Speciality
Spotlight

 




 


Obstetric & Gynaecology


 

 




Estrogen Replacement Therapy 

  

  • L
    Sourander, et al (Univ of Turku, Finland) 

    Cardiovascular and Cancer Morbidity and Mortality and Sudden Cardiac Death in Postmenopausal women on Oestrogen Replacement Therapy (ERT).
     

    Lancet 352: 1965-1969, 1998.

        


    Conclusions – Current ERT primarily reduces sudden cardiac death. It also predicts decreased cardiovascular mortality, although it does not reduce morbidity. ERT is associated with an increased risk of endometrial cancer but not of breast cancer.

       


    Editorial comments – The results of this large prospective study provide additional data regarding the effect of postmenopausal ERT on cardiovascular disease and breast cancer. The results of this study are similar to some other epidemiologic studies, which report no change in the risk of breast cancer with the use of ERT. However, other observational studies indicate that long-term use of estrogen does increase the risk of breast cancer by about 30%. The lack of uniformity regarding this issue among observational epidemiologic studies indicates that a casual relation between estrogen use and initiation of breast cancer is unlikely. This study also provides additional data supporting the beneficial effect of estrogen on coronary artery
    atherosclerosis.

       

  • A
    Randomised, Open, Parallel-Group Study on the Preventive Effect of an Estradiol-releasing Vaginal Ring (Estring) on Recurrent Urinary Tract Infections in Postmenopausal women.
     

    BC Eriksen (Nord-Rogland Med Ctr, Haugesund, Norway). 

    Am J Obstet Gynecol 180:1072-1079, 1999.

       


    Conclusions – Estring prolongs time to UTI recurrence and reduces the number of recurrences per year in postmenopausal women with recurrent UTI. This silicone vaginal ring also significantly relieves other postmenopausal urogenital symptoms. It is safe and tolerated well. 

       


    The local vaginal administration of estrogen to postmenopausal women promotes growth of the atrophic vaginal epithelium, as well as the cells that line the urethra and trigone of the urinary bladder. As a result of this proliferation, local estrogen is effective for not only treating symptoms of atrophic vaginitis but also urinary symptoms. In this study, a device releasing estradiol locally into the vagina significantly reduced symptoms of vaginal dryness as well as the number of urinary tract infections. In addition, about half of the women treated with local estrogen no longer had symptoms of stress or urinary incontinence, compared with 10% to 15% of women in the control group.

        

  • Herrington DM, Reboussin DM, et al (Wake Forest Univ, Winston-Salem, NC; et al)

    Effects of Estrogen Replacement on the Progression of Coronary-Artery Atherosclerosis

    N Engl J Med 343: 522-529, 2000

      

    Editor’s Comments: The results of this randomized clinical trial suggest that estrogen has no effect on the progression of coronary artery disease in older (mean age, 68 years) women with established coronary artery disease despite having a beneficial effect on the lipid profile.

      

    For women with established coronary artery disease, statins or other treatments should be used to retard the progress of the disease. However, there is good evidence in animals and human beings that estrogens will retard the development of coronary artery atherosclerosis when given to young healthy postmenopausal women without evidence of coronary artery disease.

        

  • Uhler ML, Marks JW, et al (Loyola Univ, Maywood, III; Univ of California, Los Angeles)

    Estrogen Replacement Therapy and Gallbladder Disease in Postmenopausal Women

    Menopause 7: 162-167, 2000

      

    Background: Estrogen increases cholesterol saturation in bile and alters the composition of biliary acids by increasing levels of cholate and decreasing levels of chenodeoxycholate. Estrogen may also decrease bile flow, which would presumably promote cholesterol precipitation into crystals.

       

    Results: The route of estrogen administration has different effects on hepatic and nonhepatic markers of estrogen’s actions. Hepatic first-pass metabolism after oral dosing enhances the effect of estrogen on lipid and protein synthesis. Thus, it has been hypothesized that nonoral administration of estrogen may reduce its effects on bile composition.

      

    Nonetheless, one study showed that oral or transdermal estrogen administration both cause significant increases in the biliary cholesterol saturation index and levels of arachidonic acid and prostaglandin E2 and significant decreases in nucleation time. Each of these factors would increase the likelihood of gallstone formation.

     

    Editor’s Comments: Some, but not all, observational epidemiologic studies-including the large, prospective Nurses’ Health Study-indicate that when exogenous estrogen is given to postmenopausal women, there is a significantly increased risk of the development of gallbladder disease. There is a biological basis for this effect of estrogen, and women should be counseled about this possible deleterious effect of taking
    ERT.

