Hormone Therapy in Menopause.

Hormone Therapy in Menopause. Adv Exp Med Biol. 2020;1242:89-120 Authors: Paciuc J Abstract As longevity expands, women are spending a third of their existence in menopause and beyond. The vast majority suffer from symptoms that negatively impact their quality of life. Systemic vasomotor symptoms (VMS) are the classic cluster affecting 80% of peri- and post-menopausal women. Once thought to be relatively brief, they sometimes persist more than 10 years. Compelling, yet enigmatic, is the recent finding that women with bothersome and long VMS compared with age-matched peers often have worst underlying preclinical markers of cardiovascular disease (CVD).Local vulvovaginal and urinary symptoms, now termed genitourinary syndrome of menopause (GSM), are seen in 50% of postmenopausal women, and it negatively impacts quality of life. Estrogen remains the most effective treatment for both VMS and GSM, for osteoporosis prevention, and for symptom relief as well as chronic disease prevention in women who experience premature menopause whether from primary ovarian insufficiency (POI) or iatrogenic etiologies. For women who have contraindications to estrogen therapy or who personally object, a panoply of nonhormonal modalities can be offered to treat both systemic and local menopausal symptoms. A historical review of estrogen studies reveals why its persona has vacillated from hero to villain (after the WHI) and back to hero. The "timing hypothesis" and...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research

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We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovas...
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
AbstractPurpose of ReviewFor decades the medical community recommended menopausal hormone therapy (MHT) for prevention of atherosclerotic cardiovascular disease (ASCVD) and osteoporosis in addition to relieving unpleasant vasomotor and genitourinary symptoms. These recommendations were largely based on observational studies. Several large randomized placebo-controlled trials led to the surprising finding that postmenopausal women were at higher risk of cardiovascular disease (CVD) events compared with women in the placebo group. For the next decade, women were less frequently prescribed MHT and more often declined MHT.Rece...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research
The menopause transition can have a significant impact on many women, with more than 75% experiencing menopausal symptoms, and a quarter describing severe symptoms. Symptoms on average last 7 years and a third of women experience long-term symptoms. Menopausal hormone therapy (MHT), compared with placebo, has consistently shown improvements in menopausal symptoms and overall quality of life. Furthermore, MHT has a significant protective effect against osteoporosis and cardiovascular disease in women initiating MHT under the age of 60 [1,2].
Source: Maturitas - Category: Primary Care Authors: Source Type: research
CONCLUSIONS: Hormone replacement therapy may slightly improve overall survival in women who have undergone surgical treatment for EOC, but the certainty of the evidence is low. HRT may make little or no difference to quality of life, incidence of breast cancer, TIA, CVA and MI as the certainty of the evidence has been assessed as very low. There may be little or no effect of HRT use on progression-free survival. The evidence in this review is limited by imprecision and incompleteness of reported relevant outcomes and therefore the results should be interpreted with caution. Future well-designed RCTs are required as this is...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
The objective is to provide a sound pathophysiological background along with evidence-based and practical recommendations for physicians managing such women. PMID: 31853818 [PubMed - as supplied by publisher]
Source: Hormones - Category: Endocrinology Tags: Hormones (Athens) Source Type: research
AbstractPurpose of ReviewThe goal of the review is to assess the appropriateness of menopausal hormone therapy (MHT) for the primary prevention of bone loss in women at elevated risk in the early years after menopause.Recent FindingsEstrogen alone or combined with progestin to protect the uterus from cancer significantly reduces the risk of osteoporosis-related fractures. MHT increases type 1 collagen production and osteoblast survival and maintains the equilibrium between bone resorption and bone formation by modulating osteoblast/osteocyte and T cell regulation of osteoclasts. Estrogens have positive effects on muscle an...
Source: Current Osteoporosis Reports - Category: Orthopaedics Source Type: research
Menopausal hormone therapy (MHT) is the treatment of choice for menopausal symptoms and urogenital atrophy. Furthermore, it has beneficial effects on chronic diseases related to estrogen deficiency, such as osteoporosis and cardiovascular disease [1 –4]. Women worldwide have been using MHT to alleviate their symptoms for decades. However, fear of breast cancer, hinders menopausal women from seeking medical advice and renders clinicians reluctant to prescribe MHT.
Source: Maturitas - Category: Primary Care Authors: Source Type: research
The use of menopause hormone therapy (MHT) has decreased dramatically in all countries since the initial findings of the Women ’s Health Initiative (WHI) were published in 2002 (1). Physicians’ advice and women’s decisions regarding MHT have been clouded by anxiety and confusion for the past decade (2). Moreover, a generation of physicians has not been adequately trained in menopause management (2,3).
Source: Maturitas - Category: Primary Care Authors: Source Type: research
In this report, we examined if hormone secretion from cHT constructs is impacted by incorporation of bone marrow-derived mesenchymal stem cells (BMSC) since these cells contain regulatory factors such as aromatase necessary for estrogen production. Incorporation of BMSCs led to enhanced estrogen secretion in vitro. Moreover, cHT constructs with BMSCs achieved estrogen secretion levels significantly greater than constructs without BMSCs in ovariectomized rats from 70 to 90 days after implantation, while also regulating pituitary hormones. cHT constructs with BMSC ameliorated estrogen deficiency-induced uterine atrophy ...
Source: Annals of Biomedical Engineering - Category: Biomedical Engineering Authors: Tags: Ann Biomed Eng Source Type: research
Introduction: The use of menopause hormone therapy has dramatically decreased in all countries since 2002. Physicians ’ advices and women's decisions regarding such therapy have been surrounded by anxiety and confusion for the last decade. Moreover, a generation of physicians has not been trained in menopause management. Only during the last years have emerged again guidelines and opinion papers in leading journa ls, reinstalling the place of menopause hormone therapy (MHT). A gap may therefore exist between scientific society guidelines and physicians’ prescription attitudes.
Source: Maturitas - Category: Primary Care Authors: Tags: O24 Source Type: research
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