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Dave A, Patel DJ, Shrivastava D, Chaudhari K, Manchanda R. Considerations in Premature Menopause: A Review. Cureus 2024; 16:e69744. [PMID: 39429402 PMCID: PMC11490301 DOI: 10.7759/cureus.69744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 09/19/2024] [Indexed: 10/22/2024] Open
Abstract
Premature menopause impacts 1% of women under the age of 40. The women are at risk of premature death, ischemic disease of the heart, neurological conditions, mood disturbances, psychosexual problems, osteoporosis, and subfertility. There is an imperative for less complicated protocols and enhanced approaches for oocyte donation to get pregnant and achieve motherhood in at-risk women. A review of the pertinent literature on premature ovarian insufficiency and selected references was done. A comprehensive review was undertaken by searching the databases PubMed, Scopus, EMBASE, Web of Science, and Science Direct. Pregnancy in women with premature menopause was formerly uncommon, but because of recent advances in oocyte donation, women with premature menopause can now aspire to have a child. Hormone replacement treatment is useful in treating the negative effects of premature ovarian insufficiency. Women who experience early menopause are at risk for early mortality, ischemic heart disease, neurological conditions, mood problems, psychosexual disorder, osteoporosis, and subfertility. Public awareness and education are critical tools for saving women at peril.
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Affiliation(s)
- Apoorva Dave
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dharmesh J Patel
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepti Shrivastava
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul Manchanda
- Department of Obstetrics and Gynecology, Holy Family Hospital, New Delhi, IND
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Massawe ER, Rahib JS. Prevalence of Age-Related Sensorineural Hearing Loss and Related Factors in Elderly Patients Attending Tertiary Hospital in Tanzania. Indian J Otolaryngol Head Neck Surg 2024; 76:788-793. [PMID: 38440513 PMCID: PMC10908963 DOI: 10.1007/s12070-023-04281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/09/2023] [Indexed: 03/06/2024] Open
Abstract
PURPOSE Age-related sensorineural hearing loss (SNHL), is a progressive, usually bilateral hearing loss that occurs in elderly. It is correctable using rehabilitative hearing devices, which can vastly improve the older person's quality of life. This study aimed to find out the prevalence and related factors of age-related sensorineural hearing loss among elderly patients in Tanzania. METHODS A total of 380 elderly patients who received Otorhinolaryngology (ORL) services at Muhimbili tertiary hospital were enrolled. Participants were screened for hearing loss and interviewed by the structured questionnaire followed by otoscopic examination and Pure tone Audiometry (PTA). RESULTS This study included 182(47.9%) males, and 198 (52.1%) females. The prevalence of SNHL was 27.6%, males were mostly affected 57(31.3%) p = 0.574. Bilateral SNHL was found 90 (85.7%) p = 0.026, and the severity of age-related SNHL was found to increase as age increases. CONCLUSION Sensorineural hearing loss among the elderly was prevalent, mostly bilateral, and the severity increases with age. Confounding factors such as hypertension, diabetes mellitus (DM), cigarette smoking, and ototoxic medication may have contributed. Elderly should be screened for hearing loss especially on the individuals with other co-morbidities for early diagnosis and management in order to improve the quality of life of the elderly.
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Affiliation(s)
- Enica Richard Massawe
- College of Medicine, School of Clinical Medicine, Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, P.o.Box 65001, Dar-es- salaam, Tanzania
| | - Jaria Suleiman Rahib
- Department of Otorhinolaryngology, Emilio Mzena Memorial Hospital, Dar-es-salaam, Tanzania
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3
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Chen W, Chen M, Tang H, Wei W, Shao P, Dou S, Wu J, Lu B, Shi R, Chen J. Advances in diagnosis and treatment of perimenopausal syndrome. Open Life Sci 2023; 18:20220754. [PMID: 38152579 PMCID: PMC10751995 DOI: 10.1515/biol-2022-0754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 12/29/2023] Open
Abstract
With the development and progress of society, people's average life expectancy has increased, and relevant literature reports that the number of postmenopausal women in China continues to increase. With lifespans extended, the transition period and post-menopause period have become the longest essential period in every woman's life. The life quality of women troubled by perimenopausal syndrome has been significantly reduced, which also places a burden on families and society. It is well known that hormone replacement therapy plays a vital role in improving women's menopause-related symptoms and is the most effective medical measure. With research ongoing into the treatment of menopausal symptoms in different patients, dose size, treatment duration, and medication regimens for hormones are still hot topics of discussion. This article reviews the definition, clinical diagnosis, staging, clinical manifestations, and treatment of menopause and explores the current diagnosis and treatment scenarios of perimenopausal syndrome.
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Affiliation(s)
- Wanying Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Mengjuan Chen
- Zhoukou Maternal and Child Health Hospital, Zhoukou, Henan, 466000, PR China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Weiwei Wei
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Panqiu Shao
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Shulan Dou
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Jia Wu
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Bingying Lu
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Ruxia Shi
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213003, PR China
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Martins R, de Sousa B, Rodrigues V. The geography of the age at menopause in central Portugal since the early twentieth century. Sci Rep 2022; 12:22020. [PMID: 36539449 PMCID: PMC9768149 DOI: 10.1038/s41598-022-25475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
This work aims at studying the spatio-temporal evolution of the age at menopause in central Portugal since the early twentieth century. We analyzed [Formula: see text] women that had already reached the menopause within a free breast cancer screening program between 1990 and 2018 and born in the period 1910-1960. One of the concerns was about early or late menopause thus we considered percentile regression to build the respective percentile curves inside the package GAMLSS in R. In order to capture the correlation at the regional level, a spatial random-effect was considered. The obtained clustered spatial effects were analyzed to assess geographical differences among the percentiles of the age at menopause by year of birth. An increasing trend in the median age at menopause and regional differences for all the considered percentiles were found. From 47.1 years in 1910 to 49.59 years in 1960 (about 2.49 years in 5 decades). Early and premature menopause (below percentile 5%) occur in the interior north (north-eastern). Late menopause (above percentile 95%) occur predominantly in the central-north and central-south areas.
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Affiliation(s)
- Rui Martins
- Departamento de Estatística e Investigação Operacional, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal.
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Lisboa, Portugal.
| | - Bruno de Sousa
- Faculty of Psychology and Education Sciences (FPCE), Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Vítor Rodrigues
- Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Liga Portuguesa Contra o Cancro, Núcleo Regional do Centro, Rua Dr. Antonio José de Almeida, 329 - piso 2 - Sala 56, 3000-045, Coimbra, Portugal
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Armeni E, Paschou SA, Goulis DG, Lambrinoudaki I. Hormone therapy regimens for managing the menopause and premature ovarian insufficiency. Best Pract Res Clin Endocrinol Metab 2021; 35:101561. [PMID: 34274232 DOI: 10.1016/j.beem.2021.101561] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The transition to menopause is associated with a changing hormonal milieu, leading to bothersome menopausal symptoms in the short-term and chronic health problems in the long-term. Premature ovarian insufficiency (POI) is characterized by the cessation of menses before the age of 40 years. Hormone replacement therapy (HRT) is indicated to restore sex hormones to normal premenopausal levels and prevent chronic diseases, such as osteoporosis and cardiovascular disease. Menopausal hormone therapy (MHT) is indicated in perimenopausal and postmenopausal women over 45 years of age for managing menopausal symptoms, symptoms of vulvovaginal atrophy, and reducing the risk of postmenopausal osteoporosis. Individualization is the key to management, aiming at maximizing efficacy and minimizing clinically relevant risks. This review aimed to present the hormone therapy regimens for women during the transition or after menopause and women with POI and early menopause, as well as advise on: i) the initiation of MHT, ii) steps for monitoring during follow up, iii) weaning and discontinuation of treatment.
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Affiliation(s)
- Eleni Armeni
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece; Department of Diabetes and Endocrinology, University College London Hospital, London, United Kingdom
| | - Stavroula A Paschou
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotele University of Thessaloniki, Thessaloniki, Greece
| | - Irene Lambrinoudaki
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
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Qrareya AN, Mahdi F, Kaufman MJ, Ashpole NM, Paris JJ. HIV-1 Tat promotes age-related cognitive, anxiety-like, and antinociceptive impairments in female mice that are moderated by aging and endocrine status. GeroScience 2021; 43:309-327. [PMID: 32940828 PMCID: PMC8050151 DOI: 10.1007/s11357-020-00268-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Hypogonadism is a common comorbidity associated with HIV-1 that is more prevalent among infected individuals over the age of 45. The underlying mechanisms are unknown, but both combined antiretroviral therapeutics and HIV-1 proteins, such as trans-activator of transcription protein (Tat), dysregulate steroid-synthetic mechanisms including lipid storage/synthesis and mitochondrial function. Thus, Tat expression may accelerate age-related comorbidities partly by impairing endocrine function. Few studies exist of Tat-mediated behavioral deficits in aged animals and effects of endocrine status have not been investigated. Accordingly, we tested whether conditional Tat expression in aged (~ 1.5 years old), female, Tat-transgenic [Tat(+)] mice increases anxiety-like behavior, impairs cognition, and augments mechanical allodynia, when compared to age-matched controls that do not express Tat protein [Tat(-)]. We further tested whether aged mice that maintained their endocrine status (pre-estropausal) were more resilient to Tat/age-related comorbidities than peri- or post-estropausal mice. Tat and endocrine aging status exerted separate and interacting effects that influenced anxiety-like and cognitive behaviors. Peri- and post-estropausal mice exhibited greater anxiety-like behavior in the elevated plus-maze and impaired learning in the radial arm water maze compared to pre-estropausal mice. Irrespective of estropause status, Tat(+) mice demonstrated impaired learning, reduced grip strength, and mechanical allodynia compared to Tat(-) mice. Tat exposure reduced circulating estradiol in post-estropausal mice and increased the estradiol-to-testosterone ratio in pre-estropausal mice. Changes in circulating estradiol, testosterone, and progesterone correlated with grip strength. Thus, endocrine status is an important factor in age-related anxiety, cognition, neuromuscular function, and allodynia that can be accelerated by HIV-1 Tat protein.
