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1
Pearce, Jane, Keith Hawton e Fiona Blake. "Psychological and Sexual Symptoms Associated with the Menopause and the Effects of Hormone Replacement Therapy". British Journal of Psychiatry 167, n. 2 (agosto 1995): 163–73. http://dx.doi.org/10.1192/bjp.167.2.163.
Testo completoAbstract (sommario):
BackgroundThere is considerable inconsistency in the results of studies of the psychological and sexual sequelae of the menopause and their treatment.MethodA search of the literature on Medline was made of studies of psychological symptoms in women who were either naturally or surgically menopausal or who were receiving hormone replacement therapy for menopausal symptoms.ResultsThere is evidence of a small increase in psychological morbidity (not usually amounting to psychiatric disorder) preceding the natural menopause and following the surgical menopause. Psychosocial as well as hormonal factors are relevant. While the response of psychosocial symptoms to hormone replacement therapy with oestrogens is variable and most marked in the surgical menopause, in some studies the effect is little greater than that for placebo. Where sexual symptoms are present, there is more consistent evidence that hormone replacement therapy is effective.ConclusionsIn the light of the available evidence, the current use of hormone replacement therapy to treat psychological symptoms detected at the time of (but not necessarily therefore due to) the natural menopause must be questioned. It does appear that oestrogen therapy ameliorates psychological symptoms after surgical menopause.
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Hernández, Víctor Manuel Vargas. "Long-Term Consequences of Menopause Victor manuel vargas hernandez Academic of the Mexican Academy of Surgery Secretary of the Mexican Association for the study of Climacteric". Obstetrics Gynecology and Reproductive Sciences 4, n. 3 (14 dicembre 2020): 01–06. http://dx.doi.org/10.31579/2578-8965/094.
Testo completoAbstract (sommario):
The dramatic changes in sex hormone levels that occur during the transition to menopause and beyond are responsible for the long-term consequences, which are of primary importance to healthy aging in women. Sex hormones have a vital physiological role in maintaining the health and normal functioning of various organs; like bone, heart and brain. Disease activity is highly dependent on estrogen exposure; cardiovascular and musculoskeletal disorders frequently occur during postmenopause. Even cognitive decline is related to hypoestrogenism during the menopausal transition. Several lines of evidence indicate that the presence, duration and severity of menopausal vasomotor symptoms, especially hot flashes, not only have an impact on quality of life, but are biomarkers of increased risk of chronic conditions, which require prevention strategies, including menopausal hormone therapy. Nutrition, exercise, and other lifestyle measures, use of appropriate hormonal treatments in symptomatic women during the "window" of opportunity (under 60 years or within 10 years after menopause) can significantly counteract the process of aging of the female body. Meanwhile an individualized menopausal hormone therapy helps postmenopausal women overcome the burden of symptoms, including those related to Genitourinary Menopause Syndrome.
3
Romanenko, T. H., G. M. Zhaloba e N. V. Yesyp. "Menopause hormone therapy (Literature review)". HEALTH OF WOMAN, n. 6(142) (29 luglio 2019): 87–91. http://dx.doi.org/10.15574/hw.2019.142.87.
Testo completoAbstract (sommario):
Practitioners in the fields of obstetrics and gynecology get used to look at the women’s health from the point of view of maintaining her reproductive potential and assistance in its fulfillment. Less attention is paid to the problem of reproductive function`s descent. Common changes during the menopausal transition were out of specialists` focus and women were left with no choice but to deal with those problems on their own. Nevertheless, global tendency of population ageing and growing awareness about the importance of professional and cultural activities of these women makes it important to deepen the knowledge of this subject and find out effective therapeutical methods for the liquidation of pathological manifestations of menopausal transition and improving life quality. Menopause hormone therapy received strong evidence to prove its effectiveness. However, specialists often underestimate or overestimate its potential in several clinical cases. Consequently, information about this method, precautions and contraindications should be well known for doctors and explained to their patients. Key words: perimenopause, climacteric syndrome, menopause hormone therapy, urogenital atrophy, osteoporosis, cardiovascular diseases, venous thromboembolism.
4
Noble, Nikki. "Hormone replacement therapy: update and practical prescribing". Practice Nursing 32, n. 4 (2 aprile 2021): 148–56. http://dx.doi.org/10.12968/pnur.2021.32.4.148.
Testo completoAbstract (sommario):
Peri-menopause and menopause are a normal part of ageing. Nikki Noble gives an overview of hormone replacement therapy and practical prescribing tips Menopause is a physiological event of ovarian failure due to a loss of ovarian follicular activity. This leads to a lack of oestrogen, resulting in the cessation of menstruation and loss of reproductive function. This article discusses the symptoms of menopause and treatment with hormone replacement therapy. This includes practical prescribing, side effects and long-term benefits and risks. The current shortages of hormone replacement therapy are also addressed. The aim of this article is to enable health professionals to define menopause and gain an understanding of the symptoms associated with it. After reading this article you should be able to: describe when peri-menopause and menopause occur, describe the common symptoms that may be experienced during peri-menopause and menopause, understand of the hormones used in hormone replacement therapy, and understand the practical prescribing of hormone replacement therapy and the benefits, risks, contraindications and side-effects.
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Noble, Nikki. "Hormone replacement therapy: update and practical prescribing". Journal of Prescribing Practice 2, n. 2 (2 febbraio 2020): 91–97. http://dx.doi.org/10.12968/jprp.2020.2.2.91.
Testo completoAbstract (sommario):
Menopause is a physiological event of ovarian failure due to a loss of ovarian follicular activity. This leads to a lack of oestrogen, resulting in the cessation of menstruation and loss of reproductive function. This article discusses the symptoms of menopause and treatment with hormone replacement therapy. This includes practical prescribing, side effects and long term benefits and risks. The current shortages of hormone replacement therapy are also addressed. The aim of this article is to enable healthcare professionals to define menopause and gain an understanding of the symptoms associated with it. After reading this article you should be able to: describe when peri-menopause and menopause occur, describe the common symptoms that may be experienced during peri-menopause and menopause, understand of the hormones used in hormone replacement therapy, and understand the practical prescribing of hormone replacement therapy and the benefits, risks, contraindications and side-effects.
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Watt, Fiona E. "Hand osteoarthritis, menopause and menopausal hormone therapy". Maturitas 83 (gennaio 2016): 13–18. http://dx.doi.org/10.1016/j.maturitas.2015.09.007.
