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Memi E, Pavli P, Papagianni M, Vrachnis N, Mastorakos G. Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09882-0. [PMID: 38652231 DOI: 10.1007/s11154-024-09882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
Progesterone is a natural steroid hormone, while progestins are synthetic molecules. In the female reproductive system, progesterone contributes to the control of luteinizing hormone and follicle-stimulating hormone secretion and their pulsatility, via its receptors on the kisspeptin, neurokinin B, and dynorphin neurons in the hypothalamus. Progesterone together with estradiol controls the cyclic changes of proliferation and decidualization of the endometrium; exerts anti-mitogenic actions on endometrial epithelial cells; regulates normal menstrual bleeding; contributes to fertilization and pregnancy maintenance; participates in the onset of labor. In addition, it exerts numerous effects on other endocrine systems. Micronized progesterone (MP) is natural progesterone with increased bioavailability, due to its pharmacotechnical micronized structure, which makes it an attractive diagnostic and therapeutic tool. This critical literature review aims to summarize and put forward the potential diagnostic and therapeutic uses of MP in the field of endocrinology. During reproductive life, MP is used for diagnostic purposes in the evaluation of primary or secondary amenorrhea as a challenge test. Moreover, it can be prescribed to women presenting with amenorrhea or oligomenorrhea for induction of withdrawal bleeding, in order to time blood-sampling for diagnostic purposes in early follicular phase. Therapeutically, MP, alone or combined with estrogens, is a useful tool in various endocrine disorders including primary amenorrhea, abnormal uterine bleeding due to disordered ovulation, luteal phase deficiency, premenstrual syndrome, polycystic ovary syndrome, secondary amenorrhea [functional hypothalamic amenorrhea, premature ovarian insufficiency], perimenopause and menopause. When administrated per os, acting as a neurosteroid directly or through its metabolites, it exerts beneficial effects on brain function such as alleviation of symptoms of anxiety and depression, asw well as of sleep problems, while it improves working memory in peri- and menopausal women. Micronized progesterone preserves full potential of progesterone activity, without presenting many of the side-effects of progestins. Although it has been associated with more frequent drowsiness and dizziness, it can be well tolerated with nocturnal administration. Because of its better safety profile, especially with regard to metabolic ailments, breast cancer risk and veno-thromboembolism risk, MP is the preferred option for individuals with an increased risk of cardiovascular and metabolic diseases and of all-cause mortality.
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Affiliation(s)
- Eleni Memi
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Polina Pavli
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece
| | - Maria Papagianni
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100, Trikala, Greece
- Endocrine Unit, 3rd Department of Pediatrics, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642, Thessaloniki, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Chaidari, Athens, Greece
- St George's NHS Foundation Trust Teaching Hospitals, St George's University of London, London, UK
| | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus, and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Vas. Sophias Av. 76, 11528, Athens, Greece.
