Hormone replacement therapy in postmenopausal asthmatic women

OBJECTIVES: Assessment of mean 24 h oestradiol (E2) and oestrone (E1) concentration and basic FSH secretion in postmenopausal asthmatic women, before and after HRT use, and to identify any connections between changes in hormone concentrations and patients' clinical state. SUBJECTS: Postmenopausal women (55 asthmatic and 20 healthy, aged 48-60 years). METHOD: Serum hormone concentration was assessed by radioimmunoassay before HRT and after 6 months of transdermal 17beta-E2 and medroxyprogesterone acetate treatment (cyclical method). Intensification of menopausal symptoms was assessed by Kupperman's index. RESULTS: Secretion of oestrogens was lower in postmenopausal women asthmatic women than in postmenopausal healthy women. HRT caused an increase in oestrogen concentration. The 24-h fluctuations of E1 and E2 in all studied groups before and after HRT did not differ significantly. A statistically significant decrease in the number of menopausal symptoms was found during the course of HRT. During the period of HRT, there was a reduction in the number of patients in whom it was necessary to use oral glucocorticoid therapy during exacerbation of asthma. CONCLUSION: A greater reduction in oestrogen secretion was found in postmenopausal asthmatic women than in postmenopausal healthy women. HRT resulted in normalization of serum oestrogen concentration in asthmatic women and diminishing psychosomatic symptoms of the menopause and symptoms of asthma.     

Oestrogen replacement therapy lowers plasma levels of asymmetrical dimethylarginine in healthy postmenopausal women

Oestrogen replacement therapy (ERT) has been shown to lead to favourable changes in the cardiovascular risk profile of postmenopausal women. Part of this effect is ascribed to increased production or bioavailability of nitric oxide (NO). We have tested the hypothesis that ERT lowers plasma levels of asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of NO synthase (NOS). In a randomized double-blind study design, 40 hysterectomized postmenopausal women received conjugated equine oestrogen (CEE; 0.625 mg/day; n =14), the selective oestrogen receptor modulator raloxifene (150 mg/day; n =13) or placebo ( n =13). At baseline and after 6, 12 and 24 months of treatment, plasma was analysed for levels of arginine, ADMA, and symmetrical dimethylarginine (SDMA), a stereoisomer of ADMA that does not inhibit NOS. An overall treatment effect on ADMA levels was observed in the CEE group ( P =0.004 compared with placebo), but not in the raloxifene group ( P =0.50). The decrease of ADMA levels by CEE treatment was consistent over the 2-year study period, without significant differences between the effects at 6, 12 and 24 months. The average post-baseline change in ADMA in the CEE group compared with placebo was -7.8% (95% confidence interval -12.8% to -2.9%; P =0.003). Arginine or SDMA levels did not change during treatment in any of the groups. Thus ERT with oral conjugated oestrogen, but not with raloxifene, significantly reduced plasma concentrations of the cardiovascular risk factor ADMA in healthy postmenopausal women.     

Hormone replacement therapy may reduce high serum homocysteine in postmenopausal women

Abstract In a prospective study we investigated the possible changes in fasting serum total homocysteine concentrations during continuous micronized 17 β -oestradiol, 2 mg daily, in combination with cyclic dydrogesterone, 10 mg daily during the first 14 days of each 28 day cycle, in 21 healthy non-hysterectomized postmenopausal women. During the first six cycles mean serum homocysteine decreased by 10·9% ( P = 0·013), after which no further significant changes were found during the 2 years of treatment. A 16·9% decrease ( P = 0·017; n = 8) was found in women with high homocysteine concentrations, while in women with low homocysteine concentrations ( n = 13) no significant changes were observed. The observed decrease in high homocysteine concentrations in postmenopausal women may in part contribute to the decreased risk of developing cardiovascular disease during hormone replacement therapy.     

Hormone replacement therapy, insulin sensitivity, and abdominal obesity in postmenopausal women.