       

      



 

 

Speciality Spotlight

 

 

Estrogen Replacement Therapy 
  

  • L Sourander, et al (Univ of Turku, Finland) 
    Cardiovascular and Cancer Morbidity and Mortality and Sudden Cardiac Death in Postmenopausal women on Oestrogen Replacement Therapy (ERT).
     
    Lancet 352: 1965-1969, 1998.
        
    Conclusions – Current ERT primarily reduces sudden cardiac death. It also predicts decreased cardiovascular mortality, although it does not reduce morbidity. ERT is associated with an increased risk of endometrial cancer but not of breast cancer.
       
    Editorial comments – The results of this large prospective study provide additional data regarding the effect of postmenopausal ERT on cardiovascular disease and breast cancer. The results of this study are similar to some other epidemiologic studies, which report no change in the risk of breast cancer with the use of ERT. However, other observational studies indicate that long-term use of estrogen does increase the risk of breast cancer by about 30%. The lack of uniformity regarding this issue among observational epidemiologic studies indicates that a casual relation between estrogen use and initiation of breast cancer is unlikely. This study also provides additional data supporting the beneficial effect of estrogen on coronary artery atherosclerosis.
       

  • A Randomised, Open, Parallel-Group Study on the Preventive Effect of an Estradiol-releasing Vaginal Ring (Estring) on Recurrent Urinary Tract Infections in Postmenopausal women. 
    BC Eriksen (Nord-Rogland Med Ctr, Haugesund, Norway). 
    Am J Obstet Gynecol 180:1072-1079, 1999.
       
    Conclusions – Estring prolongs time to UTI recurrence and reduces the number of recurrences per year in postmenopausal women with recurrent UTI. This silicone vaginal ring also significantly relieves other postmenopausal urogenital symptoms. It is safe and tolerated well. 
       
    The local vaginal administration of estrogen to postmenopausal women promotes growth of the atrophic vaginal epithelium, as well as the cells that line the urethra and trigone of the urinary bladder. As a result of this proliferation, local estrogen is effective for not only treating symptoms of atrophic vaginitis but also urinary symptoms. In this study, a device releasing estradiol locally into the vagina significantly reduced symptoms of vaginal dryness as well as the number of urinary tract infections. In addition, about half of the women treated with local estrogen no longer had symptoms of stress or urinary incontinence, compared with 10% to 15% of women in the control group.
        

  • Herrington DM, Reboussin DM, et al (Wake Forest Univ, Winston-Salem, NC; et al)
    Effects of Estrogen Replacement on the Progression of Coronary-Artery Atherosclerosis
    N Engl J Med 343: 522-529, 2000
      
    Editor’s Comments: The results of this randomized clinical trial suggest that estrogen has no effect on the progression of coronary artery disease in older (mean age, 68 years) women with established coronary artery disease despite having a beneficial effect on the lipid profile.
      
    For women with established coronary artery disease, statins or other treatments should be used to retard the progress of the disease. However, there is good evidence in animals and human beings that estrogens will retard the development of coronary artery atherosclerosis when given to young healthy postmenopausal women without evidence of coronary artery disease.
        

  • Uhler ML, Marks JW, et al (Loyola Univ, Maywood, III; Univ of California, Los Angeles)
    Estrogen Replacement Therapy and Gallbladder Disease in Postmenopausal Women
    Menopause 7: 162-167, 2000
      
    Background: Estrogen increases cholesterol saturation in bile and alters the composition of biliary acids by increasing levels of cholate and decreasing levels of chenodeoxycholate. Estrogen may also decrease bile flow, which would presumably promote cholesterol precipitation into crystals.
       
    Results: The route of estrogen administration has different effects on hepatic and nonhepatic markers of estrogen’s actions. Hepatic first-pass metabolism after oral dosing enhances the effect of estrogen on lipid and protein synthesis. Thus, it has been hypothesized that nonoral administration of estrogen may reduce its effects on bile composition.
      
    Nonetheless, one study showed that oral or transdermal estrogen administration both cause significant increases in the biliary cholesterol saturation index and levels of arachidonic acid and prostaglandin E2 and significant decreases in nucleation time. Each of these factors would increase the likelihood of gallstone formation.
     
    Editor’s Comments: Some, but not all, observational epidemiologic studies-including the large, prospective Nurses’ Health Study-indicate that when exogenous estrogen is given to postmenopausal women, there is a significantly increased risk of the development of gallbladder disease. There is a biological basis for this effect of estrogen, and women should be counseled about this possible deleterious effect of taking ERT.
       

      

 

By |2022-07-20T16:43:07+00:00July 20, 2022|Uncategorized|Comments Off on Estrogen Replacement Therapy

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