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Topo, Paivi, e Elina Hemminki. "Is menopause withering away?" Journal of Biosocial Science 27, n. 3 (luglio 1995): 267–76. http://dx.doi.org/10.1017/s0021932000022793.
Testo completoAbstract (sommario):
SummaryMenopause (cessation of menstruction) and the period surrounding it (climacterium) are often defined retrospectively by asking a woman the date of her last menstrual period (LMP). Based on a survey of 2000 women aged 45–64 in 1989 in Finland, this study examines (1) the relation between these definitions and women's own definitions of their climacteric status and of the cessation of menstruction and (2) the effect of menopausal and postmeno pausal hormone therapy and hysterectomy on the definition of menopause and climacterium. Agreement of the woman's own definition of her climacteric status and interval since LMP was 25% among current hormone users, 41% among hysterectomised women and 64% among those who were neither currently using hormones nor had been hysterectomised. Current hormone users defined the climacteric phase as longer than their LMP suggested. Current hormone use and hysterectomy had little effect on reported final cessation of menstrual periods. It is concluded that hysterectomy and hormone therapy shape women's thinking about the end of reproductive life, blur the concepts of menopause and postmenopause and confuse the measurement of age at menopause.
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Smail, Linda, Ghufran A. Jassim e Khawla I. Sharaf. "Emirati Women’s Knowledge about the Menopause and Menopausal Hormone Therapy". International Journal of Environmental Research and Public Health 17, n. 13 (6 luglio 2020): 4875. http://dx.doi.org/10.3390/ijerph17134875.
Testo completoAbstract (sommario):
The aim of this study was to investigate the knowledge of Emirati women aged 30–64 about menopause, menopausal hormone therapy (MHT), and their associated health risks, and additionally, to determine the relationships between Emirati women’s knowledge about menopause and their sociodemographic and reproductive characteristics. A community-based cross-sectional study was conducted of 497 Emirati women visiting five primary healthcare centers in Dubai. Data were collected using a questionnaire composed of sociodemographic and reproductive characteristics, menopause knowledge scale (MKS), and menopause symptoms knowledge and MHT practice. The mean menopause symptoms knowledge percentage was 41%, with a standard deviation of 21%. There were significant differences in the mean knowledge percentage among categories of education level (p < 0.001) and employment (p = 0.003). No significant differences in the knowledge percentages were found among categories of menopausal status. “Pregnancy cannot occur after menopause” was the statement with the highest knowledge percentage (83.3%), while the lowest knowledge percentages were “risk of cardiovascular diseases increases with menopause’’ (23.1%), “MHT increases risk of breast cancer’’ (22.1%), and “MHT decreases risk of colon cancer’’ (13.9%). The knowledge of Emirati women about menopause, MHT, and related heart diseases was very low; therefore, an education campaign about menopause and MHT risks is needed to improve their knowledge for better coping with the symptoms.
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Anagnostis, Ellena A. "Menopausal Hormone Therapy (MHT)". Journal of Pharmacy Practice 25, n. 3 (1 maggio 2012): 324–30. http://dx.doi.org/10.1177/0897190012442064.
Testo completoAbstract (sommario):
The perceptions of menopausal hormone therapy (MHT) have evolved considerably. Observational studies suggested that MHT could relieve vasomotor symptoms and prevent coronary heart disease (CHD). However, randomized controlled trials later showed no reduction in CHD and an increased risk of stroke. Subsequent analyses of these trials have shown that in women younger and closer to menopause, the risks associated with MHT may not be as great as originally thought. Several organizations, including the North American Menopause Society, the International Menopause Society, and the Endocrine Society, have published guidelines and statements that help health care providers translate the research findings into clinical practice. A common theme from these organizations is the need for health care providers to tailor information to their patients so they may make informed treatment decisions (especially considering the media attention MHT has received). It is particularly important to individualize therapy, considering patients’ risk factors for atherosclerotic disease, venous thromboembolic disease, osteoporosis, and breast cancer. Ongoing research in women younger than those in prior trials is evaluating lower doses of MHT and directly comparing transdermal and oral formulations. Such research should help define the population of women most likely to benefit from MHT without undue risk of adverse outcomes.
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Cabral, Aléxia Alves, Vanessa Manso Torres e Janaína Henriques Sobrinho Ribeiro. "Indicações, riscos e benefícios da reposição de hormônios bioidênticos na menopausa: uma revisão narrativa". Cadernos UniFOA 17, n. 48 (1 aprile 2022): 147–52. http://dx.doi.org/10.47385/cadunifoa.v17.n48.3592.
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RESUMOAtualmente, a terapia de reposição hormonal (TRH) na menopausa está indicada na presença de sintomas vasomotores e síndrome geniturinária da menopausa e para prevenção da perda de massa óssea e menopausa precoce. Após serem demonstrados riscos cardiovasculares e tromboembólicos em mulheres em uso da TRH, iniciaram-se novas buscas por alternativas de reposição hormonal. Essa revisão objetiva pontuar as indicações da TH para mulheres na menopausa e discutir sobre a atualização das novas tecnologias de TH, tratando-se dos hormônios bioidênticos (HB). Trata-se de uma revisão narrativa, realizada no intervalo de Outubro a Novembro de 2020, por meio do levantamento de evidências nos bancos de dados Google Acadêmico, PubMed® e Scielo. Apesar da controversa envolvida na prescrição de HB na literatura, é irrefutável sua importância novo método terapêutico pós-menopausa, que vem sendo alvo de discussões e detém emergente necessidade de novos ensaios clínicos bem delineados. Diante disso, nota-se que a eficácia e segurança dos HB ainda estão em estudo e que, dentre as evidências já existentes, mostram-se associados à redução de efeitos colaterais, em comparação às TRH convencionais, e apresentam boa resposta clínica para os sintomas da menopausa. ABSTRACTCurrently, menopausal hormone replacement therapy (HRT) is indicated in the presence of vasomotor symptoms and menopausal genitourinary syndrome and for preventing bone mass loss and early menopause. After cardiovascular and thromboembolic risks were demonstrated in women using HRT, new searches for hormone replacement alternatives began. This review aims to point out the indications of HRT for women in menopause and discuss the update of the new bioidentical hormone therapy (BHT). This is a narrative review, carried out from October to November 2020, by means of the survey of evidence in the Google Scholar, PubMed® and Scielo databases. Despite the controversy in literature involved in prescribing BHT, its importance as a new post-menopausal therapeutic method is irrefutable, which has been the subject of discussions and has an emerging need for new well-designed clinical trials. Therefore, it is noted that the efficacy and safety of BHT are still under study and that, among the existing evidence, they are associated with the reduction of side effects, compared to conventional HRT, and have a good clinical response to symptoms of menopause.
