Does hormone replacement therapy have beneficial effects on renal functions in menopausal women?

Background

The study was carried out to evaluate the possible effects of hormone replacement therapy (HRT) on renal functions in postmenopausal women.

Methods

A total of 85 postmenopausal women without a history of medical illness were enrolled in the study. They were divided into HRT users and control groups. After 30?weeks of HRT use, the changes in serum urea, creatinine, uric acid, urinary protein, urinary creatinine, urinary protein/creatinine ratio and glomerular filtration rate (GFR) (mL/min/1.73 m²) were evaluated.

Results

HRT was associated with statistically significant increases in glomerular filtration rate (p?Conclusion In our study, we suggested that usage of hormone replacement therapy appeared to affect renal functions in postmenopausal women. There were beneficial effects of HRT on GFR in our postmenopausal patients. HRT may have possible protective mechanisms for kidney against adverse effects of aging.     

Is there a role for hormone replacement therapy after breast cancer?

Breast cancer is the most common female malignancy in the UK, with an overall lifetime risk of 1 in 9. Despite the high incidence, breast cancer mortality is decreasing. Approximately 40,000 women were diagnosed with breast cancer in England and Wales in 2000 but the majority will have normal or near-normal life expectancy. One of the main contributory factors to this marked improvement in survival over the last 20 years in women of all ages has been the more widespread use of systemic therapy in early-stage disease. For women with hormone-sensitive cancer, this involves adjuvant endocrine therapy that reduces estrogen synthesis (i.e. ovarian suppression in premenopausal women or aromatase inhibitors in postmenopausal women) or estrogen activity (the anti-estrogen tamoxifen, irrespective of menopausal status). Many women experience health and quality-of-life problems related to estrogen deficiency as a result, the commonest being vasomotor symptoms and vaginal dryness. This article summarizes and interprets key recent papers on the use of hormone replacement therapy (HRT) and selective serotonin reuptake inhibitors in breast cancer survivors. HRT may be safe in women with receptor-negative disease or receptor-positive cancers in the presence of tamoxifen. However, there is a dearth of useful alternatives.     

Does hormonal replacement therapy actually protect against cardiovascular disease?

It is generally accepted that menopausal symptoms can be controlled by HRT. As additional (putative) benefits of HRT were discovered, it was claimed that such uses were also important. Soon, trials were instituted to test these assertions, some of them quite large and projected to last a long time (> or = 5 years). The most instructive for medical practice are the observational trials and, still more, randomized, controlled trials. Unfortunately, the results of these trials for both primary and secondary prevention of CHD are not in agreement, although the observational trials are mostly more favorable to the benefits of HRT on CHD. The present review considers both kinds of trials and their effects on primary and secondary CHD prevention. It also attempts to group the studies by their results and their implications for guiding patients in choices and decisions regarding HRT.     

Is dosage of hormone replacement therapy related with endometrial polyp formation?

PURPOSE OF INVESTIGATION: To evaluate the effect of different doses of hormone replacement therapy (HRT) on endometrial polyp formation. METHODS: 398 menopausal women were initially evaluated through transvaginal ultrasound and patients who already had endometrial polyps were excluded from the study. One hundred and six (26.6%) eligible patients were enrolled and randomized into two groups of 53 patients to receive two different doses of HRT. RESULTS: Six patients with endometrial polyps were detected in the first group and one patient in the second one (p = 0.0502 for total chi-square and p = .1172 for chi-square with continuity correction) after a mean duration of treatment of 26 months and 28,5 months, respectively. There was no difference in the mean number or the mean volume of the polyps between the two subgroups with positive results. CONCLUSION: Our study showed that endometrial polyp formation may be related with HRT dosage.     

Risiko von Brustkrebs unter „hormone replacement therapy“

The Women’s Health Initiative demonstrated an increased risk of breast cancer with conjugated equine estrogens plus medroxyprogesterone acetate but a reduced one with estrogens alone compared to placebo. These data correlate with observational studies, whereby estrogens alone can increase breast cancer risk after long-term treatment (after 15 years in the Nurses Health Study). A risk decrease has been found for early and also late treatment onset with estrogens and with equine estrogens as well as estradiol. The clinical data are also biologically plausible. Estrogens can be protective by e.g. by increasing apoptosis but also proliferative and in rare cases via genotoxic metabolites as in the case of genetic polymorphisms of normally protective key enzymes and uncontrolled oxidative cell stress. According to own research certain cell membrane structures can be found in cancerous tissue but not in benign tissue of women with breast cancer, which in combination with stromal effects can trigger strong proliferative effects in the presence of synthetic progestins but not by progesterone. These results correlate with clinical observational studies demonstrating no increased breast cancer risk with progesterone or its retroisomer dydrogesterone in combination with estradiol in contrast to the most synthetic progestins. However, long-term proliferative effects cannot be excluded at least for certain metabolites of progesterone and dydrogesterone and are the subject of current research to identify women with increased risk.     

