Recommendations for estrogen and progestin replacement in the climacteric and postmenopause

The diversity of function that sex steroids have proven to have in the female body, gives them a position of central importance in gynaecology. Scientific research demonstrates not only the well known genital functions of sexual steroids, furthermore, various extragenital organs are influenced and modulated by ovarian hormones. Therefore, the general benefit of HRT for the female organism becomes clearer and the clinical management of menopause is developing to a broad new discipline, the gender specific medicine. In clinical practise, phytosteroids are claimed by the patient and therefore, also of high interest for the scientific research. Also, tissue specificity of the endocrine treatment and the biological relevance of different steroid receptors of HRT are discussed, leading to the development of new HrT preparations. Individualisation, the tailoring of HRT, according to the patients needs, and low dose steroids management, will also become an important aspect in the recommendations for estrogen and progestin replacement therapy.     

Compliance with hormone replacement therapy in Chinese women in Hong Kong

Compliance with hormone replacement therapy (HRT) has been extensively studied in western countries. However, there is little data concerning women in Asian countries. A retrospective study was performed to determine compliance in a group of Hong Kong Chinese women who commenced HRT over a 2 year period. Two years after the commencement of HRT, 68.3% were still taking HRT, although not always in the original formulation. The highest drop out rate occurred during the first 6 months. Factors which were associated with a higher degree of compliance were young age at menopause and at the time of initial consultation and the use of unopposed HRT. A number of significant medical problems were identified during the 2 years of follow up which may have remained otherwise undetected. Compliance with HRT appears to be comparable to that reported in other western specialist centres. Nearly 9% of women who stopped HRT did so because other doctors told them that they did not need the treatment and another 6.5% because of the fear of breast cancer.     

绝经后妇女骨质疏松症的治疗进展

近年来,骨质疏松症治疗的研究进展发展很快。本文针对绝经后妇女的骨质疏松症,从诊疗方案的设计原则到具体药物的治疗进展进行综述。     

超声观察绝经后长期小剂量激素替代疗法对子宫、卵巢和乳腺的影响

目的观察长期小剂量激素替代疗法(HRT)对绝经后妇女子宫、卵巢和乳腺的影响。方法52例绝经后妇女,根据不同用药方案分为利维爱组和雌孕激素组,分别给予小剂量激素利维爱或雌激素联合孕激素替代治疗,用药时间5~31年,采用经阴道超声及高频超声观察子宫、卵巢和乳腺的形态结构特征。结果利维爱组和雌孕激素组妇女的子宫体积、内膜厚度、双侧卵巢面积、双侧乳腺厚度及导管宽度均大于对照组,其中利维爱组和雌孕激素组内膜厚度与对照组之间差异均有显著性(P<0.05);雌孕激素组的子宫体积和乳腺腺体厚度显著大于对照组(P<0.05)。两种用药组间比较差异均无显著性。乳腺结构改变方面,小叶增生型中利维爱组和雌孕激素组的发生率均显著高于对照组(P<0.05,P<0.005);导管增生型中仅雌孕激素组较对照组差异具有显著性(P<0.05)。结论长期小剂量HRT能够延缓子宫、卵巢和乳腺的萎缩进程,子宫体积、内膜厚度、双侧卵巢面积及乳腺腺体层厚度均大于对照组;不同的用药方案对上述靶器官的影响有所不同;小剂量HRT对发生子宫内膜癌、卵巢癌和乳腺癌的危险性无明显影响;在应用HRT过程中,运用超声检查监测子宫、卵巢和乳腺的变化具有重要意义。     

