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

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• There is no clinical trial evidence that estrogen improves symptoms or delays symptomatic progression in women with Alzheimer’s disease. • There are no published long-term clinical trial data on potential effects of HRT on ageassociated cognitive decline. • One clinical trial found that vitamin E slows progression without improving cognition in patients with moderate dementia due to Alzheimer’s Disease. • One clinical trial of antihypertensive medication in cognitively intact older adults with hypertension showed a small but significant difference in the rate of memory loss and the incidence of dementia in those on active treatment. • One clinical trial found raloxifene was associated with less cognitive decline in two cognitive function tests in older women. 6.2.4 Complementary and Alternative Therapies • There is limited trial evidence that gingko biloba may offer mild cognitive benefit when given to patients with dementia. 288 7. CONCLUSIONS In the last 20 years, menopause has become a household word, with much better understanding of its consequences. The growing numbers of postmenopausal women and clinical trials have coincided to draw increasing attention to the perimenopausal and postmenopausal years. Better studies of older therapies and the expanded number of new choices today, with more in development and evaluation, have complicated provider and patient choices, but greatly improved the potential for effective intervention.
SUGGESTED READING (SYSTEMATIC REVIEWS <strong>AND</strong> RECENT CLINICAL TRIALS ONLY) Menopause Transition Albertazzi P, Pansini F, Bonaccorsi G, Zanotti L, Forini E, De Aloysio D. The effect of dietary soy supplementation on hot flushes. Obstet Gynecol 1998;1:6–11. Anderson RU, Mobley D, Blank B, Saltzstein D, Susset J, Brown JS. Once daily controlled versus immediate release oxybutynin chloride for urge urinary incontinence. OROS Oxybutynin Study Group. J Urol 1999;161:1809–12. Brzezinski A, Adlercreutz H, Shaoul R. et al. Short-term effects of phytoestrogen-rich diet on postmenopausal women. Menopause 1997;4:89–94. Burgio KL, Locher JL, Goode PS, et al. Behavioral vs. drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA 1998;280:1995–2000. Chenoy R, Hussain S, Tayob Y, O’Brien PM, Moss MY, Morse PF. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. Br Med J 1994;308:501–503. Coope J, Williams S, Patterson JS. A study of the effectiveness of propranolol in menopausal hot flushes. Br J Obstet Gynaecol 1978;85:472–5. Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol 1999;180:1072–79. Grady D, Brown JS, Vittinghoff E, Applegate W, Varner E, Snyder T. Postmenopausal hormones and incontinence: The <strong>Heart</strong> and Estrogen/Progestin Replacement Study. Obstet Gynecol 2001;97:116–20. Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol 1998;92:982–8. Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68:981–986. Lopes P, Merkus HM, Nauman J, Bruschi F, Foidart JM, Calaf J. Randomized comparison of intranasal and transdermal estradiol. Obstet Gynecol 2000;96:906–12. Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 2000;356:2059–63. Loprinzi CL, Michalak JC, Quella SK, et al. Megestrol acetate for the prevention of hot flashes. N Engl J Med 1994;331:347–52. Pandya KJ, Raubertas RF, Flynn PJ, et al. Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program study. Ann Intern Med 2000;132:788–93. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993;329:753–756. Rebar RW, Trabal J, Mortola J. Low-dose esterified estrogens (0.3 mg/day): long-term and short-term effects on menopausal symptoms and quality of life in postmenopausal women. Climacteric 2000;3:176–82. Rymer J, Morris EP. Extracts from “Clinical Evidence”: Menopausal symptoms. BMJ 2000;321:1516–9. Saletu B, Brandstatter N, Metka M, et al. Double-blind, placebo-controlled, hormonal, syndromal and EEG mapping studies with transdermal oestradiol therapy in menopausal depression. Psychopharmacology 1995;122:321–9. 289
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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
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42 Gluer CC. Quantitative ultrasoun
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85 Ettinger B, Pressman A, Silver P
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130 Jeffcoat MK, Lewis CE, Reddy M,
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1. INTRODUCTION Perimenopausal wome
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for breast cancer are at increased
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findings on biopsy in women with an
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thra. Patients typically describe l
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Biofeedback: Used in conjunction wi
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There has been one systematic revie
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ence in pelvic organ prolapse. The
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21 Ferenczy A. Endometrial carcinom
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65 Wyman JF, Fantl JA, McClish DK,
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222
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1. INTRODUCTION Worldwide, breast c
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difficult to compare because of com
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Although HRT has been related to an
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cyclic use and 2.9 (95 percent CI 2
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TABLE 11-3 Selected Studies on Horm
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TABLE 11-3 (continued) Thus, a stro
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TABLE 11-4 236 Cohort Studies on Ho
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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 264 and 265: 93 Rodriguez C, Patel AV, Calle EE,
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 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
Page 314 and 315: PTCA percutaneous transluminal coro
Page 316: U.S. DEPARTMENT OF HEALTH AND HUMAN
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