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Abitbol, Jean. "Hormone Replacement Therapy and Voice". Perspectives of the ASHA Special Interest Groups 4, n. 4 (15 agosto 2019): 607–14. http://dx.doi.org/10.1044/2019_pers-sig3-2018-0007.
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The purpose of this article is to update the management of the treatment of the female voice at perimenopause and menopause. Voice and hormones—these are 2 words that clash, meet, and harmonize. If we are to solve this inquiry, we shall inevitably have to understand the hormones, their impact, and the scars of time. The endocrine effects on laryngeal structures are numerous: The actions of estrogens and progesterone produce modification of glandular secretions. Low dose of androgens are secreted principally by the adrenal cortex, but they are also secreted by the ovaries. Their effect may increase the low pitch and decease the high pitch of the voice at menopause due to important diminution of estrogens and the privation of progesterone. The menopausal voice syndrome presents clinical signs, which we will describe. I consider menopausal patients to fit into 2 broad types: the “Modigliani” types, rather thin and slender with little adipose tissue, and the “Rubens” types, with a rounded figure with more fat cells. Androgen derivatives are transformed to estrogens in fat cells. Hormonal replacement therapy should be carefully considered in the context of premenopausal symptom severity as alternative medicine. Hippocrates: “Your diet is your first medicine.”
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&NA;. "Hormone Therapy After Menopause". Nurse Practitioner 28, n. 4 (aprile 2003): 55–56. http://dx.doi.org/10.1097/00006205-200304000-00021.
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Heutling, D., e H. Lehnert. "Hormone therapy and menopause". DMW - Deutsche Medizinische Wochenschrift 130, n. 13 (aprile 2005): 829–34. http://dx.doi.org/10.1055/s-2005-865097.
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Henderson, VW, e BB Sherwin. "Surgical vs Natural Menopause: Cognitive Issues". Journal of SAFOMS 2, n. 1 (2014): 54–55. http://dx.doi.org/10.5005/jsafoms-2-1-54.
Testo completoAbstract (sommario):
Abstract Objective Women who undergo both natural and surgical menopause experience the loss of cyclic ovarian production of estrogen, but hormonal and demographic differences distinguish these two groups of women. Our objective was to review published evidence on whether the premature cessation of endogenous estrogen production in women who underwent a surgical menopause has deleterious consequences for cognitive aging and to determine whether consequences differ for women if they undergo natural menopause. Studies of estrogen-containing hormone therapy are relevant to this issue. Design We reviewed evidence-based research, including the systematic identification of randomized clinical trials of hormone therapy with cognitive outcomes that included an objective measure of episodic memory. Results As inferred from very small, short-term, randomized, controled trials of high-dose estrogen treatment, surgical menopause may be accompanied by cognitive impairment that primarily affects verbal episodic memory. Observational evidence suggests that the natural menopausal transition is not accompanied by substantial changes in cognitive abilities. For initiation of hormone therapy during perimenopause or early postmenopause when the ovaries are intact, limited clinical trial data provide no consistent evidence of short-term benefit or harm. There is stronger clinical trial evidence that initiation of hormone therapy in late postmenopause does not benefit episodic memory or other cognitive skills. Conclusion Further research is needed on the long-term cognitive consequences of surgical menopause and long-term cognitive consequences of hormone therapy initiated near the time of surgical or natural menopause. A potential short-term cognitive benefit might be weighed when a premenopausal woman considers initiation of estrogen therapy at the time of, or soon after, hysterectomy and oophorectomy for benign conditions, although data are still quite limited and estrogen is not approved for this indication. Older postmenopausal women should not initiate hormone therapy to improve or maintain cognitive skills.
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Rees, Margaret, Roberto Angioli, Robert L. Coleman, Rosalind M. Glasspool, Francesco Plotti, Tommaso Simoncini e Corrado Terranova. "European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis". International Journal of Gynecologic Cancer 30, n. 4 (11 febbraio 2020): 428–33. http://dx.doi.org/10.1136/ijgc-2020-001217.
Testo completoAbstract (sommario):
Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and vagina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.
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Apetov, S. S., e V. V. Apetova. "Advantages of the Ultralow-dose Hormonal Menopausal Therapy: An Ample Opportunity with Minimal Risks". Doctor.Ru 20, n. 8 (2021): 41–47. http://dx.doi.org/10.31550/1727-2378-2021-20-8-41-47.
Testo completoAbstract (sommario):
Objective of the Review: To analyse the efficacy and safety of the ultralow-dose menopausal hormonal therapy (MHT). Key Points. In developed countries, the life expectancy is growing and the issue of improved quality of life of elderly women is becoming quite acute. On the average, a third (or a half for early menopause) of a modern woman’s life falls on the post-menopause period. Termination of oestrogen synthesis in ovaries during menopause is associated with marked reduction in the quality of life, development of vasomotor symptoms, sleep disturbances, accelerated skin ageing, an increased risk of cardiovascular pathologies and a number of somatic disorders, urinogenital atrophy, osteoporosis, and cognitive disorders. MHT is a proven and efficient means of quality of life improvement; however, the safety of sex hormone therapy in elderly women is still a topical issue. In this article, we are discussing the efficacy and safety of oral MHT drug containing 0.5 mg of 17β-estradiol and 2.5 mg of didrogesteron. Conclusion. The advent of ultralow-dose MHT drugs allowed significantly reducing the number of side effects from sex hormone therapy during post-menopause vs. side effects from higher doses of estradiol with comparable clinical effects. Keywords: menopausal hormonal therapy, ultralow-dose drugs, estradiol, didrogesteron.
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Smith, R., e J. W. W. Studd. "A Pilot Study of the Effect upon Multiple Sclerosis of the Menopause, Hormone Replacement Therapy and the Menstrual Cycle". Journal of the Royal Society of Medicine 85, n. 10 (ottobre 1992): 612–13. http://dx.doi.org/10.1177/014107689208501008.
