Postmenopausal treatment

Ethinyloestradiol Synthetic oestrogen Used for oestrogen replacement therapy in deficient states, both pre- and postmenopausal. Treatment of prostate cancer (male), breast cancer (post-menopausal women). Component of many oral contraceptives... 

Estrogens can cause or aggravate constipation (47), but when it occurs it is more likely to be due to the calcium carbonate that many women take as a daily supplement in postmenopausal treatment. 

Various companies and investigational groups continue to examine the relative efficacy and safety of different forms of combined postmenopausal treatment. In a randomized, placebo-controlled trial 579 women were treated for 26 cycles with sequential combinations of 17-beta-estradiol 1 mg plus dydrogesterone 5 or 10 mg or 17-beta-estradiol 2 mg with dydrogesterone 10 or 20 mg (27). The effects of these treatments in the 442 women who underwent biopsy were considered satisfactory in terms of... 

Despite the limitations imposed by the physiology of the skin, several marketed controUed release transdermal dmg dehvery systems are available in the United States for example, scopolamine [51-34-3] for the treatment of motion sickness, nitroglycerin [55-63-0] for angina, estradiol [50-28-2] for the rehef of postmenopausal symptoms and osteoporosis, clonidine [4205-90-7] for the treatment of hypertension, fentanyl [437-38-7] as an analgesic, and nicotine [54-11-5] as an aid to smoking cessation. These systems are designed to dehver dmg for periods of one to seven days. 

Heterocycles as synthetic estrogens in emerging therapies for the prevention or treatment of postmenopausal osteoporosis 99JMC1. 

STAR trial (Study of tamoxifen and raloxifene), which was completed in 2006, demonstrated additional utility of raloxifene in the prevention and treatment of breast cancer. In fact, the absence of associated uterotrophic effects with raloxifene suggests that it may be a safer agent than tamoxifen for use as a chemopreventative in high-risk postmenopausal women [3] therefore, raloxifene has very recently become a new option for breast cancer prevention now available for physicians and their patients. 

Summary term for a number of steroid hormones and their precursors with differentiation-inducing activity in many tissues. As regards bone, three components are relevant cholecalciferol ( vitamin D ) 25-hydroxyvi-taminD3 (calcidiol) and 1,25-dihydroxy vitamin D3 (calcitriol). The latter is the biologically active form and increases both intestinal calcium absoiption and bone resorption. Vitamin D preparations are widely used for the treatment of osteoporosis. Daily supplementation with vitamin D reduces bone loss in postmenopausal women and hip fractures in elderly subjects. 

Treatment and prevention of postmenopausal osteoporosis glucocorticoid-induced osteoporosis osteoporosis in men Paget s disease... 

The bisphosphonates are used to treat osteoporosis in postmenopausal women, Paget s disease of the bone, and postoperative treatment after total hip replacement (etidronate). 

Studies have demonstrated that treatment with soy or phytoestrogen enriched diets is effective in conserving bone in rodent models of osteoporosis (Anderson and Gamer, 1998 Ishimi et al, 2000 Draper et al, 1997). The mechanism of action of phytoestrogens on bone health is unclear but several mechanisms including inhibition of bone resorption and stimulation of bone formation maybe involved (Fanti etal, 1998 Ishimi e/a/., 1999 Picherit eta/., 2000). Limited data from studies in postmenopausal women have indicated that phytoestrogen supplements have a small, beneficial effect on bone loss in the lumbar spine (Alekel et al, 2000 Potter et al, 1998 Somekawa et al, 2001). 

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). 

Crocq et al. (1997) have synthesized trimegestone through Bakers yeast mediated reduction of a ketone (this material is a new progestomimetic molecule for the treatment of postmenopausal diseases). The key step of the multistep synthesis is the chemo-, regio- and almost stereospecific bioreduction of a triketone to the desired alcohol. 

The need to continue dopamine agonists in postmenopausal women must be reassessed because these patients have a higher probability of maintaining normal prolactin levels after treatment is discontinued.52... 

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. 

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... 

All postmenopausal women with a personal history of osteoporotic fracture and/or low bone mineral density with risk factors for osteoporosis should receive treatment for osteoporosis. 

Osteoporosis is a common and often silent disorder associated with significant morbidity and mortality and reduced quality of life. It is associated with increased risk and rates of bone fracture and is responsible for over 1.5 million fractures in the United States annually, resulting in direct health care costs of over 17 billion.1 As the population ages, these numbers are expected to increase. It is estimated that postmenopausal Caucasian women have a 50% lifetime chance of developing an osteoporosis-related fracture.1 Common sites of fracture include the spine, hip, and wrist, although almost all sites can be affected. Only a fraction of patients with osteoporosis receive optimal treatment. 

Osteoporosis is the most common skeletal disorder, and approximately one in five Caucasian women in the United States has the disease. The prevalence of vertebral fracture in postmenopausal women is greater than 20%.2 Only one in three patients with osteoporosis has been diagnosed, and only one in seven will receive treatment.2... 

Compared with postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide also has been studied, but no data are available yet on fracture rates. At this time, alendronate and teriparatide are approved by the FDA for the treatment of osteoporosis in men. Owing to proven benefit in reducing fractures and relative safety, alendronate should be considered first-line treatment for primary osteoporosis in men. Teriparatide should be reserved as alternate therapy in this population. 

AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis ... 

Eichner SF, Lloyd KB, Timpe EM. Comparing therapies for postmenopausal osteoporosis prevention and treatment. Ann Pharmacother 2003 37 711-724. 

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