Menopause estrogen treatment

In untreated women, the main risk factors for endometrial carcinoma are age, obesity, nulliparity, late menopause (and possibly early menarche), the Stein-Leventhal syndrome, exposure to exogenous estrogens, radiation, and certain systemic diseases, including diabetes mellitus, hypertension, hypothyroidism, and arthritis (SED-14, 1451) (88). Certain of these risk factors indicate that an altered endocrine state with increased estrogen stimulation is a predisposing cause, and one might thus in theory expect estrogen treatment (and notably hormonal replacement therapy) to increase the risk (SEDA-22, 466). 

The choice of an optimal and reasonably safe dose of a hormonal product varies with race and population, at least because of variations in body weight and possibly also differences in metabolic processes. Dosage studies, for example with very low-dose estrogen treatment, must therefore of necessity be conducted in different populations. In menopausal Chinese women, a daily dose of... 

Estrogenic agents, listed in Table 5, hasten sexual maturation in the female. The widest use of estrogens is in the treatment of the menopause. Estrogens are also used in the control of cancer of the prostate in the male. 

Doctors advise many menopausal patients to counter their symptoms with hormone replacement therapy, but this approach isn t appropriate for all women. A family history of breast or uterine cancer precludes estrogen treatment, as does a history of chronic liver disease. 

Menopause begins a period of bone loss that extends until the end of life. It is the major contributor to higher rates of osteoporotic fractures in older women. The decrease in serum estrogen concentrations at menopause is associated with accelerated bone loss, especially from the spine, for the next 5 years, during which approximately 15% of skeletal calcium is lost. The calcium loss by women in early menopause cannot be prevented unless estrogen therapy is provided. Calcium supplements alone are not very helpful in preventing postmenopausal bone loss. Upon estrogen treatment, bone resorption is reduced and the intestinal calcium... 

ERT is a clinical treatment whereby premenopausal estrogen levels are restored and the symptoms of menopause are relieved. 

Vasomotor symptoms, as well as other menopausal symptoms, occur in over 50% of perimenopausal women and over 80% of menopausal women.5 Menopausal symptoms tend to be more severe in women who undergo surgical menopause compared with natural menopause because of the more rapid decline in estrogen concentrations. Women who seek medical treatment should undergo laboratory evaluation to rule out other conditions that may present with similar symptoms, such as abnormal thyroid function or pituitary adenoma. Once other conditions have been excluded, HRT should be considered. 

Estrogen currently is indicated for the treatment of moderate to severe vasomotor symptoms and vulvovaginal atrophy associated with menopause. In addition, it is indicated for the prevention of postmenopausal osteoporosis in women with significant risk however, it is recommended that non-estrogen medications receive consideration for long-term use. Oral or transdermal estrogen products should be prescribed at the lowest... 

Salicylate esters may be promising prodrug candidates for estrogen. 0-Estradiol has been used for treatment of various conditions such as menopausal... 

Note that the dried rhizome of Cimicifuga racemosa (British Pharmaceutical Codex, 1934 black cohosh) has been used as a bitter and mild expectorant in the form of a liquid alcoholic extract (1 in 1 dose 0.3-2 mL) and is sold as alternative remedy for the treatment of menopausal syndrome at dose of 40-80 mg/day. The active constituents of black cohosh, and, therefore, the precise molecular mechanism of action involved in the climacteric property of Cimicifuga racemosa, are still unknown. The most recent data suggest that the plant is not estrogenic sensu stricto (126). 

TABLE 31-2 Estrogen for Treatment of Menopausal Symptoms and Osteoporosis Prevention ... 

In conclusion, a shorter time since menopause and surgical menopause are important predictors of hot flashes not only before but also during treatment with raloxifene. Previous estrogen/progestin therapy also increases the risk... 

Besides contraception, the uses of estrogens can largely be put into three main groups the management of the menopausal and postmenopausal syndrome (its widest use) physiological replacement therapy in deficiency states and the treatment of prostatic cancer and of breast cancer in postmenopausal women. 

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