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Affiliation(s)
- Alaa N Qrareya
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA
| | - Fakhri Mahdi
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA
| | - Marc J Kaufman
- Department of Psychiatry, McLean Imaging Center, McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA
| | - Nicole M Ashpole
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS, 38677, USA
| | - Jason J Paris
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, 315 Faser Hall, P.O. Box 1848, University, MS, 38677-1848, USA.
- Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS, 38677, USA.
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Cesarone MR, Belcaro G, Scipione C, Scipione V, Dugall M, Hu S, Cotellese R, Feragalli B, Ledda A. Prevention of vaginal dryness in perimenopausal women. Supplementation with Lady Prelox®. ACTA ACUST UNITED AC 2020; 71:434-441. [PMID: 32064827 DOI: 10.23736/s0026-4784.19.04466-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this pilot registry study was to use a standardized supplement (Lady Prelox®, Horphag Research) - including Pycnogenol®, l-arginine, L-citrulline and rose hip extract - to improve signs and symptoms associated with vaginal dryness in pre and post-menopausal healthy women. A group of women used only a standard management (SM) and a second group added Lady Prelox®. METHODS Four groups of women were included in the study. 34 pre-menopausal and 38 post-menopausal women took Lady Prelox®, four tablets daily for 8 weeks and 33 pre-menopausal women and 35 post-menopausal women served as controls. RESULTS No safety problems were observed with the supplement that was well tolerated. The subgroups of controls and supplemented subjects were comparable in both the pre- and post-menopausal groups. Among pre-menopausal women, results of the female sexual function index (FSFI) were significantly improved with the supplement in comparison with the control subjects' group (P<0.05). The results of the FSFI questionnaire for post-menopausal women indicated a significant improvement at 8 weeks with Lady Prelox® (P<0.05) in comparison with controls. Preclinical items (vaginal dryness, pain/discomfort during intercourse, mucus, minimal infections, presence of candida and oxidative stress) were significantly improved (P<0.05) with Lady Prelox®) in comparison to minimal changes with the SM group. These measurements included all women. CONCLUSIONS The effects of the supplementation with Lady Prelox® on vaginal dryness were significant. The supplement was well accepted and revealed no side effects or tolerability problems. Further studies are evaluating the effects of Lady Prelox® on other aspects of the menopausal transition that may alter the quality of life of most women in advanced age. A gentle approach with suitable dietary supplementation, represents a promising option for addressing common challenges that women experience in such conditions.
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Affiliation(s)
- Maria R Cesarone
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy.,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
| | - Gianni Belcaro
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy - .,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
| | - Claudia Scipione
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy.,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
| | - Valeria Scipione
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy.,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
| | - Mark Dugall
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy.,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
| | - Shu Hu
- Department of Medical, Oral Sciences and Biotechnologies, G. D'Annunzio University, Pescara, Italy
| | - Roberto Cotellese
- Department of Medical, Oral Sciences and Biotechnologies, G. D'Annunzio University, Pescara, Italy
| | - Beatrice Feragalli
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy.,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
| | - Andrea Ledda
- IRVINE3 Labs & Pap/Pea Screening Project and the International Irvine Network, Pescara, Italy.,IAAPS, International Agency for Pharma Standard Supplements, Chieti, Italy
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Tsiligiannis S, Panay N, Stevenson JC. Premature Ovarian Insufficiency and Long-Term Health Consequences. Curr Vasc Pharmacol 2020; 17:604-609. [PMID: 30819073 DOI: 10.2174/1570161117666190122101611] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 01/26/2023]
Abstract
Premature ovarian insufficiency (POI) is defined as the cessation of ovarian function before the age of 40 years. The trio of amenorrhea, elevated gonadotropins and oestrogen deficiency is associated with long-term health consequences including increased cardiovascular disease (CVD), decreased bone mineral density (BMD), significantly reduced fertility, psychological distress, vulvovaginal atrophy, neurological effects and overall reduced life expectancy. There are deficits in our understanding of this condition and subsequently the long-term health consequences. The underlying aetiology of POI and the optimal management strategies are also poorly understood. Our knowledge of long-term cardiovascular consequences specifically relating to women with POI is limited as most data on the subject are derived from studies involving women who experienced menopause at the natural age (after 40 years with an average age of 51).
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Affiliation(s)
| | - Nick Panay
- Chelsea and Westminster Hospital, London, United Kingdom.,Imperial College Healthcare, NHS Trust, London, United Kingdom
| | - John C Stevenson
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
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9
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Utilization pattern of hormone therapy in UK general practice between 1996 and 2015: a descriptive study. Menopause 2019; 26:741-749. [DOI: 10.1097/gme.0000000000001300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Guañabens N, Moro-Álvarez MJ, Casado E, Blanch-Rubió J, Gómez-Alonso C, Díaz-Guerra GM, Del Pino-Montes J, Valero Díaz de Lamadrid C, Peris P, Muñoz-Torres M. The next step after anti-osteoporotic drug discontinuation: an up-to-date review of sequential treatment. Endocrine 2019; 64:441-455. [PMID: 30963388 DOI: 10.1007/s12020-019-01919-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/29/2019] [Indexed: 12/16/2022]
Abstract
Several antiresorptive drugs, like bisphosphonates and denosumab, are currently available for the treatment of osteoporosis due to their evidenced efficacy in reducing fracture risk at mid-term. Osteoanabolic therapies, like teriparatide, whose treatment duration is limited to 2 years, have also shown efficacy in the reduction of fracture risk. However, depending on the severity of osteoporosis and the presence of other associated risk factors for fracture, some patients may require long-term treatment to preserve optimal bone strength and minimize bone fracture risk. Given the limited duration of some treatments, the fact that most of the antiresorptive drugs have not been assessed beyond 10 years, and the known long-term safety issues of these drugs, including atypical femoral fractures or osteonecrosis of the jaw, the long-term management of these patients may require an approach based on drug discontinuation and/or switching. In this regard, interest in sequential osteoporosis therapy, wherein drugs are initiated and discontinued over time, has grown in recent years, although the establishment of an optimal and individualized order of therapies remains controversial. This review reports the currently available clinical evidence on the discontinuation effects of different anti-osteoporotic drugs, as well as the clinical outcomes of the different sequential treatment regimens. The objective of this article is to present up-to-date practical knowledge on this area in order to provide guidance to the clinicians involved in the management of patients with osteoporosis.
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Affiliation(s)
- Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.
