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Estrogens in the treatment of climacteric depression, premenstrual depression, postnatal depression and chronic fatigue syndrome
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
The effect of estrogen therapy on mood has been studied by many workers, but few have concentrated on patients with major depressive disorder. One of the earliest and most convincing studies as to the benefits of estrogen in depression is that of Klaiber and associates11, who studied the use of oral equine estrogens in severely depressed inpatients who had been unresponsive to conventional treatments such as electroconvulsive therapy, an and psychotherapy. According to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, these patients all had primary, recurrent unipolar major depressive disorders. Conjugated equine estrogens were commenced in huge doses, starting with a dose of 5 mg and increasing weekly in 5 mg increments to a maximum of 25 mg daily, a dose achieved in 50% of those receiving active treatment. The results were impressive in that there were highly significant reductions in depression scores in the estrogen-treated group, as well as clinically significant improvements in mood as observed by trained personnel (Figure 1). This important study was overlooked because of fears of high-dose estrogens and is only recently being corroborated.
The Treatment of Advanced Prostatic Cancer with Drugs and Hormones
Published in Nicholas Bruchovsky, James H. Goldie, Drug and Hormone Resistance in Neoplasia, 2019
High-dose estrogen may act directly on the tumor via estrogen receptors. It is of interest that castration induces the appearance of prostatic estrogen receptors in the rat.236 Objective responses to high-dose estrogen can sometimes be seen.237, 238 It would be of considerable interest to know whether this correlated with estrogen receptor content.
Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Persistent controversy exists concerning OCs and the risk of stroke in migraineurs. During the last two decades, at least 15 retrospective studies have looked at the influence of OCs on the risk of cerebral thromboembolic events. Most (11/15) were conducted during a period when high-dose estrogen pills were widely used. These data suggest that OCs that contain more than 50µg, 50 µg, and 30–40 µg of estrogen are associated with odds ratios for cerebral thromboembolic attacks of about 8–10, 2–4, and 1.5–2.5, respectively, whereas those containing only a progestin are not associated with any increased risk (Table 6.29).171
Effects of different doses of estrogen on ER expression and ovarian function in patients with unexplained recurrent abortion
Published in Gynecological Endocrinology, 2022
Yamin Qiu, Jie Lin, Qing Xu, Linhua Zeng, Chao Liu
In clinical practice, estrogen and pregnancy stimulus are commonly used for sequential treatment. However, due to the lack of uniform treatment guidelines, the dosage of hormone therapy is different, the course of treatment is different, and the ratio of progesterone is different, so the curative effect varies greatly. When the number of endometrial receptors is reduced or the function is abnormal, the endometrial proliferation ability is decreased, and the responsiveness to estrogen stimulation under physiological conditions is reduced. It is speculated that it may be related to the reduction and saturation of estrogen receptors. Therefore, in the hormone therapy of URSA, high-dose estrogen is mostly used, ignoring the side effects of high-dose estrogen. Roy [18] and other studies have shown that for some patients, the treatment of high-dose estrogen has little effect. Some researcher even believe that high-dose estrogen will cause endometrial fibrosis and affect the expression of receptors [19]. High-dose hormone therapy also has risks of breast hyperplasia, gastrointestinal reactions, weight gain, liver and kidney damage, thrombosis, and cardiovascular and cerebrovascular diseases.
The role of pharmacotherapy in the treatment of endometriosis across the lifespan
Published in Expert Opinion on Pharmacotherapy, 2020
Kaia Schwartz, Natalia C. Llarena, Jenna M. Rehmer, Elliott G. Richards, Tommaso Falcone
Due to the substantial menopausal side effects caused by GnRH agonists and antagonists, including vaginal dryness, hot flushes, and decreased bone density, add-back therapy should be used. Add-back therapy may include progesterone alone or estrogen combined with progesterone. A large-randomized trial compared three modes of add-back therapy to leuprolide acetate alone: GnRH agonist plus a progestin (norethindrone acetate 5 mg orally daily); GnRH agonist plus low-dose estrogen and a progestin (conjugated estrogen 0.625 mg and norethindrone acetate 5 mg PO daily); and GnRH agonist plus high-dose estrogen and a progestin (conjugated estrogen 1.25 mg and norethindrone acetate 5 mg PO daily). The authors concluded that all four regimens significantly reduced pelvic pain, but bone density was higher among women who received any of the add-back therapy regimens than those who received a GnRH agonist alone. Additionally, vasomotor symptoms were significantly lower in the add-back therapy groups [55]. Newer studies have shown that add-back therapy with both progestin and estrogen is superior to add-back therapy with progestin alone, especially in preserving bone mineral density and lean body mass [56]. Therefore, it is recommended that women use add-back therapy with both progestin and estrogen while on GnRH agonists or antagonists.
Emerging data on improving response to hormone therapy: the role of novel targeted agents
Published in Expert Review of Anticancer Therapy, 2018
Breast cancer is the most common cancer diagnosis for women. Hormone receptor positive (HR+) disease represents the most common subtype of breast cancer, accounting for 70% of metastatic breast cancer. Drugs that block the production or effect of estrogen are one of the primary treatments for HR+ breast cancer, in early and advanced stages. Standard hormone therapies include nonsteroidal aromatase inhibitors (AIs) (letrozole and anastrozole) and the steroidal AIs (exemestane), which block the conversion of androgens to estrogen by inhibiting the aromatase enzyme; tamoxifen, which selectively blocks the binding of estrogen to the estrogen receptor (ER), and fulvestrant, which downregulates the ER. Ovarian suppression with a gonadotrophin receptor (GnRH) agonist or oophorectomy may be used in combination with hormone therapy in premenopausal women; AIs and fulvestrant are only approved in postmenopausal women. Other forms of hormone therapy for advanced disease include high dose estrogen and the synthetic progestin megestrol acetate.