ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo evaluate the effect of a pharmacologically induced, temporary suppression of ovarian hormones on healthy young women's cognitive functioning.DesignSixteen healthy women with normal menstrual cycles completed the California Verbal Learning Test, a digit span test, and a verbal fluency test in the follicular phase of a normal menstrual cycle and a second time after four monthly injections of the gonadotropin-releasing hormone (GnRH) agonist. Women were randomly assigned to complete a third testing either after resuming cycles in the follicular phase or after three more injections of the GnRH agonist and while wearing an estradiol patch. The control group consisted of 10 women who were tested three times in the follicular phase of their menstrual cycles.ResultsResults showed no change in cognitive functioning across sessions or groups in women with suppressed ovarian function. Women who had the highest levels of menopausal symptoms when taking the GnRH agonist did not have significantly lower cognitive functioning.ConclusionsThis study did not find any effect of suppression in ovarian hormones on cognitive performance of young women.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo examine the utility of a low-dose estrogen and pulsed progestogen hormone replacement therapy (HRT) regimen for add-back during long-term gonadotropin-releasing hormone-agonist (GnRH-agonist) therapy.DesignA pilot clinical trial conducted at a tertiary referral, academic, reproductive sciences center. The study included 15 patients with endometriosis and 5 patients with severe premenstrual syndrome (PMS). Patients with endometriosis received leuprolide acetate depot 3.75 mg IM monthly until their symptoms had resolved (2–3 months), at which time HRT was initiated along with the GnRH-agonist. Patients with severe PMS received the same treatment with the addition of HRT after 1 month. The HRT regimen consisted of 1 mg oral micronized estradiol daily and 0.35 mg norethindrone daily for 2 days alternating with 2 days without norethindrone. The main outcome measure included bone density assessment in the lumbar spine and femoral neck by dual-energy x-ray absorptiometry at 6- to 12-month intervals. The mean follow-up duration ± SD while on GnRH-agonist treatment was 31.2 ± 17 months (for endometriosis patients) and 37.7 ± 8.4 months (for patients with severe PMS).ResultsBone mineral density was stable after initiation of HRT for the entire follow-up period. No patient had return of pelvic pain or resumption of mood swings after HRT add-back. After the first 3 months of HRT, all women remained amenorrheic.ConclusionsLong-term GnRH-agonist down-regulation is safe and effective when combined with HRT add-back. Furthermore, on the basis of this small study, the low-dose pulsed progestogen, continuous estrogen HRT regimen seems to be safe for use as add-back therapy in terms of bone health.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo measure the effects of 2 years' treatment with tibolone on the reproductive tract of female monkeys (Macaca fascicularis) in comparison with conventional hormone replacement therapy.DesignOvariectomized adult female monkeys were randomized for 2 years of treatment into five groups: controls (n= 31); tibolone at 0.05 mg/kg (LoTIB group;n= 30); tibolone at 0.2 mg/kg (HiTIB group;n= 31); conjugated equine estrogens (CEE) at 0.042 mg/kg (CEE group;n= 28); or CEE + medroxyprogesterone acetate (MPA) at 0.167 mg/kg (CEE + MPA group;n= 29). Endpoints included vaginal cytology; uterine weight; histopathologic evaluation of the uterus, vagina, and cervix; histomorphometry of the endometrium; and immunohistochemical detection of the proliferation marker Ki67 and progesterone receptor in endometrial tissue.ResultsEndometrial atrophy was found in 29 of 30 and 23 of 31 animals in the LoTIB and HiTIB groups, respectively, compared with 0 of 28 and 11 of 29 in the CEE and CEE + MPA groups, respectively. All ovariectomized control animals had atrophic endometria. No complex or atypical hyperplasia was seen. Simple endometrial hyperplasia of a significant degree was seen in 3 of 31 HiTIB-treated animals, 1 of 30 LoTIB-treated animals, 26 of 28 CEE-treated animals, and 16 of 29 CEE + MPA-treated animals, and in none of the control animals. Marked simple endometrial hyperplasia and Ki-67 expression was induced by CEE and partially antagonized by MPA. LoTIB and HiTIB slightly increased endometrial thickness, whereas CEE and CEE + MPA induced a marked increase of 350% and 200%, respectively. Neither LoTIB nor HiTIB increased endometrial proliferation (Ki67 labeling) or induced vaginal keratinization. Endometrial bleeding was not seen in tibolone-treated animals but was present in 10 of 29 animals given CEE + MPA.ConclusionsThe effect of tibolone on the uterus and lower reproductive tract was minimal. The lack of a proliferative response of the endometrium to tibolone, coupled with the lower incidence of endometrial bleeding, suggests that tibolone may have advantages over CEE and CEE + MPA regarding endometrial safety and efficacy.