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Morga A, Ajmera M, Gao E, Patterson-Lomba O, Zhao A, Mancuso S, Siddiqui E, Kagan R. Systematic review and network meta-analysis comparing the efficacy of fezolinetant with hormone and nonhormone therapies for treatment of vasomotor symptoms due to menopause. Menopause 2024; 31:68-76. [PMID: 38016166 DOI: 10.1097/gme.0000000000002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
IMPORTANCE The neurokinin 3 receptor antagonist fezolinetant 45 mg/d significantly reduced frequency/severity of moderate to severe vasomotor symptoms (VMS) of menopause compared with placebo in two phase 3 randomized controlled trials. Its efficacy relative to available therapies is unknown. OBJECTIVE We conducted a systematic review and Bayesian network meta-analysis to compare efficacy with fezolinetant 45 mg and hormone therapy (HT) and non-HT for VMS in postmenopausal women. EVIDENCE REVIEW Using OvidSP, we systematically searched multiple databases for phase 3 or 4 randomized controlled trials in postmenopausal women with ≥7 moderate to severe VMS per day or ≥50 VMS per week published/presented in English through June 25, 2021. Mean change in frequency and severity of moderate to severe VMS from baseline to week 12 and proportion of women with ≥75% reduction in VMS frequency at week 12 were assessed using fixed-effect models. FINDINGS The network meta-analysis included data from the pooled phase 3 fezolinetant trials plus 23 comparator publications across the outcomes analyzed (frequency, 19 [34 regimens]; severity, 6 [7 regimens]; ≥75% response, 9 [15 regimens]). Changes in VMS frequency did not differ significantly between fezolinetant 45 mg and any of the 27 HT regimens studied. Fezolinetant 45 mg reduced the frequency of moderate to severe VMS events per day significantly more than all non-HTs evaluated: paroxetine 7.5 mg (mean difference [95% credible interval {CrI}], 1.66 [0.63-2.71]), desvenlafaxine 50 to 200 mg (mean differences [95% CrI], 1.12 [0.10-2.13] to 2.16 [0.90-3.40]), and gabapentin ER 1800 mg (mean difference [95% CrI], 1.63 [0.48-2.81]), and significantly more than placebo (mean difference, 2.78 [95% CrI], 1.93-3.62]). Tibolone 2.5 mg (the only HT regimen evaluable for severity) significantly reduced VMS severity compared with fezolinetant 45 mg. Fezolinetant 45 mg significantly reduced VMS severity compared with desvenlafaxine 50 mg and placebo and did not differ significantly from higher desvenlafaxine doses or gabapentin ER 1800 mg. For ≥75% responder rates, fezolinetant 45 mg was less effective than tibolone 2.5 mg (not available in the United States) and conjugated estrogens 0.625 mg/bazedoxifene 20 mg (available only as 0.45 mg/20 mg in the United States), did not differ significantly from other non-HT regimens studied and was superior to desvenlafaxine 50 mg and placebo. CONCLUSIONS The only HT regimens that showed significantly greater efficacy than fezolinetant 45 mg on any of the outcomes analyzed are not available in the United States. Fezolinetant 45 mg once daily was statistically significantly more effective than other non-HTs in reducing the frequency of moderate to severe VMS. RELEVANCE These findings may inform decision making with regard to the individualized management of bothersome VMS due to menopause.
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Affiliation(s)
| | | | | | | | | | | | | | - Risa Kagan
- University of California, San Francisco and Sutter East Bay Medical Foundation, Berkeley, CA
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3
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Prior JC, Cameron A, Fung M, Hitchcock CL, Janssen P, Lee T, Singer J. Oral micronized progesterone for perimenopausal night sweats and hot flushes a Phase III Canada-wide randomized placebo-controlled 4 month trial. Sci Rep 2023; 13:9082. [PMID: 37277418 DOI: 10.1038/s41598-023-35826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
This study tested progesterone for perimenopausal hot flush ± night sweat (vasomotor symptom, VMS) treatment. It was a double-blind, randomized trial of 300 mg oral micronized progesterone@bedtime versus placebo for 3-months (m) after a 1-m untreated baseline during 2012/1-2017/4. We randomized untreated, non-depressed, screen- and baseline-eligible by VMS, perimenopausal women (with flow within 1-year), ages 35-58 (n = 189). Participants aged 50 (± SD = 4.6) were mostly White, educated, minimally overweight with 63% in late perimenopause; 93% participated remotely. The 1° outcome was 3rd-m VMS Score difference. Participants recorded VMS number and intensity (0-4 scale)/24 h on a VMS Calendar. Randomization required VMS (intensity 2-4/4) of sufficient frequency and/or ≥ 2/week night sweat awakenings. Baseline total VMS Score (SD) was 12.2 (11.3) without assignment difference. Third-m VMS Score did not differ by therapy (Rate Difference - 1.51). However, the 95% CI [- 3.97, 0.95] P = 0.222, did not exclude 3, a minimal clinically important difference. Women perceived progesterone caused decreased night sweats (P = 0.023) and improved sleep quality (P = 0.005); it decreased perimenopause-related life interference (P = 0.017) without increased depression. No serious adverse events occurred. Perimenopausal night sweats ± hot flushes are variable; this RCT was underpowered but could not exclude a minimal clinically important VMS benefit. Perceived night sweats and sleep quality significantly improved.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada.