Are smoking-associated cancers prevented or postponed in women using hormone replacement therapy?

OBECTIVE: To investigate the relationship between hormone replacement therapy (HRT), smoking, and cancer incidence. METHODS: Baseline interviews were conducted from 1990 to 1992 in a population-based cohort of 29,508 Swedish women aged 25-65 years with no history of cancer. Cancer incidence in the cohort was assessed through December 31, 1999, with the Swedish Cancer Registry, the Population Census Registry, and the Cause of Death Registry. RESULTS: When follow-up ended, the cohort included 226,611 person-years. A total of 1145 malignancies were diagnosed (observed), and 1166.6 were expected (standardized incidence ratio 0.98; 95% confidence interval [CI] 0.93, 1.04). Women who had experienced a natural menopause and had ever used HRT had no increased incidence of cancer overall (standardized incidence ratio 1.03; 95% CI 0.88, 1.19). Long-term HRT users who smoked had a decreased incidence of smoking-related cancers, such as the oral cavity, pharynx, hypopharynx, larynx, esophagus, lung, cervix, and bladder (standardized incidence ratio 0.24; 95% CI 0.08, 0.76). The effect was seen regardless of the type of HRT (progestin versus non-progestin-containing preparations) used and number of cigarettes smoked. The protective role of HRT for colon cancer was evident among both smokers and nonsmokers. An increased incidence of endometrial cancer was seen only for nonsmokers who used HRT. CONCLUSION: Our data indicate that HRT use protects women against smoking-associated cancers. This effect occurs regardless of the type of HRT and the amount of smoking.     

Is postmenopausal hormone replacement therapy suitable after a cardio- or cerebrovascular event?

Purpose

Vascular disease is the leading cause of death in women. One-third of acute events affect women below age 60, when the prevalence of menopausal symptoms is high. This raises the question if hormone replacement therapy (HRT) may be an appropriate treatment for individual women although vascular disease is generally considered a contraindication.

Methods

Selective literature search was used for this study.

Results

In healthy women, HRT increases risks for venous thromboembolism and ischemic stroke, but for cardiovascular disease apparently only beyond 10 years after menopause or 60 years of age. Limited data in women with cardio or cerebrovascular disease have not demonstrated an increased risk for a vascular recurrent event, but for the first year after initiation. In HRT users affected by a cardiovascular event continuation of HRT has not been found to be associated with adverse outcome. Low dose estradiol––preferentially as transdermal patches, if necessary combined with metabolically neutral progestins––appears to convey lower risk.

Conclusions

Safety data on HRT in survivors of cardiovascular events or ischemic stroke are limited, but exceptionally increased risk appears to be excluded. If off-label use of HRT is considered to be initiated or continued in women with cardio- or cerebrovascular disease, extensive counseling on the pros and cons of HRT is mandatory.

     

Turbulent times for hormone replacement therapy: is there a way out?

The long-awaited results of the large Women's Health Initiative (WHI) trial on the effects of combined estrogen-progestin hormone replacement therapy (HRT) in postmenopausal women show that the overall benefits are smaller than the risks. Herein I argue that many of the findings could be predicted from earlier observational studies. Although the WHI trial will rightly reverse the soaring HRT use of the last decades, there is unquestionably a future for HRT. A consensus is growing that postmenopausal women may be treated with HRT only when seeking help for disturbing symptoms of the ovarian hormone insufficiency syndrome, rather than be treated for menopause per se. The ovarian hormone insufficiency syndrome comprises conditions of estrogen and/or androgen insufficiency; at this time, the diagnosis of these clinical entities is based largely on symptomatology. Future research should disclose why the deprivation of ovarian hormones has a variable impact on women's functioning, and further trials ought to reveal effective and safe treatments for women suffering from this syndrome.     

Eating disorders in adolescence: what is the role of hormone replacement therapy?