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo compare the mood and somatic effects during the initial 2 months of medroxyprogesterone acetate (MPA) or progesterone combined with conjugated equine estrogen (CEE) in early postmenopausal women.DesignTwenty-three nondepressed, early postmenopausal women (average age, 52.5 years) completed a 91-day, single-blind pilot study with the following sequence of treatments: 1 week of no substance; 2 weeks of placebo; 2 weeks of progestogen only; 1 week of placebo; and 2 months of “standard hormone replacement therapy cycles,” which consisted of (in order) 2 weeks of 0.625 mg CEE, 2 weeks of CEE plus progestogen, 2 weeks of CEE, and 2 weeks of CEE plus progestogen. Ten women who completed the study received MPA (5 mg/day) as their progestogen, and 13 who completed the study received micronized, oil-suspended progesterone (200 mg/day) as their progestogen. All participants made daily assessments of mood using the Profile of Mood States and daily recordings of somatic symptoms. All subjects had plasma follicle-stimulating hormone of greater than 35 IU/L and had not had spontaneous vaginal bleeding for more than 1 year.ResultsNone of the hormone treatments had a detectable effect on mood. MPA users reported more vaginal bleeding and breast tenderness than progesterone users.ConclusionsIn contrast with the widely held belief among psychiatrists that progesterone depresses mood, neither of the progestogens we used in normal, nondepressed and nonanxious women showed this effect. Absence of an effect on mood was also found when the results of the two progestogens were combined. The lesser side effects of the micronized progesterone-containing regimen suggest that some women may prefer it to an MPA-containing regimen.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo use a nationally representative sample to examine the prevalence of hormone replacement therapy (HRT) use and its relationship to different markers of social class in American women 60 years of age and older.DesignNationally representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 3,479 women aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans, non-Hispanic blacks and much older women were oversampled to produce reliable estimates for these groups.ResultsOverall, the number of women who reported ever having used HRT was 37% [confidence interval (CI), 33%–40%] of all women older than 60 years of age; 40% (CI, 37%–41%) of older, non-Hispanic white women; 20% (CI, 14%–25%) of non-Hispanic black women; and 24% (CI, 20%-29%) of Mexican American women. HRT was used by 43% (CI, 38%–47%) of women 60 to 70 years old, 37% (CI, 32%–41%) of those 71 to 80 years old, and 20% (CI, 13%–26%) of women older than 80. HRT use was lowest among women who did not complete high school or among those in the lowest family income categories. Among women more than 60 years old who reported having a hysterectomy, 51% (CI, 47%–55%) reported using HRT, whereas only 20% (CI, 17%–23%) of those who had a natural menopause reported using HRT.ConclusionsAlthough many women can benefit from HRT, the number of American women who report they have ever used it remains low. More research is needed to examine the implications of racial differences in compliance, patient and physician attitudes toward HRT, and possible environmental barriers that may prevent use.