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Postmenopause
Published in Carolyn Torkelson, Catherine Marienau, Beyond Menopause, 2023
Carolyn Torkelson, Catherine Marienau
The history of hormone therapy use goes back to the 1940s when Premarin, an estrogen replacement, was introduced to the market. Premarin is estrogen that has been isolated from horse urine, or conjugated equine estrogen (CEE). In fact, the name of the drug is short for PREgnant MARes’ urINe.
Hormones and Cardiovascular Disease
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
WHI enrolled 16,608 postmenopausal women aged 50–79 years. The subjects were supposed to be healthy postmenopausal women, but instead 36% were on medication for high blood pressure, 35% were overweight, 34% were obese, and about half were current or past smokers. They likely had vascular dysfunction at baseline. The median age was 63, so most were 10 years or more from menopause. The distribution of women by age was uneven: 10% were 50–54, whereas 70% were 60–79, an age where established CVD was likely present given the risk factors in the study population. The subjects were treated with pregnant mare’s urine, or conjugated equine estrogen, and medroxyprogesterone acetate—both of which are structurally unlike the endogenous estrogen and progesterone made by the female body, and at appropriate levels for function, serve as a defense against CVD.
Practice exam 3: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Persistent oestrogenic side effects may be eliminated by reducing the dose of oestrogen, changing the oestrogen type (e.g. conjugated equine oestrogen to oestradiol), or altering the route of administration (e.g. oral, transdermal patch or vaginal ring) (2).
Is now the time to reconsider risks, benefits, and limitations of estrogen preparations as a treatment for menstrually related migraine?
Published in Expert Review of Neurotherapeutics, 2023
Lara Tiranini, Laura Cucinella, Silvia Martella, David Bosoni, Ellis Martini, Rossella E. Nappi
In women with MRM, shortening the 7-day HFI of COC to 4-day may be beneficial [133], as well as extending active pills over time to delay estrogen-withdrawal headaches as much as possible [134]. In a double-blind, randomized, placebo-controlled pilot study of women, with MRM using an extended 168-day COC regimen, the prophylactic drug frovatriptan during the 4-day HFI was able to block the increase in headache score over placebo [135]. However, following the withdrawal of the frovatriptan, headache scores increased despite resuming COC [135] confirming the importance of the HFI in the occurrence of MRM. Some early experiences in small samples of women treated with estrogen supplementation during the 7-day HFI showed MRM improvement [136,137], but data on a larger scale are lacking. In a double-blind, placebo-controlled pilot study, 50 mcg E2 patches were used to supplement the hormone free interval of monophasic and triphasic 21/7 pills showing a trend toward reducing the frequency and severity of MRM [136]. In another open study, 0.9 mg of oral conjugated equine estrogens were used and the review of retrospective charts indicated less days with MRM and decreased severity review during the 7-days HFI of a low-dose (20 mcg EE) pill [137].
Primary choice of estrogen and progestogen as components for HRT: a clinical pharmacological view
Published in Climacteric, 2022
Remarkably, the content of 17β-estradiol is only about 1%. It is produced by the metabolism of estrone, the amount of which, however, is dependent on the activity of 17β-reductases differing in the target tissues such as the brain, bone, urogenital tract and vasculature. Likewise, other components can also function as prodrugs for active metabolites. Equilin can be metabolized to 17β-dihydroequilin (and vice versa) or to equilenin [13], both with strong biological activities, as presented in Table 4 [14]. This table summarizes several experimental studies in ovariectomized rats, showing the mean percentages of the CEE components used in these studies and the biological activity with respect to the potency in the vagina and uterus. The strong efficacy of these equine estrogens has been also shown in a variety of clinical studies with different results according to different endpoints. For example, equilenin increased the hepatic proteins high density lipoprotein-cholesterol, SHBG, CBG and angiotensinogen to a six or seven-times higher extent than the use of 17β-estradiol [14]. These effects are not dependent on the binding affinity to these proteins, which is about 30% lower for equilenin compared to 17β-estradiol [14].
Hormone therapy effect on menopausal systemic lupus erythematosus patients: a systematic review
Published in Climacteric, 2022
J. M. Soares-Jr, I. C. Espósito Sorpreso, J. F. Nunes Curado, E. S. Ferreira Filho, R. dos Santos Simões, E. Bonfá, C. A. Silva, E. C. Baracat
A randomized clinical trial with 106 patients with SLE reported that, except for the patients with high disease activity, there was significant improvement in menopausal symptoms at the end of 2 years of conjugated equine estrogens (CEE), 0.625 mg/day, and medroxyprogesterone acetate (MPA), 5 mg for 10 days/month (p = 0.03) [10]. The same type of HT was used in another randomized clinical trial with 28 patients, resulting in an increase in bone mineral density (BMD) at the end of 2 years (p < 0.05) [11]. In 2004, Bhattoa et al. carried out a randomized clinical trial for 1 year with 32 patients with SLE and osteopenia using transdermal estradiol and MPA; they also found improved BMD (p < 0.005) [12]. A study with 30 patients followed up for 1 year observed that those who underwent therapy with tibolone showed improved menopausal symptoms (p = 0.03) [13].