Focus on cardiovascular health: hormone replacement therapy, estrogen replacement therapy, and selective estrogen receptor modulators.
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Cardiovascular Diseases↗
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Results for “Estrogen Replacement Therapy”
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The risks and benefits of long-term estrogen replacement therapy.
Estrogen replacement therapy (ERT) for postmenopausal women greatly reduces the risk of osteoporotic fractures, but carries an increased risk of endometrial cancer. This risk can be reduced by the addition of progestin, which does not interfere with the osteoporotic benefit of estrogen. Although long-term use data are few, there is presently little evidence for an increase or decrease in breast cancer risk associated with estrogen by itself (unopposed estrogen), or estrogen plus progestin. In contrast, a large body of evidence suggests that unopposed estrogen significantly reduces the risk of cardiovascular disease; there is no evidence that this benefit will persist when a progestin is added. The preferred method of estrogen replacement therapy, to prevent osteoporosis in a postmenopausal woman with an intact uterus, should be chosen with these different risks and benefits in mind.
Adult↗
Women's and physicians' utilities for health outcomes in estrogen replacement therapy.
Estrogen replacement therapy (ERT) prevents fractures and relieves vasomotor symptoms, but it increases the risk of endometrial cancer. Previous studies and national prescribing patterns show that physicians are conservative in their approach to this therapy. The authors interviewed physicians and perimenopausal women to assess their utilities for the various health outcomes of estrogen replacement therapy. On all outcomes, physicians rated illness episodes followed by recovery as being closer to perfect health than did perimenopausal women. Physicians, in judging which outcomes were most important to women, estimated relief of symptoms above fracture prevention, whereas women rated fracture prevention above symptom relief. These results emphasize the need to assess patients' utilities directly, particularly when utilities for the outcome of a particular therapy may influence the choice of a therapeutic regimen.
Adult↗
A review of the evidence for the use of phytoestrogens as a replacement for traditional estrogen replacement therapy.
Estrogen replacement therapy (ERT) is recommended for postmenopausal women primarily for reduction of menopausal symptoms and prevention of osteoporosis and cardiovascular disease. However, only 35% to 40% of women ever start ERT, and many do not continue it. One of the reasons women are reluctant to receive postmenopausal ERT is that they perceive prescription estrogens as being "unnatural." Because of this, there is increasing interest in the use of plant-derived estrogens, also known as phytoestrogens. This article reviews the evidence for the potential of phytoestrogens, either in dietary or supplemental form, to replace traditional forms of ERT. A comprehensive search of the English-language literature identified more than 1000 articles published in the past 30 years about phytoestrogens. In total, 74 studies were selected for inclusion in this review based on relevance, inclusion of human subjects wherever possible, and study design. The studies examine phytoestrogens' inhibition of the growth of cancer cell lines in vitro and in animals. They also look at the role of phytoestrogens in the reduction of cholesterol levels, and the use of one phytoestrogen derivative, ipriflavone, in the prevention of osteoporosis. Some small studies examine the role of phytoestrogens in the prevention of menopausal symptoms. Evidence for the potential health benefits of phytoestrogens is increasing. However, the clinically proven health benefits of prescribed ERT far outweigh those of phytoestrogens. Therefore, there is insufficient evidence to recommend the use of phytoestrogens in place of traditional ERT, or to make recommendations to women about specific phytoestrogen products.
Breast Neoplasms↗
Benefits and risks of estrogen replacement therapy.
Estrogen replacement therapy (ERT) has been shown to reduce the risk of cardiovascular disease (CVD) and osteoporosis in postmenopausal women. Studies also indicate a reduced risk of stroke and its consequent mortality among estrogen users, and ERT may also have a role in reducing the risk of Alzheimer's disease and increasing a woman's overall quality of life. On the negative side, some studies show a small duration-related risk of breast cancer with estrogen use and a significant increase in endometrial cancer; the latter is virtually eliminated with the addition of a progestin to the regimen. Although the definitive answer is not yet available, recent epidemiologic data suggest no reduction in protection against CVD and bone fracture with the addition of progestin, which is referred to as hormone replacement therapy, as opposed to using estrogen alone. A woman's potential risks associated with ERT or hormone replacement therapy must be weighed against her lifetime risks of developing CVD, stroke, and bone fracture. The reduction in mortality and morbidity rates with hormone use is generally viewed to be substantial and cost-effective. Health care professionals have an important role in shaping their patients' attitudes. Patients need more information from their physicians about the risks and benefits of estrogen therapy.
Administration, Oral↗
Catecholestrogens excretion in smoking and non-smoking postmenopausal women receiving estrogen replacement therapy.