| | | | - Enrique Casado
- Rheumatology Department, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Carlos Gómez-Alonso
- Bone and Mineral Metabolism Unit, Central University Hospital of Asturias (HUCA), University of Oviedo, Oviedo, Spain
| | | | | | - Carmen Valero Díaz de Lamadrid
- University Hospital Marqués de Valdecilla, Research Institute Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Manuel Muñoz-Torres
- Endocrinology and Nutrition Unit, Hospital Universitario San Cecilio de Granada, Department of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (Ibs.GRANADA), CIBERFES, Instituto de Salud Carlos III, Granada, Spain
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Abstract
OBJECTIVE To illustrate the marked differences between classical endocrinology that distributes hormones to all tissues of the body through the bloodstream and the science of intracrinology, whereby each cell of each peripheral tissue makes a small and appropriate amount of estrogens and androgens from the inactive precursor dehydroepiandrosterone (DHEA), DHEA being mainly of adrenal origin. Because only the inactivated sex steroids are released in the blood, influence in the other tissues is avoided. METHODS Molecular biology has been used for the identification/characterization of the steroid-forming and steroid-inactivating enzymes, whereas steroids have been measured by mass spectrometry-based assays validated according to the US Food and Drug Administration guidelines. RESULTS Evolution over 500 million years has engineered the expression of about 30 steroid-forming enzymes specific for each peripheral tissue. These tissue-specific enzymes transform DHEA into the appropriate small amounts of estrogens and androgens for a strictly intracellular and local action. Humans, contrary to species below primates, also possess intracellular steroid-inactivating enzymes, especially glucuronyl transferases and sulfotransferases, which inactivate the estrogens and androgens at their local site of formation, thus preventing the release of a biologically significant amount of estradiol (E2) and testosterone in the circulation. Since DHEA becomes the unique source of sex steroids after menopause, serum E2 and testosterone are thus maintained at low biologically inactive concentrations with no activity outside the cells of origin. DHEA secretion, unfortunately, starts decreasing at about the age of 30 at various rates in different women. Moreover, there is no feedback mechanism to increase DHEA secretion when the concentration of serum DHEA decreases. Considering this mechanism is unique to the human, it seems logical to replace DHEA locally in women suffering from vulvovaginal atrophy (genitourinary syndrome of menopause). The clinical data obtained using a small dose of intravaginal DHEA (prasterone) confirm the mechanisms of intracrinology mentioned above which avoid biologically significant changes in serum E2 and testosterone. CONCLUSIONS The symptoms and signs of vulvovaginal atrophy (genitourinary syndrome of menopause) can be successfully treated by the intravaginal administration of DHEA without safety concerns. This strategy exclusively replaces in the vagina the missing cell-specific intracellular estrogens and androgens. This approach avoids systemic exposure and the potential risks of estrogen exposure for the tissues other than the vagina.
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13
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Ke Y, Gonthier R, Simard JN, Archer D, Lavoie L, Martel C, Vaillancourt M, Labrie F. Serum steroids remain within the same normal postmenopausal values during 12-month intravaginal 0.50% DHEA. Horm Mol Biol Clin Investig 2016; 24:117-29. [PMID: 26509785 DOI: 10.1515/hmbci-2015-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/07/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Analyze the serum levels of DHEA (prasterone) and its metabolites after daily intravaginal 0.50% (6.5 mg) DHEA in postmenopausal women with vulvovaginal atrophy (VVA). METHODS Serum samples were obtained at baseline and after 12, 26 and 52 weeks of treatment. The serum levels of DHEA, DHEA-sulfate (DHEA-S), androstene-3β, 17β-diol (5-diol), androstenedione (4-dione), testosterone, dihydrotestosterone (DHT), estrone (E1), estradiol (E2), E1-sulfate (E1-S), androsterone glucuronide (ADT-G) and androstane-3α,17β-diol 17-glucuronide (3α-diol-17G) were measured by validated liquid chromatography-tandem mass spectrometry. RESULTS A total of 435 women were exposed for 52 weeks. All serum steroids remained within normal values with no significant differences between lengths of treatment. For the most relevant estrogen-related compounds, namely E1, E2, and E1-S, a reliable marker of total estrogen exposure, the values in the DHEA-treated group at 52 weeks were -3.4%, -9.1% and +1.8%, respectively, compared to the normal postmenopausal values, thus clearly confirming the absence of significant systemic estrogen exposure. CONCLUSION While confirming that all serum sex steroids originating exclusively from DHEA after menopause are maintained within the normal postmenopausal values, the present data show that the dose of intravaginal DHEA used is free from systemic exposure with no detectable change in metabolism up to 52 weeks of treatment.
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Alhurani RE, Chahal CAA, Ahmed AT, Mohamed EA, Miller VM. Sex hormone therapy and progression of cardiovascular disease in menopausal women. Clin Sci (Lond) 2016; 130:1065-74. [PMID: 27215679 PMCID: PMC5316470 DOI: 10.1042/cs20160042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/04/2016] [Indexed: 02/07/2023]
Abstract
One of the most controversial health decisions facing women is deciding upon the use of hormonal treatments for symptoms of menopause. This brief review focuses on the historical context of use of menopausal hormone treatments (MHT), summarizes results of major observational, primary and secondary prevention studies of MHT and cardiovascular (CV) outcomes, provides evidence for how sex steroids modulate CV function and identifies challenges for future research. As medicine enters an era of personalization of treatment options, additional research into sex differences in the aetiology of CV diseases will lead to better risk identification for CV disease in women and identify whether a woman might receive CV benefit from specific formulations and doses of MHT.
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Affiliation(s)
- Rabe E Alhurani
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A. Department of Neurology, Mayo Clinic, Rochester, MN 55905, U.S.A
| | - C Anwar A Chahal
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, U.S.A
| | - Ahmed T Ahmed
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A. Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, U.S.A
| | - Essa A Mohamed
- Mayo Clinic Graduate School of Medicine, Rochester, MN 55905, U.S.A
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN, U.S.A. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, U.S.A.
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Tierney DK, Palesh O, Johnston L. Sexuality, Menopausal Symptoms, and Quality of Life in Premenopausal Women in the First Year Following Hematopoietic Cell Transplantation. Oncol Nurs Forum 2016; 42:488-97. [PMID: 26302277 DOI: 10.1188/15.onf.488-497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe sexuality, menopausal symptoms, and quality of life (QOL) in premenopausal women in the first year following hematopoietic cell transplantation (HCT)
. DESIGN One-year prospective longitudinal study. SETTING Stanford University Medical Center in California.
. SAMPLE 63 premenopausal female recipients of HCT with a mean age of 34.5 years. METHODS Three instruments were used. MAIN RESEARCH VARIABLES Sexuality, menopausal symptoms, and QOL
. FINDINGS At one year post-HCT, women reported absent to low desire and arousal, adequate lubrication less than half of the time, absent or rare orgasm, pain during vaginal penetration more than half the time, and dissatisfaction with overall sex life. Women also reported moderate to severe vasomotor symptoms, including hot flashes, night sweats, and sweating. Twenty-one women were avoiding sexual activity, and 25 women were not sexually active. Mean QOL scores significantly increased (p = 0.028) in the first year, signifying an improvement in QOL. Variables predictive of improved QOL at one year post-HCT include decreased psychosocial and physical symptoms, sexual satisfaction, and pre-HCT QOL score
. CONCLUSIONS One year post-HCT, women reported sexual dysfunction, sexual dissatisfaction, and menopausal symptoms, which negatively affect QOL. IMPLICATIONS FOR NURSING Nurses and other healthcare providers working with recipients of HCT can provide anticipatory guidance on potential changes in sexuality and menopausal symptoms to facilitate adaptation by reducing discordance between expectations and new realities
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Canonico M, Carcaillon L, Plu-Bureau G, Oger E, Singh-Manoux A, Tubert-Bitter P, Elbaz A, Scarabin PY. Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen. Stroke 2016; 47:1734-41. [PMID: 27256671 PMCID: PMC4927222 DOI: 10.1161/strokeaha.116.013052] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/03/2016] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The benefit/risk analysis of hormone therapy in postmenopausal women is not straightforward and depends on cardiovascular disease. Evidence supports the safety of transdermal estrogens and the importance of progestogens for thrombotic risk. However, the differential association of oral and transdermal estrogens with stroke remains poorly investigated. Furthermore, there are no data regarding the impact of progestogens. Methods— We set up a nested case–control study of ischemic stroke (IS) within all French women aged 51 to 62 years between 2009 and 2011 without personal history of cardiovascular disease or contraindication to hormone therapy. Participants were identified using the French National Health Insurance database, which includes complete drug claims for the past 3 years and French National hospital data. We identified 3144 hospitalized IS cases who were matched for age and zip code to 12 158 controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Results— Compared with nonusers, the adjusted ORs of IS were1.58 (95% CI, 1.01–2.49) in oral estrogen users and 0.83 (0.56–1.24) in transdermal estrogens users (P<0.01). There was no association of IS with use of progesterone (OR, 0.78; 95% CI, 0.49–1.26), pregnanes (OR, 1.00; 95% CI, 0.60–1.67), and nortestosterones (OR, 1.26; 95% CI, 0.62–2.58), whereas norpregnanes increased IS risk (OR, 2.25; 95% CI, 1.05–4.81). Conclusions— Both route of estrogen administration and progestogens were important determinants of IS. Our findings suggest that transdermal estrogens might be the safest option for short-term hormone therapy use.
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Affiliation(s)
- Marianne Canonico
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.).
| | - Laure Carcaillon
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
| | - Geneviève Plu-Bureau
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
| | - Emmanuel Oger
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
| | - Archana Singh-Manoux
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
| | - Pascale Tubert-Bitter
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
| | - Alexis Elbaz
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
| | - Pierre-Yves Scarabin
- From the Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Centre de Recheche en Epidémiologie et Santé des Populations, INSERM UMRS1018, Villejuif, France (M.C., E.O., A.S.-M., A.E., P.-Y.S.); Institut de veille sanitaire (InVS), Département des Maladies Chroniques et des, Traumatismes, F-94415 Saint-Maurice, France (L.C.); APHP, Hôpitaux Paris Centre, Unité de gynécologie endocrinienne, Paris, 75014, France et Université Paris Descartes (G.P.-B.); Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, INSERM UMRS1181, Villejuif, France (P.T.-B.); and Institut Pasteur, Paris, France (P.T.-B.)
