ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Our objective was to examine the effect on all-cause mortality and tumor recurrence rate of combined continuous estrogen-progestin therapy given to symptomatic menopausal women with a personal history of breast cancer. We performed a nested case-control study in a cohort of women with a personal history of breast cancer. The entire database comprised 901 women with surgically confirmed breast cancer attending one of three teaching hospitals in south-eastern Sydney, Australia. Ninety had taken estrogen for relief of severe menopausal symptoms after their diagnosis and treatment of breast cancer. Most were using combined continuous estrogen-progestin therapy, usually an oral estrogen with a moderate dosage progestin. Controls were matched subjects from the same database who had not taken sex steroids after their diagnosis of cancer. The main outcome measures were all-cause mortality and recurrence of breast cancer (or new contralateral breast cancer). Relative risks (RR) were then calculated comparing sex-hormone users with matched controls. Among the 90 estrogen users, there were no deaths and only 7% developed a recurrence, compared to 17% of the nonusers (using two matched controls); RR = 0.40 (95% CI 0.17–0.93). These results suggest that short-term usage of combined continuous hormone replacement therapy (HRT) by women with a personal history of breast cancer may be safe and might even reduce the risk of recurrence. A formal prospective double-blind controlled study is needed to confirm these results.

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Breast cancer is the most common malignancy in women in the United Kingdom, and survival of women with a diagnosis of breast cancer is increasing due to early detection and adjuvant treatment. However, this improvement in prognosis is not necessarily associated with a good quality of life since many patients experience debilitating symptoms resulting from estrogen deficiency. The traditional view is that hormone replacement therapy (HRT) is contraindicated because of the fear of precipitating recurrence. Although endogenous risk factors are associated with the development of breast cancer, and ovarian ablation or medical hormone manipulation are effective treatments, there is unconvincing evidence to implicate the oral contraceptive pill and HRT in the pathogenesis of breast cancer. There is also very little evidence that a high endogenous estrogen level is associated with a poor prognosis in patients with breast cancer, and the small non-randomized studies to date have reported no adverse effects of HRT in women after the diagnosis of breast cancer. The time has come for this proscription to be reevaluated.

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Our study was conducted to define the characteristics of the ventilatory response associated with menopausal hot flashes. Two procedures were used. In the first procedure, respiratory volume was assessed in 2-min epochs before, during, and after hot flashes in eight postmenopausal women. The mean percentage changes for abdominal amplitude showed significant differences between the before and flash epochs and the before and post epochs. In the second procedure, direct metabolic measurements of ventilation were taken every 30 s during a 50-min period in nine postmenopausal women. Respiratory measurements occurring during a 4-min period beginning with the onset of a hot flash were isolated from the 50-min recording and compared to a stable baseline period. Tidal volume, oxygen consumption, and carbon dioxide production were all significantly increased during hot flashes compared to baseline. Minute ventilation significantly increased at the beginning of the hot flash, and breathing rate significantly declined as the hot flash progressed, compared to baseline. These data suggest that alterations in respiration consistently occur in conjunction with menopausal hot flashes and that menopausal symptomatology may involve several diverse biological systems that may be responsive to different treatment approaches.

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To examine the prevalence of urinary problems, 285 consecutive climacteric women seen in a menopause clinic were studied. The average age was 50.2 years; the mean body mass index was 0.251. Women were categorized on the basis of their menopausal age; 113 (40%) were perimenopausal. Assessment consisted of a medically administered 39-part questionnaire documenting urological and related symptoms, a urological, gynecological, and neurological examination; urine analysis for microscopy and culture; hormone profiles; a 1-h hospital pad test, uroflowmetry, and dynamic videourodynamics. The data were analyzed with respect to menopausal age. Incontinence was a common complaint, with 152 (53%) admitting to stress incontinence, 75 (26%) to urge incontinence, and 71 (25%) to postmicturiction dribbling. The symptoms of frequency (29%), nocturia (27%), and urgency (51%) were also common, but pain on micturition was less prevalent (11%), as were symptoms of voiding difficulties (∼15%). Only 49 (17%) admitted to having any urinary tract infection in the previous 2 years. The urethral syndrome was rare, with only six (2%) women admitting to it. Only 168 women (59%) were urodynamically normal, the diagnoses being genuine stress incontinence (22%), detrusor instability (10%), voiding difficulties (7%), and sensory urgency (4%). Despite such a high prevalence of lower urinary tract dysfunction in the menopause clinic population, there did not appear to be any increase with duration of estrogen deprivation (menopausal age) in any of the symptoms or urodynamic pathologies, with the exception of diurnal frequency and nocturia. It is therefore suggested that during the climacteric, the menopause has no significant effect on urinary incontinence or voiding dysfunction but may lower the sensory threshold of the bladder, resulting in increasing frequency and nocturia with advancing menopausal age.