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A questionnaire enquiring about changes in severity of symptoms of multiple sclerosis with the menstrual cycle, menopause and use of hormone replacement therapy was answered retrospectively by 11 premenopausal and 19 postmenopausal women. Eighty-two per cent of menopausal women reported an increase in severity premenstrually. Of the postmenopausal women 54% reported a worsening of symptoms with the menopause, and 75% of those who had tried hormone replacement therapy reported an improvement. The results of this pilot study indicate the need for further research to clarify the effects of the menopause and hormone replacement therapy upon multiple sclerosis.
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Pirhadi, Roxanna, Vikram Sinai Talaulikar, Joseph Onwude e Isaac Manyonda. "It is all in the name: The importance of correct terminology in hormone replacement therapy". Post Reproductive Health 26, n. 3 (9 maggio 2020): 142–46. http://dx.doi.org/10.1177/2053369120924175.
Testo completoAbstract (sommario):
The global increase in life expectancy to 74 years for women, while the median age of the menopause remains at 51 years, means that an increasing number of women will live a significant portion of their adult lives in the menopause. The WHI publications in 2003/4 reported on the dangers of hormone replacement therapy, in particular with respect to breast cancer and dementia risk. This resulted in a dramatic reduction in hormone replacement therapy prescription and use. However, the findings from the WHI studies have been re-appraised, and the new perspective is reflected in the guidance published by NICE in 2015 in which they recommended that more women be offered hormone replacement therapy as the benefits are now perceived to outweigh the risks for most women. However, controversy continues to surround hormone replacement therapy, and there are probably few areas in medicine where the misuse of terminology causes quite as much confusion as in hormone replacement therapy. Commonly used terms such as ‘menopausal hormone therapy’ and ‘hormone replacement therapy’ lack specificity and there is an urgent need for correct terminology to accurately describe the hormones replaced.
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Soares, Claudio N., Jennifer Prouty, Leslie Born e Meir Steiner. "Treatment of Menopause-Related Mood Disturbances". CNS Spectrums 10, n. 6 (giugno 2005): 489–97. http://dx.doi.org/10.1017/s109285290002318x.
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AbstractMore than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.
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Martins, Vera, Nick Legroux, Monica Lascar e Marion Gluck. "Compounded bioidentical HRT improves quality of life and reduces menopausal symptoms". Journal of Prescribing Practice 2, n. 7 (2 luglio 2020): 384–90. http://dx.doi.org/10.12968/jprp.2020.2.7.384.
Testo completoAbstract (sommario):
Bioidentical hormone replacement therapy, a form of hormone balancing and treatment that uses hormones identical to the ones naturally produced by the body, is an effective and well-tolerated method of hormone replacement therapy. The Marion Gluck Clinic conducted a small-scale study to assess the effectiveness of compounded bioidentical hormone replacement therapy treatment protocols and their impact on the quality of life of women experiencing symptoms of the menopause. Quality of life was assessed by completing the Greene Climacteric Scale questionnaire before and after bioidentical hormone replacement therapy treatment. Statistical significance of the data was tested using a Student's two-tailed, paired t-test. The results demonstrated a significant improvement of 52% in quality of life after bioidentical hormone replacement therapy treatment. All 21 menopausal symptoms assessed were greatly reduced after BHRT treatment. Evidence is provided showing that bioidentical hormone replacement therapy, performed according to the Marion Gluck Clinic local clinical guidelines, improves quality of life and reduces menopause-associated symptoms in women. In addition, this pilot study paves the way for a future full-scale study, where the authors aim to assess quality of life and safety in a significantly larger number of women.
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Gava, Orsili, Alvisi, Mancini, Seracchioli e Meriggiola. "Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy". Medicina 55, n. 10 (1 ottobre 2019): 668. http://dx.doi.org/10.3390/medicina55100668.
Testo completoAbstract (sommario):
During the menopausal transition, which begins four to six years before cessation of menses, middle-aged women experience a progressive change in ovarian activity and a physiologic deterioration of hypothalamic-pituitary-ovarian axis function associated with fluctuating hormone levels. During this transition, women can suffer symptoms related to menopause (such as hot flushes, sleep disturbance, mood changes, memory complaints and vaginal dryness). Neurological symptoms such as sleep disturbance, “brain fog” and mood changes are a major complaint of women transitioning menopause, with a significant impact on their quality of life, productivity and physical health. In this paper, we consider the associations between menopausal stage and/or hormone levels and sleep problems, mood and reduced cognitive performance. The role of estrogen and menopause hormone therapy (MHT) in cognitive function, sleep and mood are also discussed.
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Cheng, Yu-Jung, Chieh-Hsin Lin e Hsien-Yuan Lane. "From Menopause to Neurodegeneration—Molecular Basis and Potential Therapy". International Journal of Molecular Sciences 22, n. 16 (11 agosto 2021): 8654. http://dx.doi.org/10.3390/ijms22168654.
Testo completoAbstract (sommario):
The impacts of menopause on neurodegenerative diseases, especially the changes in steroid hormones, have been well described in cell models, animal models, and humans. However, the therapeutic effects of hormone replacement therapy on postmenopausal women with neurodegenerative diseases remain controversial. The steroid hormones, steroid hormone receptors, and downstream signal pathways in the brain change with aging and contribute to disease progression. Estrogen and progesterone are two steroid hormones which decline in circulation and the brain during menopause. Insulin-like growth factor 1 (IGF-1), which plays an import role in neuroprotection, is rapidly decreased in serum after menopause. Here, we summarize the actions of estrogen, progesterone, and IGF-1 and their signaling pathways in the brain. Since the incidence of Alzheimer’s disease (AD) is higher in women than in men, the associations of steroid hormone changes and AD are emphasized. The signaling pathways and cellular mechanisms for how steroid hormones and IGF-1 provide neuroprotection are also addressed. Finally, the molecular mechanisms of potential estrogen modulation on N-methyl-d-aspartic acid receptors (NMDARs) are also addressed. We provide the viewpoint of why hormone therapy has inconclusive results based on signaling pathways considering their complex response to aging and hormone treatments. Nonetheless, while diagnosable AD may not be treatable by hormone therapy, its preceding stage of mild cognitive impairment may very well be treatable by hormone therapy.
