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Stroke Findings in the Women's Health Initiative
Semin Reprod Med 2014; 32: 438-446DOI: 10.1055/s-0034-1384627The Women's Health Initiative (WHI) clinical trials of estrogen with or without progestin versus placebo in 27,341 postmenopausal women are the largest randomized, placebo-controlled, double-blind clinical trials to look at the effect of hormone therapy on the outcomes of stroke, dementia, and cognition. Data from a parallel prospective observational study of 93,676 women examine biomarkers and risk factors associated with stroke. We summarize the results of 29 published articles in the WHI with stroke or cognition as outcomes of interest. Estrogen alone or in co...
Source: Seminars in Reproductive Medicine - October 16, 2014 Category: Reproduction Medicine Authors: Wassertheil-Smoller, SylviaKaplan, Robert C.Salazar, Christian R. Source Type: research

Postmenopausal Hormone Therapy and the Risks of Coronary Heart Disease, Breast Cancer, and Stroke
Semin Reprod Med 2014; 32: 419-425DOI: 10.1055/s-0034-1384624The principal findings are briefly reviewed from the Women's Health Initiative trials of the most commonly used postmenopausal hormone regimens in the United States—conjugated equine estrogens and these same estrogens plus medroxyprogesterone acetate. A more detailed review is presented for three major clinical outcomes: coronary heart disease (CHD), the primary trial outcome for which a major benefit was hypothesized; invasive breast cancer, the primary safety outcome for which some adverse effect was expected; and stroke which surfaced as an important adverse...
Source: Seminars in Reproductive Medicine - October 16, 2014 Category: Reproduction Medicine Authors: Prentice, Ross L. Source Type: research

Vaginal estradiol use and the risk for cardiovascular mortality
STUDY QUESTION Does the use of post-menopausal vaginal estradiol (VE) affect the mortality risk for coronary heart disease (CHD) and stroke. SUMMARY ANSWER The use of VE reduces the risk for cardiovascular mortality. WHAT IS KNOWN ALREADY A growing number of women use VE for post-menopausal genitourinary symptoms. Although this therapy is intended to have only local effects, estrogen is absorbed into the blood circulation and thus VE use may also have systemic effects. STUDY DESIGN, SIZE, DURATION We studied a nationwide cohort in Finland 1994–2009 during which post-menopausal women (n = 195 756) initiated the use...
Source: Human Reproduction - March 15, 2016 Category: Reproduction Medicine Authors: Mikkola, T. S., Tuomikoski, P., Lyytinen, H., Korhonen, P., Hoti, F., Vattulainen, P., Gissler, M., Ylikorkala, O. Tags: Puberty, Aging and HRT Source Type: research

Current recommendations: what is the clinician to do?
Menopausal hormone therapy (HT) has complex biologic effects but continues to have an important clinical role in the management of vasomotor and other menopausal symptoms. The rational use of menopausal HT requires balancing the potential benefits and risks of treatment. Findings from the Women's Health Initiative (WHI) and other randomized clinical trials have helped to clarify the benefits and risks of HT and have provided insights to improve decision making. Several clinical characteristics have utility in identifying women for whom benefits of HT are likely to outweigh the risks. Age and time since menopause are strong...
Source: Fertility and Sterility - March 31, 2014 Category: Reproduction Medicine Authors: JoAnn E. Manson Tags: Views and reviews Source Type: research

Prevention of Cardiovascular Disease in Women
Semin Reprod Med 2014; 32: 447-453DOI: 10.1055/s-0034-1384628Cardiovascular disease is the leading cause of death among women. In fact, the cardiovascular disease mortality rate among women exceeds the rate in men. Unfortunately, many minority women are still unaware of the importance of this disease. All women, including those with no history of cardiovascular disease, should have an accurate estimate of the probability of a cardiovascular disease event (death, myocardial infarction, or stroke) usually within the next decade. Such an estimate will help determine if women are candidates for preventive measures and specific...
Source: Seminars in Reproductive Medicine - October 16, 2014 Category: Reproduction Medicine Authors: Bavry, Anthony A.Limacher, Marian C. Source Type: research