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Bones and fractures
Published in Henry J. Woodford, Essential Geriatrics, 2022
Tibolone is a partial oestrogen, progestogen and androgen receptor agonist that may have a role in the treatment of osteoporosis in specific subgroups of women – i.e. post-menopausal women aged up to 60.21
DRCOG OSCE for Circuit C Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Explain that the HRT may be offered in the form of creams, implants, injections, nasal spray, transdermal patches, pessaries or tablets. Explain that the different forms of HRT include systemic sequential combined HRT, continuous combined HRT, unopposed oestrogen (post-hysterectomy), progestogen-only therapy, gonadomimetic (tibolone) and selective (o)estrogen receptor modulators (SERMs). Tibolone has oestrogenic, progestogenic and androgenic effects and treats menopausal symptoms and protects against osteoporosis. It is a no-bleed HRT for use in women at least 1 year postmenopause. SERMs, i.e. raloxifene, are licensed for the prevention and treatment of spinal osteoporosis and also have an oestrogen-like effect on bones and the vagina, with an anti-oestrogen effect on the breasts and endometrium. Explain that local HRT is offered as oestrogen only.
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
Hormone replacement therapy (HRT) consists of oestrogen alone for hysterectomized women, or oestrogen and progestogen for the patient with an intact uterus. Progestogens are given cyclically or continuously. Progestogen can be administered for 10–14 days every four weeks, or for 14 days every 13 weeks, or every day. The first results in monthly bleeds, the second causes bleeding every three months, and the last causes amenorrhoea. Tibolone is a synthetic compound taken daily by postmenopausal women who desire amenorrhoea. It is therefore similar to the continuous combined HRT in that it treats vasomotor symptoms and prevents osteoporosis as well as causing no bleeding. Tibolone also contains androgen and can therefore improve libido. Testosterone implants may improve libido but not all women are responders (3).
Short-term administration of tibolone reduces inflammation and oxidative stress in the hippocampus of ovariectomized rats fed high-fat and high-fructose
Published in Nutritional Neuroscience, 2023
Norma A. Estrada-Cruz, Leticia Manuel-Apolinar, Julia J. Segura-Uribe, Julio C. Almanza-Pérez, Ángeles Fortis-Barrera, Sandra Orozco-Suárez, Guadalupe Bautista-Poblet, Angélica Coyoy-Salgado, Christian Guerra-Araiza
As the caloric intake of the animals in these groups was lower than that of the groups that did not receive TB, a possible explanation for this response could involve the hypothalamus—an important center for the coordination of food intake, body weight homeostasis and energy expenditure [26]. In addition, estrogens modulate, directly and indirectly, the activity of molecules involved in food intake and may regulate energy intake through a direct action of ER-α or indirectly through downregulation of orexigenic peptides. Therefore, the absence of estrogens may promote hyperphagia [27] as ERs are present in adipose tissue and act as its regulators [28]. ER-α predominantly regulates homeostasis through adipocyte growth and proliferation, whereas ER-β regulates the sex-dependent distribution of fatty tissue. Thus, disruption of gonadal estrogen secretion, with consequent androgen/estrogen imbalance, favors abdominal fat deposition with increased visceral fat [29,30]. The estrogenic effect of tibolone could be modulating this response, resulting in decreased weight gain in these groups.
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].
Prediagnostic use of estrogen-only therapy is associated with improved colorectal cancer survival in menopausal women: a Swedish population-based cohort study
Published in Acta Oncologica, 2021
Johanna Simin, Qing Liu, Xinchen Wang, Katja Fall, Cecilia Williams, Steven Callens, Lars Engstrand, Nele Brusselaers
This population-based cohort study shows that past E-MHT use before CRC diagnosis is associated with over 30% lower CRC-specific mortality and all-cause mortality, as compared with women with CRC who did not receive MHT. However, elevated all-cause mortality was noted among older women (at diagnosis) who had received E-MHT within 6 months before their CRC diagnosis. Among EP-MHT users, current prediagnostic use was associated with higher CRC-specific mortality among women diagnosed at older age, whereas no association with all-cause mortality was shown. These findings support the role and chemopreventive effects of particularly estrogens in development of CRC, as prediagnostic use of E-MHT was associated with lower mortality. Furthermore, current use of tibolone is suggested for lower risk of all-cause mortality, based on smaller groups.