- School of Population and Public Health, UBC, Vancouver, Canada.
- British Columbia Women's Health Research Institute, Vancouver, Canada.
- Endocrinology and Metabolism, Department of Medicine, UBC, Vancouver, BC, Canada.
| | - Andrea Cameron
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
| | - Michelle Fung
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- Etobicoke General Hospital, William Osler Health System, Etobicoke, ON, Canada
| | - Christine L Hitchcock
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- Hitchcock Consulting, Oakville, ON, Canada
| | - Patricia Janssen
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia (UBC), 2775 Laurel Street, Suite 4111, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, Canada
- British Columbia Women's Health Research Institute, Vancouver, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Joel Singer
- School of Population and Public Health, UBC, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
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Costa APF, Sarmento ACA, Vieira-Baptista P, Eleutério J, Cobucci RN, Gonçalves AK. Hormonal Approach for Postmenopausal Vulvovaginal Atrophy. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:783247. [PMID: 36303971 PMCID: PMC9580661 DOI: 10.3389/frph.2021.783247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/29/2021] [Indexed: 11/14/2022] Open
Abstract
Menopause is a physiological and progressive phenomenon secondary to decreased ovarian follicular reserve that significantly affects the genital tract. Although postmenopausal vulvovaginal atrophy primarily affects postmenopausal women, it is also seen in premenopausal women. The hypoestrogenic condition results in hormonal and anatomical changes, with the main symptoms, are dryness, burning and genital irritation, decreased lubrication, urinary urgency, dysuria, and recurrent urinary tract infections. This review aims to update hormone therapy for urogenital atrophy, both local and systemic, and discusses the importance of understanding and the need for active treatment of this condition. The main therapeutic objective is the relief of symptoms, and hormonal therapy (HT) is still the most effective choice for treating clinical manifestations, despite the side effects of its use. HT should be used in an individualized way to the needs of the women and appropriate to the stage in which she is menopausal, perimenopausal, or after menopause.
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Affiliation(s)
- Ana Paula Ferreira Costa
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- *Correspondence: Ana Paula Ferreira Costa
| | | | - Pedro Vieira-Baptista
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
- Hospital Lusíadas Porto, Porto, Portugal
| | - José Eleutério
- Department of Obstetrics and Gynecology, Federal University of Ceará, Fortaleza, Brazil
| | | | - Ana Katherine Gonçalves
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Department of Obstetrics and Gynaecology, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Women’s reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women’s health. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.ddmod.2020.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Estrogen has been known for a long time to be a trigger on auto-immunity and may influence the course of lupus. Women experiencing systemic lupus are at high risk for premature ovarian insufficiency if using cyclophosphamide, of osteoporosis, arterial ischemic diseases and venous thrombosis at young age. In about 30% of them, an antiphospholipid/anticoagulant antibody can occur which is associated with very high risk of thrombosis. However, the severity of the disease may vary and some women with lupus could benefit from a menopausal hormone therapy (MHT). As a consequence, management of menopause symptoms needs to evaluate carefully the condition of the patient, her lupus history and cardiovascular risk. We will describe the effect of lupus on menopause, of menopause on lupus and report in detail the literature available on MHT and the risk of lupus or the risk of flares in women with lupus. Some other options than MHT for the management of climacteric symptoms will be discussed.
