WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

12.2 Miscellaneous Conditions
Pulmonary lymphangioleiomyomatosis is a disease
confined to women in their reproductive, years and
there are some reports that hormonal factors play a
role in the development of the disease before and
after the menopause and that hormonal treatment
may be beneficial in older women. 251 There is one
report which suggests that estrogen medication
without progesterone in postmenopausal heterozygous
women with cystic fibrosis can cause falsenegative
tests. This report suggested a balance
between progesterone and estrogen for cystic
fibrosis lectin activity. 252 Obstructive sleep apnea
syndrome has been associated with massive obesity
in the appearance of this syndrome in women. 253
13. CONCLUSIONS
CVD remains the commonest single cause of
female mortality and morbidity in the Western
World. Despite the apparent protection offered by
endogenous sex hormones in their premenopausal
years, the greater longevity of women exposes
them to a similar lifetime risk of coronary and
other vascular disease compared to men. Women
tend to develop disease at a later age than men, and
are more likely to have complicating co-morbidities
such as hypertension and diabetes mellitus, which
contribute to poorer short term outcomes following
coronary events or revascularization. The atherogenic
risk profile of older women is appreciably
more adverse than that of younger women, though
it is uncertain whether age or hormones are the
primary determinant of the evolution of the adverse
risk profile. HRT has been shown to consistently
and markedly improve the lipid risk profile,
though a benefit on cardiovascular outcomes, such
as MI or cardiac mortality, has not yet been
demonstrated. A lack of benefit may be due
to countervailing adverse changes in coagulation
or inflammatory mechanisms. In view of gender
differences in atherosclerotic plaque and the vascular
remodeling effects of estrogen and progesterone,
HRT may still prove to have an important
role in the management of CVD in women.
Except for asthma, there appears to be little impact
of menopause or HRT on the pulmonary system
although further research is warranted.
14. FUTURE NEEDS
• RCTs are urgently required to investigate the
potential benefits and risks of different hormone
preparations (different estrogens, progestins,
combinations, and routes of administration) in
women with and without prior CHD. Low-dose
oral estrogens, nonoral preparations, SERMs
and androgens have to be
investigated in trials with
CVD remains the
clinical outcomes.
• Future clinical trials of prevention
treatments and treatments
of existing disease should
include sufficient women to
allow for an adequate assessment
of the effects in women
and men.
commonest single
cause of female
mortality and
morbidity in the
Western World.
• Except for asthma, very few data exist on the
effect of the menopause or HRT on the respiratory
system, and investigation of the effects on
important disease entities should be considered.
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