Estrogens are involved in the etiology of breast cancer. Their blastomogenic influence may be partly realized through their conversion into catecholestrogens, rate of which may be modified by smoking. The risk of having breast cancer diagnosed can increase in women using estrogen replacement therapy (ERT). The principal aim of this investigation was to compare the excretion of classical estrogens and catecholestrogens in smoking and non-smoking postmenopausal women receiving Progynova (estradiol valerate, 2 mg/day, 1 month). Total 16 women were studied before and after treatment. Urinary estrogen profile method based on isotope dilution capillary gas chromatography-mass spectrometry was used. Before ERT, significantly lower excretion of 16-epiestriol and 4-hydroxyestrone (4-OHE1) and lower ratio of 4-OHE1/E1 were revealed in smokers. After ERT, much higher excretion of 2-OHE1, and 4-hydroxyestradiol (4-OHE2), higher ratios of 2-OHE1/E1 and 4-OHE1/E1 and lower ratio of 2-methoxyestrone/2-OHE1 were discovered in smokers as compared to non-smoking women. In conclusion only combination of ERT + smoking and not smoking itself leads to the specific prevalence of catecholestrogens (2-OH- and carcinogenic and DNA-damaging 4-OH-metabolites) that may increase risk of genotoxic variant of hormone-induced breast carcinogenesis without influence on the total morbidity.
Breast Neoplasms↗
Update on continuous estrogen-progestin replacement therapy.
Estrogen replacement therapy is recommended for the prevention of osteoporosis and the attenuation of symptoms associated with menopause. Compliance may be a problem with sequential regimens of estrogen and progestin. To address this issue, continuous-dosing regimens of estrogen and progestin have been used. These regimens cause significantly less cyclic and intermenstrual bleeding and induce amenorrhea in most women, which should enhance compliance.
Clinical Trials as Topic↗
Cardiovascular implications of estrogen replacement therapy.
Estrogen appears to protect against the development of cardiovascular disease, the leading cause of death in women, by a number of mechanisms. The protective effect is believed to be mediated principally by beneficial changes in cholesterol levels. Estrogen decreases low-density lipoprotein (LDL) cholesterol and increases high-density lipoprotein (HDL) cholesterol levels by mechanisms that include the possible induction of LDL receptors and the destruction of hepatic lipase, which degrades HDL cholesterol. However, estrogen also appears to have a direct beneficial effect on vessel-wall physiology. One of these effects may be an increase in local prostacyclin production. The type of estrogen used in hormone replacement therapy and the route of administration determine the positive and negative effects of estrogen on the cardiovascular system. In general, synthetic estrogens, because they are manyfold more potent than natural estrogens, should not be used. Most studies show a 50% or greater reduction in cardiovascular disease and related mortality with postmenopausal estrogen administration. There is no evidence that postmenopausal estrogen replacement adversely affects carbohydrate metabolism, blood pressure, or coagulation. By use of a mathematical model to study the overall effects of estrogen therapy, it can be shown that more lives can be saved from the reduction in cardiovascular disease with estrogen use than from the reduction in death from osteoporosis or any other disease state affected by estrogen. Serious consideration has to be given to the cardiovascular effects of added progestogen, which may attenuate or eliminate the beneficial effects of estrogen on HDL2 cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Interdisciplinary review of estrogen replacement therapy.
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Estrogen Replacement Therapy↗
Effect of age on the exercise response in normal postmenopausal women during estrogen replacement therapy.
Postmenopausal estrogen replacement therapy (ERT) has been associated with a reduced risk of coronary artery disease (CAD). Whether this apparent cardioprotective effect is mediated by a cardiovascular benefit during exercise, however, has not been clearly defined. To evaluate rest and exercise variables with and without ERT, a randomized crossover trial was conducted in 23 postmenopausal women, ranging in age from 44 to 75 years, mean age 57+/-8 years. The rest and exercise variables were compared on ERT and during a drug-free period. The baseline measure was compared to the effects after 4 weeks of ERT and after 4 drug-free weeks. Echocardiographic treadmill exercise variables of heart rate (HR), blood pressure, rate-pressure product (RPP), and cardiac dimensions were determined at baseline and at the end of each treatment period. In response to ERT, there was a decrease in low-density lipoprotein (LDL) cholesterol (drug-free: 142+/-40 mg/dl, ERT: 124+/-34 mg/dl) and an increase in high-density lipoprotein (HDL) cholesterol (drug-free: 52+/-14 mg/dl, ERT: 62+/-15 mg/dl, both p<0.01). At rest, the study population had no overall significant change in HR, blood pressure, RPP, or left ventricular end-systolic and end-diastolic diameters when ERT was compared to the drug-free period. However, subjects with the fastest baseline resting HR had the greatest decrease in HR with ERT relative to the drug-free period (p<0.05). During exercise, ERT effected no change in peak HR, blood pressure, or RPP, although end-systolic diameter decreased slightly (p<0.05). With ERT, subject age correlated negatively with systolic blood pressure (p<0.05) and RPP (p<0.01); both blood pressure and RPP decreased in older subjects. In conclusion, ERT has differential effects dependent on baseline HR and age.
Adult↗
Controversies concerning the safety of estrogen replacement therapy.