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Bulchandani S, Toozs-Hobson P, Verghese T, Latthe P. Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications? Post Reprod Health 2015; 21:141-145. [PMID: 26537626 DOI: 10.1177/2053369115614704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. STUDY DESIGN We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). RESULTS Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. CONCLUSION Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse.
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Affiliation(s)
| | | | - Tina Verghese
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham UK
| | - Pallavi Latthe
- Birmingham Women's NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, Birmingham UK
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Cortés-Bonilla M, Bernardo-Escudero R, Alonso-Campero R, Francisco-Doce MT, Hernández-Valencia M, Celis-González C, Márquez-Oñate R, Chedraui P, Uribe JA. Treatment of menopausal symptoms with three low-dose continuous sequential 17β-estradiol/progesterone parenteral monthly formulations using novel non-polymeric microsphere technology. Gynecol Endocrinol 2015; 31:552-9. [PMID: 26062108 PMCID: PMC4776687 DOI: 10.3109/09513590.2015.1019853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To analyze the short-term efficacy and safety over menopausal symptoms of three low-dose continuous sequential 17β-estradiol (E)/progesterone (P) parental monthly formulations using novel non-polymeric microspheres. METHODS This was a multicenter, randomized, single blinded study in which peri- and postmenopausal women were assigned to receive a monthly intramuscular injection of 0.5 mg E + 15 mg P (Group A, n = 34), 1 mg E + 20 mg P (Group B, n = 24) or 1 mg E + 30 mg P (Group C, n = 26) for 6 months. Primary efficacy endpoints included mean change in the frequency and severity of hot flushes and the effect over urogenital atrophy symptoms at 3 and 6 months. Safety variables included changes in the rate of amenorrhea, endometrial thickness and histopathology, and local and systemic adverse events. RESULTS Compared to baseline at month 6, the three treatment schemes significantly decreased the rate of urogenital atrophy symptoms and the frequency (mean number per day) and severity (mean number graded as moderate and severe per month) of hot flushes. No differences in studied efficacy parameters were observed between studied groups at baseline or at the end of the study. For all groups the most frequent adverse event was pain at the injection site; however they were all rated as mild. At the end of the study peri- and postmenopausal women displayed no significant changes in endometrial thickness or histopathology in all treated groups. The rate of amenorrhea at the end of the study decreased for all studied groups yet was less evident among postmenopausal women as compared to perimenopausal ones. CONCLUSIONS The three low-dose continuous sequential intramuscular monthly treatments of E/P using novel microsphere technology were effective at reducing menopausal symptoms at short-term with a low rate of adverse events. More long-term and comparative research is warranted to support our positive findings.
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Affiliation(s)
- Manuel Cortés-Bonilla
- Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”,
Mexico City,
Mexico
- Address for correspondence: Manuel Cortés-Bonilla, MD,
Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, C.P. 11000,
Mexico City,
Mexico. Tel: +52 55 55208585/+52 55 52022493. E-mail:
| | | | | | | | - Marcelino Hernández-Valencia
- Unidad de Investigación en Endocrinología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social,
Mexico City,
Mexico
| | - Cuauhtémoc Celis-González
- Hospital de Gineco-Obstetricia No. 4 “Luis Castelazo Ayala” – Instituto Mexicano del Seguro Social,
Mexico City,
Mexico
| | | | - Peter Chedraui
- Facultad de Ciencias Médicas, Instituto de Biomedicina, Área Investigación para la Salud de la Mujer, Universidad Católica de Santiago de Guayaquil,
Guayaquil,
Ecuador
| | - Juan A. Uribe
- Centro A.F. de Estudios Tecnológicos, S.A. de C.V.,
Mexico City,
Mexico
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Croden J, Ross S, Yuksel N, Sydora BC. A survey of the availability in Canadian pharmacy chains of over-the-counter natural health products for menopause symptoms. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:86. [PMID: 25887967 PMCID: PMC4414444 DOI: 10.1186/s12906-015-0608-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/12/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Menopause is a natural phase in a woman's aging process, characterized by the cessation of menstruation. Women who are going through the menopause transition can experience physiological symptoms that significantly impact their quality of life. Concern about adverse effects of traditional hormone therapy often leads women to purchase over-the-counter (OTC) natural health products (NHPs). The goal of this study was toinvestigate the range of OTC NHPs for menopause available to Canadian women, and the packaging information they can access to make self-management decisions. METHODS Edmonton stores belonging to each of nine Canadian pharmacy chains were visited to identify NHPs marketed for the relief of menopausal symptoms. Details were extracted from the packaging: a) product name and manufacturer, b) Health Canada license number, c) medically active ingredients, d) claims of efficacy, e) contra-indications and warnings, and f) daily cost. Data were entered and analyzed using Microsoft Excel. RESULTS We identified 20 OTC NHP menopausal products, 19 of which had Health Canada license numbers. Twenty-eight medically active ingredients were identified, with the most common being black cohosh (in 14 products) and soy isoflavones (n = 7), chaste tree (n = 5), and dong quai (n = 3). Most products claimed they would relieve vasomotor symptoms, including hot flashes (n = 14) and night sweats (n = 10). Each product had a labeled contraindication for at least one specific condition. Costs per recommended daily dose ranged from $0.07 to a maximum of $2.50 (CAD$). CONCLUSION Natural health products for menopausal symptoms are easily available to Canadian women. The lack of clear evidence of product efficacy makes the need for easily accessible, balanced information on this topic important for women to make well informed choices.
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Affiliation(s)
- Jennifer Croden
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, 5S131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3 V9, Canada.
| | - Sue Ross
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, 5S131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3 V9, Canada.
| | - Nese Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, 11405 - 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada.
| | - Beate C Sydora
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, 5S131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3 V9, Canada.
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Maggio M, Lauretani F, De Vita F, Basaria S, Lippi G, Butto V, Luci M, Cattabiani C, Ceresini G, Verzicco I, Ferrucci L, Ceda GP. Multiple hormonal dysregulation as determinant of low physical performance and mobility in older persons. Curr Pharm Des 2015; 20:3119-48. [PMID: 24050169 DOI: 10.2174/13816128113196660062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/13/2013] [Indexed: 12/16/2022]
Abstract
Mobility-disability is a common condition in older individuals. Many factors, including the age-related hormonal dysregulation, may concur to the development of disability in the elderly. In fact, during the aging process it is observed an imbalance between anabolic hormones that decrease (testosterone, dehydroepiandrosterone sulphate (DHEAS), estradiol, insulin like growth factor-1 (IGF-1) and Vitamin D) and catabolic hormones (cortisol, thyroid hormones) that increase. We start this review focusing on the mechanisms by which anabolic and catabolic hormones may affect physical performance and mobility. To address the role of the hormonal dysregulation to mobility-disability, we start to discuss the contribution of the single hormonal derangement. The studies used in this review were selected according to the period of time of publication, ranging from 2002 to 2013, and the age of the participants (≥65 years). We devoted particular attention to the effects of anabolic hormones (DHEAS, testosterone, estradiol, Vitamin D and IGF-1) on both skeletal muscle mass and strength, as well as other objective indicators of physical performance. We also analyzed the reasons beyond the inconclusive data coming from RCTs using sex hormones, thyroid hormones, and vitamin D (dosage, duration of treatment, baseline hormonal values and reached hormonal levels). We finally hypothesized that the parallel decline of anabolic hormones has a higher impact than a single hormonal derangement on adverse mobility outcomes in older population. Given the multifactorial origin of low mobility, we underlined the need of future synergistic optional treatments (micronutrients and exercise) to improve the effectiveness of hormonal treatment and to safely ameliorate the anabolic hormonal status and mobility in older individuals.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, Section of Geriatrics via Gramsci 14, 43100, Parma, Italy.
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Corbelli J, Shaikh N, Wessel C, Hess R. Low-dose transdermal estradiol for vasomotor symptoms. Menopause 2015; 22:114-21. [DOI: 10.1097/gme.0000000000000258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Eder SE. Ospemifene: a novel selective estrogen receptor modulator for treatment of dyspareunia. WOMEN'S HEALTH (LONDON, ENGLAND) 2014; 10:499-503. [PMID: 25335541 DOI: 10.2217/whe.14.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ospemifene is a novel, oral selective estrogen receptor modulator that has been approved in the USA for treatment of dyspareunia. The decline in estrogen during menopause creates vulvovaginal changes that can cause symptoms that adversely impact women psychosexually. Many women are reluctant to discuss painful sex and providers must proactively inquire about sexuality issues. Ospemifene has been shown to reverse changes associated with vulvovaginal atrophy and relieve symptoms of dyspareunia. Safety studies of treatment up to 52 weeks have shown ospemifene to be safe with no impact on endometrial hyperplasia/carcinoma, venous thrombotic events or pelvic organ prolapse. Further studies are needed to evaluate its role in bone and breast health.
