Hormone replacement therapy postmenopausal

Hormone-replacement therapy Postmenopausal women without contraindications... 

KOMULAINEN M, KROGER H, TUPPURAINEN M T, HEIKKINEN A M, ALHAVA E, HONKANEN R, lURVELIN I and SAARiKOSKi s (1999) Prevention of femoral and lumbar bone loss with hormone replacement therapy and vitamin D3 in early postmenopausal women a population-based 5-year randomized trial. J Clin Endocrinol Metab 84, 546-52. 

MORABITO N, CRISAFULLI A, VERGARA C, GAUDIO A, LASCO A, FRISINA N, D ANNA R, CORRADO F, PIZZOLEO M A, CINCOTTA M, ALTAVILLA d, lentile r, squadrito f (2002), Effects of genistein and hormone-replacement therapy on bone loss in early postmenopausal women A randomized double-blind placebo-controlled study. J Bone Miner Res 17, 1904-1912. 

PRINCE R L, SMITH M, DICK I M, PRICE R I, WEBB P G, HENDERSON N K and HARRIS M M (1991) Prevention of postmenopausal osteoporosis. A comparative study of exercise, calciiun supplementation, and hormone-replacement therapy. N Eng J Med 325, 1189-95. 

For some conditions, a large placebo effect can be anticipated. For example, studies of hormone replacement therapies for hot flashes in postmenopausal women consistently show a 50% decline from baseline in the number of daily hot flashes in the placebo group. Therefore, in order to show significance, an active treatment must produce an effect that is substantially larger than 50%. A marked placebo response is commonly observed with any condition that has a subjective component, such as chronic pain (e.g. arthritis), episodic pain (e.g. headaches), psychological states (e.g. anxiety), and certain physiologic measurements (e.g. blood pressure). 

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. 

Long-term use of hormone-replacement therapy and concurrent use of progestins appear to contribute to breast cancer risk.7 The use of postmenopausal estrogen-replacement therapy in women with a history of breast cancer generally is considered contraindicated. However, most experts believe that the safety and benefits of low-dose oral contraceptives currently outweigh the potential risks and that changes in the prescribing practice for the use of oral contraceptives are not warranted. Oral contraceptives are known to reduce the risk of ovarian cancer by about 40% and the risk of endometrial cancer by about 60%. 

Diamanti-Kandarakis E, Sykiotis GP, Papavassiliou AG (2003) Selective modulation of postmenopausal women cutting the Gordian knot of hormone replacement therapy with breast carcinoma. Cancer 97 12... 

Alexandersen P, Riis BJ, Stakkestad JA, Delmas PD, Christiansen C (2001) Efficacy of levormeloxifene in the prevention of postmenopausal bone loss and on the lipid profile compared to low dose hormone replacement therapy. J Clin Endocrinol Metab 86 755-760... 

Manson JE, Martin KA (2001) Postmenopausal hormone-replacement therapy. N Engl J Med 345 34-40... 

Nelson HD, Humphrey LL, Nygren P, Teutsch SM, Allan JD (2002) Postmenopausal hormone replacement therapy scientific review. J Am Med Assoc 288 872-881... 

Wells G, Tugwell P, Shea B, Guyatt G, Peterson J, Zytaruk N, Robinson V, Henry D, O Connell D, Cranney A (2002) Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 23 529-539... 

Anderson PW, Cox DA, Sashegyi A, Paul S, Silfen SL, Walsh BW (2001) Effects of raloxifene and hormone replacement therapy on markers of serum atherogenicity in healthy postmenopausal women. Maturitas 39 71-77... 

Chen FPL, Lee N, Wang CH, Soong YK (1998) Effects of hormone replacement therapy on cardiovascular risk factors in postmenopausal women. Fertil Steril 69 267-273... 

Heikkinen AM, Niskanen L, Yla-Herttuala S, Luoma J, Tuppurainen MT, Komu-lainen M, Saarikoski S (1998) Postmenopausal hormone replacement therapy and autoantibodies against oxidized LDL. Maturitas 29 155-161... 

Saitta A, Altavilla D, Cucinotta D, Morabito N, Frisina N, Corrado F, D Anna R, Lasco A, Squadrito G, Gaudio A, Cancellieri F, Arcoraci V, Squadrito F (2001) Randomized, double-blind, placebo-controlled study on effects of raloxifene and hormone replacement therapy on plasma no concentrations, endothelin-1 levels, and endothelium-dependent vasodilation in postmenopausal women. Arterioscler Thromb Vase Biol 21 1512-1519... 

Walsh BW, Paul S, Wild RA, Dean RA, Tracy RP, Cox DA, Anderson PW (2000) The effects of hormone replacement therapy and raloxifene on C-reactive protein and homocysteine in healthy postmenopausal women a randomized, controlled trial. J Clin Endocrinol Metab 85 214-218... 

Fugere P, Scheele WH, Shah A, et al. (2000) Uterine effects of raloxifene in comparison with continuous-combined hormone replacement therapy in postmenopausal women. Am J Obstet Gynecol 182 568-574... 

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... 

New therapeutic approaches and special patient populations (such as pediatrics, geriatrics, bioidentical hormone replacement therapy for postmenopausal women, pain management, and dental patients)... 

Estrogens are most commonly used as a component of combination contraceptives or as hormone replacement therapy in postmenopausal women. Benefits in postmenopausal women include relief of moderate to severe vasomotor symptoms and decreased risk of osteoporosis. Hormone replacement therapy also may be used in vaginal and vulvar atrophy and in hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure. Less commonly, select breast or prostate cancer... 

There is considerable interest in the role of estrogen hormone replacement therapy as a cognitive enhancer in postmenopausal women. Although there is some evidence for improved cognitive abilities in postmenopausal women receiving estrogen replacement therapy, the effects reported thus far are modest. 

Nelson HD et al. Postmenopausal hormone replacement therapy Scientific review. JAMA 2002 288 872-881. 

Clarkson TB, Anthony MS, Williams JK, Honore EK, Cline JM. The potential of soybean phytoestrogens for postmenopausal hormone replacement therapy. Proc. Soc. Exp. Biol Med. 217, 365-368, 1998. 

Psaty, B.M., N.L. Smith, R.N. Lemaitre, H.L. Vos, S.R. Heckbert, A.Z. LaCroix, and F.R. Rosendaal, Hormone replacement therapy, prothrombotic mutations, and the risk of incident nonfatal myocardial infarction in postmenopausal women. Jama, 2001.285(7) 906-13. 

Finally, sex steroids are also implicated in the pathophysiology of depression. Estrogen deficiency states, which occur in the postpartum and postmenopausal periods, are thought to play a role in the etiology of depression in some women. Likewise, severe testosterone deficiency in men is sometimes associated with depressive symptoms. Hormone replacement therapy in hypogonadal men and women may be associated with an improvement in mood and depressive symptoms. 

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