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Gaur, Komal, Sourabh B. Fulmali e Nalini Adele Pinto. "Current Understanding and Practice in Menopause Hormone Therapy: Indian Perspective". Indian Journal of Obstetrics and Gynecology 7, n. 3 (P-1) (2019): 413–18. http://dx.doi.org/10.21088/ijog.2321.1636.7319.11.
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Balan, Vera E., Elena V. Tikhomirova, Anastasia S. Zhuravel, Julia P. Titchenko e Tatyana V. Lovygina. "New trends in current menopausal hormone therapy". Gynecology 23, n. 1 (21 marzo 2021): 33–36. http://dx.doi.org/10.26442/20795696.2021.1.200635.
Testo completoAbstract (sommario):
The article presents the results of recent studies on the effectiveness, safety and duration of menopausal hormone therapy (MHT). The main cardio-metabolic risk factors for cardiovascular diseases are formed in women precisely during the transition to menopause and are clearly associated with the appearance of vegetative menopausal symptoms and the development of endothelial dysfunction, which is a predictor of future serious health problems, especially cardiovascular diseases. The results of a number of epidemiological studies have shown that in women with severe climacteric manifestations, especially with hot flashes, the overall risk of developing cardiovascular diseases is increased. The need for early initiation of MHT is an indisputable truth and is not disputed by anyone, but the formed tendency to discontinue treatment in 56 years raises many questions among patients and their doctors. However, recent guidelines from the International Menopause Society state that there is no reason to arbitrarily limit the duration of MHT. This paper presents current evidence on the indications and benefits of low and ultra-low doses of MHT. In view of the high efficacy and safety of low doses of MHT, they seem to be the most acceptable starting doses of oral MHT for most women. In addition, women with early menopause should also receive higher doses of estrogens, as they are more physiological for them. The choice in favor of starting MHT in a postmenopausal woman with a low or ultra-low dose in each case should be selected individually.
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Diaz Brinton, Roberta. "Minireview: Translational Animal Models of Human Menopause: Challenges and Emerging Opportunities". Endocrinology 153, n. 8 (9 luglio 2012): 3571–78. http://dx.doi.org/10.1210/en.2012-1340.
Testo completoAbstract (sommario):
Increasing importance is placed on the translational validity of animal models of human menopause to discern risk vs. benefit for prediction of outcomes after therapeutic interventions and to develop new therapeutic strategies to promote health. Basic discovery research conducted over many decades has built an extensive body of knowledge regarding reproductive senescence across mammalian species upon which to advance animal models of human menopause. Modifications to existing animal models could rapidly address translational gaps relevant to clinical issues in human menopausal health, which include the impact of 1) chronic ovarian hormone deprivation and hormone therapy, 2) clinically relevant hormone therapy regimens (cyclic vs. continuous combined), 3) clinically relevant hormone therapy formulations, and 4) windows of opportunity and optimal duration of interventions. Modifications in existing animal models to more accurately represent human menopause and clinical interventions could rapidly provide preclinical translational data to predict outcomes regarding unresolved clinical issues relevant to women's menopausal health. Development of the next generation of animal models of human menopause could leverage advances in identifying genotypic variations in estrogen and progesterone receptors to develop personalized menopausal care and to predict outcomes of interventions for protection against or vulnerability to disease. Key to the success of these models is the close coupling between the translational target and the range of predictive validity. Preclinical translational animal models of human menopause need to keep pace with changes in clinical practice. With focus on predictive validity and strategic use of advances in genetic and epigenetic science, new animal models of human menopause have the opportunity to set new directions for menopausal clinical care for women worldwide.
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John, Nimmy N., Riya Juan e Manchu S. Danam. "An epidemiological study on knowledge, attitude and practice of married women about menopause and hormone replacement therapy". International Journal Of Community Medicine And Public Health 8, n. 5 (27 aprile 2021): 2299. http://dx.doi.org/10.18203/2394-6040.ijcmph20211749.
Testo completoAbstract (sommario):
Background: Women all over the world now have to spend almost 1/3rd of their lives in menopausal years. Therefore, menopause now is a concerning matter to maintain and improve women’s health. Hormone replacement therapy (HRT) is an effective treatment for menopausal symptoms. This study was conducted to determine knowledge, attitude and practice toward menopause HRT among women. Objective of the study was to determine the level of knowledge, attitude, and practice related to menopause and HRT among women.Methods: This cross-sectional study was carried out in May 2020 to July 2020 in a rural area of Ernakulam district of Kerala, India. 150 women were interviewed using a predesigned, pretested questionnaire.Results: In the present study, 42.6% of menopausal women had knowledge of menopausal symptoms. 31.3%, 38% and 26% knew that menopause increases risk of cardiovascular, osteoporosis and breast cancer respectively. 16.6% think menopausal women should consult a physician, only 42% of menopausal women are aware of HRT. 60.6% think menopausal symptoms affect quality of life. 50.6% think that menopause means end of sexual life. 42.6% think that absence of menstruation is a relief. 48.6% think physical changes of menopause are inevitable, hence acceptable. 35.3% had consulted a physician at the onset of menopause. 80% preferred natural approaches when compared to HRT. 76% and 86% think that HRT has many complications and side effects hence should be avoided respectively.Conclusions: The study concluded that the knowledge and attitude of the participants towards menopause and HRT was poor in the study population.
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Karpenko, V. G., e Viktoriia Aleksandrovna Ilchenko. "PRINCIPLES OF HORMONE REPLACEMENT THERAPY IN WOMEN DURING MENOPAUSE". International Medical Journal, n. 2 (15 luglio 2020): 29–31. http://dx.doi.org/10.37436/2308-5274-2020-2-6.