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Affiliation(s)
- A Gompel
- Gynaecological Endocrinology Unit, Paris Descartes University, Paris, France
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7
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Carr C, Vertelney H, Fronk J, Trieu S. Dronabinol for the Treatment of Paraneoplastic Night Sweats in Cancer Patients: A Report of Five Cases. J Palliat Med 2019; 22:1221-1223. [DOI: 10.1089/jpm.2018.0551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Connie Carr
- School of Nursing, San Francisco State University, San Francisco, California
| | - Haley Vertelney
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joshua Fronk
- Oncology Palliative Care, Stanford University School of Medicine, Stanford, California
| | - Sandy Trieu
- Palliative Medicine, Stanford University School of Medicine, Stanford, California
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8
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Brazaitis M, Eimantas N, Baranauskiene N, Kilikeviciene S, Vitkauskiene A, Daniuseviciute L. Effects of severe whole-body hyperthermia on ovarian hormone and extracellular Hsp72 responses in young adult women. Int J Hyperthermia 2019; 36:660-665. [DOI: 10.1080/02656736.2019.1627431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marius Brazaitis
- Institute of Sports Science and Innovations Lithuanian Sports University, Kaunas, Lithuania
| | - Nerijus Eimantas
- Institute of Sports Science and Innovations Lithuanian Sports University, Kaunas, Lithuania
| | - Neringa Baranauskiene
- Institute of Sports Science and Innovations Lithuanian Sports University, Kaunas, Lithuania
| | - Sandra Kilikeviciene
- Institute of Sports Science and Innovations Lithuanian Sports University, Kaunas, Lithuania
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laura Daniuseviciute
- Department of Educational Studies, Kaunas University of Technology, Kaunas, Lithuania
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Casimiro I, Cohen RN. Severe Vasomotor Symptoms Post-Oophorectomy Despite Testosterone Therapy in a Transgender Man: A Unique Case Study. J Endocr Soc 2019; 3:734-736. [PMID: 30931422 PMCID: PMC6436763 DOI: 10.1210/js.2018-00367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/07/2019] [Indexed: 11/19/2022] Open
Abstract
Vasomotor symptoms (VMS), such as hot flashes and night sweats, are intense and rapid sensations of internal heat, peripheral vasodilation, and profuse sweating that can be debilitating. They occur as a result of central norepinephrine discharge and narrowing of the core body thermoneutral zone with dropping brain estrogen levels in women and men. Therapy options for the treatment of VMS in postmenopausal women have been widely studied. However, we address treatment strategies for VMS that occur in some transgender men who have undergone oophorectomy. A 35-year-old female-to-male transgender man presented with symptoms of severe and frequent VMS that began shortly after total hysterectomy and oophorectomy. The patient was treated with a stable dose of testosterone for gender affirmation, and previous attempts to increase his testosterone dose did not relieve the VMS. In addition to his testosterone therapy, 0.025 to 0.0375 mg, twice per week, of transdermal estradiol was added to his hormonal regimen. Addition of estradiol completely relieved the VMS, and masculinization was not affected. Discontinuation of estradiol led to the recurrence of VMS at the same severity as previously experienced, which was associated with a low level of serum estrogen. VMS in a transgender man taking testosterone were successfully treated with the addition of transdermal estradiol.
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Affiliation(s)
- Isabel Casimiro
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago Medicine, Chicago, Illinois
| | - Ronald N Cohen
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago Medicine, Chicago, Illinois
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10
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Affiliation(s)
- J. C. Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, BC, Canada
- Associate to the School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Women’s Health Research Institute, Vancouver, BC, Canada
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11
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Gompel A, Plu-Bureau G. Progesterone, progestins and the breast in menopause treatment. Climacteric 2018; 21:326-332. [DOI: 10.1080/13697137.2018.1476483] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- A. Gompel
- Unité de Gynécologie Endocrinienne, Université Paris Descartes Hôpitaux, Universitaires Port Royal-Cochin, Paris, France
| | - G. Plu-Bureau
- Unité de Gynécologie Endocrinienne, Université Paris Descartes Hôpitaux, Universitaires Port Royal-Cochin, Paris, France
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12
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Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women's Health Study. Menopause 2016; 22:1098-107. [PMID: 25783472 DOI: 10.1097/gme.0000000000000434] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the associations of demographic characteristics, health behaviors, and hormone concentrations with the experience of any, current, more severe, and more frequent midlife hot flashes. METHODS Baseline data from 732 women aged 45 to 54 years who were enrolled in the Midlife Women's Health Study were analyzed. A clinic visit was conducted to collect blood samples for hormone assays and to measure ovarian volume using transvaginal ultrasound. A self-administered questionnaire ascertained information on demographic factors, health habits, and hot flash history. Multivariable logistic regression was conducted to examine associations between potential risk factors and hot flash outcomes. RESULTS Approximately 45% of participants reported experiencing midlife hot flashes. In covariate-adjusted models, older age, perimenopause status, current and past cigarette smoking, and depressive symptoms were significantly associated with increased odds of all of the hot flash outcomes. In addition, history of oral contraceptive use was associated with increased odds of any hot flashes. In contrast, higher current alcohol intake was significantly associated with decreased odds of any, current, and more severe hot flashes. Higher estradiol and progesterone concentrations were significantly associated with decreased odds of all hot flash outcomes. CONCLUSIONS Although the temporality of such associations is not known because of the cross-sectional nature of the data, these observed relationships can help to identify women at risk for hot flashes.
