Selección de
Resúmenes de Menopausia
Abril de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de
Chile
Semana del 1 al 8 de Abril de 2009
Rev Med Chil. 2008 Dec;136(12):1511-7. Epub
2009 Mar 23.
Assessment of quality of life using the
Menopause Rating Scale in women aged 40 to 59 years.
Del Prado A M, Fuenzalida A, Jara D, Figueroa J R, Flores D, Blumel M JE.
Departamento
de Gineco-obstetricia, Escuela de Medicina,
Universidad Diego Portales, Santiago, Chile.
Background:
Climacteric symptoms have a direct relationship with biological and sociocultural factors and significantly impair the quality
of life of women. Aim: To assess quality of life and factors affecting it in
women aged 40 to 59 years. Material and methods: The Menopause Rating Scale
(MRS) was applied to 370 healthy women aged 49 +/- 6 years,
that accompanied patients to public hospitals in
Gynecol
Obstet Invest. 2009
Apr 7;68(1):33-39. [Epub
ahead of print]
Effects of either Tibolone
or Continuous Combined Transdermal Estradiol with Medroxyprogesterone
Acetate on Coagulatory Factors and Lipoprotein(a)
in Menopause.
Perrone G, Capri O, Galoppi P, Brunelli R, Bevilacqua E, Ceci F, Ciarla MV, Strom R.
Departments of Gynecology and Obstetrics, University 'Sapienza', Rome, Italy.
Background/Aim:
The aim of this prospective controlled study was to compare the effects of two
therapies for menopause on factor VII (FVII) and hemostatic
variables. Methods: Postmenopausal women were assigned to receive one of the
following treatments: transdermal estradiol
(TTS E2; 50 mug) combined in a continuous sequential regimen with oral medroxyprogesterone acetate (MPA; 10 mg/day for 12 days)
(group A; n = 20), tibolone (2.5 mg/day) (group B; n
= 21) or placebo (group C; n = 19). Sixty women completed the 1-year treatment
and underwent follow-up examinations after 3, 6 and 12 months. Results: TTS
E2/MPA induced various changes in procoagulatory
factors. At 12 months, fibrinogen, activated FVII (FVIIa)
and coagulative FVII (FVIIc)
had increased by 10.7, 12.9 and 3.7%, respectively. Among the fibrinolytic factors, plasminogen
and alpha2-antiplasmin increased by 11.3 and 7.2%, respectively. Lipoprotein(a)
[Lp(a)] and antithrombin
III (ATIII) did not show any significant variation. Tibolone
induced some changes toward a more homogeneous antithrombotic profile.
Fibrinogen, FVIIa and FVIIc
decreased significantly by 7.5, 8.1 and 21.3%, respectively. Plasminogen increased (by 11.8%) and Lp(a)
decreased (by 28.4%). ATIII was unchanged with tibolone
therapy. Conclusion: Our results show that tibolone
induces a significant reduction in FVIIc and Lp(a) and
a greater enhancement of factors promoting fibrinolysis
than the TTS E2/MPA regimen.
Osteoporos
Int. 2009 Apr 3. [Epub ahead of print] Links
Depression and low bone mineral density:
a meta-analysis of epidemiologic studies.
Wu
Q, Magnus
JH, Liu
J, Bencaz
AF, Hentz
JG.
Biostatistics,
Mayo Clinic,
The
association between depression and loss of bone mineral density (BMD) has been
reported inconsistently. This meta-analysis, which pooled results from 14
qualifying individual studies, found that depression was associated with a
significantly decreased BMD, with a substantially greater BMD decrease in
depressed women and in cases of clinical depression. INTRODUCTION: The reported
association between depression and loss of BMD has been controversial. This
meta-analysis was conducted to determine whether depression and BMD are
associated and to identify the variation in some subgroups. METHODS:
English-language articles published before October 2008 were used as the data
source. A total of six case-controlled and eight cross-sectional studies met prestated inclusion criteria (N = 10,523). Information on
study design, participant characteristics, measurements of BMD and depression,
and control for potential confounders was abstracted independently by two
investigators using a standardized protocol. RESULTS: Overall, depression was
associated with a significant decrease in mean BMD of spine (-0.053 g/cm(2)
[95% confidence interval {CI} -0.087 to -0.018 g/cm(2)]) and hip (-0.052
g/cm(2) [95% CI -0.083 to -0.022 g/cm(2)]). A substantially greater BMD
decrease was observed in depressed women (-0.076 g/cm(2) in spine; -0.059
g/cm(2) in hip) and in cases of clinical depression (-0.074 g/cm(2) in spine;
-0.080 g/cm(2) in hip). CONCLUSION: Depression is associated with low BMD, with
a substantially greater BMD decrease in depressed women and in cases of
clinical depression. Depression should be considered as an important risk
factor for osteoporosis.
Semin Cutan Med Surg. 2009
Mar;28(1):19-32. Links
Hair loss in women.
Department
of Dermatology,
Female
pattern hair loss (FPHL) is a clinical problem that is becoming more common in
women. Female alopecia with androgen increase is called female androgenetic alopecia (FAGA) and without androgen increase
is called female pattern hair loss. The clinical picture of typical FAGA begins
with a specific "diffuse loss of hair from the parietal or frontovertical areas with an intact frontal hairline."
Ludwig called this process "rarefaction." In Ludwig's classification
of hair loss in women, progressive type of FAGA, 3 patterns were described:
grade I or minimal, grade II or moderate, and grade III or severe. Ludwig also
described female androgenetic alopecia with male
pattern (FAGA.M) that should be subclassified
according to Ebling's or Hamilton-Norwood's
classification. FAGA.M may be present in 4 conditions: persistent adrenarche syndrome, alopecia caused by an adrenal or an
ovarian tumor, posthysterectomy, and as an involutive alopecia. A more recent classification (Olsen's
classification of FPHL) proposes 2 types: early- and late-onset with or without
excess of androgens in each. The diagnosis of FPHL is made by clinical history,
clinical examination, wash test, dermoscopy, trichoscan, trichograms and
laboratory test, especially androgenic determinations. Topical treatment of
FPHL is with minoxidil, 2-5% twice daily. When FPHL
is associated with high levels of androgens, systemic antiandrogenic
therapy is needed. Persistent adrenarche syndrome
(adrenal SAHA) and alopecia of adrenal hyperandrogenism
is treated with adrenal suppression and antiandrogens.
