GnRH Antagonists in the Treatment of Uterine Fibroids
John C. Petrozza in Uterine Fibroids, 2020
Conversely, the literature indicates that GnRH antagonists induce near-immediate pituitary inhibition without initial stimulation. They thus avoid the associated vasomotor symptoms and exacerbation of hormone-sensitive disease. Furthermore, it appears that fibroid shrinkage can occur in the absence of gonadotropin suppression, suggesting that GnRH antagonists function through alternative mechanisms. The change in fibroid echogenicity observed by Flierman et al. [34] implies that these agents affect fibroid tissue composition as well as size. Their dose-dependent effect can be exploited to obtain the desired degree of suppression while avoiding the adverse effects of hypoestrogenism [34]. Lastly, significant decrease in uterine and fibroid size can be achieved with short courses of treatment and may be a superior alternative for short-term preoperative fibroid suppression.
Novel treatment modalities
Seema Chopra in Endometriosis, 2020
GnRH antagonists act by causing direct suppression of gonadotropin release from the pituitary in a dose-dependent manner; this leads to an immediate decrease in the circulating levels of gonadal steroid hormones [15], thus creating a hypoestrogenic environment to treat ectopic endometriotic implants. As compared to GnRH agonists, GnRH antagonists immediately downregulate gonadotropin secretion by competing with the endogenous GnRH for its pituitary receptors. The advantage is avoidance of initial flare usually encountered with agonist use which may improve the compliance of the patients for long-term use. Another advantage over agonists is that circulating estradiol levels in a woman on an antagonist are in a range that is sufficient to avoid menopausal symptoms because of estrogen deprivation. Available preparations include injectables (ganirelix, cetrorelix) and oral nonpeptide forms (elagolix, abarelix, ozarelix, TAK-385) [16]. Cetrorelix (3 mg subcutaneously every week for 2 months) was used in 15 patients after laparoscopic surgery of endometriosis [17]. All patients were symptom-free during the treatment; the serum level of E2 oscillated around a mean concentration of 50 pg/mL, and there was almost complete lack of adverse events related to hypoestrogenism. A minority experienced headache (20%) and irregular bleeding (20%).
Mechanisms of action for estrogen in cardioprotection
Barry G. Wren in Progress in the Management of the Menopause, 2020
Data from experimental studies suggest that estrogens are important regulators of cardiac tissues in females in vivo. Hypoestrogenism invariably leads to changes which may be considered non-advantageous to women. These effects can be reversed, to a degree, by estrogen replacement therapy. From a clinical point of view, two types of conclus,ons can be drawn from these studies: first, that estrogen replacement therapy reduces the occurrence and impact of risk factors of cardiac ischemia in women; second, that estrogens can protect the ischemic heart in women. Understanding the cellular and molecular mechanisms by which estrogens regulate cardiovascular functions in females is important for instituting appropriate treatment modalities to postmenopausal women.
Menopausal hormonal therapy in surgically menopausal women with underlying endometriosis
Published in Climacteric, 2022
P. Tanmahasamut, M. Rattanachaiyanont, K. Techatraisak, S. Indhavivadhana, T. Wongwananuruk, P. Chantrapanichkul
Surgically induced menopause is the menopausal state following surgical removal of both ovaries (i.e. bilateral salpingo-oophorectomy [BSO]). BSO is associated with a sudden decrease in estrogen level, and a hypoestrogenic state can significantly impair quality of life due to menopause-related symptoms that include vasomotor symptoms, sleep deprivation, mood change and dyspareunia. These symptoms are more prevalent and severe in women with surgical menopause than those who naturally transition into menopause [1]. Furthermore, hypoestrogenism is a risk factor for cardiovascular disease and osteoporosis [2,3]. The Global Consensus Statement on menopausal hormone therapy (MHT) recommends that MHT for surgically menopausal women be initiated soon after surgery and continued until at least the average age at natural menopause to prevent long-term health consequences from early menopause [4,5].
Women and COVID-19: severity and mortality in hospitalized middle-aged and older patients
Published in Climacteric, 2021
L. Balcázar-Hernández, C. Martínez-Murillo, C. Ramos-Peñafiel, K. Pellón Tellez, B. Li, L. Manuel-Apolinar, L. Basurto
Despite the gender differences reported in COVID-19 outcomes1, there is a lack of information about age-related COVID-19 outcomes in women. In this study, we showed that middle-aged and older women with COVID-19 had greater severity and higher mortality compared to younger women. Our findings indicate that age is an important determinant of severity and mortality in women, independent of comorbidities. We observed a higher frequency of hypertension in middle-aged and older women; however, it was not a risk factor for mortality in our series of hospitalized women. This finding requires replication in larger studies, due to the fact that diabetes, obesity, and hypertension are important risk factors5, and should be considered in middle-aged and older women due to their increased prevalence among this age group6. In addition, hypoestrogenism has to be evaluated as a contributing factor, since it is associated with an increase in metabolic risk factor in our population7. Estrogens and progesterone have anti-inflammatory actions on innate immunity, including the promotion of anti-inflammatory cytokine profile and suppression of pro-inflammatory cytokine production3. ACE2 expression is upregulated by estrogen and androgen8. The hormone changes associated with menopause produce a reduction of immune functions, including the viral host response, and a lower ACE2 expression. ACE2 expression has a negative correlation with COVID-19 fatality8.
Effects of progestogens used in menopause hormone therapy on the normal breast and benign breast disease in postmenopausal women
Published in Climacteric, 2021
C. Rueda Beltz, A. Rojas Figueroa, S. Hinestroza Antolinez, A. Bastidas
Menopause hormone therapy (MHT) is used for improvement of climacteric syndrome in women whose quality of life is affected by hormone deprivation1–3. The clinical picture of these patients includes abnormal uterine bleeding until menopause1, vasomotor symptoms such as hot flashes (47%) and diaphoresis (46%), mood changes or emotional lability, urogenital symptoms secondary to vulvovaginal atrophy (vaginal dryness, painful intercourse, recurrent urinary tract infection, and vaginal burning associated with dysuria [urogenital syndrome]), and genital prolapse, among others2–5. These symptoms are experienced by up to 70% of women, but they are of short duration (2–3 years) and disappear in less than 5 years2,4–7. Hypoestrogenism is also related to important changes in bone and lipid metabolism, with deleterious effects such as the onset of osteoporosis and cardiovascular disease2,4,5,8.
Related Knowledge Centers
- Estrogen
- Sleep Disorder
- Urinary Tract Infection
- Osteoporosis
- Cardiovascular Disease
- Menopause
- Hot Flash
- Bone Health
- Genitourinary System
- Primary Ovarian Insufficiency