OBJECTIVE: The purpose of this study was to determine whether insulin sensitivity differs between postmenopausal women taking estradiol, women on estrogen plus progesterone hormone replacement therapy (HRT), and women not on HRT and whether differences are explained by the differences in total and/or abdominal adiposity and fat deposition in the muscle. RESEARCH DESIGN AND METHODS: We studied 28 obese, sedentary postmenopausal Caucasian women. Women taking oral estrogen (n = 6) were matched for age (57 +/- 3 vs. 58 +/- 2 years), weight (87.9 +/- 6.0 vs. 83.0 +/- 3.9 kg), and BMI (33.9 +/- 1.7 vs. 33.9 +/- 1.9 kg/m(2)) with women not on HRT (n = 6). Eight women taking oral estrogen plus progesterone were matched with eight different women not on HRT for age (59 +/- 2 vs. 60 +/- 2 years), weight (82.8 +/- 3.7 vs. 83.7 +/- 4.1 kg), and BMI (30.7 +/- 1.0 vs. 29.9 +/- 1.3 kg/m(2)). RESULTS: VO(2max) (maximal aerobic capacity), percentage of fat, total body fat mass, and fat-free mass (FFM) were similar between groups. Visceral fat, subcutaneous abdominal fat, sagittal diameter, and mid-thigh low-density lean tissue (intramuscular fat) did not differ by hormone status. Basal carbohydrate and fat utilization was not different among groups. Fasting plasma glucose and insulin did not differ by hormone use. Glucose utilization (M) was measured during the last 30 min of a 3-h hyperinsulinemic-euglycemic clamp (40 mU. m(2). min(-1)). Postmenopausal women taking oral estrogen had a 31% lower M than women not on HRT (42.7 +/- 4.0 vs. 61.7 +/- 4.7 micromol. kg(FFM). min(-1), P < 0.05). M was 26% lower in women taking estrogen plus progesterone (44.0 +/- 3.5 vs. 59.7 +/- 6.2 micromol. kg(FFM). min(-1), P < 0.05) than women not on HRT. M/I, the amount of glucose metabolized per unit of plasma insulin (I), an index of insulin sensitivity, was 36% lower in women taking estrogen compared with matched women not on HRT (P < 0.05) and 28% lower in women taking estrogen plus progesterone compared with matched women not on HRT (P < 0.05). CONCLUSIONS: Postmenopausal women taking oral estrogen or those taking a combination of estrogen and HRT are more insulin-resistant than women not on HRT, even when women are of comparable total and abdominal adiposity.     

绝经后骨质疏松症的激素补充治疗

INTRODUCTION Estrin attaches importance to development of skeleton and sustain of bone quantity.Level of estrin drops significantly after mentopause and rebuilding of bone loses balance.Absorption of bone is more than synthesis of bone and losing rate rate of bone fastens.The accelerated losing of bone occurs in the period of menstrual disorder perimenopausal period. To healthy worn, losing quantity of bone accounted for 3% to 10% on first year of menopause and 6% to 14%on second and third year.It is estimated that woman will lose 50%of bone quantity of lumbar vertebrae and 30% of bone quantity of corter, which was respectively 30% and 20% in man. The loss of skeleton after menopause occurs firetly at lumbar vertebrae and spongy bone in the end of long bone, which was often combined with changes of bonne structure Generally speaking,once bone quantity drops 10%, the risk of fracture adds one time.     

The effects of hormone replacement therapy combined with vitamins C and E on antioxidants levels and lipid profiles in postmenopausal women with Type 2 diabetes