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Our purpose was to compare the specificity profiles of progestins by multivariate analysis. Twenty steroids were screened for binding to the progesterone, androgen, and glucocorticoid receptors and for antiestrogenic activity. A minimum spanning tree and correspondence factor analysis were used to highlight the relationships among variables. In these tests, the compounds with specificity profiles most similar to that of progesterone were medroxy-progesterone acetate and chlormadinone acetate. High progestin selectivity was noted for megestrol acetate, promegestone, and for a compound with an oxathiolane function. Inhibition of the in vivo replenishment of uterine estrogen receptor was most closely correlated with binding to the progesterone receptor and less closely correlated with binding to the androgen receptor. Androgenic 17a-methyl derivatives were potent inhibitors of an estradiolinduced uterine weight increase. In conclusion, descriptive multivariate methods can help select progestins with appropriate mixes of activities for hormone replacement therapy within a biochemical and/or biological screening system.

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To compare the influence of spontaneous and surgical menopause on bone loss, we measured with dual x-ray absorptiometry (DXA) the spinal bone mineral density (BMD) in 513 women recruited at the Menopause Clinic at Ferrara University Hospital. One hundred one women were premenopausal with regular menstrual cycles; 185 women were perimenopausal with irregular periods or with absence of menstruation for <11 months; 160 women had spontaneous menopause with at least 12 months of amenorrhea; 67 women had a surgical menopause (hysterectomy with bilateral oophorectomy) prior to which they had regular menstruation. To minimize the age bias on BMD, all postmenopausal patients were selected to have the age range at menopause corresponding with the chronological age range (45–53 years) of premenopausal women used as reference. Moreover, to evaluate the influence of time since menopause on BMD, all postmenopausal women were stratified in five categories according to time lapsed since their last menses or oophorectomy. BMD values of spontaneous and surgical menopause do not appear to differ significantly (0.908 4pM 0.146 and 0.885 ± 0.129 g/cm2, mean ± SD). However, the difference between the menopausal groups becomes evident when BMD results take into account the interval since menopause. After 61–144 months of amenorrhea, women who had undergone spontaneous menopause had a cumulative bone loss of 21.8% in comparison with premenopausal BMD, whereas women who had undergone surgical menopause had a bone loss of 25.8%. The yearly percentage of bone loss values of surgical menopause (ranging from 3.72 to 7.93) settled to ∼1% per year after 5 years from oophorectomy, whereas the percentage values of spontaneous menopause (ranging from 1.75 to 4.65) settled to 1% per year after 3 years since the last menses. The difference between bone loss rates of spontaneous and surgical menopause, evaluated by comparison of regression coefficients (— 0.027 and —0.051, respectively) of linear regressions of BMD values on time since menopause, was statistically significant (p≤ 0.001). Odds ratio (OR) of osteopenia (asTscore, ≥ — 1) was significantly higher in surgical menopause (OR, 10.36; CI, 24.69–4.34) compared with spontaneous menopause (OR, 7.11; CI, 14.73–3.43). Our data support the evidence that women undergoing bilateral oophorectomy while still menstruating are at a higher risk of osteopenia than women undergoing menopause spontaneously.

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1072-3714    

出版商:OVID    

年代:1995

数据来源: OVID