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93 Rodriguez C, Patel AV, Calle EE, Jacob EJ, Thun MJ. Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women. JAMA 2001;285(11):1460–5. 94 Weiss NS, Lyon JL, Krishnamurthy S, Dietert SE, Liff JM, Daling JR. Noncontraceptive estrogen use and the occurrence of ovarian cancer. J Natl Cancer Inst 1982;68(1):95–8. 95 Franceschi S, La Vecchia C, Helmrich SP, Mangioni C, Tognoni G. Risk factors for epithelial ovarian cancer in Italy. Am J Epidemiol 1982;115(5):714–9. 96 Tzonou A, Day NE, Trichopoulos D, et al. The epidemiology of ovarian cancer in Greece: a case-control study. Eur J Cancer Clin Oncol 1984;20(8): 1045–52. 97 Harlow BL, Weiss, NS, Roth GJ, Chu J, Daling JR. Case-control study of borderline ovarian tumors: reproductive history and exposure to exogenous female hormones. Cancer Res 1988;48(20):5849–52. 98 Kaufman DW, Kelly JP, Welch WR, et al. Noncontraceptive estrogen use and epithelial ovarian cancer. Am J Epidemiol 1989;130(6):1142–51. 99 Booth M, Beral V, Smith P. Risk factors for ovarian cancer: a case-control study. Br J Cancer 1989;60(4):592–8. 100 Polychronopoulou A, Tzonou A, Hsieh C, et al. Reproductive variables, tobacco, ethanol, coffee and somatometry as risk factors for ovarian cancer. Int J Cancer 1993;55(3):402-7. 101 Parazzini F, La Vecchia C, Negri E, Villa A. Estrogen replacement therapy and ovarian cancer risk (letter). Int J Cancer 1994;57(10):135–6. 102 Purdie D, Green A, Bain C, et al. Reproductive and other factors and risk of epithelial ovarian cancer: an Australian case-control study. Int J Cancer 1995;62(2):678–84. 103 Risch HA, Marrett LD, Jain M, Howe GR. Differences in risk factors for epithelial ovarian cancer by histologic type. Results of a case-control study. Am J Epidemiol 1996;144(4):363–72. 104 Hempling RE, Wong C, Piver MS, Recio FO, O’Neill CP. Hormone replacement therapy as a risk factor for epithelial ovarian cancer: results of a case-control study. Obstet Gynecol 1997;89(6):1012–16. 248 105 Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Am J Epidemiol 1992;136(10):1184–203. 106 Harris R, Whittemore AS, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. III. Epithelial tumors of low malignant potential in White women. Am J Epidemiol 1992;136(10):1204–11. 107 Purdie D, Bain CJ, Siskind V, et al. Hormone replacement therapy and risk of epithelial ovarian cancer. Br J Cancer 1999;81(3):559–63. 108 Negri E, Tzonou A, Beral V, et al. Hormonal therapy for menopause and ovarian cancer in a collaborative re-analysis of European studies. Int J Cancer 1999;80(6):848–51. 109 Garg PP, Kerlikowske K, Subak L, Grady D. Hormone replacement therapy and the risk of epithelial ovarian carcinoma: A meta-analysis. Obstet Gynecol 1998;92(3):472–9. 110 McMichael AJ, Giles GG. Colorectal cancer. Cancer Surv 1994;19-20:77–98. 111 Wu AH, Paganini-Hill A, Ross RK, Henderson BE. Alcohol, physical activity and other risk factors for colorectal cancer: a prospective study. Br J Cancer 1987;55(6):687–94. 112 Chute CG, Willett WC, Colditz GA, Stampfer MJ, Rosner B, Speizer FE. A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiology 1991;2(3):201–7. 113 Grodstein F, Martinez E, Platz EA, et al. Postmenopausal hormone use and risk for colorectal cancer and adenoma. Ann Intern Med 1998;128(9):705–12. 114 Bostick RM, Potter JD, Kushi LH, et al. Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 1994;5(1):38–52. 115 Folsom AR, Mink PJ, Sellers TA, Hong CP, Zheng W, Potter JD. Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women. Am J Public Health 1995;85(8Pt1):1128–32.