BACKGROUND: Recent studies have demonstrated that oxidative modification of low-density lipoprotein (LDL) involving the formation of lipid peroxides (MDA), exerts several biological effects that may contribute to the onset and progression of cardiovascular diseases in postmenopausal women with Type 2 diabetes (DPMW). Therefore, the aim of our study was to evaluate the effect of hormone replacement therapy (HRT), vitamin C and E (VCE) treatments on lipid profiles, glucose and MDA levels as well as antioxidant vitamins and enzymes in plasma and red blood cells (RBC) in diabetic or non-diabetic postmenopausal women (PMW). METHODS: Oral HRT and VCE supplementation for 6 weeks were compared with HRT treatment in 40 non-diabetic PMW and 40 DPMW. RESULTS: In the 40 postmenopausal women (PMW) and 20 postmenopausal women with DPMW who received oral HRT and 20 DPMW who received HRT plus VCE, there was a significant fall in MDA, total cholesterol, LDL-cholesterol and triglyceride values. Glycated haemoglobin (HbA1c) in the DPMW was significantly improved with oral HRT and VCE although no significant change in white blood cell counts, vitamin A and HDL values occurred. Additionally, a fall in plasma glucose, HbA1c and platelet values also occurred in the PMW and DPMW groups by oral HRT and VCE treatments. There was a significant increase in plasma vitamin E and beta-carotene concentrations, catalase, glutathione peroxidase and reduced glutathione levels in RBC and plasma in DPMW by treatments with HRT and/or VCE. CONCLUSIONS: Daily VCE and HRT administrations both in PMW and DPMW seem to produce significant improvement in antioxidants concentrations, and the metabolic control of lipids and glucose. The HRT and VCE supplementations may strengthen the antioxidant defense system due to reducing blood glucose and lipid metabolites, and they may play a role in preventing cardiovascular diseases in postmenopausal women with Type 2 diabetes.     

Hormone replacement therapy for menopausal women

Hormone replacement therapy in postmenopausal women offers important benefits for preventing chronic disabling diseases, including prevention of osteoporosis and decreased risk of colon cancer. Although such therapy also carries various possible increased risks, most women will benefit from this therapy.     

Hormone replacement therapy in a postmenopausal woman with epilepsy

OBJECTIVE: To prospectively evaluate the effects of hormone replacement therapy (HRT) on seizure activity in a postmenopausal woman with epilepsy. BACKGROUND: Postmenopausal women are at an increased risk for cardiovascular disease and osteoporosis secondary to a lack of estrogen's protective effects. As a result, women without known contraindications often take HRT to counteract this risk. Postmenopausal women with epilepsy are at a greater risk for osteoporosis because of the negative effects that certain antiepileptic drugs have on bone density. Clinical studies and experience have shown that hormonal variances across a woman's lifetime play a significant role in seizure activity, but the effects of HRT in postmenopausal women with epilepsy are unknown. CASE SUMMARY: We report the case of a 51-year-old postmenopausal white woman with epilepsy who presented with frequent vasomotor flushing. To determine individual effects of HRT on seizure activity, therapy was initiated in two three-month phases, with monthly evaluation. A weekly transdermal patch of estradiol 0.1 mg/d was initiated for the first three months. During the second three months, the regimen was expanded to include oral medroxyprogesterone acetate 2.5 mg once daily. Antiepileptic medications and their dosages remained constant. HRT was associated with a decreased incidence of seizures, cessation of vasomotor flushing, improved sleep, and a positive impact on the lipid profile. CONCLUSIONS: This case report describing the prospective addition of HRT in a postmenopausal woman with epilepsy suggests that HRT can be initiated in certain women to achieve therapeutic benefits without adversely affecting seizure activity.     

The effect of estrogen replacement therapy on total plasma homocysteine in healthy postmenopausal women

OBJECTIVE: To clarify the effect of estrogen on total plasma homocysteine concentration and on the concentration of vitamins required for homocysteine metabolism (folate, vitamin B12, and vitamin B6). METHODS AND RESULTS: We measured total fasting plasma homocysteine in 16 healthy postmenopausal women before and 6 hours after a methionine load (100 mg/kg); fasting concentrations of folate, vitamin B12, vitamin B6, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were also determined. After 6 months of estrogen replacement therapy with estradiol, 2 mg daily, and 1 cycle of quarterly methoxyprogesterone acetate, 5 mg daily administered on the 91st through 100th days, measurements were repeated. There was no significant change in mean +/- SD fasting homocysteine concentration (8.8+/-2.5 vs 8.5+/-2.0 micromol/L; P=.30); homocysteine concentrations after methionine load increased from 38.8+/-12.3 to 51.1+/-12.5 micromol/L (P=.01). During this time period, no significant changes occurred in the concentrations of folate (11.7+/-4.4 vs 9.8+/-4.1 nmol/L; P=.06), vitamin B12 (394+/-182 vs 411+/-155 pmol/L; P=.40), or vitamin B6 (pyridoxal phosphate) (26+/-21 vs 36+/-25 nmol/L; P=.15). The mean +/- SD concentration of low-density cholesterol declined 20% (from 147+/-32 to 118+/-37 mg/dL) and high-density lipoprotein increased 16% (from 40+/-13 to 46+/-19 mg/dL) during the study period. CONCLUSIONS: Six months of estrogen replacement therapy did not lower fasting plasma total homocysteine concentrations and raised homocysteine concentrations following a methionine load. Lipid profiles improved significantly during the study period. A reduction in homocysteine concentrations is not likely to contribute to the reduction in cardiovascular events seen with estrogen replacement therapy.     

