Postmenopausal bleeding

Female Menstrual irregularities/amenorrhea, postmenopausal bleeding, breast tenderness... 

Estrone determinations are limited to diagnosis of postmenopausal bleeding and the menstrual dysfunction caused by extraglandular estrone production. Normally, blood estrone concentrations parallel estradiol concentrations throughout the menstrual cycle, but at slightly lower concentrations. For a specific analysis of estrone, the interested reader is directed to other references. ... 

Ovarian sex cord-stromal tumors account for about 5% of all ovarian cancers and tend to be diagnosed at stage I. ° These tumors are associated with hormonal effects, such as precocious puberty, amenorrhea, and postmenopausal bleeding. 

Gupta JK, Chien PE, Voit D, Clark TJ, Khan KS (2002) Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding a meta-analysis. Acta Obstet Gynecol Scand 81 799-816... 

Toremifene is an estrogen receptor antagonist. The pharmacokinetics of toremifene are best described by a two-compartment model, with an a half-life of 4 hours and an elimination half-life of 5 days. Peak plasma concentrations are achieved approximately 3 hours after an oral dose. Toremifene is metabolized extensively, with metabolites found primarily in the feces. Toremifene is used for the treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor-positive or unknown tumors. Toremifene causes hot flashes, vaginal bleeding, thromboembolism, and visual acuity changes. 

Continuous-combined—prevents monthly bleeding. It may initially cause unpredictable spotting or bleeding thus, it is best reserved for women who are at least 2 years postmenopause. 

Indications for estrogens and pro-gestins include hormonal contraception (p. 256), hormone replacement, as in postmenopausal women for prophylaxis of osteoporosis bleeding anomalies, menstrual complaints. Concerning adverse effects, see p. 256. 

Anastrozole (Arimidex) [Antineoplastic/Nonsteroidal Aromatase Inhibitor] Uses Breast CA postmenopausal w/ met breast CA, adjuvant Rx postmenopausal early hormone-rec tor(+) breast CA Action Selective nonsteroidal aromatase inhibitor, X circ estradiol Dose 1 mg/d Caution [D, ] Contra PRO Disp Tabs SE D, HTN, flushing, t bone/tumor pain, HA, somnolence Interactions None noted EMS May cause vag bleeding during 1st few wks of Tx OD May cause NA, abd discomfort, and bloody stools symptomatic and supportive... 

Treatment of postmenopausal women with osteoporosis with raloxifene (60mg/day or 120mg/day for 36 months) was found to significantly increase bone mineral density in the spine and femoral neck and decrease the risk of vertebral fracture compared to the placebo treatment.Treatment with raloxifene increased the risk of venous thromboembolism compared to the placebo group and was also associated with a lower risk of breast cancer and did not cause breast pain or vaginal bleeding. 

Androgens are sometimes given in combination with estrogens for replacement therapy in the postmenopausal period in an attempt to eliminate the endometrial bleeding that may occur when only estrogens are used and to enhance libido. They have been used for chemotherapy of breast tumors in premenopausal women. 

Lethaby A, Suckling J, Barlow D, Farquhar CM, Jepson RG, Roberts H. Hormone replacement therapy in postmenopausal women endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev 2004 (3) CD000402. 

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