Adrenal suppression is achieved with glucocorticosteroids.
Antiandrogens therapy includes cyproterone
acetate, drospirenone, spironolactone,
flutamide, and finasteride.
Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian hyperandrogenism is treated with ovarian suppression and antiandrogens. Ovarian suppression includes the use of
contraceptives containing an estrogen, ethinylestradiol,
and a progestogen. Antiandrogens
such as cyproterone acetate, always accompanied by tricyclic contraceptives, are the best choice of antiandrogens to use in patients with FPHL. Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress pituitary and gonadal function through a reduction in luteinizing hormone
and follicle-stimulating hormone levels. Subsequently, ovarian steroid levels
also will be reduced, especially in patients with polycystic ovary syndrome.
When polycystic ovary syndrome is associated with insulin resistance, metformin must be considered as treatment. Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be treated with bromocriptine
or cabergoline. Postmenopausal alopecia, with
previous high levels of androgens or with prostatic-specific antigen greater
than 0.04 ng/mL, improves
with finasteride or dutasteride.
Although we do not know the reason, postmenopausal alopecia in normoandrogenic women also improves with finasteride or dutasteride at a
dose of 2.5 mg per day. Dermatocosmetic concealment
with a hairpiece, hair prosthesis as extensions, or partial hairpieces can be
useful. Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
Acta
Med Port. 2009
Jan-Feb;22(1):51-8. Epub 2009 Mar 25. Links
[Quality of life and related factors
among climacteric women from south
[Article in Portuguese]
de Lorenzi DR, Saciloto B, Artico GR, Fontana SK.
Setor de
Atenção Multidisciplinar ao
Climatério da Universidade de
Caxias do Sul, Brasil.
OBJECTIVE:
This study aimed to evaluate the quality of life in climacteric and associated
factor among women from
Ann
Nutr Metab. 2009 Apr 1;54(2):138-144. [Epub ahead of
print] Links
Effect of Advice to Increase
Carbohydrate and Reduce Fat Intake on Dietary Profile and Plasma Lipid
Concentrations in Healthy Postmenopausal Women.
Arefhosseini
SR, Edwards
CA, Malkova
D, Higgins
S.
Human
Nutrition Section, Division of Developmental Medicine,
Background:
The current dietary guidelines advise an increase in carbohydrate intake.
However, there is concern regarding the effect this may have on coronary heart
disease (CHD) risk, in particular in postmenopausal women, in light of the
knowledge that raised triacylglycerol (TAG) may pose
a stronger risk for CHD in this group. Aim: To evaluate the effect of advice to
increase carbohydrate intake to 50% of energy intake as part of advice to
follow current dietary guidelines on the dietary profile, including dietary glycaemic index (GI) and plasma lipids in healthy
postmenopausal women. Methods: Twelve healthy postmenopausal women (56 +/- 6.5
years) took part in the study. Habitual diet was assessed by a 7-day weighed
intake. On the basis of the results, subjects were advised to increase their
carbohydrate intake to comply with the current dietary guidelines. Subjects
were asked to follow this diet for 4 weeks, in a free-living situation. Fasting
blood samples were obtained at baseline and after 1 and 4 weeks. Results: There
was a significant decrease in body mass index (BMI; p < 0.05) after 4 weeks.
There was a significant increase in fasting TAG concentrations after 1 week (p
< 0.05), and the high-density lipoprotein (HDL) cholesterol concentration
was significantly decreased (p < 0.05) after 1 and 4 weeks. The subjects
significantly increased their percentage of energy from carbohydrates and
starch (p < 0.05 and p < 0.01, respectively) after 1 week, and their
percentage of energy from starch after 4 weeks (p < 0.05). Dietary GI was
significantly increased (p < 0.05) after 1 and 4 weeks. Fruit and vegetable
intake was significantly increased after 1 week (p < 0.01), as was fruit
intake alone (p < 0.05), and there was a significant increase (p < 0.05)
in the 'antioxidant power' as measured by the ferric reducing ability of plasma
assay. Conclusion: In postmenopausal women, following the UK dietary guidelines
resulted in changes in the lipid profile that were more likely to favour an increased risk of CHD, as TAG concentrations were
increased and HDL cholesterol concentrations were reduced. However, in
addition, we found a significant reduction in BMI and a significant increase in
the 'antioxidant power' of plasma, which should benefit health.
J Bone Miner Metab. 2009 Mar 31. [Epub ahead of print] Links
Association between endogenous plasma
hormone concentrations and fracture risk in men and women: the EPIC-Oxford
prospective cohort study.
Roddam
AW, Appleby
P, Neale
R, Dowsett
M, Folkerd
E, Tipper
S, Allen
NE, Key
TJ.
Cancer
Epidemiology Unit,
Sex
steroids have an important role in bone health, however previous studies on
fracture risk have been carried out in older populations. The EPIC-Oxford study
is a prospective cohort of men and women living in the
Climacteric. 2009 Mar 27:1-10. [Epub ahead of print] Links
Low-dose estradiol
for climacteric symptoms in Japanese women: a randomized, controlled trial.
Aiseikai-Yamashina-Hospital,
Objectives
To investigate two different doses of oral estradiol
to reduce the number of hot flushes in Japanese women with climacteric
symptoms. Methods Women (n = 211) aged 40-64 years who had experienced natural
menopause or bilateral oophorectomy, with >/=
three moderate/severe hot flushes per day in the week before study, were
randomized to receive micronized estradiol (E2) 0.5
or 1.0 mg or placebo once daily for 8 weeks. The primary efficacy endpoint was
percentage change in mean daily number of hot flushes over 7 days from baseline
to final examination. Results Percentage change in mean daily number of hot
flushes at final examination was similar for E2 0.5 mg and E2 1.0 mg (-79.58
+/- 28.29% vs. -82.49 +/- 25.31%, p = 0.555) but was significantly lower with
placebo (-57.89 +/- 34.15%, p < 0.001 vs. E2, both doses). There was no
significant difference in number of treatment-related adverse events occurring
in the E2 0.5 and 1.0 mg groups (25% and 36.6%, respectively). The higher E2
dose showed more pronounced effects on symptom severity. Conclusions The dose
of 0.5 mg/day was effective as the oral E2 starting dose for treatment of hot
flushes in Japanese women.
