Hormone-replacement therapy in menopause

Chap. 47 - Hormone-Replacement Therapy in Menopause Universal Program Number 014-999-07-062-H04... 

Estrogen is uricosuric and that is most probably the reason why premenopausal women do not have primary gout. Estrogen hormone replacement therapy in post-menopausal women lowered serum uric acid (SUA). Consequently, the prevalence of primary gout in these subjects is similar to what is seen in pre-menopausal women. 

Uniabeled Uses Hormone replacement therapy in estrogen-treated menopausal women... 

Lemay, A., Dodin, S., and Kadri, N. 2002. Flaxseed dietary supplement versus hormone replacement therapy in hypercholesterolemic menopausal women. Obstet. Gynecol. 100, 495-504. 

Pre-menopausal women suffer less cardiovascular disease than men do. This protection disappears, however, after the menopause, and hormone replacement therapy in post-menopausal women reduces cardiovascular mortality. Animal work suggests that oestrogens dilate blood vessels by an endothelium-dependent mechanism, but as yet there is no direct evidence to show that NO generation is different between men and women. This is an area of considerable interest, particularly as women have greater longevity than men and suffer less ischaemic heart disease. Abnormal NO production may occur in hypercholesterolaemia and may be related to subsequent development of atherosclerosis. There is now a body of experimental data to suggest that an abnormality in NO production or function may be causal, or at least an amplifying factor, in both hypercholesterolaemia and atherosclerosis. 

While only steroids against asthma come high on the above lists, the chemical class as a whole plays an unusual role, being the active component of oral contraceptives some anti-asthma drugs some anti-inflammatories and conjugated estrogenic hormone, taken as hormone replacement therapy by menopausal women. Some other chemical classes resanble steroids in being therapeutically active in a number of areas, and the most important of these are shown in Table 45.3. 

Woo, ]., E. Lau, S.C. Ho, et al. 2003. Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause. Menopause 10 (4) 352-361. 

Estrogens and progestins are diminished in menopausal or ovarectomized women. In hormone replacement therapy (HRT), these hormones are substituted to alleviate hot flushes, mood changes, sleep disorders, and osteoporosis. 

There is much interest in the possible hormonal effects of phytoestrogens in both men and women. The majority of studies conducted in women have examined the ability of phytoestrogens to alleviate menopausal symptoms. Whilst hormone replacement therapy is recommended for women experiencing menopausal symptoms, there remains some uncertainty as to whether HRT can increase the risk of breast cancer. As a result of these concerns, investigations into natural alternatives such as phytoestrogens have received considerable attention. 

Many women seek medical treatment for the relief of menopausal symptoms, primarily hot flashes however, the role of hormone-replacement therapy (HRT) has changed dramatically over the years. HRT has long been prescribed for relief of menopausal symptoms and, until recent years, has been purported to protect women from CHD. The original reason behind recommending HRT in postmenopausal women revolved around a simple theory If the hormones lost during menopause were replaced through drug therapy, women would be protected from both menopausal symptoms and chronic diseases that often follow after a woman experiences menopause. Recent studies have disproved this theory. 

Osteoporosis Oral calcium supplementation (1000-5000 mg/day) Oral vitamin D Calcifediol (1000 lU/day) Calcitriol (0.5 mcg/day) Hormone-replacement therapy Calcitonin or oral bisphosphonates If daily intake less than 1000 mg elemental calcium Documented deficiency If kidney functioning If kidney not functioning Post-menopausal women without contraindications Documented loss in bone mineral density greater than 3% Data lacking for bisphosphonates in patients with Rl... 

Estrogen enhances Candida adherence to vaginal epithelial cells and yeast-mycelial transformation this is supported by the fact that infection rates are lower before menarche and after menopause (except in women taking hormone replacement therapy), while rates are higher during pregnancy... 

Hormone therapy has proven highly effective in controlling the menopausal syndrome, especially severe hot flushes (MacLennan et al. 2004), even at doses significantly lower than those used until now (Speroff et al. 2000 Utian et al. 2001). Women s Health Initiative studies found that hormone replacement therapy, when administered as a primary prevention intervention for CVD in older women, increases the risk of heart disease and breast cancer. Even if a protective effect on fracture and colon cancer was observed, the risk-benefit ratio led to a recommendation of this treatment only for the short-term relief of menopausal symptoms (Rossouw et al. 2002 Anderson et al. 2004). The role of early administration of ovarian hormones to young postmenopausal women in the prevention of cardiovascular disease or late dementia remains... 

McCoy, N. L. The menopause and sexuality. 1992. In The Menopause and Hormonal Replacement Therapy ed. R. Sitruk-Ware and W.H. Utian. New York Marcel Dekker, pp. 73—100. 

The clinical problems that arise in the menopause are hot flushes, sweating, depression, decreased libido, increased risk of cardiovascular disease and osteoporosis. The latter results in increased incidence of hip, radial and vertebral fractures. Oestrogen is one factor controlling synthesis of active vitamin D and osteoporosis is in part due to a deficiency of vitamin D. Not surprisingly, to reduce these problems, administration of oestrogen is recommended (known as hormone replacement therapy or HRT). HRT reduces some of the risk factors for coronary artery disease since it reduces blood pressure and decreases the blood level of LDL-cholesterol and increases that of HDL-cholesterol. However, there is considerable debate about whether HRT increases the risk of breast or endometrial cancer. 

Hormone replacement therapy provides relief from vasomotor symptoms, decreases the risk of osteoporosis and decreases the risk of cardiovascular disease in post-menopausal women. 

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