimaging studies. Hormone-related increases in blood flow during the resting state have been documented in healthy elderly women, elderly women with cerebrovascular disease, and middle-aged postmenopausal women with early menopause. There is no reliable influence of estrogen on blood flow during the resting state in women with Alzheimer's disease. Hormone therapy has been associated with changes in brain activation patterns in middle-aged and elderly postmenopausal women during performance of verbal and figural memory tasks, providing critical biological support for the view that estrogen might protect against age-associated changes in cognition and lower the risk of Alzheimer's disease. There is a paucity of studies examining changes in brain activation patterns across the menstrual cycle and a need for randomized studies of hormone therapy in postmenopausal women to confirm findings from observational studies. General procedural guidelines for controlling and investigating hormone effects in neuroimaging studies are discussed.
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Affiliation(s)
- P M Maki
- Gerontology Research Center, National Institute on Aging, 5600 Nathan Shock Drive, Baltimore, Maryland 21231, USA
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Obermeyer CM, Sahel A, Hajji N, Schulein M. Physicians' perceptions of menopause and prescribing practices in Morocco. Int J Gynaecol Obstet 2001; 73:47-55. [PMID: 11336721 DOI: 10.1016/s0020-7292(00)00317-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the prescribing practices of Moroccan physicians around menopause. METHODS A survey was carried out on a representative sample of physicians in the capital city Rabat. The sample included general practitioners, gynecologists, cardiologists and rheumatologists, practicing in both public and private facilities. The instrument consisted of close- and open-ended questions about the socio-demographic characteristics of physicians, their patient population, their prescribing practices, and their perceptions of menopause and the different medical approaches to managing the symptoms and risks associated with it. RESULTS Most of the physicians interviewed are positively inclined towards the notion of prevention and in favor of hormonal treatment, and approximately half report that they have prescribed hormone therapy. Gynecologists and male physicians prescribe hormones more frequently, as well as physicians who are at private facilities. These findings are discussed in relation to the physicians' perceptions of the menopause transition. CONCLUSION There are considerable variations in prescribing practices and perceptions of menopause among Moroccan physicians.
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Affiliation(s)
- C M Obermeyer
- Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA
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Li CI, Anderson BO, Porter P, Holt SK, Daling JR, Moe RE. Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer 2000. [DOI: 10.1002/1097-0142(20000601)88:11<2561::aid-cncr19>3.0.co;2-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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MacLennan AH, Wilson DH, Taylor AW. Hormone replacement therapy: prevalence, compliance and the 'healthy women' notion. Climacteric 1998; 1:42-9. [PMID: 11907925 DOI: 10.3109/13697139809080680] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The objective of this study was to assess the current trends of hormone replacement therapy (HRT) use, including rates of use, length of use, continuation rates and characteristics of users and non-users and to examine the hypothesis that 'healthy women' are more likely to be users of HRT. METHODS Analysis was carried out of three representative South Australian population studies in 1991, 1993 and 1995 comprising 3019, 3004 and 3016 personal interviews, respectively. RESULTS Current use (and ever-use) of HRT in all women aged 50 years and over rose from 13.2% (26.7%) in 1991, to 21.2% (31.9%) in 1993 and 26.0% (40.5%) in 1995. Highest use is now in the 55-59-year age group where, in 1995, current use was 50.9% and ever use was 69.0%. Median compliance rates with HRT rose from 24 months in 1991 to 60 months in 1995 for current users aged 50 years of age or above. The pattern of increasing use of HRT is not consistent across age groups. Analyses of the 1995 data show that, in contrast with increasing rates of current use in women over 55 years, there was no overall change in rates for women below this age. There were no statistically significant differences in health indicators, e.g. blood pressure, smoking, cholesterol levels or body mass index between users and non-users of HRT. However, users reported significantly higher rates of previous osteoporosis and hysterectomy. CONCLUSIONS Prevalence rates of HRT use are increasing together with compliance rates and this may reflect increased confidence with HRT therapy. Users of HRT have an increased rate of mammography compared to non-users and this may contribute to earlier detection and, therefore, increased estimates of breast cancer in HRT users. There was no support from the 1995 data for a 'healthy women' hypothesis among HRT users.
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Affiliation(s)
- A H MacLennan
- Department of Obstetrics and Gynaecology, University of Adelaide, South Australia
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Affiliation(s)
- S H Swan
- Reproductive Epidemiology Section, California Department of Health Sciences, Berkeley 94704-1011, USA
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