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Liu Z, Wang Y, Xu H, Wu J, He L, Jiang JY, Yan S, Du R, Liu B. Efficacy of electroacupuncture for symptoms of menopausal transition: study protocol for a randomized controlled trial. Trials 2014; 15:242. [PMID: 24950841 PMCID: PMC4075980 DOI: 10.1186/1745-6215-15-242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have shown that acupuncture can alleviate postmenopausal symptoms, such as hot flashes, but few studies have assessed symptoms during the menopausal transition (MT) period. Thus, the effect of acupuncture upon MT symptoms is unclear. We designed a large-scale trial aimed at evaluating the efficacy of electroacupuncture for MT symptoms compared with sham electroacupuncture and at observing the safety of electroacupuncture. METHODS/DESIGN In this multicenter randomized controlled trial, 360 women will be randomized to either an electroacupuncture group or a sham electroacupuncture group. During the 8-week-long treatment, a menopause rating scale, average 24-hour hot flash score, Menopause-Specific Quality of Life Questionnaire score, and level of female hormones will be observed. Follow-ups at the 20th and 32nd week will be made. DISCUSSION Though there is no completely inert placebo acupuncture and blinding is difficult in acupuncture trials, the placebo effect of EA can still be partially excluded in this study. For the placebo control, we use non-points and a tailor-made sham needle. This needle is different from a retractable needle, which is usually used for sham acupuncture. The needle in this trial is more simply constructed and more acceptable to Chinese people. We expect to evaluate the efficacy of electroacupuncture for MT symptoms and clarify its effect on these symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01849172 (Date of registration: 05/05/2013).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Baoyan Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No,5, Beixiange Street, 100053 Beijing, Xicheng District, China.
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PINHEIRO ANDERSON, ANTUNES ARMANDO, ANDRADE LILIANA, DE BROT LOUISE, PINTO-NETO AARÃOMENDES, COSTA-PAIVA LÚCIA. Expression of hormone receptors, Bcl-2, Cox-2 and Ki67 in benign endometrial polyps and their association with obesity. Mol Med Rep 2014; 9:2335-41. [DOI: 10.3892/mmr.2014.2125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 02/18/2014] [Indexed: 11/06/2022] Open
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Koç Z, Saglam Z, Topatan S. Determination of the use of complementary and alternative medicine by women in the climacteric period in the Turkish city of Samsun. Contemp Nurse 2014; 45:197-209. [PMID: 24299248 DOI: 10.5172/conu.2013.45.2.197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This quantitative descriptive study was carried out in order to determine the use of complementary and alternative medicine (CAM) for management of menopausal symptoms in women in Samsun, Turkey. Data on general demographic characteristics, menopause-related symptoms, and the use of CAM and herbal therapy were collected from 281 women undergoing the process of the climacteric period, admitted to the gynaecology polyclinic of a hospital in Samsun province. To evaluate the data, descriptive statistics, Student t-tests, and logistic regression analysis were used. In this study the most common CAM methods were identified as herbal therapy (29.9%), dieting (29.5%), exercise (29.2%), and massage (27.8%). Approximately one-third of the women identified as benefitting from CAM methods. More than half identified as not having informed a health care professional about their use of these methods of achieving symptom relief.
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Affiliation(s)
- Zeliha Koç
- Ondokuz Mayıs University Samsun School of Nursing, Samsun, Turkey
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Schvartzman L, Magalhães JA, Freitas FMD, Pereira C, Azevedo J, Capp E, Wender MCO. Effects of hormone therapy on the endometrium in postmenopausal women: a one year randomized trial of low dose oral estradiol in association with a levonorgestrel-releasing intrauterine system or drospirenone. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2013. [DOI: 10.1590/s1519-38292013000300007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: to compare the endometrial effects and uterine bleeding patterns associated with treatment using (1) levonorgestrel-releasing intrauterine system (LNG-IUS) and estradiol (1 mg/day, p.o.) or (2) orally administered drospirenone (2 mg/day) andestradiol (1 mg/day). METHODS: thirty-four patients (aged 52.53 ± 4.44 in the LNG-IUS group and 53.15 ± 4.018 in the DRSP group) were randomized. The severity of menopausal symptoms was evaluated using the Kupperman index every three months. Transvaginal ultrasound, hysteroscopy and histological evaluation were repeated after 12 months. During this period, patients kept menstrual calendars. All categorical variables were described as percentages. Variables were tested for normal distribution and Student's t test was applied for independent samples and ANOVA forrepeated measures when appropriate. Data were considered to be significant when p<0.05. RESULTS: slight vaginal bleeding was reported in the first month of treatment by 53.3% of patients from the LNG-IUS/estradiol group compared with 7.7% of patients from the drospirenone/estradiol group. There were no differences in endometrial thickness between the two groups throughout the study period. End-of-study histological findings showed atrophic endometrium in 53.3% of patients in the LNG-IUS/estradiol group compared with 76.9% of patients in the drospirenone/estradiol group. CONCLUSIONS: our results suggest good endometrial protection with both HT regimens.
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Affiliation(s)
| | | | | | | | | | - Edison Capp
- Universidade Federal do Rio Grande do Sul, Brasil
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Labos G, Trakakis E, Pliatsika P, Augoulea A, Vaggopoulos V, Basios G, Simeonidis G, Creatsa M, Alexandrou A, Iliodromiti Z, Kassanos D, Lambrinoudaki I. Efficacy and safety of DT56a compared to hormone therapy in Greek post-menopausal women. J Endocrinol Invest 2013; 36:521-6. [PMID: 23563111 DOI: 10.3275/8926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hormone therapy (HT) is the treatment of choice for the alleviation of menopausal symptoms; concerns, however, about its concomitant long-term health risks have limited its use. DT56a is a unique enzymatic isolate of soybeans. The purpose of our study was to evaluate the efficacy and safety of DT56a, compared to HT, in symptomatic post-menopausal women. SUBJECTS AND METHODS Eighty-nine post-menopausal women were studied prospectively. Women with climacteric symptoms were randomly assigned to receive eitherDT56a (no.=27) or oral low dose continuous combined HT (no.=26). Symptomatic women not wishing to receive any treatment served as controls (no.=36). Menopausal symptoms as assessed through the Kupperman index, serum lipids and lipoproteins, calcium, as well as bone mineral density (BMD), endometrial thickness, and mammography were assessed at baseline and at 12 months. RESULTS Patients receiving HT and DT56a showed a significant and independent decrease in menopausal symptoms (mean difference in Kupperman score, DT56a group: -3.98, HT group -5.601, no treatment group +1.76, p-value <0.001). Lumbar spine BMD T-score was significantly lower in women receiving no treatment, as opposed to the two treatment arms which showed no significant change (No treatment, baseline: -0.60, final: -0.85, p=0.001; HT, baseline: -84, final -0.99, p=0.79; DT56a, baseline -0.51, final: -0.76, p=0.75). No differences in femoral bone density, ET or mammography classification were detected in any of the treatment arms. Likewise, serum lipids or lipoproteins did not differ between the three groups. CONCLUSIONS DT56a decreased menopausal symptoms significantly and in the same degree as HT.
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Affiliation(s)
- G Labos
- 3rd Department of Obstetrics and Gynecology, University of Athens, Attikon Hospital, Athens, Greece
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Baldinger P, Kranz G, Höflich A, Savli M, Stein P, Lanzenberger R, Kasper S. [The effects of hormone replacement therapy on mind and brain]. DER NERVENARZT 2013; 84:14-9. [PMID: 22318360 DOI: 10.1007/s00115-011-3456-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hormonal fluctuations during the perimenopausal transition lead to physical discomfort but are also frequently accompanied by mood swings, depressive symptoms, anxiety and sleeping disorders. The important role of the neurotransmitter serotonin in the pathogenesis of anxiety disorders and major depression is unquestioned, but only little is known about the influence of sex hormones on the serotonergic system. This review provides an overview of potential risk factors for the occurrence of affective disorders in the menopausal transition and discusses possible therapeutic options. Current research findings from longitudinal studies testing the efficacy of hormone replacement therapy and antidepressants with effects on the serotonergic neurotransmission on physical and mental discomforts during menopause are presented. Furthermore, studies using positron emission tomography and genetic methods that explore the effects of sex steroids on different components of the serotonergic system are shown. The interactions between estrogen, progesterone and the serotonergic system are described, and possible neurobiological and endocrinological mechanisms underlying depressive symptoms in the perimenopause are elucidated.
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Affiliation(s)
- P Baldinger
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich
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Abstract
Premature menopause affects 1% of women under the age of 40 years. The women are at risk of premature death, neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease and infertility. There is need to use simplified protocols and improved techniques in oocyte donation to achieve pregnancy and mother a baby in those women at risk. Review of the pertinent literature on premature menopause, selected references, internet services using the PubMed and Medline databases were included in this review. In the past, pregnancy in women with premature menopause was rare but with recent advancement in oocyte donation, women with premature menopause now have hoped to mother a child. Hormone replacement therapy is beneficial to adverse consequences of premature menopause. Women with premature menopause are at risk of premature death, neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease and infertility. Public enlightenment and education is important tool to save those at risk.