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13
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Prior JC. Progesterone or progestin as menopausal ovarian hormone therapy: recent physiology-based clinical evidence. Curr Opin Endocrinol Diabetes Obes 2015; 22:495-501. [PMID: 26512775 DOI: 10.1097/med.0000000000000205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Provide evidence-based recent data on oral micronized progesterone (OMP) and progestins in menopausal hormonal therapy (MHT). RECENT FINDINGS Medroxyprogesterone acetate (MPA) increases breast cancer acting through the glucocorticoid receptor; progestins in MHT increase thrombosis more than oral estrogens; MPA, but not OMP or other progestins, increase monocyte cell endothelium adhesion; MPA and estradiol (E2)/MPA have negative brain effects, whereas E2/progesterone (P4) has neuroregenerative brain effects. The 'window of opportunity' cardiovascular disease hypothesis is not supported by a randomized controlled trial showing that transdermal estradiol with sequential OMP in early menopause does not prevent increased carotid intimal media thickness; P4 in the cardiac electrical system opposes E2 effects and prevents sudden death/long QT syndrome; transdermal estradiol/OMP does not increase venous thromboembolism in observational data. P4 decreases breast cell proliferation and improves prognosis through P4 receptor alteration of estrogen receptor α genetic effects; OMP with conjugated equine estrogen (CEE)/estrogen (E)/E2 does not increase breast cancer in two prospective cohorts, one population-based. Endometrial cancer is increased in MHT of CEE/E/E2+cyclic OMP at 200 mg/day. SUMMARY New data show CEE/E/E2+MPA/P mechanisms for negative breast cancer, venous thromboembolism, cardiovascular system, and brain effects. OMP/P4 counterbalances CEE/E/E2-related negative effects on breast cancer and long QT syndrome. OMP effectively treats vasomotor symptoms and sleep disturbances, and could safely be used alone for symptomatic menopause.
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Affiliation(s)
- Jerilynn C Prior
- Endocrinology and Metabolism, Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Department of Medicine, School of Population and Public Health, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver, Canada
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14
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Faubion SS, Kapoor E, Kuhle CL, Sood R, Thielen JM, Miller VM. Recommendations for hormone therapy in hysterectomized women: importance of new data in clinical management. Expert Rev Endocrinol Metab 2015; 10:55-63. [PMID: 30289039 DOI: 10.1586/17446651.2015.957182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women with a prior hysterectomy with and without oophorectomy represent special cohorts among those who require menopausal hormone therapy (HT), as a progestogen is not required for endometrial protection. This is relevant in light of recent research demonstrating superiority of estrogen therapy alone compared with estrogen plus a progestogen with respect to breast cancer risk and perhaps even cardiovascular protection. No longer is it appropriate to lump all HT regimens together when advising patients. Unfortunately, there is a general reluctance in the healthcare community to prescribe HT even a decade after publication of the results of the Women's Health Initiative trial. However, with subsequent research showing a favorable benefit/risk balance of short-term estrogen therapy in symptomatic, recently menopausal women, especially those who have undergone hysterectomy with oophorectomy, the need for educating patients and providers on the matter cannot be overemphasized.