Unopposed estrogen replacement is known to cause endometrial carcinoma in a small percentage of postmenopausal women, but the effects on ovarian and breast tissue remain uncertain. The increased risk of endometrial carcinoma seems to be related to both the dosage and duration of unopposed estrogen treatment. Until very recently, the morbidity and costs that result from the need for endometrial biopsy because of abnormal bleeding and from the need for hysterectomy due to hyperplasia have been ignored, but recent data suggest that they are likely to be considerable. Progestogens are known to protect against endometrial hyperstimulation, but the optimal duration of therapy each month and the maximally protective agent and dose remain to be determined. Estrogen replacement therapy may reduce the risk of arterial disease; however, the comparative effects of the various preparations, as well as their respective mechanisms of action, must be subjected to further study.
Breast Neoplasms↗
Is estrogen replacement therapy necessary?
Estrogen replacement therapy (ERT) is the most effective treatment for vasomotor hot flushes and urethrovaginal atrophy in postmenopausal women. Evidence also suggests that ERT delays osteoporosis and may even reduce the risk of atherosclerosis. Despite continuing controversy, the risks of ERT are now considered minimal. With individualized therapy and appropriate monitoring, ERT with progestin supplements appears to be safe and effective for the great majority of postmenopausal women.
Arteriosclerosis↗
Prevention and treatment of osteoporosis: does the future belong to hormone replacement therapy?
Estrogen replacement therapy (ERT) after menopause prevents the development of osteoporosis and reduces the risk of fracture. Other potential benefits are cardioprotection--probably related to the effects of estrogen on lipid profile and fibrinogen levels--and a delay in the onset of Alzheimer's disease and perhaps amelioration of the disease. ERT, however, increases the risk of endometriosis and endometrial cancer unless given with a progestin for at least 10 days per menstrual cycle. It also results in a small but real increase in breast cancer. Alendronate, a bisphosphonate, is the first serious competitor of conjugated equine estrogen for the treatment of osteoporosis. Nearing FDA approval are so-called designer estrogens (e.g., raloxifene), which may selectively prevent osteoporosis with little or no effects on endometrial and breast tissue.
Alendronate↗
Subcutaneous estrogen replacement therapy.
Subcutaneous estrogen replacement involves placement of estradiol pellets in the subcutaneous area of the lower abdomen or buttocks. Physiologic levels of estradiol are obtained, and follicle stimulating hormone levels are suppressed, similar to values found during premenopause. Insertion is a minor office procedure, with the usual starting dose of 25 mg of estradiol placed; it provides climacteric symptom relief and osteoporosis protection as well as the many other benefits of estrogen replacement. Supplementation with testosterone pellets can be performed, if indicated, at the same time. Patients with an intact uterus require progesterone therapy to protect the endometrium, as do patients using other forms of estrogen replacement. Return of climacteric symptoms, combined with serum levels, can be used to determine the timing of redosing, which is about every 6 months for most patients.
Absorbable Implants↗
Estrogen replacement therapy: current recommendations.
Estrogen replacement therapy is effective for the prevention and treatment of postmenopausal osteoporosis and should be offered to all women at high risk for osteoporosis. Such therapy is particularly beneficial for prevention of spinal compression fractures; in addition, it alleviates menopausal symptoms (hot flushes, genitourinary symptoms, and changes in mood). In each patient, these benefits must be weighted against the potential risks of endometrial hyperplasia and carcinoma, breast tenderness, hypertension, vascular headaches, and the inconvenience of menstrual bleeding if the uterus is intact. The risk of endometrial cancer associated with estrogen replacement therapy can be considerably reduced by the addition of a progestin, and other side effects can be diminished or eliminated by use of the new transdermal estrogen preparations. Thus, estrogen replacement therapy should be considered in all women who have experienced natural or surgically induced menopause, and it is advisable in women who have osteoporosis or an increased risk for this disorder and no contra-indications to its use. Estrogen replacement therapy should be instituted as soon after menopause as possible and seems to be well tolerated until at least 75 years of age.
Aged↗
Estrogen replacement therapy.
The use of estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement therapy are reviewed, and recommendations regarding its use are made. Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy. Prevention of cardiovascular disease, aging changes of skin, and the occurrence of mental illness have also been suggested as indications, but beneficial effects of estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of estrogen replacement therapy include endometrial cancer, hypertension, gallbladder disease, and angina pectoris. Breast cancer may also be a risk factor, but a consensus of opinion has not been established. Pulmonary embolism, cerebral vascular accident, or myocardial infarction has not been associated with estrogen replacement therapy. The use of progesterone with estrogen replacement therapy has been shown to reduce the occurrence rate of endometrial carcinoma, but it does not prevent all the actions of estrogen. Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include progesterone for hot flashes and calcium for the prevention of osteoporosis. Other agents may also be effective but have not been tested critically.
Aged↗
[Liver function test during estrogen replacement therapy in estrogen deficiency].
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Adult↗
Estrogen replacement therapy: indications and complications.
Estrogen replacement therapy is one of the most controversial issues in the field of reproductive medicine. Indications for its use include hot flashes, vaginal atrophy, and risk of osteoporosis. Risk of heart disease may also be an indication but this use has not been firmly established. The role of estrogen replacement therapy in aging changes of skin needs clarification. Complications of therapy include endometrial cancer, breast cancer, hypertension, hyperlipidemia, and gallbladder disease. The last three complications presumably result from hepatic actions of estrogen replacement therapy.
Animals↗