Eur J Intern Med. 2009 Mar;20(2):162-7. Epub
2008 Jul 30. Links
SHBG levels correlate with insulin
resistance in postmenopausal women.
Akin F, Bastemir M, Alkiş E, Kaptanoglu B.
BACKGROUND:
Overweight or central obesity is generally associated with increases in fasting
insulin levels, insulin resistance, and glucose intolerance and has been
identified as a target for new therapeutic strategies, including early change
in lifestyle. Early biochemical markers for identifying at-risk patients will
be useful for prevention studies. The aim of this study is to investigate
whether or not SHBG level is a useful index of hyperinsulinemia
and/or insulin resistance in pre- and postmenopausal obese women. At the same
time, the relationship between SHBG concentrations and features of the
metabolic syndrome were evaluated. METHODS: 229 women were eligible for this
study. MetS was defined by using a modification of
the ATP III guidelines. All patients were euthyroid,
obese and overweight, 25 to 69 years of age. Subjects were divided into groups
of premenopausal women (n=125) and postmenopausal women (n=104). Various
fatness and fat distribution parameters, SHBG, sex hormones, FSH, LH, thyroid
hormones, serum levels of fasting and postprandial glucose, lipid profile, uric
acid and serum insulin, and blood pressure were measured. RESULTS: No
significant difference was found in mean SHBG levels between pre- and
postmenopausal obese women in this study (p=0.866). In premenopausal obese
women, SHBG correlated negatively with BMI, waist circumference, fasting
glucose, uric acid levels and FAI. In postmenopausal obese women, SHBG
correlated negatively with fasting glucose, postprandial plasma glucose,
fasting insulin, HOMA-IR and FAI and positively with HDL. SHBG had a significant
inverse association with MetS parameters only in
postmenopausal women, also after adjusting for BMI, age and estradiol.
CONCLUSIONS: Obesity may influence the levels of endogenous sex steroid,
especially after menopause. SHBG concentrations are correlated with features of
the metabolic syndrome, particularly in postmenopausal obese women. These
results suggest that SHBG may be an index of insulin resistance in
postmenopausal obese women.
Semana del 8 al 14 de Abril de 2009
Neuroscientist. 2009 Apr 9. [Epub ahead of print]
Is Progesterone a Candidate Neuroprotective
Factor for Treatment following Ischemic Stroke?
Gibson CL, Coomber B, Rathbone J
From the
Gender differences
in stroke outcome have implicated steroid hormones as potential neuroprotective candidates. However, no clinical trials
examining hormone replacement therapy on outcome following ischemic stroke have
investigated the effect of progesterone-only treatment. In this review the
authors examine the experimental evidence for the neuroprotective
potential of progesterone and give an insight into potential mechanisms of
action following ischemic stroke. To date, 17 experimental studies have
investigated the neuroprotective potential of
progesterone for ischemic stroke in terms of ability to both reduce cell loss
and increase functional outcome. Of these 17 published studies the majority
reported a beneficial effect with three studies reporting a nil effect and only
one study reporting a negative effect. However, there are important issues that
the authors address in this review in terms of the methodological quality of
studies in relation to the STAIR recommendations. In terms of the proposed
mechanisms of progesterone neuroprotection we show
that progesterone is versatile and acts at multiple targets to facilitate
neuronal survival and minimize cell damage and loss. A large amount of
experimental evidence indicates that progesterone is a neuroprotective
candidate for ischemic stroke; however, to progress to clinical trial a number
of key experimental studies remain outstanding.
Maturitas. 2009 Apr 7. [Epub ahead of print
Role of testosterone in the treatment of hypoactive sexual desire
disorder.
Schwenkhagen A, Studd J.
Gynaekologicum
Hypoactive sexual
desire disorder (HSDD) is a common clinical problem that may have a very
negative impact on a woman's quality of life. Diagnosis and treatment is
challenging, as one must keep in mind the complex web of factors influencing
sexual functioning alone or in concert. Data suggest that androgens are
significant independent factors affecting sexual desire, sexual activity and
satisfaction, as well as other components of women's health such as mood and
energy. For decades, physicians used various androgen preparations to improve
sexual function in women, based on the results of smaller clinical trials and
personal clinical observations when taking care of patients. Today, there is
substantial body of evidence from randomized placebo-controlled trials that
low-dose testosterone treatment is efficacious in women with HSDD who have an
established cause of androgen deficiency such as surgical menopause. Recent
data support the hypotheses that androgens may also be beneficial in naturally
menopausal women or in premenopausal women with low circulating testosterone
levels and a decrease in satisfying sexual activity. No single testosterone level
has been found to be predictive for low female sexual function, even though
women suffering from HSDD commonly have low testosterone levels. The most
frequently reported side effects of testosterone treatment are mild hirsutism or acne. Long-term safety is not yet established.
Several clinical trials are in progress to further investigate potential
benefits and risks of androgen treatment in women with sexual dysfunction.
Drugs Aging. 2009;26(3):241-53. doi: 10.2165/00002512-200926030-00005.
Value of a new fixed-combination pack of bisphosphonate,
calcium and vitamin d in the therapy of osteoporosis: results of two
quantitative patient research studies.
Ringe JD, Fardellone P,
Kruse HP, Amling M, van der Geest SA, Möller G.