依西美坦治疗绝经后晚期乳腺癌Ⅱ期临床试验

目的：探讨依西美坦治疗绝经后妇女晚期乳腺癌的临床疗效和不良反应。方法：应用双盲双模拟随机对照方法，将40例绝经晚期乳腺癌患者分为A组（治疗组）和B组（对照组）各20例，采用双模拟阳性对照。A组：依西美坦25mg，加来曲唑模拟片，早餐后口服，每日1次；B组：来曲唑2．5mg，加依西量模拟片，早餐后口服，每日1次。两组疗前2周内及治疗每4周后检测血中雌二醇（E2）水平，治疗4－12周后评价疗效和不良反应。结果：两组所有患者均可进行疗效评价和不良反应分析。A，B组均无CR者；A组和B组部分缓解（PR）分别为4例（缓解率为20％）和2例（缓解率为10％）；稳定（SD）分别为8例和10例；软组织疗效稍高于内脏转移，治疗第8周E2抑制率分别为21．4％和11．8％；不良反应包括恶心、呕吐、潮热、头晕、浮肿，一解较轻，可以耐受。结论：依西美坦作为一种新的甾体类芳香化酶抑制剂，对血清E2有一定的抑制作用，对绝经后晚期乳腺癌疗效肯定，不良反应均较轻微，是乳腺癌内分泌治疗中一种有价值的药物。     

尼尔雌醇对绝经后妇女高脂血症的疗效观察

目的观察尼尔雌醇对绝经后妇女高脂血症的疗效。方法将 5 0例绝经后高脂血症妇女随机分为治疗组和对照组 ,治疗组 30例口服尼尔雌醇治疗 ;对照组 2 0例口服维生素E治疗。结果两组用药前TC、TG、HDL -C、VLDI-C无显著性差异 ;治疗组在用药后TC、TG无显著性变化 (P >0 .0 5 ) ;LDL -C、VLDL -C在治疗后 3个月及 6个月显著下降 (P <0 .0 1 ) ,HDL -C较治疗前明显升高 (P <0 .0 1 ) ;对照组各项血脂指标无显著性变化 (P >0 .0 5 )。结论尼尔雌醇对绝经后妇女高脂血症的治疗效果较好     

Vitamin D and HRT: No benefit additional to that of HRT alone in prevention of bone loss in early postmenopausal women. A 2.5-year randomized placebo-controlled study

The study was designed to examine the effect of hormone replacement therapy (HRT) and low-dose vitamin D (Vit D) supplementation on the prevention of bone loss in non-osteoporotic early postmenopausal women and to determine whether Vit D supplementation can give additional benefit to an already optimized estrogen regimen. The effects of HRT and Vit D on bone mineral density (BMD) were studied in postmenopausal women in a 2.5-year randomized placebo-controlled study. The study population was a subgroup of the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) (n=13100). A total of 464 early postmenopausal women were randomized to four groups: (1) HRT (a sequential combination of 2 mg estradiol valerate and 1 mg cyproterone acetate (E₂Val/CPA); (2) vitamin D₃ (cholecalciferol, 300 IU/day); (3) HRT+Vit D; and (4) placebo (calcium lactate; 93 mg Ca²⁺/day). Lumbar (L1–4) and femoral neck BMD were determined by dual-energy X-ray absorptiometry before and after 2.5 years of treatment. After 2.5 years, lumbar BMD had increased by 1.8% in the HRT group (p<0.001) and by 1.4% in the HRT+Vit D group (p=0.002), whereas lumbar BMD had decreased by 3.5% (p<0.001) in the Vit D group and by 3.7% (p<0.001) in the placebo group. The loss of femoral neck BMD was lower in the HRT (–0.3%) and the HRT+Vit D (–0.9%) groups compared with the Vit D (–2.4%) and the placebo groups (–3.7%). This study confirms the beneficial effect of HRT on BMD. It also shows that low-dose vitamin D supplementation has only a minor effect in the prevention of osteoporosis in non-osteoporotic early postmenopausal women and does not give any benefit additional to that of HRT alone.     

The role of physical activity in the prevention of osteoporosis in postmenopausal women—An update

Context and objective

Osteoporosis causes an increase in bone fragility. Its clinical significance mainly refers to (hip) fractures secondary to (low or moderate) trauma. In Europe and North America about 6% of men and 21% of women aged 50–84 years are classified to have osteoporosis. Although it is well accepted that exercise is essential for the management of osteoporosis, the exact role of physical activity in the primary and secondary prevention of osteoporotic fractures is still controversial.

