Long term hormone therapy for perimenopausal and postmenopausal women

Marjoribanks, Jane; Farquhar, Cindy; Roberts, Helen; Lethaby, Anne

doi:10.1002/14651858.cd004143.pub4

Cited by 158 publications

(124 citation statements)

References 175 publications

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“…Attempts to ameliorate losses in oestrogen through hormone replacement therapy (HRT) have, however, courted significant controversy relating both to increased risks of malignancy and vascular events, thereby standing as an exemplar for the difficulty in managing hormone balance during ageing [10,11]. Recognised changes in female sex steroids are matched by the andropause, a relatively poorly defined process characterised by a progressive age-dependent loss of the anabolic androgen testosterone within males [12].…”

Section: The Hypothalamic-pituitary-gonadal Axismentioning

confidence: 99%

“…The significant increase in the risk of heart disease in women undergoing the menopause, coupled with the relatively reduced burden of heart disease amongst premenopausal women when compared to age-matched males, indicates a cardioprotective role for oestrogen which is lost in later age [10]. The relationship between testosterone and heart disease in both males and females is less clear.…”

Section: The Hypothalamic-pituitary-gonadal Axismentioning

confidence: 99%

See 1 more Smart Citation

The Endocrinology of Ageing: A Mini-Review

Jones

Boelaert

2014

Gerontology

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Significant advances in health and social wellbeing have led to linear gains in life expectancy and an accompanying increase in the burden imposed by age-related morbidities. Complex alterations in hormonal networks which regulate homeostasis and survival may underlie this poor adaptation to later life, as exemplified by an increased fracture risk amongst post-menopausal women. Beyond overt under- or overactivity of hormonal axes, changes in the concentrations of regulatory hormones may also impact on health and disease. Subclinical hyperthyroidism, a disorder characterised by normal thyroxine levels in the presence of decreased thyroid-stimulating hormone, is, for instance, independently associated with an increased risk of atrial fibrillation amongst elderly populations. Both the menopause and subclinical thyroid disease demonstrate the difficulty in reversing endocrine changes in later life, with minimal impact from thyroxine therapy in subclinical hypothyroidism and multiple reports of harm resulting from hormone replacement therapy in peri- and post-menopausal women. Given these findings, strategies to locally regulate hormone bioavailability by altering pre-receptor metabolism may offer greater therapeutic potential in the fight against age-related disease. This review aims to provide an overview of the ageing endocrine system and its potential impact on health and disease in the elderly. It will postulate that strategies to coordinate pre-receptor hormone metabolism and a greater understanding of putative hormonal longevity pathways may offer key new drug targets in the fight against ageing, and will argue against applying the conventional endocrine maxim of ‘block and replace' to hormonal changes seen during ageing.

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Section: The Hypothalamic-pituitary-gonadal Axismentioning

confidence: 99%

Section: The Hypothalamic-pituitary-gonadal Axismentioning

confidence: 99%

The Endocrinology of Ageing: A Mini-Review

Jones

Boelaert

2014

Gerontology

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“…Although the number of women using these agents decreased in the first decade of the 21st century, reevaluation of the literature and the release of new studies have collectively suggested that such therapy may provide benefit in at least selected instances. [1][2][3] As a result, clinicians will continue to be challenged by the issue of HRT-associated postmenopausal bleeding in the near future. It is known that tamoxifen and other SERMs may increase the chance of endometrial neoplasia developing.…”

Section: Introductionmentioning

confidence: 99%

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

Munro

2014

TPJ

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“…Por lo tanto, no es sorprendente que la THM disminuya el riesgo de fractura. Un metaanálisis de la base de datos Cochrane que incluyó 23 estudios aleatorizados y controlados con placebo, entre los cuales figuraba el WHI y el HERS, y que incluyó a 42 839 mujeres posmenopáusicas mostró que, después de 5,6 años de THM combinada, el riesgo absoluto de fractura disminuía en 86 casos por 1 000 mujeres tratadas (comparado con los controles) y con estrógenos solos el riesgo absoluto después de 7,1 años caía a 102 por 1 000 (34) . Probablemente, la disminución del riesgo de fractura con la THM no solo se deba a su efecto antireabsortivo, sino que también pueden estar influyendo otros efectos positivos que tiene esta terapia.…”

Section: Osteoporosisunclassified

Terapia hormonal de la menopausia, ¿por qué prescribirla?

Maldonado

2018

Rev peru ginecol obstet.

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Financiamiento: Autofinanciado Conflicto de interés:La autora declara no tener algún conflicto de interés RESUMENDurante el climaterio, la mayoría de las mujeres presenta muchos síntomas que afectan su calidad de vida. Estos síntomas han sido vinculados con trastornos de la neuroquímica provocados por la carencia de estrógenos. El sistema nervioso central-SNC también está involucrado en los cambios de la composición corporal y en el aumento de tejido adiposo que se produce durante el climaterio. El adipocito del obeso produce adipocitoquinas que llevan a un estado inflamatorio crónico con incremento del riesgo de diabetes, hipertensión e hipercoagulabilidad, aumentando el riesgo cardiovascular. El déficit de estrógenos también modula señales celulares (RANKL, NPY) que favorecen la reabsorción ósea y el riesgo de osteoporosis. La obesidad asociada al climaterio incrementa además el riesgo de cáncer de mama, endometrio, colon y vesícula al aumentar la leptina e interleucina 6. Estas adipocitoquinas modulan una serie señales celulares (STAT3, AP-1, MAPK, ERKs) que a su vez aumentan la aromatasa, la síntesis de estrógenos y la activación de receptores alfa en las células malignas, estimulando la proliferación celular. También, algunos estudios experimentales sugieren una acción anti-Alzheimer de los esteroides ováricos. Palabras clave. Terapia hormonal, Menopausia, Calidad de vida, Enfermedades crónicas. ABSTRACTDuring the climacteric, most women have many symptoms that affect their quality of life. These symptoms have been linked to neurochemical disorders caused by the lack of estrogen. The CNS is also involved in changes in body composition and in the gain in adipose tissue that occurs during the climacteric. Obese adipocytes produce adipocytokines that lead to a chronic inflammatory status with a higher risk for diabetes, hypertension and hypercoagulability; all these increase the cardiovascular risk. Estrogen deficiency also modulates cellular signals (RANKL, NPY) that favor bone resorption and osteoporosis risk. Obesity associated with menopause also increases the risk of breast, endometrial, colon and bladder cancer by raising the levels of leptin and interleukin 6. These adipocytokines modulate a series of cellular signals (STAT3, AP-1, MAPK, ERKs) series which in turn increase aromatase, the synthesis of estrogens and the activation of alpha receptors in malignant cells, stimulating cell proliferation. Also, some experimental studies suggest an anti-Alzheimer action of ovarian steroids.

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Long term hormone therapy for perimenopausal and postmenopausal women

Cited by 158 publications

References 175 publications

The Endocrinology of Ageing: A Mini-Review

The Endocrinology of Ageing: A Mini-Review

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

Terapia hormonal de la menopausia, ¿por qué prescribirla?

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