Medizinische Klink
IV, Klinikum Leverkusen, Teaching Hospital of the
Osteoporotic patients
with insufficient calcium intake and/or vitamin D insufficiency need adequate
calcium and vitamin D supplementation with their bisphosphonate
treatment. However, consistent intake and, therefore, the effectiveness of
calcium/vitamin D supplementation may be impaired by several factors in the
individual patient: low prescription rate or lack of advice to purchase
calcium/vitamin D; reduced compliance because of the complexity of the regimen;
or incorrect intake. There is a need to provide patients with a better way of
taking bisphosphonate treatment with their
calcium/vitamin D supplementation. To this end, a fixed-combination pack to
help patients take the combination of bisphosphonate,
calcium and vitamin D correctly and regularly has been developed. To evaluate
patients' understanding of administration instructions, preferences and their
perceptions of compliance, convenience and completeness of a fixed-combination
pack of bisphosphonate, calcium and vitamin D
compared with those associated with separate packs. The new monthly
fixed-combination pack of bisphosphonate, calcium and
vitamin D contains four weekly boxes. Each box contains a blister pack with one
swallowable risedronate 35
mg film-coated tablet and six sachets of calcium/vitamin D effervescent
granules (calcium 1000 mg and vitamin D(3) [colecalciferol]
880 IU) for dissolution in water as an oral solution, together constituting 1
week of therapy, accompanied by a patient information leaflet. Two quantitative
patient research survey studies were conducted using standard questionnaires in
face-to-face interviews with 400 postmenopausal women in several French cities.
Participants were given the combined pack and two separate packs (risedronate 35 mg once weekly and calcium/vitamin D
effervescent granules in sachets). In the first study, participants'
understanding of administration instructions and preferences were evaluated. In
the second study, participants' perception of compliance, convenience and
completeness of the new combination pack of risedronate
35 mg plus calcium/vitamin D compared with two separate packs were evaluated.
Participants asked about the combined pack answered a significantly higher
proportion of questions about intake instructions correctly (80.3%) than
participants asked about the two separate packs (70.7%) [p = 0.0004]. The
combined pack was preferred by 72% of participants (p < 0.0001) for several
reasons. Compared with separate packs, the combined pack was considered easier
to use by 63% and easier to remember to use by 67% of participants.
Participants believed that use of the combined pack would be more likely to
help them take their bisphosphonate regularly (66%)
and correctly (67%), and to take their calcium/vitamin D supplementation more
regularly and correctly (68%), than use of separate packs. Seventy percent of
participants believed that use of the combination pack would help them to not
forget to take calcium/vitamin D supplementation. Use of the fixed-combination
pack of risedronate 35 mg plus calcium/vitamin D once
weekly could increase the likelihood that postmenopausal osteoporotic patients
will receive a complete bisphosphonate, calcium and
vitamin D therapy course and is likely to enhance correct intake of combination
therapy. Use of this fixed-combination product will provide patients with a
tool for improving adherence to recommended osteoporosis therapy and optimize
the effectiveness of such treatment.
Am J Epidemiol.
2009 Apr 8. [Epub ahead of print
Lipid Changes During the Menopause Transition in Relation to Age and
Weight: The Study of Women's Health Across the Nation.
Few studies have
prospectively examined lipid changes across the menopause transition or in
relation to menopausal changes in endogenous hormones. The relative independent
contributions of menopause and age to lipid changes are unclear. Lipid changes
were examined in relation to changes in menopausal status and in levels of estradiol and follicle-stimulating hormone in 2,659 women
followed in the Study of Women's Health Across the Nation (1995-2004). Baseline
age was 42-52 years, and all were initially pre- or perimenopausal.
Women were followed annually for up to 7 years (average, 3.9 years). Lipid
changes occurred primarily during the later phases of menopause, with
menopause-related changes similar in magnitude to changes attributable to
aging. Total cholesterol, low density lipoprotein cholesterol, triglycerides,
and lipoprotein(a) peaked during late peri- and early
postmenopause, while changes in the early stages of
menopause were minimal. The relative odds of low density lipoprotein
cholesterol (>/=130 mg/dL) for early
postmenopausal, compared with premenopausal, women were 2.1 (95% confidence
interval: 1.5, 2.9). High density lipoprotein cholesterol also peaked in late peri- and early postmenopause.
Results for estradiol and follicle-stimulating
hormone confirmed the results based on status defined by bleeding patterns.
Increases in lipids were smallest in women who were heaviest at baseline.
Maturitas. 2009 Mar
20;62(3):294-300.
Regular alcohol consumption is associated with increasing quality of
life and mood in older men and women: The Rancho Bernardo Study.
Chan AM, von Mühlen D, Kritz-Silverstein D,
Barrett-Connor E.
Thurgood
Marshall College, University of California, San Diego, La Jolla, CA, United
States.
OBJECTIVE: This
study examines the sex-specific association between alcohol intake and health-related
quality of life in middle class community-dwelling older adults. METHODS:
Information on alcohol intake and measures of quality of life were obtained
from 1594 participants (n=633 men, n=961 women) aged 50-97 years during a
research clinic visit in 1992-1996, and from their responses to a phone
interview and mailed questionnaires. Quality of life measures included the
Medical Outcome Study Short Form 36 (SF-36), Quality of Well-Being (QWB) Scale,
Life Satisfaction Index-Z (LSI-Z), and Satisfaction with Life Survey (SWLS).
Depressed mood was assessed using the Beck Depression Inventory (BDI). Men and
women were stratified into four groups of reported alcohol intake: non-drinker,
occasional drinker (alcohol <3 times/week), light regular drinker (alcohol
intake >/=3 times/week, but <170g/week), and moderate regular drinker
(alcohol intake >/=3 times/week and >/=170g/week). RESULTS: Average age
of both sexes was 72+/-10 years. Only 11% of the men and 17% of the women were
non-drinkers; 54% of men and 40% of women reported drinking alcohol >/=3
times per week; 18% of men and 7.5% of women were heavier regular drinkers. In
multivariable regression analyses, increasing frequency of alcohol use was
positively associated with better quality of life in men and in women.
Associations were not explained by age, physical activity, smoking, depressed
mood, or common chronic diseases including diabetes, hypertension and
cardiovascular disease. CONCLUSIONS: Regular alcohol consumption is associated
with increased quality of life in older men and women.
Semana del 15 al 21 de Abril de 2009
Cochrane Database Syst Rev. 2009 Apr
15;(2):CD006033
Steroidal
contraceptives: effect on bone fractures in women.
Lopez LM, Grimes DA, Schulz KF, Curtis KM.
Behavioral and
Biomedical Research, Family Health International, P.O. Box 13950, Research
Triangle Park, North Carolina, USA, 27709.