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Affiliation(s)
- Stephanie S Faubion
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ekta Kapoor
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Carol L Kuhle
- b 2 Department of Preventive Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Richa Sood
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jacqueline M Thielen
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Virginia M Miller
- c 3 Department of Surgery, Mayo Clinic, 4-62 Medical Sciences Building, Rochester, MN 55905, USA
- d 4 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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15
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Charkoudian N, Stachenfeld NS. Reproductive hormone influences on thermoregulation in women. Compr Physiol 2014; 4:793-804. [PMID: 24715568 DOI: 10.1002/cphy.c130029] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The present discussion reviews current knowledge regarding influences of the primary reproductive hormones on mechanisms of thermoregulatory control in women. The human body is remarkably capable of maintaining body temperature within a few tenths of a degree of normal (37°C) over a wide range of activity and environmental exposures; this regulation is accomplished via integration of central and peripheral thermal information at the preoptic area of the anterior hypothalamus (PO/AH). We describe both central and peripheral mechanisms involved in controlling thermoregulation in humans, and how these mechanisms are affected by sex and hormone exposure. Estrogens generally promote vasodilation, heat dissipation, and lower body temperature and progesterone or progestins generally have the opposite effect. Estrogens and progesterone/progestins can also interact with androgens; this is an important point because androgens in the body can increase in both older and younger women. The study of reproductive hormone (estrogens, progesterone, luteinizing, and follicle stimulating hormones) effects on body systems is challenging because of the complex and multifaceted influences of these hormones, both individually and in combination. Thus, a number of methods to alter hormone exposure are explained in this article. We conclude that men and women do not exhibit major quantitative differences in physiological thermoregulatory responses to exercise and/or body heating when factors such as fitness and body size are taken into account. However, female and male reproductive hormones have important influences that can significantly alter individual thermoregulatory responses at various points throughout the lifespan.
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Affiliation(s)
- Nisha Charkoudian
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
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Casey PM, Faubion SS, MacLaughlin KL, Long ME, Pruthi S. Caring for the breast cancer survivor’s health and well-being. World J Clin Oncol 2014; 5:693-704. [PMID: 25302171 PMCID: PMC4129533 DOI: 10.5306/wjco.v5.i4.693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/25/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
The breast cancer care continuum entails detection, diagnosis, treatment, and survivorship. During this time, focus on the whole woman and medical concerns beyond the breast cancer diagnosis itself is essential. In this comprehensive review, we critically review and evaluate recent evidence regarding several topics pertinent to and specific for the woman living with a prior history of breast cancer. More specifically, we discuss the most recent recommendations for contraceptive options including long-acting reversible contraception and emergency contraception, fertility and pregnancy considerations during and after breast cancer treatment, management of menopausal vasomotors symptoms and vulvovaginal atrophy which often occurs even in young women during treatment for breast cancer. The need to directly query the patient about these concerns is emphasized. Our focus is on non-systemic hormones and non-hormonal options. Our holistic approach to the care of the breast cancer survivor includes such preventive health issues as sexual and bone health,which are important in optimizing quality of life. We also discuss strategies for breast cancer recurrence surveillance in the setting of a prior breast cancer diagnosis. This review is intended for primary care practitioners as well as specialists caring for female breast cancer survivors and includes key points for evidence-based best practice recommendations.
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Abstract
CLINICAL SCENARIO A 51-year-old postmenopausal third-grade teacher requests help for her hot flashes. She finds them especially troubling as she stands in front of her class and starts sweating. Although one student offers her tissues, others make fun of her--disrupting the class. Her sleep is interrupted several times a night. She refuses to use any form of estrogen because her mother died of breast cancer at the age of 60 years. Perhaps alternative therapies can help her.
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