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Affiliation(s)
- Tc Okeke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria ; Department of Physiology, College of Medicine, University of Nigeria, Enugu Campus, Awka, Nigeria
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Xu LW, Jia M, Salchow R, Kentsch M, Cui XJ, Deng HY, Sun ZJ, Kluwe L. Efficacy and side effects of chinese herbal medicine for menopausal symptoms: a critical review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2012:568106. [PMID: 23365599 PMCID: PMC3551256 DOI: 10.1155/2012/568106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/03/2012] [Indexed: 11/17/2022]
Abstract
This study evaluates 23 (9 Chinese and 14 non-Chinese) randomized controlled trials for efficacy and side effects of Chinese herbal medicine on menopausal symptoms. Menopause was diagnosed according to western medicine criteria in all studies while seven Chinese studies and one non-Chinese study further stratified the participants using traditional Chinese medical diagnosis "Zheng differentiation." Efficacy was reported by all 9 Chinese and 9/14 non-Chinese papers. Side effects and adverse events were generally mild and infrequent. Only ten severe adverse events were reported, two with possible association with the therapy. CHM did not increase the endometrial thickness, a common side effect of hormone therapy. None of the studies investigated long-term side effects. Critical analysis revealed that (1) high-quality studies on efficacy of Chinese herbal medicine for menopausal syndrome are rare and have the drawback of lacking traditional Chinese medicine diagnosis (Zheng-differentiation). (2) Chinese herbal medicine may be effective for at least some menopausal symptoms while side effects are likely less than hormone therapy. (3) All these findings need to be confirmed in further well-designed comprehensive studies meeting the standard of evidence-based medicine and including Zheng-differentiation of traditional Chinese medicine.
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Affiliation(s)
- Lian-Wei Xu
- Gynecology Department, Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
- HanseMerkur Traditional Chinese Medicine Centre, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Man Jia
- Gynecology Department, Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Roland Salchow
- HanseMerkur Traditional Chinese Medicine Centre, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Michael Kentsch
- Department of Internal Medicine, University Teaching Hospital Itzehoe, 25524 Itzehoe, Germany
| | - Xue-Jun Cui
- Clinical Evaluation Centre, Longhua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Hong-Yong Deng
- Technology Information Centre, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Zhuo-Jun Sun
- Gynecology Department, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
| | - Lan Kluwe
- Laboratory for Research and Diagnostics, Departments of Maxillofacial Surgery and Neurology, University Medical Center Hamburg-Eppendorf, Martinistraβe 52, 20246 Hamburg, Germany
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Steady-state pharmacokinetics of gabapentin after administration of a novel gastroretentive extended-release formulation in postmenopausal women with vasomotor symptoms. Clin Drug Investig 2012; 32:593-601. [PMID: 22775354 DOI: 10.1007/bf03261914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Approximately 75% of postmenopausal women experience vasomotor symptoms (hot flashes). Currently, hormone replacement therapy is the only approved treatment for hot flashes. However, its use has been associated with an increased risk of invasive breast cancer, coronary heart disease, stroke and venous thromboembolic disease. Gabapentin has also been demonstrated to be efficacious in the treatment of vasomotor symptoms in postmenopausal women when administered three times a day. A gastroretentive extended-release formulation of gabapentin (gabapentin-ER) has recently been demonstrated to be efficacious in the treatment of postmenopausal hot flashes. The objective of this paper is to report the steady-state pharmacokinetics and safety of gabapentin with different dosing regimens of gabapentin-ER in postmenopausal women with hot flashes. METHODS This was a multicentre, randomized, double-blind, dose-escalating, placebo-controlled, parallel group study in 124 postmenopausal women experiencing ≥7 moderate to severe hot flashes per day. The study consisted of two 5-week treatment periods, with each one preceded by a 1-week titration to the assigned dose. Groups A, B and C received gabapentin-ER 600 mg evening (pm), 600 mg morning (am)/600 mg pm and 1200 mg pm in the first period, and then 600 mg am/1200 mg pm, 600 mg am/1800 mg pm and 1200 mg am/1800 mg pm in the second period, respectively. The tablets were taken after a non-specified meal. Pharmacokinetic sampling was conducted over a 24-hour period at the end of each study period. Plasma samples were analysed by a validated liquid chromatography tandem mass spectrometry method. Non-compartmental pharmacokinetic analysis was performed on the concentration-time data to determine area under the plasma concentration versus time curve from time zero to 24 hours (AUC(24)). Maximum (C(max)), minimum (C(min)) and average (C(avg)) drug concentration and time to reach C(max) (t(max)) were determined by inspection of the data. Tolerability was evaluated by physical examination, clinical laboratory measurements and adverse events monitoring. RESULTS Gabapentin exposure at steady state, as measured by AUC(24), increased with doses from 600 mg/day to 3000 mg/day, although there was a slight decrease in gabapentin's relative bioavailability with increasing dose compared with the 600 mg dose. The relative bioavailability compared with the 600 mg dose was 86-88% for the 1200 mg/day doses, 75% for the 1800 mg/day dose, 84% for the 2400 mg/day dose, and 73% for the 3000 mg/day dose. C(max) generally increased with increasing dose as did C(min) and C(avg) for the various treatments in a manner that was consistent with the dosing regimen. The values of t(max) were not different between the various doses, with the median t(max) values relative to the most recent dose ranging from 6 to 8 hours for all dose levels. Gabapentin-ER was generally well tolerated at all doses studied. The most common AEs were headache, dizziness and somnolence, with most being mild in intensity. Seven patients withdrew from the study due to AEs. CONCLUSION The pharmacokinetic profile of gabapentin-ER may allow for once- or twice-daily dosing while maintaining bioavailability and thus efficacy. Gabapentin-ER was well tolerated. CLINICAL TRIAL REGISTRATION Registered as ClinicalTrials.gov Identifier: NCT00511953.
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Colau JC, Vincent S, Marijnen P, Allaert FA. Efficacy of a non-hormonal treatment, BRN-01, on menopausal hot flashes: a multicenter, randomized, double-blind, placebo-controlled trial. Drugs R D 2012; 12:107-19. [PMID: 22852580 PMCID: PMC3585763 DOI: 10.2165/11640240-000000000-00000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Homeopathic medicines have a place among the non-hormonal therapies for the treatment of hot flashes during the menopause. OBJECTIVE The objective of this study was to evaluate the efficacy of the non-hormonal treatment BRN-01 in reducing hot flashes in menopausal women. STUDY DESIGN This was a multicenter, randomized, double-blind, placebo-controlled study carried out between June 2010 and July 2011. SETTING The study was conducted in 35 active centers in France (gynecologists in private practice). PATIENTS One hundred and eight menopausal women, ≥ 50 years of age, were enrolled in the study. The eligibility criteria included menopause for <24 months and ≥ 5 hot flashes per day with a significant negative effect on the women's professional and/or personal life. INTERVENTION Treatment was either BRN-01 tablets, a registered homeopathic medicine containing Actaea racemosa (4 centesimal dilutions [4CH]), Arnica montana (4CH), Glonoinum (4CH), Lachesis mutus (5CH), and Sanguinaria canadensis (4CH), or identical placebo tablets, prepared by Laboratoires Boiron according to European Pharmacopoeia standards. Oral treatment (2 to 4 tablets per day) was started on day 3 after study enrollment and was continued for 12 weeks. MAIN OUTCOME MEASURE The main outcome measure was the hot flash score (HFS) compared before, during, and after treatment. Secondary outcome criteria were the quality of life (QoL) [measured using the Hot Flash Related Daily Interference Scale (HFRDIS)], severity of symptoms (measured using the Menopause Rating Scale), evolution of the mean dosage, and compliance. All adverse events (AEs) were recorded. RESULTS One hundred and one women were included in the final analysis (intent-to-treat population: BRN-01, n = 50; placebo, n = 51). The global HFS over the 12 weeks, assessed as the area under the curve (AUC) adjusted for baseline values, was significantly lower in the BRN-01 group than in the placebo group (mean ± SD 88.2 ± 6.5 versus 107.2 ± 6.4; p = 0.0411). BRN-01 was well tolerated; the frequency of AEs was similar in the two treatment groups, and no serious AEs were attributable to BRN-01. CONCLUSION BRN-01 seemed to have a significant effect on the HFS, compared with placebo. According to the results of this clinical trial, BRN-01 may be considered a new therapeutic option with a safe profile for hot flashes in menopausal women who do not want or are not able to take hormone replacement therapy or other recognized treatments for this indication. Trial registration number (EudraCT): 2009-016959-21.
