Menopausal Symptoms in Older Women and the Effects of Treatment With Hormone Therapy

Barnabei, Vanessa M.; Grady, Deborah; Stovall, Dale W.; Cauley, Jane A.; Lin, Feng; Stuenkel, Cynthia A.; Stefanick, Marcia L.; Pickar, James H.

doi:10.1097/00006250-200212000-00011

Cited by 45 publications

(66 citation statements)

References 12 publications

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“…The goals of menopausal hormone therapies are to [1] reduce symptoms resulting from estrogen depletion, including hot flushes, sleeplessness, lethargy, and depressed mood; [2] treat urogenital atrophy and vaginal dryness; and [3] minimize the risk of disorders that may be more frequent during hormone treatment.…”

Section: Goals Of Therapymentioning

confidence: 99%

“…Only a small percentage of women continue to suffer from vasomotor flushes 10 years after their menopause. Fifteen years after menopause, approximately 3% of women report very frequent hot flushes, and 12% report moderate to severe hot flushes (2,3).…”

Section: Treatment Of Estrogen Deficiency Symptoms Neurovascular Sympmentioning

confidence: 99%

“…During the third year, because the placebo group was experiencing fewer symptoms, the NNT would rise to six patients. In the Heart and Estrogen/ progestin Replacement Study (HERS), HT reduced hot flashes, trouble sleeping, and vaginal dryness more than placebo among women who were on average 18 years postmenopausal (mean age, 67 years), and the benefit was greatest for younger women who were symptomatic at study entry (2).…”

Section: Treatment Of Estrogen Deficiency Symptoms Neurovascular Sympmentioning

confidence: 99%

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Estrogen and progestogen therapy in postmenopausal women

2006

Fertility and Sterility

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Hormone therapy (HT) can be used to manage problems associated with the decline in ovarian estrogen production after menopause. Menopause occurs naturally when the ovarian follicular pool is functionally exhausted or can be induced by surgical removal of both ovaries. The resulting hypoestrogenic state may adversely affect estrogen target tissues, which include the brain, skeleton, and skin, as well as the cardiovascular and genitourinary systems. The concentration and function of hormone receptors varies in these organs and systems. Differences in genetics, body mass index, and body habitus also may influence the levels of endogenous estrogen and androgen in postmenopausal women. The frequency and severity of menopausal symptoms, the reaction of target tissues to estrogen deficiency, and the response to HT varies significantly among women.

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Section: Goals Of Therapymentioning

confidence: 99%

Section: Treatment Of Estrogen Deficiency Symptoms Neurovascular Sympmentioning

confidence: 99%

Section: Treatment Of Estrogen Deficiency Symptoms Neurovascular Sympmentioning

confidence: 99%

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Estrogen and progestogen therapy in postmenopausal women

2006

Fertility and Sterility

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“…Menopause is symptomatic in variable percentages of women, with vasomotor symptoms occurring in most women, of whom 50% will continue to have symptoms for at least 5 years [16][17][18]. Estrogen-related atrophic vaginitis produces symptoms of vaginal burning, itching, and secondary dyspareunia and is responsive to estrogen supplementation in 60% of the case [19].…”

mentioning

confidence: 99%

Menopause hormonal therapy from the urologist’s perspective

Lightner¹

2006

Curr Urol Rep

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Many of the paradigms about hormone-replacement therapy in the postmenopausal female have changed drastically recently. Estrogen was thought to be cardioprotective for women until the landmark Heart and Estrogen/progestin Replacement Study [1] and the twin Women's Health Initiative studies [2,3] confirmed that neither combination estrogen with progesterone therapy (EPT) nor estrogen therapy (ET) alone are protective of coronary events in women with established coronary vascular disease. Sex steroid supplementation for female sexual dysfunction is widely promoted, despite sparse evidence of use outside of those with hypopituitary deficiency [4] or surgically induced menopause [5]. Given the increased risk of cardiac events, stroke [6], breast [7-9], endometrial [10] and ovarian cancers [11][12][13], and the aromatization of androgens to estrogenic compounds in fatty tissues and muscle [14,15] with the use of ET and EPT, a risk-benefit assessment for sex steroid supplementation for women with genitourinary complaints appears to be limited to short-term local estrogen therapy for vulvovaginal complaints in patients with documented vaginal atrophy.Indeed, the effects of menopause on urogenital function also have been upturned. Menopause is symptomatic in variable percentages of women, with vasomotor symptoms occurring in most women, of whom 50% will continue to have symptoms for at least 5 years [16][17][18]. Estrogen-related atrophic vaginitis produces symptoms of vaginal burning, itching, and secondary dyspareunia and is responsive to estrogen supplementation in 60% of the case [19]. Using a locally applied estrogen cream is as effective as systemic use in the treatment of atrophic vaginitis [20] and is recommended [21]. Determining if vulvovaginal complaints are the result of vaginal atrophy prior to instituting estrogen therapy is accomplished by vaginal cytology, which will show the characteristic increase in basal and parabasal cells.It remains clear that gradual loss of estrogen results in lower glycogen production by the now thinning vaginal epithelium. This reduction reduces the population of glycogen-dependent lactobacilli, allowing coliform bacteria to populate the vagina. This increases the reservoir of urinary pathogens and changes the microbiology of the woman with postmenopausal urinary tract infections (UTI) in the more acidic environment that results. However, although the epidemiology of UTI changes over the life cycle, the risk of a UTI does not appear to be significantly affected by estrogen status [22][23][24][25][26]. Indeed, those women taking higher daily doses of ET were found to be at an increased risk of UTI compared with those not undergoing ET [25]. The greatest risk for a community-acquired UTI in the postmenopausal female is her lifetime history of UTI [26,27].Likewise, despite older studies to the contrary, estrogen replacement does not appear to significantly alter the recurrence rate for UTI. A double-blind, randomized, placebo-controlled trial (RPCT) of low-dose ET for recurrent U...

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“…Sobald die Hitzewallung abgeklungen ist, folgt bei vielen Frauen ein profuser Schweißausbruch verbunden mit einem Gefühl des Frös-telns und Frierens. Die Wirksamkeit einer sachgerechten und adäquaten Östro-gensubstitution auf die vasomotorisch-vegetative Symptomatik ist eindeutig nachgewiesen[1,12,13].Viele Frauen leiden in der Postmenopause unter psychischen Symptomen, beschrieben werden depressive Verstimmung, Schlaflosigkeit, mangelndes Leistungsvermögen, Antriebsschwäche, Reizbarkeit, Kopfschmerzen, Angstzustände, verminderte Libido, Vereinsamungsgefühl und Vergesslichkeit. Nicht alle emotionalen und psychischen Probleme der Postmenopause sind lapidar als Folgen des Östrogenmangels zu erklären, sodass eine gleichsam automatische Substitution von Östrogenen nicht angebracht ist.…”

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Altersgynäkologische Sprechstunde

Distler

2006

Gynäkologe

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Menopausal Symptoms in Older Women and the Effects of Treatment With Hormone Therapy

Cited by 45 publications

References 12 publications

Estrogen and progestogen therapy in postmenopausal women

Estrogen and progestogen therapy in postmenopausal women

Menopause hormonal therapy from the urologist’s perspective

Altersgynäkologische Sprechstunde

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