BACKGROUND:
Steroidal contraceptive use has been associated with changes in bone mineral
density in women. Whether such changes increase the risk of fractures later in
life is not clear. However, osteoporosis is a major public health concern.
Age-related decline in bone mass increases the risk of fracture, especially of
the spine, hip, and wrist. Concern about bone health influences the
recommendation and use of these effective contraceptives globally. OBJECTIVES:
To evaluate the effect of using hormonal contraceptives before menopause on the
risk of fracture in women SEARCH STRATEGY: We searched for studies of fracture
or bone health and hormonal contraceptives in MEDLINE, POPLINE, CENTRAL,
EMBASE, and LILACS, as well as in clinical trials databases (ClinicalTrials.gov
and ICTRP). We wrote to investigators to find additional trials. SELECTION
CRITERIA: Randomized controlled trials were considered if they examined
fractures, bone mineral density (BMD), or bone turnover in women with hormonal
contraceptive use prior to menopause. Studies were excluded if hormones were
provided for treatment of a specific condition rather than for contraception.
Interventions could include comparisons of a hormonal contraceptive with a
placebo or with another hormonal contraceptive. Interventions could also
include the provision of a supplement versus a placebo. DATA COLLECTION AND
ANALYSIS: We assessed for inclusion all titles and abstracts identified through
the literature searches with no language limitation. The mean difference was
computed with 95% confidence interval (CI) using a fixed-effect model. MAIN
RESULTS: We found 13 RCTs, 2 of which used a placebo. No trial had fracture as
an outcome but most measured BMD. Combination contraceptives did not appear to
affect bone health. Of progestin-only methods, depot medroxyprogesterone
acetate (DMPA) was associated with decreased bone mineral density, while
results were inconsistent for implants. The two placebo-controlled trials
showed BMD increases for DMPA plus estrogen supplement and decreases for DMPA
plus placebo. AUTHORS' CONCLUSIONS: Whether steroidal contraceptives influence
fracture risk cannot be determined from existing information. Due to different
interventions, no trials could be combined for meta-analysis. Many trials had
small numbers of participants and some had large losses to follow up. Health
care providers and women should consider the costs and benefits of these
effective contraceptives. For example, injectable
contraceptives and implants provide effective, long-term birth control yet do
not involve a daily regimen. Progestin-only contraceptives are considered
appropriate for women who should avoid estrogen due to medical conditions.
Cochrane Database Syst Rev. 2009 Apr
15;(2):CD004143
Long term hormone
therapy for perimenopausal and postmenopausal women.
Farquhar C, Marjoribanks J, Lethaby A, Suckling
JA, Lamberts Q.
Obstetrics and Gynaecology,
BACKGROUND:
Hormone therapy (HT) is widely used for controlling menopausal symptoms and has
also been used for the management and prevention of cardiovascular disease,
osteoporosis and dementia in older women. This is an updated version of the
original Cochrane review first published in 2005. OBJECTIVES: To assess the
effect of long-term HT on mortality, cardiovascular outcomes, cancer,
gallbladder disease, cognition, fractures and quality of life. SEARCH STRATEGY:
We searched the following databases to November 2007: Trials Register of the
Cochrane Menstrual Disorders and Subfertility Group,
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Biological
Abstracts. Also relevant non-indexed journals and conference abstracts.
SELECTION CRITERIA: Randomised double-blind trials of
HT versus placebo, taken for at least one year by perimenopausal
or postmenopausal women. HT included oestrogens, with
or without progestogens, via oral, transdermal, subcutaneous or transnasal
routes. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial
quality and extracted data. MAIN RESULTS: Nineteen trials involving 41,904
women were included. In relatively healthy women, combined continuous HT
significantly increased the risk of venous thrombo-embolism
or coronary event (after one year's use), stroke (after three years), breast
cancer and gallbladder disease. Long-term oestrogen-only
HT significantly increased the risk of venous thrombo-embolism,
stroke and gallbladder disease (after one to two years, three years and seven
years' use respectively), but did not significantly increase the risk of breast
cancer. The only statistically significant benefits of HT were a decreased
incidence of fractures and (for combined HT) colon cancer, with long-term use.
Among women aged over 65 who were relatively healthy (i.e. generally fit,
without overt disease) and taking continuous combined HT, there was a
statistically significant increase in the incidence of dementia. Among women
with cardiovascular disease, long-term use of combined continuous HT
significantly increased the risk of venous thrombo-embolism.One
trial analysed subgroups of 2839 relatively healthy
50 to 59 year old women taking combined continuous HT and 1637 taking oestrogen-only HT, versus similar-sized placebo groups. The
only significantly increased risk reported was for venous thrombo-embolism
in women taking combined continuous HT: their absolute risk remained low, at
less than 1/500. However, this study was not powered to detect differences
between groups of younger women. AUTHORS' CONCLUSIONS: HT is not indicated for
the routine management of chronic disease. We need more evidence on the safety
of HT for menopausal symptom control, though short-term use appears to be
relatively safe for healthy younger women.
Cochrane Database Syst Rev. 2009 Apr
15;(2):CD000402
Hormone therapy in
postmenopausal women and risk of endometrial hyperplasia.
Furness S, Roberts H, Marjoribanks J, Lethaby A, Hickey M, Farquhar C.
Obstetrics & Gynaecology, University of Auckland , 85 Park Rd, Grafton ,
Auckland, New Zealand.
BACKGROUND:
Declining circulating estrogen levels around the time of the menopause can
induce unacceptable symptoms that affect the health and well being of women.