Methods

The MEDLINE database and reference lists of selected publications were systematically searched for randomized controlled trials and prospective cohort studies, respectively, published since January 2000 regarding the association of physical activity and osteoporosis in postmenopausal women.

Results

Two prospective cohort studies indicate the clinical relevance of this association by showing an inverse relationship between physical activity and the risk of hip fracture. There is convincing evidence that physical activity effectively slows bone loss in postmenopausal women in a dose-dependent manner. Exercise programs may increase bone mineral density.

Conclusion

In order to maximize the goals of public health most effective, individually adapted, intense, high impact exercise programs are needed. However, they may be complicated to communicate and adherence on the population level may be hard to achieve. These programs must be weighed against popular and applicable existing programs (e.g. aerobic classes, Tai Chi, and walking) which appear to be easier to adhere to but appear to be less effective in the prevention of osteoporotic fractures in the individual postmenopausal women.     

Bleeding patterns in recent postmenopausal outpatients with uterine myomas: comparison between two regimens of HRT

Objectives: To evaluate and to compare the bleeding patterns obtained with two regimens of hormone replacement therapy given to early postmenopausal women with asymptomatic uterine leiomyomas. Methods: In this randomised prospective 1-year study 50 early postmenopausal women with one to four asymptomatic uterine leiomyomas were enrolled into two study-groups to take two regimens of hormone replacement therapy for 12 28-day cycles: (A) Tibolone, 2.5 mg/day; (B) conjugated equine estrogens (CEE), 0.625 mg/day plus medroxyprogesterone acetate (MPA), 5 mg/day. The bleeding patterns and the changes in uterine volume of the 47 outpatients who completed the study were evaluated and compared. Results: Amenorrhea incidence was higher in group A (75.0% of the cycles) than in group B (65.6% of the cycles), while irregular bleeding and irregular spotting incidences were higher in group B (29.7 and 4.7% of the cycles, respectively) compared to group A (22.6 and 2.4% of the cycles, respectively). The mean bleeding and spotting lengths were not statistically different between patients in group A and those in group B. Finally, at the end of the study period transvaginal ultrasonography showed no significant change in leiomyoma size. Conclusions: The results demonstrate that, in early postmenopausal patients with asymptomatic uterine leiomyomas, Tibolone treatment seems to be preferable compared to CEE–MPA continuous combined treatment in relation to the lesser occurrence of irregular bleeding. Furthermore, neither Tibolone nor CEE–MPA therapy, at the doses used here, promote fibroid growth.     

Hot flash severity in hormone therapy users/nonusers across the menopausal transition

OBJECTIVES: The purpose of this study was to examine the pattern of and factors that influence hot flash severity across the menopausal transition (MT) and early postmenopause (PM). METHODS: Women from the Seattle Midlife Women's Health Study (N=302) provided data for these analyses: at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and FSH. Linear mixed effects modeling was used to identify change in hot flash severity scores over time, including the relationship to age, MT-related, psychosocial and lifestyle factors. RESULTS: Increases in hot flash severity were associated with late transition stage, early postmenopause, use of HRT, duration of early transition stage, age of entry into early PM and level of FSH. Age of entry into early transition and estrone levels were associated with decreased hot flash severity. Not associated with hot flash severity were being in early transition stage, age of entry into or duration of late transition stage and all of the psychosocial (anxiety, stress, depressed mood) and lifestyle variables (BMI, activity level, sleep, alcohol use). CONCLUSIONS: Variables associated with reproductive aging independently predicted changes in hot flash severity; psychosocial and lifestyle variables did not. The effect of age dropped out when factors associated with reproductive aging were considered. Use of HRT ameliorated but did not eliminate severe hot flashes suggesting that there is room for alternative approaches less likely to cause harm.