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Affiliation(s)
| | - Stéphane Vincent
- />Laboratoires Boiron, 20 rue de la Libération, 69110 Sainte Foy-lès-Lyon, France
| | - Philippe Marijnen
- />Laboratoires Boiron, 20 rue de la Libération, 69110 Sainte Foy-lès-Lyon, France
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Cowles VE, Gordi T, Hou SYE. Steady-State Pharmacokinetics of Gabapentin after Administration of a Novel Gastroretentive Extended-Release Formulation in Postmenopausal Women with Vasomotor Symptoms. Clin Drug Investig 2012. [DOI: 10.2165/11634520-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Jellinger PS, Smith DA, Mehta AE, Ganda O, Handelsman Y, Rodbard HW, Shepherd MD, Seibel JA. American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis. Endocr Pract 2012; 18 Suppl 1:1-78. [PMID: 22522068 DOI: 10.4158/ep.18.s1.1] [Citation(s) in RCA: 313] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Panay N, Maamari R. Treatment of postmenopausal vaginal atrophy with 10-μg estradiol vaginal tablets. ACTA ACUST UNITED AC 2012; 18:15-9. [PMID: 22393176 DOI: 10.1258/mi.2012.011120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Postmenopausal estrogen deficiency can lead to symptoms of urogenital atrophy. Individuals with urogenital atrophy have symptoms that include vaginal dryness, vaginal and vulval irritation, vaginal soreness, pain and burning during urination (dysuria), increased vaginal discharge, vaginal odour, vaginal infections, recurrent urinary tract infections, pain associated with sexual activity (dyspareunia) and vaginal bleeding associated with sexual activity. Despite the frequency and effects of vaginal atrophy symptoms, they are often under-reported and, consequently, under-treated. Therefore, care of a menopausal woman should include a physical assessment of vaginal atrophy and a dialogue between the physician and the patient that explores existing symptoms and their effect on vulvovaginal health, sexuality and quality-of-life issues. The development of the ultra-low-dose 10-µg estradiol vaginal tablets is in line with the requirements of regulatory agencies and women's health societies regarding the use of the lowest effective hormonal dose. Because of its effectiveness and safety profiles, in addition to its minimal systemic absorption, the 10-µg estradiol vaginal tablet can offer greater reassurance to health-care providers and postmenopausal women with an annual estradiol administration of only 1.14 mg.
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Affiliation(s)
- Nick Panay
- Queen Charlotte's & Chelsea Hospital, & Westminster Hospitals, London, UK.
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Hormone therapy prescribing trends in the decade after the Women's Health Initiative: how patients and providers have found a way to sleep better at night. Menopause 2012; 19:600-1. [PMID: 22648300 DOI: 10.1097/gme.0b013e318255b441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ortmann O, Lattrich C. The treatment of climacteric symptoms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:316-23; quiz 324. [PMID: 22611453 DOI: 10.3238/arztebl.2012.0316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 03/12/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peri- and postmenopausal women commonly suffer from climacteric symptoms. In this article, we provide information to help physicians recognize climacteric symptoms and treat them appropriately. METHODS The information presented here is based on a selective search of the literature for pertinent articles that appeared from 2008 to early 2011, including the German S3 guideline on hormone therapy (HT) during and after menopause, which was published in 2009. RESULTS Perimenopausal women often suffer from climacteric symptoms. Typically, women undergoing menopause complain of heat waves and vaginal dryness. According to randomized controlled trials as well as national and international guidelines, HT is the most effective treatment for vasomotor symptoms and also improves vulvovaginal atrophy; for the latter indication, HT is preferably administered locally. Vaginal estrogen therapy lowers the frequency of recurrent urinary tract infections. However, HT is associated with an increased risk for a number of diseases, including stroke, thromboembolic events, gall-bladder diseases, and breast cancer. Alternative treatments for climacteric symptoms have little or no efficacy. CONCLUSION HT should only be used to treat climacteric symptoms after extensive patient education about its benefits and risks. Participatory decision-making is desirable. The generalized use of HT by all women with climacteric symptoms cannot be recommended.
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Affiliation(s)
- Olaf Ortmann
- Department of Obstretics and Gynecology, University Medical Center Regensburg, Germany.
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Lee E, Maneno MK, Wutoh AK, Zuckerman IH. Long-term effect of the Women's Health Initiative study on antiosteoporosis medication prescribing. J Womens Health (Larchmt) 2012; 19:847-54. [PMID: 20459329 DOI: 10.1089/jwh.2009.1441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To describe long-term prescribing patterns of osteoporosis therapy before and after the Women's Health Initiative (WHI) publication. METHODS We conducted a time-series analysis from 1997 to 2005 using nationally representative data based on office-based physician and hospital ambulatory clinic visits. Bivariate and multivariable analyses were conducted using chi-square tests and logistic regression, respectively, and trends in the prevalence of osteoporosis therapies were evaluated per 6-month (semiannual) intervals. Linear regression and graphic techniques were used to determine statistical differences in the prevalence trends between the two periods. RESULTS Overall prevalence of therapeutic or preventive osteoporosis therapy was similar between the WHI periods. However, a significant decrease in estrogen therapy and increases in bisphosphonates, calcium/vitamin D were observed in the period after the WHI publication (p < 0.05). Multiple logistic regression analysis showed older age and white race were associated with a higher likelihood of antiosteoporosis medication (AOM) prescription, and Medicaid insurance type was associated with a lower likelihood of an AOM prescription. Excluding calcium/vitamin D, nonestrogen therapy was more likely to be prescribed in the after-WHI period (office-based physician clinic: [adjusted OR, aOR] 2.49 [2.04-4.04]; hospital-based clinic: aOR 2.42 [1.67-7.50]) Nonestrogen therapy was more prevalent in visits made by older women, women of white race, women with contraindicated conditions for estrogen therapy, and women from the Northeast region. CONCLUSIONS After the WHI publication, the overall prevalence of osteoporosis therapy did not change; however, a shift from estrogen to nonestrogen therapy was observed after the WHI publication. Black women were less likely to receive nonestrogen antiosteoporosis therapy in hospital-based clinics.
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Affiliation(s)
- Euni Lee
- Department of Clinical and Administrative Pharmacy Sciences, School of Pharmacy, Howard University, Center for Minority Health Services Research, Washington, District of Columbia, USA.
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Dominguez LJ, Barbagallo M. Antiageing Strategies. PATHY'S PRINCIPLES AND PRACTICE OF GERIATRIC MEDICINE 2012:1575-1587. [DOI: 10.1002/9781119952930.ch130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Rosano G, Vitale C, Spoletini I, Fini M. Cardiovascular health in the menopausal woman: impact of the timing of hormone replacement therapy. Climacteric 2012; 15:299-305. [PMID: 22424090 DOI: 10.3109/13697137.2012.658899] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The cardiovascular effects of hormone replacement therapy (HRT) have been the subject of much debate since the initial findings from the Women's Health Initiative (WHI) were reported. However, re-analyses of WHI results have suggested that the association between HRT use and cardiovascular risk is influenced by several factors and that, among these, age and time since menopause may play a key role. Preclinical and human studies have shown differential effects of estrogen on the vasculature of healthy subjects compared with those with existing atherosclerosis. Indeed, while HRT has shown no protective effects in the presence of established atherosclerotic disease, it may have beneficial or neutral effects on healthy vasculature or early atherosclerosis. However, the final cardiovascular effects of estrogens in non-hysterectomized women are influenced by the type, dosage, and route of administration of the progestin used in association. The results of ongoing studies on the timing of HRT initiation will help women make better informed decisions regarding their menopausal health. Current treatment guidelines recommend initiation of HRT in recently postmenopausal women for the relief of vasomotor symptoms.
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Affiliation(s)
- G Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Via della Pisana 235, Rome, Italy
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Takeda T, Wong TF, Kitamura M, Yaegashi N. Estrogen formulations and beauty care practices in Japanese women. Int J Womens Health 2012; 4:19-24. [PMID: 22312196 PMCID: PMC3271811 DOI: 10.2147/ijwh.s28368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Traditionally, oral estrogens have been used for hormone replacement therapy. However, in Japan, additional estrogen formulations have been used, including transdermal patches and transdermal gels. The latter have a unique commonality with cosmetics because both of them are applied to the skin. Beauty care is one of the most important lifestyle factors for women, and it has been reported that the amount of attention paid to beauty care has an effect in determining whether or not women will choose to undergo HRT during menopause. Therefore, our study focused on estrogen formulations and beauty care practices. Patients and methods Fifty women who use hormone replacement therapy were recruited from the outpatient clinic of Tohoku University Hospital. They were treated with oral conjugated estrogen (n = 11), transdermal 17β-estradiol patch (n = 11), and transdermal 17β-estradiol gel (n = 28). They completed a questionnaire to assess their lifestyle (beauty care practices and exercise habits) and their compliance. The transdermal gel users were further interviewed about their subjective impressions regarding “smell”, “sticky feeling”, “spreadability”, and “irritation” on the skin using a five-grade scale. Results There were no differences in the usability of medicines and patient compliance among the estrogen formulations. We observed a positive tendency between the level of beauty care and transdermal gel use (P = 0.0645, ordinary logistic regression analysis). The gel users placed top priority on a lack of “sticky feeling” but the subjective impression regarding “sticky feeling” was worst among the four factors (P < 0.01, Steel–Dwass test). Correspondence analysis showed that the subjective impressions of transdermal gel corresponding to usability in the range of “moderate” to “very good” and “sticky feeling” greatly affected the usability of the formulation. Conclusion These results suggest that the level of attention to beauty care plays some role in the choice of estrogen formulations.