PURPOSE OF REVIEW: To review the diagnostic criteria and clinical presentation of eating disorders in adolescence, to outline an approach to treatment, and examine evidence for prescribing hormone replacement therapy to increase bone mineral density in anorexia nervosa. RECENT FINDINGS: Eating disorders are prevalent in adolescents and can present with amenorrhea and menstrual disturbances. Reduced bone mineral density leading to osteoporosis and increased fracture risk is a frequent, severe, and potentially irreversible complication of anorexia nervosa. The degree of bone mineral density reduction depends on the duration of amenorrhea and degree of malnutrition. Limited evidence supports the use of hormone replacement therapy to increase bone mineral density in adolescents with anorexia nervosa. SUMMARY: In adolescents with amenorrhea or menstrual disturbances, the gynecologist should consider the possibility of an eating disorder. The diagnosis can be made on history and physical examination. If an eating disorder is suspected, the patient should be referred for evaluation and treatment. Support for the use of hormone replacement therapy to increase bone mineral density in adolescents with anorexia nervosa is limited, and its routine use should be discouraged. Weight restoration, calcium and vitamin D supplementation and the resumption of spontaneous menses is the mainstay of treatment.     

Are randomized trials of hormone replacement therapy in symptomatic women with breast cancer feasible?

OBJECTIVE: To evaluate the feasibility of conducting a large randomized trial of HRT in symptomatic women with early-stage breast cancer. DESIGN: Open randomized study. SETTING: Outpatient clinics at The Royal Marsden and St. George's Hospitals, London. PATIENT(S): One hundred postmenopausal women with early-stage breast cancer, experiencing vasomotor symptoms and/or vaginal dryness. INTERVENTION(S): Randomization (1:1) to HRT or no HRT for 6 months. MAIN OUTCOME MEASURE(S): Acceptance, continuance rates, and the reasons eligible women declined study entry. RESULT(S): Acceptance (38.8%) and continuance rates (>80%) were encouraging. The efficacy of HRT did not appear to be antagonized with concomitant tamoxifen. Seventy-five percent of women continued HRT after the study ended. Three women developed metastatic disease. Two used HRT. CONCLUSION(S): Despite informed consent, a national UK randomized trial of HRT should be feasible and has now been planned. Successful implementation necessitates the provision of information about HRT and the estrogen deficiency side effects of breast cancer therapy to health professionals and women with breast cancer.     

The World Health Organization defines hormone replacement therapy as carcinogenic: Is this plausible?

In June 2005 the World Health Organization's International Agency for Research on Cancer (IARC) classified combined hormone contraception and menopausal therapy as carcinogenic in humans. The IARC's function is to identify potential carcinogens associated with nutrition, environment and pharmaceutical products. They do not produce risk–benefit analyses for any country or population. Their conclusions are highly controversial in that no proof is presented for a causal relationship of estrogens with reproductive cancer, be it plausibility according to mechanisms of action or experimental evidence in an animal model. Equating natural compounds like estradiol with defined carcinogens like asbestos, tobacco smoke as well as indispensable drugs such as aspirin and tamoxifen is of no substantial clinical relevance. Thus, there are no new reasons to change current management principles with combination hormone contraception and therapy.     

Oral versus non-oral hormone replacement therapy: how important is the route of administration?

Although there are differences in the pharmacokinetic profiles of oral and non-oral routes of administration the clinical relevance of these differences remains to be determined. Likewise, there are differences in the metabolic and haemostatic effects of different routes of administration of oestrogen but these may have clinical relevance. For some parameters, such as lipids and lipoproteins, glucose and insulin metabolism, there are greater benefits from oral administration; for others, particularly haemostatic changes and effects on CRP, there are advantages from transdermal administration. For the potential benefits of HRT on CHD, these differences probably have less impact than the effect of the dose of hormones used and the lowest effective should be prescribed. Irrespective of dose, certain small sub-groups of patients should be specifically treated with an oral regimen eg those with lipid and lipoprotein abnormalities and impaired glucose tolerance whereas others should be treated with a transdermal regimen eg those with a personal or relevant family history of venous thrombosis. However, the vast majority of patients possess none of these risk factors and for them it will come down to personal preference. The availability of different combinations and doses of hormones, as well as different routes of administration, allows HRT to be tailored to the individual and there are few women for whom a suitable form of HRT cannot be found. Although data are lacking we believe it unwise to believe that fully transdermal combination therapy will not impact on risk of incident breast cancer. Based on current evidence transdermal HRT may also cause more irregular and breakthrough bleeding with sequential and continuous therapies than oral counterparts.