Postmenopausal women

The effects of risedronate on bone density and vertebral fracture have been studied in 518 patients (mean age 59 years, 40% with rheumatoid arthritis, 56% men, 64% of the women postmenopausal) taking moderate to high doses of oral glucocorticoids (equivalent to prednisone... 

Similar results have been reported in a clinical trial in 290 patients (38% men, 55% of the women postmenopausal) taking high-dose glucocorticoid therapy (prednisone over 7.5 mg/day or equivalent) (257). The subjects were randomized to receive placebo or risedronate 2.5 or 5 mg/day for 1 year. All took elemental calcium 1000 mg/ day and vitamin D 400 IU/day. Risedronate 5 mg increased bone mineral density at 1 year by a mean of 2.9% in the lumbar spine, 1.8% in the femoral neck, and 2.4% in the trochanter. The values for placebo were 0.4%, -0.3%, and 1.0% respectively. The results for risedronate... 

Gas-Liquid Chromatographic Quantitation of Urinary Estrogens in Nonpregnant Women, Postmenopausal Women, and Men... 

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. 

The presence of an enlarged endometrium (> 5 mm) may be associated with endometrial abnormalities, principally polyps, hyperplasia, or even adenocarcinoma of the endometrium, in the postmenopausal woman (Dijkhuizen et al. 1996 Granberg et al. 1991 Holbert 1997). It seems that treatment with tamoxifen in postmenopausal women sustains this association. Thus, in the previously mentioned study by Cohen et al. (1994), the only endometrial abnormalities were found in those women whose endometrium had a thickness... 

Healthy lifestyle is mandatory for all postmenopausal women together with adequate correction of detected risk factors. That is why this intervention is in the center of the diagram and concerns 100% of the women in this period. Then a decision must be made as to whether the woman s risk profile calls for any intervention beyond lifestyle improvement. The use of surrogate markers or risk scores can be useful in evaluating individual patients. 

This is a proposal to help the clinician to counsel individual women. This process of individualization is crucial and is the best guarantee of a wise use of the different alternatives presently available for an efficient management of the postmenopausal period. Guidelines are only indications of the best choice for a majority of women, but, as health agents of our patients, we have the responsibility of determining how suitable they are for a given woman and introduce the appropriate corrections. In this context SERMs are an early alternative for osteoporosis prevention and treatment that provide an additive protective effect on the breast and are neutral on cardiovascular risk. 

Concomitant progestin therapy When estrogen is prescribed for a postmenopausal woman with a uterus, also initiate progestin to reduce the risk of endometrial cancer. 

Estrogens can prevent accelerated bone loss during the immediate postmenopausal period and at least transiently increase bone in the postmenopausal woman. 

Davis SR, Burger HG. Androgens and the postmenopausal woman. J Clin Endocrinol Metab 1996 81(8) 2759-63. 

Sclerosing glomerulonephritis has been attributed to anastrozole in a 73-year-old postmenopausal woman with breast cancer (18). 

A 47-year-old postmenopausal woman developed eczematous lesions at the sites of application of an estradiol transdermal system and subsequently at the sites of application of an estradiol gel (55). She was therefore given oral estrogen instead, but this promptly elicited a systemic pruritic rash. The causal link was in all instances confirmed by patch-testing. 

Miyagawa A, Yuba Y, Haga H, Nishimura S, Kobashi Y. Fibrous tumor of the breast in a postmenopausal woman receiving estrogen. Pathol Int 2001 51(2) 123-6. 

Wenger NK. Hormonal and nonhormonal therapies for the postmenopausal woman what is the evidence for cardiopro-tection Am J Geriatr Cardiol 2000 9(4) 204-9. 

Speroff L (1994) The menopause. A signal for the future. In RALobo (ed) Treatment of the postmenopausal woman Basic and clinical aspects. Raven Press Ltd, New York, 1-8... 

Kronenberg F (1994) Hot flashes. In RA Lobo (ed) Treatment of the Postmenopausal Woman Basic and Clinical Aspects. Raven Press, New York, 97-117... 

Although estrogen replacement therapy at menopause can prevent bone loss and cardiovascular disease, there is evidence that estrogens are associated with an increased risk of breast cancer as well as endometrial cancer(Gambrell, 1994), which thus seriously limits the use of estrogen replacement therapy. The ideal compound for women s health should be one able to decrease the risk of the most important causes of morbidity and mortality in women, namely breast cancer, uterine cancer, osteoporosis, bone fractures, and cardiovascular disease. Heart disease is, in fact, the leading cause of death in postmenopausal women (Lerner and Kannel, 1986). This ideal compound should also have an excellent safety profile to ensure compliance over 20 to 40 years of a woman s life. 

Because the postmenopausal woman is usually treated concomitantly with an oral progestin (i.e. in addition to the need for estrogen replacement), there have been, and continue to be, attempts to formulate a combination estrogen-progestin patch. One of the first of these systems containing estradiol and levonorgestrel has recently been approved for marketing. 

Mrs TY is an elderly woman with a fractured hip. NICE (2005) recommends that postmenopausal patients who have experienced a fracture should receive bisphosphonates as treatment for secondary prevention of fractures. 

Contraindications to oestrogen therapy include women who may have an oestrogen-dependent neoplasm, e.g. breast cancer, who may be pregnant, or have a disposition to thromboembolism. Hypertension, liver disease or gallstones, migraine, diabetes, uterine fibroids or endometriosis may all be made worse by oestrogen. These are not necessarily absolute contraindications, and HRT should not for instance be denied to a poly-symptomatic woman with mild hypertension. If necessary, it may be permissible to treat both the hypertension and the postmenopausal symptoms with separate drugs. 

A 62-year-old postmenopausal woman with metastatic breast cancer is starting treatment with anastrozole. Which potential side effect(s) do you anticipate and monitor ... 

In the normal, nonpregnant woman, estradiol is produced at the rate of 100 to 300pg/day. The production of estrone ranges from 100 to 200pg/day. Diurnal variation of blood estrone concentrations occurs in postmenopausal women, presumably reflecting the variation in the androstenedione precursor that originates in the adrenal glands. However, no such diurnal rhythms have been demonstrated for estradiol. 

Figure 5.6 Spectra and distinction of human cervical cells, (a, b) Spectra and images of superficial and intermediate cell of premenopausal women, respectively (c, d) Spectra and images of superficial and intermediate cell of a postmenopausal woman,...

Should hormone-replacement therapy be prescribed for this postmenopausal woman ... 

Should we begin hormone-replacement therapy (intervention compared with no intervention) to prevent cardiovascular events (outcome) in this asymptomatic postmenopausal woman with a family history of coronary artery disease (patient) ... 

Evaluation of each individual woman is essential in determining the appropriateness of perimenopausal and postmenopausal hormone therapy, and collaboration between a woman and her primary care provider in the decision-making process is essential. The benefits and risks of hormone therapy should be reassessed annually. 

The initial visit of a perimenopausal or postmenopausal woman is the most appropriate time to obtain a complete medical history, perform a physical examination, and educate the patient. Medical history should include determination of a personal or family history of thrombotic problems. The physical examination should include a complete cardiovascular examination, clinical assessment of thyroid status, and breast and pelvic examinations. Papanicolaou cervical cytologic examination and screening mammography negative for malignancy are required before initiating hormone therapy. Thyroid function tests and lipoprotein lipid profile also should be performed at the discretion of the clinician. 

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