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Page 1:
National Heart, Lung, and Blood Ins
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CHAIRS AND EDITORS Chair and Editor
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Anne McTiernan, M.D., Ph.D. Associa
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Lenore Manderson, Ph.D. Director an
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Michael Mendelsohn, M.D. Director,
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TABLE OF CONTENTS Preface XIII 1 Ex
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PREFACE Women’s health and menopa
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CHAPTER 1: EXECUTIVE SUMMARY Nanett
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TABLE 1-1 Evidence Categories Evide
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TABLE 1-2 (continued) Possible Bene
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symptom measures, cultural factors,
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5. PHYSIOLOGICAL ROLE OF ESTROGEN A
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The atherogenic risk profile of old
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• Hormone replacement therapy: Fi
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tion of the remaining ridge in area
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9.3.1 Interventions • In many cas
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Parkinson’s disease, no overall p
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TABLE 1-3 (continued) Sexuality •
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CHAPTER 2: THE MENOPAUSE AND AGING
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oped and are less prepared to addre
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FIGURE 2-4 Diabetes Mellitus. Estim
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Sarcopenia, defined as reduced musc
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Perimenopause WHO The term “perim
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decrease about 2 years before the F
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4.3 Menstrually Defined Menopausal
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to be under stress and to hold part
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21 Brincat MP. Hormone replacement
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62 Orentreich N, Brind JL, Rizer RL
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CHAPTER 3: SYMPTOMS AND THE MENOPAU
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women who may have reached natural
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numb-tingling feelings, headaches,
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(47 percent), problems sleeping (39
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FIGURE 3-2 Proportion of Women Both
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tomized hypogonadotropic women expe
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5.1 Exercise It has been suggested
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to consume 20-150 mg/day of isoflav
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REFERENCES 1 Stewart AL, Hays RD, W
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48 Avis NE, Crawford SL, McKinlay S
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92 Albertazzi P, Pansini F, Bonacco
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Hällström wrote that the psycholo
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countries. Perhaps, as the authors
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Beyene used a systematic ethnograph
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ange of variables, such as genetic
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REFERENCES 1 Gannon L, Ekstrom B. A
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47 George T. Women in a south India
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9. Estrogen and inhibins produced b
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HRT) display tissue-selective estro
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a partial agonist. In contrast, wit
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3. UROGENITAL TRACT ERα and ERβ a
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4. BONE: DEVELOPMENT AND HOMEOSTASI
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in response to estrogen. 106,105 In
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lation of sleep, motor behavior, an
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7. HORMONE REPLACEMENT THERAPY: TRA
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REFERENCES 1 Jensen EV, Jacobsen HI
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40 Power RF, Mani SK, Codina J, Con
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83 Oursler MJ, Pederson L, Fitzpatr
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125 Gabrielsson BG, Carmignac DF, F
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169 Renier MA, Vereecken A, Buytaer
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FIGURE 6-1 Structural features of E
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ound, the conformation of the recep
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with extremely potent estrogenic ac
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Its potency as an antiestrogen was
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The observation that the degree of
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findings were remarkable because a
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Recently, the use of phage display
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20 Crawley G. Non steroidal estroge
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65 Qu Q, Zheng H, Dahllund J, et al
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in their survey of postmenopausal w