Hormone therapy (both unopposed estrogen and estrogen/progestogen
combinations) is an effective treatment for these symptoms, but is associated
with risk of harms. Guidelines recommend that hormone therapy be given at the
lowest effective dose and treatment should be reviewed regularly. The aim of
this review is to identify the minimum dose(s) of progestogen
required to be added to estrogen so that the rate of endometrial hyperplasia is
not increased compared to placebo. OBJECTIVES: The objective of this review is
to assess which hormone therapy regimens provide effective protection against
the development of endometrial hyperplasia and/or carcinoma. SEARCH STRATEGY:
We searched the Cochrane Menstrual Disorders and Subfertility
Group trials register (searched January 2008), The Cochrane Library (Issue 1,
2008), MEDLINE (1966 to May 2008), EMBASE (1980 to May 2008), Current Contents
(1993 to May 2008), Biological Abstracts (1969 to 2008), Social Sciences Index
(1980 to May 2008), PsycINFO (1972 to May 2008) and
CINAHL (1982 to May 2008). Attempts were made to identify trials from citation
lists of reviews and studies retrieved, and drug companies were contacted for
unpublished data. SELECTION CRITERIA: Randomised
comparisons of unopposed estrogen therapy, combined continuous estrogen-progestogen therapy and/or sequential estrogen-progestogen therapy with each other or placebo,
administered over a minimum period of twelve months. Incidence of endometrial
hyperplasia/carcinoma assessed by a biopsy at the end of treatment was a
required outcome. Data on adherence to therapy, rates of additional
interventions, and withdrawals due to adverse events were also extracted. DATA
COLLECTION AND ANALYSIS: In this substantive update, forty five studies were
included. Odds ratios were calculated for dichotomous outcomes. The small
numbers of studies in each comparison and the clinical heterogeneity precluded
meta analysis for many outcomes. MAIN RESULTS: Unopposed estrogen is associated
with increased risk of endometrial hyperplasia at all doses, and durations of
therapy between one and three years. For women with a uterus the risk of
endometrial hyperplasia with hormone therapy comprising low dose estrogen
continuously combined with a minimum of 1 mg norethisterone
acetate or 1.5 mg medroxyprogesterone acetate is not
significantly different from placebo (1mg NETA: OR=0.04 (0 to 2.8); 1.5mg MPA:
no hyperplasia events). AUTHORS' CONCLUSIONS: Hormone therapy for
postmenopausal women with an intact uterus should comprise both estrogen and progestogen to reduce the risk of endometrial hyperplasia.
Cochrane Database Syst Rev. 2009 Apr
15;(2):CD000340
Interventions for
preventing falls in elderly people.
Gillespie
LD,
Gillespie
WJ, Robertson
MC, Lamb SE, Cumming RG, Rowe BH.
Department of
Medical and Surgical Sciences,
BACKGROUND:
Approximately 30 per cent of people over 65 years of age and living in the
community fall each year; the number is higher in institutions. Although less
than one fall in 10 results in a fracture, a fifth of fall incidents require
medical attention. OBJECTIVES: To assess the effects of interventions designed
to reduce the incidence of falls in elderly people (living in the community, or
in institutional or hospital care). SEARCH STRATEGY: We searched the Cochrane
Bone, Joint and Muscle Trauma Group Specialised
Register (January 2003), Cochrane Central Register of Controlled Trials (The
Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988
to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register,
Issue 2, 2003, Current Controlled Trials (www.controlled-trials.com accessed 11
July 2003) and reference lists of articles. No language restrictions were
applied. Further trials were identified by contact with researchers in the
field. SELECTION CRITERIA: Randomised trials of
interventions designed to minimise the effect of, or
exposure to, risk factors for falling in elderly people. Main outcomes of
interest were the number of fallers, or falls. Trials reporting only
intermediate outcomes were excluded. DATA COLLECTION AND ANALYSIS: Two
reviewers independently assessed trial quality and extracted data. Data were
pooled using the fixed effect model where appropriate. MAIN RESULTS: Sixty two
trials involving 21,668 people were included.Interventions
likely to be beneficial:Multidisciplinary, multifactorial, health/environmental risk factor
screening/intervention programmes in the community
both for an unselected population of older people (4 trials, 1651 participants,
pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of
falling or selected because of known risk factors (5 trials, 1176 participants,
pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1
trial, 439 participants, cluster-adjusted incidence rate ratio 0.60, 95%CI 0.50
to 0.73) A programme of muscle strengthening and
balance retraining, individually prescribed at home by a trained health
professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95%
confidence interval (95%CI) 0.66 to 0.98) Home hazard assessment and
modification that is professionally prescribed for older people with a history
of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81)
Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard
0.34, 95%CI 0.16 to 0.74) Cardiac pacing for fallers with cardioinhibitory
carotid sinus hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI
-9.40 to -1.00) A 15 week Tai Chi group exercise intervention (1 trial, 200
participants, risk ratio 0.51, 95%CI 0.36 to 0.73). Interventions of unknown effectiveness:Group-delivered exercise interventions (9
trials, 1387 participants) Individual lower limb strength training (1 trial,
222 participants) Nutritional supplementation (1 trial, 46 participants)
Vitamin D supplementation, with or without calcium (3 trials, 461 participants)
Home hazard modification in association with advice on optimising
medication (1 trial, 658 participants), or in association with an education
package on exercise and reducing fall risk (1 trial, 3182 participants)
Pharmacological therapy (raubasine-dihydroergocristine,
1 trial, 95 participants) Interventions using a cognitive/behavioural
approach alone (2 trials, 145 participants) Home hazard modification for older
people without a history of falling (1 trial, 530 participants) Hormone
replacement therapy (1 trial, 116 participants) Correction of visual deficiency
(1 trial, 276 participants).Interventions unlikely to be beneficial:Brisk
walking in women with an upper limb fracture in the previous two years (1
trial, 165 participants). AUTHORS' CONCLUSIONS: Interventions to prevent falls
that are likely to be effective are now available; less is known about their
effectiveness in preventing fall-related injuries. Costs per fall prevented
have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is
important. Some potential interventions are of unknown effectiveness and
further research is indicated.
Cochrane Database Syst Rev. 2009 Apr
15;(2):CD000227
Vitamin D and
vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.
Avenell A, Gillespie
WJ, Gillespie
LD, O'Connell
D.