Testo completoAbstract (sommario):
One of the most pressing problems is the onset of menopause in the women over the age of 45 and the development of menopausal syndrome. Because a large number of women with severe menopausal symptoms does not receive adequate therapy and applies for the alternative ineffective ways to alleviate the condition, they should be informed about preventive measures and treatment of this syndrome. The paper describes in details the disorders that occur during menopause. Particular attention is paid to the examination of such women, the study of complaints related to the nervous and cardiovascular systems, urogenital tract, metabolic processes. In addition to the general examination, special methods are used as follows: ultrasound, cytological examination of secretions from the surface of the cervix, cervical canal. If necessary, in women with cyclic bleeding, an endometrial biopsy is performed with a biopsy. In recent years, hormone replacement therapy has been widely used to treat menopausal syndrome as the most effective way to prevent disorders (osteoporosis, atrophy of the urogenital tract, etc.). The purpose of its implementation is to maintain the function of hormone−producing organs in a normal state, reduce the expression of symptoms, prevention and treatment of osteoporosis. Treatment is usually performed on an outpatient basis. Only natural estrogens are used, which are chemically similar to those synthesized in the female body. In order to prevent the development of hyperplastic processes in the endometrium, the women are prescribed with progestins in a cyclic or continuous mode from several months to several years. Hormone replacement therapy will help a woman to avoid the negative effects of estrogen deficiency on the body, maintain bone density and cardiovascular health, as well as improve overall quality of life. Key words: menopause, menopausal syndrome, vascular disorders, hormone replacement therapy.
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Mehedintu, Claudia, Andreea Carp-Veliscu, Antoine Edu, Mihaela Plotogea, Aida Petca, Cristina Veronica Andreescu, Diana Secara, Mihai Dumitrascu e Ana-Maria Rotaru. "Non-hormonal management for menopause". Romanian Journal of Medical Practice 16, S6 (15 dicembre 2021): 79–85. http://dx.doi.org/10.37897/rjmp.2021.s6.17.
Testo completoAbstract (sommario):
Menopause is a physiological process, but for many women it is a difficult time due to vasomotor symptoms and symptoms related to the urogenital sphere. The hormonal changes and biological disorders that occur have a negative influence on women's health and functionality, on their physique and mental health. In addition, many women associate menopause as a transition from middle age to old age, which is psychologically difficult to face. Disturbing manifestations such as hot flushes, sleep disturbances, dyspareunia and decreased libido affect the quality of life of menopausal women and they must receive optimal therapy to help them get through this period more easily. The most effective therapy for treating menopausal symptoms is hormone replacement therapy. However, this is contraindicated for some women and avoided by others. That's why efforts are continually being made to find alternative and complementary therapies for menopause. Doctors must also be prepared to offer psychological support to these women.
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Lersten, Ivy, Elizabeth Clain e Nanette Santoro. "Use of Hormone Therapy in Women with Early Menopause and Premature Ovarian Insufficiency". Seminars in Reproductive Medicine 38, n. 04/05 (settembre 2020): 302–8. http://dx.doi.org/10.1055/s-0040-1721719.
Testo completoAbstract (sommario):
AbstractWomen with early menopause or primary ovarian insufficiency (POI) experience a menopausal state a decade or more earlier than their peers. The health consequences for POI are vast and varied with detrimental effects seen on neurological, psychological, bone, and cardiovascular systems. The risk profile of POI patients requires special attention, as they differ from a typical menopausal population. This review will explore the health risks associated with POI and examine the various treatment options and also the risks associated with hormone therapy. Given the risks and benefits, POI patients should be strongly encouraged to start hormone therapy until the median age of menopause.
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Mahmud, Khalid. "Natural hormone therapy for menopause". Gynecological Endocrinology 26, n. 2 (8 dicembre 2009): 81–85. http://dx.doi.org/10.3109/09513590903184134.
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Short, Hannah. "Menopause and hormone replacement therapy". InnovAiT: Education and inspiration for general practice 8, n. 4 (3 marzo 2015): 204–12. http://dx.doi.org/10.1177/1755738015571771.
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Gass, Margery L. S., e Robert W. Rebar. "Menopause and hormone replacement therapy". Current Opinion in Endocrinology and Diabetes 1, n. 1 (gennaio 1994): 206–11. http://dx.doi.org/10.1097/00060793-199400010-00036.
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Stuenkel, C. A. "Menopause, hormone therapy and diabetes". Climacteric 20, n. 1 (2 gennaio 2017): 11–21. http://dx.doi.org/10.1080/13697137.2016.1267723.
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Johnson, Susan R. "MENOPAUSE AND HORMONE REPLACEMENT THERAPY". Medical Clinics of North America 82, n. 2 (marzo 1998): 297–320. http://dx.doi.org/10.1016/s0025-7125(05)70608-8.
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Schneider, Philip J. "Hormone Replacement Therapy for Menopause". Journal for Nurse Practitioners 9, n. 8 (settembre 2013): 541–43. http://dx.doi.org/10.1016/j.nurpra.2013.06.003.
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Santoro, Nanette, e Judi Lee Chervenak. "Menopause and Hormone Replacement Therapy". Endocrinology and Metabolism Clinics of North America 33, n. 4 (dicembre 2004): ix—xi. http://dx.doi.org/10.1016/j.ecl.2004.08.001.
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Speroff, Leon. "Menopause and Hormone Replacement Therapy". Clinics in Geriatric Medicine 9, n. 1 (febbraio 1993): 33–55. http://dx.doi.org/10.1016/s0749-0690(18)30421-x.
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Wylie-Rosett, Judith. "Menopause, micronutrients, and hormone therapy". American Journal of Clinical Nutrition 81, n. 5 (1 maggio 2005): 1223S—1231S. http://dx.doi.org/10.1093/ajcn/81.5.1223.
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Pham, Kim-Thu C., Ellen W. Freeman e Jeane Ann Grisso. "Menopause and Hormone Replacement Therapy". Menopause 4, n. 2 (1997): 71–79. http://dx.doi.org/10.1097/00042192-199704020-00003.
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Sohail, Rubina. "Latest Recommendations for Hormone Replacement Therapy". Journal of SAFOMS 1, n. 2 (2013): 82–83. http://dx.doi.org/10.5005/jp-journals-10032-1019.
Testo completoAbstract (sommario):
ABSTRACT Menopause is an area of increasing importance. Menopause management and hormone replacement therapy have had their share of popularity and downward trends. At the peak of its popularity came the WHI trial resulting in a lot of confusion and worry leading to the diuse of HRT. However the recent guidelines published by the British Menopause Society have put HRT in perspective. How to cite this article Sohail R. Latest Recommendations for Hormone Replacement Therapy. J South Asian Feder Menopause Soc 2013;1(2):82-83.
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Schulkin, Jay. "Hormone Therapy, Dilemmas, Medical Decisions". Journal of Law, Medicine & Ethics 36, n. 1 (2008): 73–88. http://dx.doi.org/10.1111/j.1748-720x.2008.00239.x.