Increase in circulating levels of cardiac natriuretic peptides after hormone replacement therapy in postmenopausal women.

The mechanisms that mediate the cardioprotective action of steroid hormones in postmenopausal women are poorly understood. To study the inter-relationship between female steroid hormones and cardiac natriuretic peptides, plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured in postmenopausal women, both before and after oestrogen replacement therapy. A total of 22 healthy postmenopausal women (mean age 51.9+/-4.6 years) were enrolled in the study; all had been postmenopausal for at least 1 year and all reported climacteric symptoms accompanied by increased levels of follicle-stimulating hormone (>30 m-i.u./ml) and luteinizing hormone (>20 m-i.u./ml), and a reduction in oestradiol (<25 pg/ml). All women were given hormone replacement therapy with transdermal oestradiol, either patch (50 microg/24 h) or gel (1 mg/day), cyclically combined with oral dihydrogesterone (10 mg/day for 12 days/month, on days 19-30 of the month). ANP and BNP were measured directly in plasma samples with specific and sensitive immunoradiometric assays before and after hormone replacement therapy (transdermal oestradiol combined with oral dihydrogesterone). Body weight, arterial blood pressure and echocardiographic examination values did not change after hormone replacement therapy. As expected, serum oestradiol increased significantly and gonadotropins decreased as an effect of the hormone replacement therapy. On average, both ANP and BNP had increased significantly after 3 months of hormone replacement therapy [ANP: before treatment, 17.6+/-9.6 pg/ml; after, 23.6+/-5.6 pg/ml (P=0.0173); BNP: before treatment, 12.6+/-10.2 pg/ml; after, 19.8+/-14.0 pg/ml (P<0.0001)]. Our study indicates that hormone replacement therapy for a period of 3 months induces a rise in the circulating levels of cardiac natriuretic hormones in postmenopausal women. Our data also suggest the working hypothesis that cardiac natriuretic peptides may play an important role in mediating the cardioprotective effects of female steroid sex hormones in women throughout life.     

Benefits of hormone replacement therapy in postmenopausal women

PURPOSE: To provide an overview of current research regarding hormone replacement therapy (HRT) and to assist healthcare providers to better educate patients about potential benefits of this therapy. DATA SOURCES: A systematic review of healthcare literature was conducted with 602 articles selected from CINAHL, Medscape, Pubmed, and Medline databases. Keywords directing the search included hormone replacement therapy, benefits of hormone replacement therapy and trends, hormone replacement therapy and osteoporosis, hormone replacement, and menopause symptoms. CONCLUSIONS: According to the literature, HRT can assist women with postmenopausal symptoms. In addition, research shows that HRT can help some postmenopausal women with selected comorbid conditions such as osteoporosis, type II diabetes, certain cardiovascular pathologies, and colorectal cancer. The decision as to who should use any form of HRT needs to be based on the individual woman's needs, quality of life, and potential risks versus benefits. IMPLICATIONS FOR PRACTICE: HRT has been a benefit to many women in the treatment of postmenopausal symptoms. Recent studies have shown that HRT, whether it is combined estrogen and progestin therapy, or estrogen-only therapy, can help postmenopausal women with osteoporosis and some selected comorbid conditions. Recent research indicates that some women are dying from comorbid conditions rather than breast cancer. Although the research regarding HRT in some areas may be limited, further research adds to existing knowledge and offers new ideas and possibilities in the treatment of postmenopausal symptoms and selected comorbid conditions. Certainly HRT can improve quality of life and possibly longevity for selected women. Ongoing research is needed to further validate such benefits, as well as to further explore the risks and benefits of long-term HRT. Increased knowledge about HRT will help healthcare providers better educate patients about the potential benefits of HRT, while providing documentation about who should take selected types of HRT or whether alternative treatment is preferred.     