Health Services
Research Unit,
BACKGROUND:
Vitamin D and related compounds have been used to prevent osteoporotic
fractures in older people. OBJECTIVES: To determine the effects of vitamin D or
related compounds, with or without calcium, for preventing fractures in older
people. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma
Group Specialised Register, the Cochrane Central
Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE,
EMBASE, CINAHL, and reference lists of articles. Most recent search: October
2007. SELECTION CRITERIA: Randomised or quasi-randomised trials comparing vitamin D or related compounds,
alone or with calcium, against placebo, no intervention, or calcium alone,
reporting fracture outcomes in older people. DATA COLLECTION AND ANALYSIS: Two
authors independently assessed trial quality, and extracted data. Data were
pooled, where admissible, using the fixed-effect model, or random-effects model
if heterogeneity between studies appeared high. MAIN RESULTS: Forty-five trials
were included. Vitamin D alone appears unlikely to be effective in preventing
hip fracture (nine trials, 24,749 participants, RR 1.15, 95% CI 0.99 to 1.33),
vertebral fracture (five trials, 9138 participants, RR 0.90, 95% CI 0.42 to
1.92) or any new fracture (10 trials, 25,016 participants, RR 1.01, 95% CI 0.93
to 1.09).Vitamin D with calcium reduces hip fractures (eight trials, 46,658
participants, RR 0.84, 95% CI 0.73 to 0.96). Although subgroup analysis by
residential status showed a significant reduction in hip fractures in people in
institutional care, the difference between this and the community-dwelling
subgroup was not significant (P = 0.15).Overall hypercalcaemia
is significantly more common in people receiving vitamin D or an analogue, with
or without calcium (18 trials, 11,346 participants, RR 2.35, 95% CI 1.59 to
3.47); this is especially true of calcitriol (four
trials, 988 participants, RR 4.41, 95% CI 2.14 to 9.09). There is a modest
increase in gastrointestinal symptoms (11 trials, 47,042 participants, RR 1.04,
95% CI 1.00 to 1.08, P = 0.04) and a small but significant increase in renal
disease (11 trials, 46,537 participants, RR 1.16, 95% CI 1.02 to 1.33).
AUTHORS' CONCLUSIONS: Frail older people confined to institutions may sustain fewer
hip fractures if given vitamin D with calcium. Vitamin D alone is unlikely to
prevent fracture. Overall there is a small but significant increase in
gastrointestinal symptoms and renal disease associated with vitamin D or its
analogues. Calcitriol is associated with an increased
incidence of hypercalcaemia.
Menopause. 2009 Apr
14. [Epub ahead of print
Trends in hormone
therapy use before and after publication of the Women's Health Initiative
trial: 10 years of follow-up.
Barbaglia G, Macià F, Comas M, Sala M, Del Mar Vernet M, Casamitjana M, Castells X.
From the 1Evaluation and Clinical Epidemiology Department, Hospital
Universitari del Mar, Barcelona, Spain;
2Preventive Medicine and Public Health
Training Unit, Institut
Municipal d'Assistència Sanitària-Universitat
Pompeu Fabra-Agència de Salut Publica de Barcelona; 3CIBER de Epidemiología y Salud
Pública; and 4Obstetrics and Gynecology Service, Hospital Universitari
del Mar, Barcelona, Spain.
OBJECTIVE:: The
aim of this study was to assess the impact of the scientific evidence reported
by Women's Health Initiative (WHI) trial on hormone therapy (HT) use in a
10-year follow-up retrospective cohort of women participating in a breast
cancer screening program. METHODS:: Between 1998 and 2007, a retrospective
cohort of participants in a population-based breast cancer screening program in
the city of
Menopause. 2009 Apr
8. [Epub ahead of print
Do Japanese
American women really have fewer hot flashes than European Americans? The
Brown DE, Sievert LL, Morrison
LA, Reza AM, Mills PS.
From the
1Department of Anthropology, University of Hawaii at Hilo, Hilo, HI; and
2Department of Anthropology, University of Massachusetts at Amherst, Amherst,
MA.
OBJECTIVE:: Many
studies have found a significantly lower frequency of reported hot flashes (HFs)
in Japanese and Japanese American (JA) populations, leading to speculation
about possible dietary, genetic, or cultural differences. These studies have
relied on subjective reports of HFs. Accordingly, the purpose of this study was
to compare both reported and objective HFs measured by sternal
and nuchal skin conductance among JA and European
American (EA) women. METHODS:: Two surveys of HF frequencies were carried out
among women of either EA or JA ethnicity; aged 45 to 55 years; living in
Neuroepidemiology. 2009 Apr
8;33(1):32-40. [Epub ahead of print
Increased Mortality
for Neurological and Mental Diseases following Early Bilateral Oophorectomy.
Rivera CM, Grossardt BR, Rhodes DJ, Rocca WA.
Division of
Preventive and Occupational Medicine, Department of Internal Medicine, College
of Medicine, Mayo Clinic, Rochester, Minn., USA.
Background: The
effects of oophorectomy on brain aging remain
uncertain. Methods: We conducted a cohort study with long-term follow-up of
women in
Semana del 21 al 28 de Abril de
2009
Climacteric. 2009 Apr 22:1-11.
Postmenopausal hormone therapy with estradiol
and norethisterone acetate and mammographic density:
findings from a cross-sectional study among Norwegian women.
Stuedal A, Ma H, Bjørndal H, Ursin G.
Department of
Nutrition,
Background
Although a number of studies have evaluated the associations between use of
postmenopausal hormone therapy (HT) and mammographic density, few have assessed
the effects of the medications containing estradiol
(E2) plus norethisterone acetate (NETA). In
particular, there are few data on the effects of the low-dose E2/NETA regimen.
Methods We included data from 724 women, aged 50-70 years, residing in
south-east
Climacteric. 2009 Apr 22:1-9. [Epub
ahead of print
Depressive symptoms in climacteric women are related to menopausal
symptom intensity and partner factors.
Chedraui P, Perez-Lopez FR, Morales B, Hidalgo L.
Academic and
Research Department, Enrique C. Sotomayor Obstetrics
and
Objective To
determine the prevalence of depressive symptoms and associated risk factors
among climacteric women. Methods In this cross-sectional study, women aged
40-59 years, visiting inpatients at the Enrique C. Sotomayor
Obstetrics and Gynecology Hospital, Guayaquil,
Ecuador, were surveyed with the 17-item Hamilton Depression Rating Scale
(HDRS), the Menopause Rating Scale (MRS) and a questionnaire seeking personal
and partner data. Results A total of 404 women filled out the HDRS and the MRS.