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Affiliation(s)
- Takashi Takeda
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Moegele M, Buchholz S, Seitz S, Ortmann O. Vaginal estrogen therapy in postmenopausal breast cancer patients treated with aromatase inhibitors. Arch Gynecol Obstet 2012; 285:1397-402. [PMID: 22212649 DOI: 10.1007/s00404-011-2181-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 12/13/2011] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Breast cancer is the most frequent cancer among women with about 1.38 million new cases worldwide every year. Most of these patients are postmenopausal and suffer from hormone receptor positive breast tumors. About 50% of postmenopausal women between 50 and 60 years and 72% of women over 70 years suffer from vulvovaginal athrophy (VVA). Adjuvant treatment with aromatase inhibitors (AIs) improves outcomes in postmenopausal women with hormone receptor positive early stage breast cancer compared with tamoxifen. A frequent side effect of AI use is VVA with symptoms like vaginal dryness, vaginitis, pruritus, dyspareunia and cystitis. MATERIALS AND METHODS We searched major databases (i.e. pubmed) with the following selection criteria: breast cancer, hormone therapy, vaginal estrogen, aromatase inhibitor, vaginal atrophy, serum estrogen levels. CONCLUSIONS Vaginal administration of estradiol is a well known and safe alternative to systemic estrogen therapy, but studies demonstrated significant increases in plasma concentrations of estradiol. Such observations have also been reported in postmenopausal breast cancer patients treated with AIs. Further studies are needed to explore risk of breast cancer recurrence after vaginal estrogen application for patients on adjuvant endocrine therapy with AIs.
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Affiliation(s)
- M Moegele
- Department of Obstetrics and Gynecology, University Medical Center Regensburg, Landshuter Str. 65, 93053 Regensburg, Germany
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Xu LW, Kluwe L, Zhang TT, Li SN, Mou YY, Sang Z, Ma J, Lu X, Sun ZJ. Chinese herb mix Tiáo-Gēng-Tāng possesses antiaging and antioxidative effects and upregulates expression of estrogen receptors alpha and beta in ovariectomized rats. Altern Ther Health Med 2011; 11:137. [PMID: 22206438 PMCID: PMC3286390 DOI: 10.1186/1472-6882-11-137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 12/30/2011] [Indexed: 11/30/2022]
Abstract
Background Herb mixtures are widely used as an alternative to hormonal therapy in China for treatment of the menopausal syndrome. However, composition of these herb mixtures are complex and their working mechanism is often unknown. This study investigated the effect of Tiáo-Gēng-Tāng (TG-decoction), a Chinese herbal mixture extract, in balancing female hormones, regulating expression of estrogen receptors (ERs), and preventing aging-related tissue damage. Methods Ovariectomized 5-month-old female rats were used to model menopause and treated with either TG-decoction or conjugated estrogen for 8 weeks. Estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured in serum and in the hypothalamus. Hypothalamic expression of estrogen receptor (ER) alpha and beta were studied by real-time PCR and western blotting. Total antioxidant capacity (T-AOC), oxidation indicator superoxide dismutase (SOD) activity and tissue damage parameter malondialdehyde (MDA) were measured using standard assays. Aging-related ultrastructural alterations in mitochondria were studied in all animals by transmission electron microscopy. Results TG-decoction-treatment elevated E2 and lowered FSH in serum of ovariectomized rats. The potency and efficacy of TG-decoction on the hypothalamus was generally weaker than that of conjugated estrogens. However, TG-decoction was superior in upregulating expression of ERα and β. TG-decoction increased hypothalamic SOD and T-AOC levels and decreased MDAlevels and mitochondrial damage in hypothalamic neurons. Conclusions TG-decoction balances female hormones similarly to conjugated estrogens but less effectively. However, it is superior in up regulating ERα and β and exhibits antioxidative antiaging activities. Whilst it shares similar effects with estrogen, TG-decoction also seems to have distinctive and more complex functions and activities.
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Miller VM, Kaplan JR, Schork NJ, Ouyang P, Berga SL, Wenger NK, Shaw LJ, Webb RC, Mallampalli M, Steiner M, Taylor DA, Merz CNB, Reckelhoff JF. Strategies and methods to study sex differences in cardiovascular structure and function: a guide for basic scientists. Biol Sex Differ 2011; 2:14. [PMID: 22152231 PMCID: PMC3292512 DOI: 10.1186/2042-6410-2-14] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/12/2011] [Indexed: 02/02/2023] Open
Abstract
Background Cardiovascular disease remains the primary cause of death worldwide. In the US, deaths due to cardiovascular disease for women exceed those of men. While cultural and psychosocial factors such as education, economic status, marital status and access to healthcare contribute to sex differences in adverse outcomes, physiological and molecular bases of differences between women and men that contribute to development of cardiovascular disease and response to therapy remain underexplored. Methods This article describes concepts, methods and procedures to assist in the design of animal and tissue/cell based studies of sex differences in cardiovascular structure, function and models of disease. Results To address knowledge gaps, study designs must incorporate appropriate experimental material including species/strain characteristics, sex and hormonal status. Determining whether a sex difference exists in a trait must take into account the reproductive status and history of the animal including those used for tissue (cell) harvest, such as the presence of gonadal steroids at the time of testing, during development or number of pregnancies. When selecting the type of experimental animal, additional consideration should be given to diet requirements (soy or plant based influencing consumption of phytoestrogen), lifespan, frequency of estrous cycle in females, and ability to investigate developmental or environmental components of disease modulation. Stress imposed by disruption of sleep/wake cycles, patterns of social interaction (or degree of social isolation), or handling may influence adrenal hormones that interact with pathways activated by the sex steroid hormones. Care must be given to selection of hormonal treatment and route of administration. Conclusions Accounting for sex in the design and interpretation of studies including pharmacological effects of drugs is essential to increase the foundation of basic knowledge upon which to build translational approaches to prevent, diagnose and treat cardiovascular diseases in humans.
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Affiliation(s)
- Virginia M Miller
- Departments of Surgery, Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Affiliation(s)
- Amos Pines
- Department of Medicine "T", Ichilov Hospital, Tel-Aviv, The International Menopause Society, World School for the Study of Menopause (WSSM), Israel
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Further evidence for promoting transdermal estrogens in the management of postmenopausal symptoms. Menopause 2011; 18:1038-9. [PMID: 21946050 DOI: 10.1097/gme.0b013e31822d6677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Osteoporosis causes approximately 1.5 million fractures every year in the United States. Not only can these fractures be painful and disfiguring but they may reduce a person's ability to lead an active life as well. Osteoporosis affects every bone in the body, but the most common places where fractures occur are the back, hips, and wrists. Because osteoporosis thins bones, weakening them and making them more susceptible to fractures, practitioners must understand the risk factors and the diagnosis and management of this very common problem. This article, geared toward advanced practice nurses, presents a summary of the latest diagnostic tests and medication treatments available and approved by the Food and Drug Administration for the management of osteoporosis.
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Abstract
Although women have a lower incidence of stroke than men in most age groups, women have an overall increased lifetime risk of stroke. Women also have unique risk factors for stroke, including the menopausal transition, the existence of debilitating vasomotor symptoms for some women, and the issues related to hormonal treatment for those symptoms. Although the initial studies of hormone therapy (HT) use in postmenopausal women suggested significant protection against heart disease, there was no obvious protection against stroke. Randomized trials of HT for secondary prevention showed a lack of benefit for both heart disease and stroke, and the suggestion of some early risk after initiation. However, the Women's Health Initiative (WHI), a primary prevention study of the impact of HT on women aged 50 to 79 years, showed an increased risk of stroke, whether the HT was estrogen alone or estrogen combined with progestin. Therefore, HT is not recommended for stroke prevention, and it appears to cause harm. The reason for this increased stroke risk is not understood, but some have suggested that the initiation of HT closest to the time of menopausal transition should decrease the risk. Although there was a lower risk of heart disease when HT was initiated earlier, the risk appeared to be the same for stroke regardless of the timing. This was shown in both the WHI and the Nurses' Health Study cohorts. Therefore, more research is needed to understand the mechanisms for the increased stroke risk and to identify those who may be at risk because of HT for vasomotor symptoms, atrophic vaginitis, or osteoporosis, the three remaining indications for HT use in women. Trials are under way to assess the intermediate outcomes of HT on subclinical vascular disease in perimenopausal/early postmenopausal women.
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