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveProgestin addition to estradiol (E2) replacement therapy may lead to a deterioration of beneficial effects on the vasculature. The effect of the two clinically most common progestins, medroxyprogesterone acetate (MPA) and norethisterone (NET), during continuous combination with E2on the synthesis of markers for coronary endothelial function, atherosclerotic plaque initiation, and plaque formation was investigated in human female vascular cell cultures and compared with that of E2alone.DesignEndothelial cell cultures from human female coronary arteries were used to evaluate the effect of progestin addition to E2on the production of the following endothelial markers: prostacyclin, endothelin, plasminogen activator inhibitor-1, E-selectin, intercellular adhesion molecule-1, monocyte chemoattractant protein-1 (MCP-1), and the precursor of matrix metalloproteinase-1 (pro-MMP-1). E2was tested at 0.1 &mgr;M, 1 &mgr;M, and 10 &mgr;M alone and in equimolar combinations with MPA or NET. The markers were determined by enzyme immunoassays in the cell supernatant.ResultsE2induced a significant increase of endothelial prostacyclin production and was able to significantly decrease the synthesis of endothelin, plasminogen activator inhibitor-1, E-selectin, and intercellular adhesion molecule-1. Neither MPA nor NET addition negatively interfered with these E2-induced benefits. However, MPA antagonized the E2-induced significant reduction of MCP-1 synthesis, with the difference between both progestins being significant (p< 0.01). Interestingly, an enhancement of the positive E2-effect on pro-MMP-1 production was observed by the addition of both MPA and NET (p< 0.01).ConclusionE2can positively influence various markers of endothelial function. Addition of MPA or NET can elicit different effects, which has been demonstrated for the first time in human coronary cell cultures. No impact was found on markers representing primarily vasotonus and thrombogenicity. In terms of MMP-1, which is crucial for atherosclerotic plaque stability, an enhancement of the beneficial E2effect was observed. However, regarding MCP-1, contrary effects of progestins cannot be excluded. This indicates that progestins may differ in their effects, particularly in the early stages of atherosclerosis, which has also been supported by other studies.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe administration of hormonal replacement treatment to women with an intact uterus needs to be supplemented with progestogenic compounds to avoid endometrial hyperplasia. However, progestins may cancel the beneficial effects of estrogens on the cardiovascular system. The goal of this study was to examine the effects of adding cyproterone acetate to estradiol (E2)on aorta atherogenesis.DesignThirty-two cholesterol-fed New Zealand white rabbits were studied for 4 months. The animals underwent laparotomy and were randomly allocated to four groups. Twenty-four rabbits underwent bilateral ovariectomy, and the other eight were sham-operated (group S). The ovariectomized rabbits were allocated to three groups of eight animals each receiving E2valerate (group E), E2valerate plus cyproterone acetate (group EC), or placebo after sterilization (group C).ResultsAfter 4 months, the cholesterol-rich diet caused atherosclerotic aortic lesions in both treated groups that affected 17.91% ± 10.19% and 28.16% ± 7.97% of the aortic surface of groups E and EC, respectively, with a markedly lower aortic plaque size in group E than in groups C and S. Rabbits from group E (but not from group EC) had aortic cholesterol content significantly lower than rabbits from the sham-operated and control groups.ConclusionE2valerate reduces aortic atheromatosis in cholesterol-fed, ovariectomized rabbits, and the addition of cyproterone acetate may neutralize this effect.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo evaluate endocrine responses to short-term medroxyprogesterone acetate (MPA) administered as a respiratory stimulant in postmenopausal women with mild nocturnal hypoxemia.DesignOpen-label trial with 14-day MPA (60 mg daily) and 3-week follow-up posttreatment. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and insulin-like growth factor-I (IGF-I) were assessed at baseline, while on MPA and at the 3-week washout in eight subjects.ResultsWith MPA, FSH decreased by 47.5% (p< 0.01) and LH by 64.9% (p< 0.001), whereas IGF-I increased by 39.6% (p< 0.01). FSH and LH remained suppressed at the 3-week washout (−23.8%,p< 0.05 and −44.3%,p< 0.01, respectively). IGF-I returned to pretreatment level at the 3-week washout. Neither serum estradiol nor progesterone concentrations changed during or after progestogen therapy.ConclusionsDaily administration of MPA (60 mg) for 2 weeks has both immediate (FSH, LH and IGF-I) and sustained (FSH, LH) effects up to 3 weeks after treatment. Therefore, prolonged MPA-induced effects should be taken into account when interpreting hormone assessments after progestogen therapy.

ISSN:1072-3714    

出版商:OVID    

年代:2002

数据来源: OVID