Homocysteine in postmenopausal women and the importance of hormone replacement therapy.

Homocysteine (Hcy) has been shown to damage the vascular endothelial cells, contributing to atherothrombosis. The increase in plasma Hcy levels with natural menopause suggests a close relationship between Hcy metabolism and estrogen status and proposes one of the mechanisms through which menopause unfavorably affects cardiovascular disease risk in women. In addition to the prevention of osteoporosis, hormone replacement therapy (HRT) lowers Hcy levels in postmenopausal women. The first report by van der Mooren et al., demonstrated in an uncontrolled study a significant reduction (11%) in fasting serum Hcy level after 6 months of treatment with sequentially combined estradiol-dydrogesterone therapy in 21 healthy postmenopausal women. This effect was particularly evident in women with initially elevated baseline serum Hcy concentrations. Similar results were found in other studies in which women were treated with various transdermal as well as oral HRT regimens, although two studies could not confirm these findings. All these studies were uncontrolled, and three of them consisted of a relatively small number of participants. Therefore, they remained inconclusive. Three randomized controlled trials on HRT and Hcy were published to date, confirming that postmenopausal HRT reduces circulating levels of Hcy. Current and recent HRT use is associated with a slight increased risk of breast cancer. As a result of this, research has centered on finding compounds that can prevent the consequences of estrogen deficiency, without the potential risk of HRT. Raloxifene, referred to as a Selective Estrogen Receptor Modulator (SERM), has the potential as a viable alternative to HRT. Recently, two randomized controlled trials demonstrated that raloxifene lowers plasma Hcy levels in postmenopausal women, similar to the reduction obtained with HRT. Little is known about the mechanisms underlying the HRT-associated lowering of plasma Hcy. Proposed mechanisms relate to an increase in kidney methionine synthase activity or may be related to the transamination of methionine. We conclude that HRT decreases plasma Hcy levels in postmenopausal women and that the strongest reductions can be achieved in women with the highest concentrations.     

Estrogen replacement therapy for Alzheimer disease in postmenopausal women

OBJECTIVE: To evaluate the clinical utility of oral conjugated equine estrogen in postmenopausal women with Alzheimer disease. DATA SOURCES: Literature was identified through MEDLINE (1997-January 2002). Key search terms included Alzheimer disease, estrogen replacement therapy, and treatment. DATA SYNTHESIS: Estrogen has been identified as a neuroprotective agent with possible application in degenerative disorders. Observational studies have demonstrated an association between estrogen replacement therapy and decreased incidence of Alzheimer disease. Two recent, controlled clinical trials have evaluated the role of oral conjugated estrogen in the treatment of Alzheimer disease. CONCLUSIONS: Clinical trials indicate that oral conjugated equine estrogen is not an effective treatment for Alzheimer disease in postmenopausal women.     

Effects of hormone replacement therapy with vitamin C and E supplementation on plasma thyroid hormone levels in postmenopausal women with Type 2 diabetes

Recent studies have shown that hormone replacement therapy (HRT) can exert regulatory affects on lipid and glucose homeostasis. It has been demonstrated that hyperglycemia also involving the formation of lipid peroxides, exert several biological effects that may contribute to the onset and progression of thyroid and kidney abnormalities of postmenopausal women Type 2 diabetes. Therefore, the aim of our study was to evaluate the effect of HRT, vitamin C and E (VCE) treatments on some plasma biochemical and hematological parameters and plasma thyroid hormone levels in postmenopausal women with or without diabetes.