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where over half the world’s popul
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The Danish study of Koster and Gard
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Many studies of sexual interest in
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7. ASSESSING SEXUAL ACTIVITY Clinic
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None of these studies evaluated the
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estrogen-androgen group during the
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REFERENCES 1 Sarrel PM, Whitehead M
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52 Utian WH. The true clinical feat
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140
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outes of administration and differe
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FIGURE 8-2 Change in Age-Adjusted D
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fied as overweight or obese. 32 The
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TABLE 8-1 148 Guide to Risk Reducti
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TABLE 8-1 (continued) 150 Recommend
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TABLE 8-1 (continued) 152 Recommend
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Interesting differences in atherosc
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similar effects in both patients wi
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a lowering of triglycerides, 140 an
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may account for a substantial propo
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associated with an independent prot
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eases preoperatively. Quality of li
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excess risk of 6-18 per 10,000 per
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REFERENCES 1 NHLBI Morbidity and Mo
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36 Samaras K, Hayward CS, Sullivan
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79 Collins P, Rosano GM, Jiang C, L
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121 Mäkelä S, Savolainen H, Aavik
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162 Clarke S, Kelleher H, Lloyd-Jon
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201 Rahimtoola SH, Bennett AJ, Grun
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243 Varas-Lorenzo C, Garcia-Rodriqu
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7. A connection between menopausal
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3. PATHOGENESIS OF FRACTURE Fractur
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Diagnosis of osteoporosis according
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density and has a favorable effect
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How should this information be inco
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emergence of proved treatment alter
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Data on the relation between skelet
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REFERENCES 1 Osteoporosis Preventio
Page 214 and 215: 42 Gluer CC. Quantitative ultrasoun
Page 216 and 217: 85 Ettinger B, Pressman A, Silver P
Page 218 and 219: 130 Jeffcoat MK, Lewis CE, Reddy M,
Page 220 and 221: 1. INTRODUCTION Perimenopausal wome
Page 222 and 223: for breast cancer are at increased
Page 224 and 225: findings on biopsy in women with an
Page 226 and 227: thra. Patients typically describe l
Page 228 and 229: Biofeedback: Used in conjunction wi
Page 230 and 231: There has been one systematic revie
Page 232 and 233: ence in pelvic organ prolapse. The
Page 234 and 235: 21 Ferenczy A. Endometrial carcinom
Page 236 and 237: 65 Wyman JF, Fantl JA, McClish DK,
Page 238 and 239: 222
Page 240 and 241: 1. INTRODUCTION Worldwide, breast c
Page 242 and 243: difficult to compare because of com
Page 244 and 245: Although HRT has been related to an
Page 246 and 247: cyclic use and 2.9 (95 percent CI 2
Page 248 and 249: TABLE 11-3 Selected Studies on Horm
Page 250 and 251: TABLE 11-3 (continued) Thus, a stro
Page 252 and 253: TABLE 11-4 236 Cohort Studies on Ho
Page 254 and 255: TABLE 11-5 238 Case-Control Studies
Page 256 and 257: TABLE 11-5 (continued) 240 Adjustme
Page 258 and 259: When the same women in NSABP were r
Page 260 and 261: REFERENCES 1 Pisani P, Parkin DM, B
Page 262 and 263: 47 Day NE. Epidemiology: the role o
Page 266 and 267: 139 Parazzini F, La Vecchia C, Negr
Page 268 and 269: 1. INTRODUCTION Menopause is associ
Page 270 and 271: inverse relation with nonverbal mem
Page 272 and 273: ease decreased significantly with i
Page 274 and 275: of households selected to be repres
Page 276 and 277: standard antipsychotic drugs increa
Page 278 and 279: 5. FUTURE NEEDS • Explore the pos
Page 280 and 281: 19 Berman KF, Schmidt PJ, Rubinow D
Page 282 and 283: 64 Lerner A, Koss E, Debanne S, Row
Page 284 and 285: 114 Smith R, Studd JW. A pilot stud
Page 286 and 287: 162 Klein BE. Lens opacities in wom
Page 288 and 289: patients with strong personal convi
Page 290 and 291: Therefore, convincing evidence of t
Page 292 and 293: 3.1.1 Risk Factors Many factors are
Page 294 and 295: 278 lower dosages of estrogen will
Page 296 and 297: • Diabetes: Women with diabetes b
Page 298 and 299: Lipids and lipoproteins • LDL cho
Page 300 and 301: 284 persists but is less steep in w
Page 302 and 303: 5.2.3 Pharmacotherapy Breast Cancer
Page 304 and 305: • There is no clinical trial evid
Page 306 and 307: Sirtori CR, Pazzucconi F, Colombo L
Page 308 and 309: Hansson L, Zanchetti A, Carruthers
Page 310 and 311: Dementia and Mental Health Forette
Page 312 and 313: CRP C-reactive protein CT computed
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PTCA percutaneous transluminal coro
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U.S. DEPARTMENT OF HEALTH AND HUMAN
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