Post-menopausal women

Since dietary cereals are low in sulfur-containing amino acids, they produce an alkaline urine which favors the retention of bone minerals. In post-menopausal women, there appears to be some interaction between the diet and the effect produced by estrogens on bone mineral content (28). 

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... 

Although the human pituitary is the obvious source of human gonadotrophins, it also constitutes an impractical source of medically useful quantities of these hormones. However, the urine of post-menopausal women does contain both FSH and LH activity. Up until relatively recently, this has served as the major source used medically, particularly of FSH. 

Badia X, Diez-Perez A, Lahoz R, Lizan L, Nogues X, Iborra J (2004) The ECOS-16 questionnaire for the evaluation of health related quality of life in post-menopausal women with osteoporosis. Health Qual Life Outcomes 2(1) 41... 

Endogenous Hormones and Breast Cancer Collaborative Group (2003) Body mass index, serum sex hormones and breast cancer risk in post menopausal women. J Natl Cancer Inst 95 1218-1226... 

Love RR, Mazess RB, Barden HS et al. (1992) Effects of tamoxifen in bone mineral density in post menopausal women with breast cancer. N Engl J Med 326 852-856... 

A 3-week study of MK-0822 (0.5, 2.5 and 10 mg qd) in post-menopausal women showed a 70-80% reduction in serum CTx at the top dose and an 80% reduction in urinary NTx at both the 2.5 and 10 mg doses [74]. The compound was safe and well-tolerated throughout the dosing period. 

Raloxifene, a more complete uterine antagonist than tamoxifen or clomiphene, significantly reduces leiomyoma size in post-menopausal women [31], yet it is less efficacious at reducing tumor volume in pre-menopausal women [32], This result has been attributed to the poor pharmacokinetic properties of this compound in which extensive conjugative metabolism of the phenol(s) limits the circulating levels of the parent drug. In addition, clinical outcomes in premenopausal women treated with raloxifene suggest that this compound, like tamoxifen and clomiphene, can affect the ovaries via the HPO axis [33]. These data, taken collectively, indicate that current SERMs lack the efficacy, pharmacokinetic, and ovarian safety properties needed to treat leiomyoma in ovulatory women. 

Bone is the main source of calcium in the human body. Osteoporosis, decreased calcium salt reserves in the body, has become the most prevalent bone disease in the U.S., being especially prevalent among post-menopausal women (1). Typical signs of this debilitating condition include backache with spasms, wedge fractures of the dorsal and lumbar vertebrae, and hip fractures (2). 

Age, calcium intake, hormonal status, exercise and vitamin status have all been implicated in the development of osteoporosis. Estrogen levels represent an important factor in skeletal calcium retention and homeostasis. In therapeutic trials in which post-menopausal women were given daily doses of estrogens, such therapy has been demonstrated to be partially effective in reducing the rate of bone resorption. However, this therapy has the concomitant hazard of endometrial cancer (10). Vitamin D and its hormones have been given considerable attention in the more recent studies. Without adequate dietary and tissue levels of such vitamins, calcium absorption and bone status will be impaired. 

Howes, J.B., Sullivan, D., Lai, N., Nestel, P., Pomeroy, S., West, L., Eden, J.A. and Howes, L.G. (2000). The effects of dietary supplementation with isoflavones from red clover on the lipoprotein profiles of post menopausal women with mild to moderate h5q)ercholesterolaemia, Atherosclerosis, 152, 143-147. 

Petrakis, N.L., Barnes, S., King, E.B., et al. (1996). Stimulatory influence of soy protein isolate on breast secretion in pre- and post menopausal women, Cancer Epidemiol Biomark and Prevention, 5, 785-794. 

V. Costarelli, T. J. Key, P. N. Appleby, D. S. Allen, I. S. Fentiman and T. A. B. Sanders, A prospective study of serum bile-acid concentrations and colorectal cancer risk in post-menopausal women on the island of Guernsey, Br. J. Cancer, 2002, 86, 1741. 

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

The biologically inactive estrone sulfate (EIS) and dehydro-epiandrosterone-sulfate (DHEAS) are the most abundant circulating estrogenic precursors in the plasma of post-menopausal women [103]. Desulfation of inactive steroid-3-0-sulfates by estrone-sulfatase (STS) plays a key role in the regulation of levels of receptor-active estrogenic steroids (estradiol and androstenediol) in breast cancer cells (Fig. 9). There is strong evidence suggesting that estrone sulfatase (STS) and DHEA-sulfatase are the same enzyme [103]. 

The novel SERMs, which include bazedoxifene and ospemifene (also known as deaminohydroxy-toremifene), are being investigated for the prevention and treatment of osteoporosis in post-menopausal women in phase III clinical trials [151,165]. The non-steroidal SERM lasofoxifene (CP-336156) [151], currently under consideration by the Food and Drug Administration for both prevention of osteoporosis and urogenital atrophy, may have potential for... 

Eulvestrant has been evaluated in two randomised phase III trials in postmenopausal women with advanced disease after progression on prior antiestrogen therapy. In both trials, fulvestrant was at least as effective as anas-trozole. In a prospectively designed combined analysis of the results from both trials, median time to progression (TTP) was 5.5 months for fulvestrant versus 4.1 months for anastrozole [172]. Eulvestrant and tamoxifen have been compared as first-line treatments in a trial including post-menopausal women with advanced breast cancer. In this study, the between-treatment difference was non-significant (median TTP 6.8 versus 8.3 months) [173]. 

High-dose progestins are used as last-line endocrine therapy [223]. They inhibit the adrenal steroid biosynthesis. The decrease of estrogen levels is comparable to that caused by the administration of aromatase inhibitors. In post-menopausal women, the progestin megestrol acetate (MGA) decreases serum plasma level of DEAH, androstenedione and cortisol to less than 10% [223,224]. 

Tamoxifen is used for palliative treatment of breast cancer in pre- and post-menopausal women. 

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