Testo completoAbstract (sommario):
The question of why women, in consultation with their physicians, should choose hormone therapy (HT) in response to menopause represents a renewed controversy at the beginning of the new century. Conflicting messages regarding the health risks and benefits of HT have been conveyed in the mainstream media, especially information in the media regarding the results of large-scale studies of the health impact of hormone therapy. Women who have been on one or another of the hormone replacement regimes have been forced to reconsider continuing on HT. Doctors who suggest these hormones to their patients are somewhat confused, as are perimenopausal women who are considering HT. Pharmaceutical companies that produce these compounds are worried, and public health officials are on the defensive.Media coverage of HT research has been extensive. In particular, two large-scale studies, one here in the U.S. (the Women's Health Initiative, or WHI) and the other in Great Britain, have recently cast a negative light on the use of hormone therapy, after years of routine prescription of HT for menopausal women.
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Protasova, Protasova A. E., Yureneva S. V. Yureneva, Bairamova N. N. Bairamova e Komedina V I. Komedina V. "Menopause, obesity, and comorbidity: possibilities of menopausal hormone therapy". Akusherstvo i ginekologiia 5_2019 (31 maggio 2019): 43–48. http://dx.doi.org/10.18565/aig.2019.5.43-48.
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Garg, Akanksha, e Lynne Robinson. "Surgical menopause: A toolkit for healthcare professionals". Post Reproductive Health 27, n. 4 (11 novembre 2021): 222–25. http://dx.doi.org/10.1177/20533691211038455.
Testo completoAbstract (sommario):
Surgical menopause (bilateral oophorectomy) is commonly undertaken during a hysterectomy to treat various medical conditions. Menopausal symptoms can be particularly severe due to the sudden loss of ovarian function. This clinical toolkit is intended to guide healthcare professionals caring for women undergoing surgical menopause. Women commonly experience vasomotor symptoms, sexual dysfunction and an increased risk of cardiovascular and osteoporotic disease. Compared with a natural menopause, loss of libido can be more pronounced following a surgical menopause. Hormone Replacement Therapy (HRT) plays a significant role in managing surgical menopause, especially in women aged under 45 years old. All women undergoing surgical menopause should have adequate counselling regarding the hormonal consequences of surgery and the role of HRT with a view to provide individualised, patient-centred care.
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Anagnostis, Panagiotis, Stavroula A. Paschou, Niki Katsiki, Dimitrios Krikidis, Irene Lambrinoudaki e Dimitrios G. Goulis. "Menopausal Hormone Therapy and Cardiovascular Risk: Where are we Now?" Current Vascular Pharmacology 17, n. 6 (2 ottobre 2019): 564–72. http://dx.doi.org/10.2174/1570161116666180709095348.
Testo completoAbstract (sommario):
Transition to menopause is associated with an increase in cardiovascular disease (CVD) risk, mainly attributed to lipid and glucose metabolism dysregulation, as well as to body fat redistribution, leading to abdominal obesity. Indeed, epidemiological evidence suggests that both early menopause (EM, defined as age at menopause <45 years) and premature ovarian insufficiency (POI, defined as age at menopause <40 years) are associated with 1.5-2-fold increase in CVD risk. Menopausal hormone therapy (MHT) exerts a favorable effect on CVD risk factors (with subtle differences regarding oestrogen dose, route of administration, monotherapy or combination with progestogen and type of progestogen). Concerning CVD morbidity and mortality, most studies have shown a beneficial effect of MHT in women at early menopausal age (<10 years since the final menstrual period) or younger than 60 years. MHT is strongly recommended in women with EM and POI, as these women, if left untreated, are at risk of CVD, osteoporosis, dementia, depression and premature death. MHT has also a favorable benefit/ risk profile in perimenopausal and early postmenopausal women, provided that the patient is not at a high CVD risk (as assessed by 10-year calculation tools). Transdermal oestrogens have a lower risk of thrombosis compared with oral regimens. Concerning progestogens, natural progesterone and dydrogesterone have a neutral effect on CVD risk factors. In any case, the decision for MHT should be individualized, tailored according to the symptoms, patient preference and the risk of CVD, thrombotic episodes and breast cancer.
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Van Schoor, Jacky. "Hot flushes". South African Family Practice 57, n. 6 (1 novembre 2015): 4. http://dx.doi.org/10.4102/safp.v57i6.4393.
Testo completoAbstract (sommario):
Vasomotor symptoms, such as hot flushes and night sweats, are considered to be the cardinal symptoms of menopause, and are experienced by most women. The physiology of hot flushes is not fully understood, and is likely to reflect the interplay between multiple central and peripheral physiological systems. Reproductive hormones play an integral role, as evidenced by the onset of vasomotor symptoms during the dramatic reproductive hormone changes of the menopausal transition, and by the efficacy of exogenous oestrogen in the treatment of hot flushes. Menopausal hormone therapy with oestrogen, and with or without a progestogen, is the most widely studied and most effective treatment option for the relief of menopause-related vasomotor symptoms. It is also considered to be the standard of care for women with moderate to severe vasomotor symptoms.
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Akter, Mst Jesmin, e Eliza Shirin. "Latest Evidence on Using Hormone Replacement Therapy in the Menopause". Journal of Bangladesh College of Physicians and Surgeons 36, n. 1 (29 gennaio 2018): 26–32. http://dx.doi.org/10.3329/jbcps.v36i1.35508.
Testo completoAbstract (sommario):
Hormone replacement therapy (HRT) is the most effective therapy of menopausal symptoms for perimenopausal and menopausal women. When HRT is individually tailored women gain maximum advantages and the risk are minimized. There are different types of hormones with different doses and different routes of delivery exist. . The use of HRT is an individual decision which women can only make once she has been given correct information and advice from healthcare professionals. HRT should be recommended in women with premature ovarian insufficiency with advice to continue until the average age of menopause at 51.4 years. This review item promotes confidence in prescribing HRT in most symptomatic women. Prescribing HRT in women with relative contraindication where evidence is limited. Quality of life is priority. Multidisciplinary approach may be necessary and informed written consent documented.J Bangladesh Coll Phys Surg 2018; 36(1): 26-32
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Alhurani, Rabe E., C. Anwar A. Chahal, Ahmed T. Ahmed, Essa A. Mohamed e Virginia M. Miller. "Sex hormone therapy and progression of cardiovascular disease in menopausal women". Clinical Science 130, n. 13 (23 maggio 2016): 1065–74. http://dx.doi.org/10.1042/cs20160042.