The mean age was 48.2 +/- 5.7 years; 85.1% had 12 or less years of schooling
and 44.8% were postmenopausal. None were on hormonal therapy for the menopause
or on psychotropic drugs. The mean total HDRS score was 13.7 +/- 7 (median 13);
this was higher among perimenopausal women. Of all
the respondents, 78.7% had some degree of depressive symptoms (HDRS total score
>/=8), which was mild in 32.2% and ranged from moderate to very severe in
46.5%. Logistic regression analysis determined that the severity of the
menopausal symptoms related to the somatic and psychological domains of the MRS
and the partner profile (low education and alcohol abuse) were the main
determinants for women having higher depressive scores (total HDRS >/=8).
Conclusion In this specific climacteric population, depressive symptoms were
very prevalent and were associated with the severity of menopausal symptoms
(somatic and psychological) and partner's problems.
Mol Cell Endocrinol. 2009 Apr 16. [Epub ahead of print]
A paradigm of integrative physiology, the crosstalk between bone and
energy metabolisms.
Confavreux CB, Levine R, Karsenty G.
Department of
Genetics and Development, College of Physicians and Surgeons, Columbia
University, New York, NY-10032 USA; INSERM U831, Department of Rheumatology,
Lyon 1 University, Lyon, F-69003 France.
Thanks to integrative
physiology, new relationships between organs and homeostatic functions have
emerged. This approach to physiology based on a whole organism approach has
allowed the bone field to make fundamental progress. In the last decade,
clinical observations and scientific evidences in vivo have uncovered that fat
with leptin controls bone mass through brain
including a hypothalamic relay and sympathetic nervous system. The finding that
energy metabolism affects bone remodelling suggested that in an endocrine
perspective, a feedback loop should exist. Beside its classical functions, bone
can now be considered as a true endocrine organ secreting osteocalcin,
a hormone pharmacologically active on glucose and fat metabolism. Indeed osteocalcin stimulates insulin secretion and beta-cell
proliferation. Simultaneously, osteocalcin acts on adipocytes to induce Adiponectin
which secondarily reduce insulin resistance. This cross regulation between bone
and energy metabolism offers novel therapeutic targets in type 2 diabetes and
osteoporosis.
Maturitas. 2009 Apr 15. [Epub
ahead of print
Estrogen replacement and migraine.
The City of London
Migraine Clinic, 22 Charterhouse Square, London EC1M 6DX, United Kingdom;
Research Centre for Neuroscience within the Institute of Cell and Molecular
Science, Barts and the London School of Medicine and
Dentistry, United Kingdom.
Four of every 10
women will experience migraine at some time in their lives, with peak
prevalence in middle life. Evidence supports estrogen
'withdrawal' as one of the important triggers of menstrual attacks of migraine
without aura. Improvement of migraine without aura postmenopause
is generally attributed to the absence of variations in sex hormone levels.
Maintaining a stable estrogen environment is best
achieved using non-oral estrogen replacement. Unlike
migraine without aura, migraine with aura is recognized as a marker for
increased risk of ischemic stroke. Research suggests that aura may be more
likely to affect women with underlying coagulation disorders. This could, at
least in part, account for both increased risk of stroke and the dose related
effect of estrogen replacement on the development of
aura. Hence women with migraine with aura requiring estrogen
replacement should be given the lowest effective dose necessary to control
menopause symptoms, by a non-oral route.
Climacteric. 2009 Apr 22:1-8. [Epub
ahead of print]
Progestin may modify the effect of low-dose hormone therapy on
mammographic breast density.
Panoulis C, Lambrinoudaki I, Vourtsi A, Augoulea A, Kaparos G, Aravantinos L, Christodoulakos G, Creatsas G.
2nd Department of
Obstetrics and Gynecology,
Objectives To
evaluate the effect on breast density of two low-dose hormone therapy regimens
identical in their estrogen component but different
in the progestin. Methods A total of 81 non-hysterectomized
postmenopausal women were allocated either to 17beta-estradiol 1 mg and norethisterone acetate 0.5 mg (E2/NETA, n = 43) or to
17beta-estradiol 1 mg and drospirenone 2 mg (E2/DRSP,
n = 38). Treatment was continuous and lasted 12 months. The main outcomes were
the changes in breast density according to the Wolfe classification between
baseline and 12-month mammograms. Results Involution of the fibroglandular
tissue was not seen in either of the treatment groups. Under E2/NETA, breast
density increased in seven women (16.3%). In contrast, only three women (7.9%)
exhibited a density increase under E2/DRSP. Conclusions Although hormone
therapy appears to suspend breast involution, it does not increase breast
density in the majority of treated women. Progestins
differing in pharmacological properties may have a variable impact on breast
density.
Cancer Causes Control. 2009 Apr 23. [Epub ahead of print
Consumption of sweet foods and breast cancer risk: a case-control study
of women on
Bradshaw PT, Sagiv SK, Kabat GC, Satia JA, Britton JA, Teitelbaum SL, Neugut AI, Gammon MD.
Department of
Epidemiology, CB#7435 McGavran-Greenberg Hall, School
of Public Health, University of North Carolina, Chapel Hill, NC, 27599-7435,
USA, patrickb@email.unc.edu.
Several
epidemiologic studies have reported a positive association between breast
cancer risk and high intake of sweets, which may be due to an insulin-related
mechanism. We investigated this association in a population-based case-control
study of 1,434 cases and 1,440 controls from
Fertil Steril.
2009; 91(3):694-7 (ISSN: 1556-5653)
Gonadotropin-releasing hormone agonists for prevention
of chemotherapy-induced ovarian damage: prospective randomized study.
Badawy A; Elnashar A; El-Ashry M; Shahat M
Department of Obstetrics & Gynecology, Mansura University, Mansoura, Egypt. abadawy@yahoo.com
OBJECTIVE: To
determine whether GnRHa administration before and
during combination chemotherapy for breast cancer could preserve posttreatment ovarian function in young women or not.
DESIGN: Prospective randomized controlled study. SETTING: Department of
Obstetrics and Gynecology,