Testo completoAbstract (sommario):
Menopausal hormone treatments (MHT) relieve symptoms of menopause. However, their long-term effects on reducing chronic conditions of aging, in particular, cardiovascular (CV) disease, are controversial. With the changes in clinical practice towards lower doses and differing formulations of these products, future investigations into CV consequences of these treatments will be challenging. The current approach to individualizing MHT considers the severity of the menopausal symptoms, a personalized risk assessment, and the patient's personal preferences [1]. Further study is needed to determine whether accounting for genetic variants of oestrogen metabolism and the influence of genetic variants contributing to complex traits, such as those defining CV disease, with the hormone treatment (pharmacogenomics of hormones) will assist in personalizing treatment and benefit CV health. In order for a precise, personalized approach to maximize benefit and reduce risk of menopausal hormones to become a reality, algorithms will need to include genotype in conjunction with the treatment goal (symptom relief), consideration of other medications and environmental factors.
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Smetnik, V. P. "Perimenopause - from contraception to hormone replacement therapy". Journal of obstetrics and women's diseases 48, n. 1 (15 febbraio 1999): 89–93. http://dx.doi.org/10.17816/jowd88686.
Testo completoAbstract (sommario):
Perimenopause is a period of age-related decline in ovarian function, mostly after age 45, including premenopause and one year after menopause or 2 years after the last independent menstruation. Menopause is the last independent menstruation due to the function of the reproductive system. The date of menopause is set retrospectively, that is, after 12 months of no menstruation. Menopause occurs on average around the age of 50.
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Centers, Nicole, Olga Ivanov, Cynthia Buffington e Aileen Caceres. "Hormone replacement therapy (HRT) among BRCA mutation carriers." Journal of Clinical Oncology 35, n. 15_suppl (20 maggio 2017): 1561. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.1561.
Testo completoAbstract (sommario):
1561 Background: BRCA mutation carriers are often offered risk-reducing surgery (oophorectomy, hysterectomy) and medication regimens (hormone modulators, chemotherapy) in a preventative format. These therapies cause premature menopause and associated symptoms including reduced libido and sexuality. Hormone replacement therapy (HRT) is beneficial in alleviating climacteric symptoms of menopause. However, due to high risk for breast cancer in BRCA mutation carriers, many within the healthcare community oppose the use of HRT, despite recent studies that fail to demonstrate an adverse effect on oncologic outcomes. The purpose of this study was to identify current HRT practices among BRCA1,2 mutation carriers. Methods: The study population included 763 BRCA1,2 mutation carriers (52% previvors, 48% survivors) who are members of Facing Our Risk of Cancer Empowered, a support, education, and advocacy group for individuals with gene mutations. Data was collected via an online survey that included questions pertaining to patient characteristics, preventative procedures, menopausal status and symptoms, HRT use, and provider recommendations. Results: According to the survey findings, 73% of BRCA mutation carriers were postmenopausal (59% previvors, 88% survivors) and, among these, 81% had become menopausal prematurely due to risk-reducing surgery or medications. Major postmenopausal concerns of BRCA mutation carriers involved low libido/sexuality (78%) and an increased risk for weight gain (83%), cardiovascular disease (77%), and osteoporosis (65%). Despite the high incidence of premature menopause and associated symptomatology of the population, HRT usage was low (13% previvors, 28% survivors). According to the survey respondents, only 26% of healthcare providers for the previvors and 8% for the survivors favored HRT use. Conclusions: High rates of premature menopause with related symptoms occur among BRCA1,2 mutation carriers in association with cancer preventative therapies. Despite the young age of this postmenopausal population, only a small percentage are on HRT. These findings suggest the need for improved education to patients and providers regarding HRT and cancer risk, as well as the exploration of HRT options.
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Honigberg, Michael C., Aniruddh P. Patel, Tim Lahm, Malissa J. Wood, Jennifer E. Ho, Puja Kohli e Pradeep Natarajan. "Association of premature menopause with incident pulmonary hypertension: A cohort study". PLOS ONE 16, n. 3 (10 marzo 2021): e0247398. http://dx.doi.org/10.1371/journal.pone.0247398.
Testo completoAbstract (sommario):
Background Several forms of pulmonary hypertension (PH) disproportionately affect women. Animal and human studies suggest that estradiol exerts mixed effects on the pulmonary vasculature. Whether premature menopause represents a risk factor for PH is unknown. Methods and findings In this cohort study, women in the UK Biobank aged 40–69 years who were postmenopausal and had complete data available on reproductive history were included. Premature menopause, defined as menopause occurring before age 40 years. Postmenopausal women without premature menopause served as the reference group. The primary outcome was incident PH, ascertained by appearance of a qualifying ICD code in the participant’s UK Biobank study record. Of 136,715 postmenopausal women included, 5,201 (3.8%) had premature menopause. Participants were followed up for a median of 11.1 (interquartile range 10.5–11.8) years. The primary outcome occurred in 38 women (0.73%) with premature menopause and 409 (0.31%) without. After adjustment for age, race, ever-smoking, body-mass index, systolic blood pressure, antihypertensive medication use, non-high-density lipoprotein cholesterol, cholesterol-lowering medication use, C-reactive protein, prevalent type 2 diabetes, obstructive sleep apnea, heart failure, mitral regurgitation, aortic stenosis, venous thromboembolism, forced vital capacity (FVC), the forced expiratory volume in 1 second-to-FVC ratio, use of menopausal hormone therapy, and hysterectomy status, premature menopause was independently associated with PH (hazard ratio 2.13, 95% CI 1.31–3.23, P<0.001). In analyses of alternate menopausal age thresholds, risk of PH appeared to increase progressively with younger age at menopause (Ptrend <0.001), with 4.8-fold risk in women with menopause before age 30 years (95% CI 1.82–12.74, P = 0.002). Use of menopausal hormone therapy did not modify the association of premature menopause with PH. Conclusions Premature menopause may represent an independent risk factor for PH in women. Further investigation of the role of sex hormones in PH is needed in animal and human studies to elucidate pathobiology and identify novel therapeutic targets.