‘Understanding HRT and the menopause’

To Treat or Not to Treat: The Use of Hormone Replacement Therapy in Patients With Ovarian Cancer.

Objective: The use of hormone replacement therapy (HRT) started later in China than in European countries. The purpose of the present study was to investigate HRT patterns and reasons for the initiation and discontinuation of HRT among women in South China.Methods: A telephone survey about menopausal status, the use of HRT, reasons for HRT discontinuation and duration of HRT treatment was conducted in 2014.Results: A total of 825 telephone surveys were carried out, and 217 previous HRT users and 390 current users were recruited for this study. Among these 607 subjects, 50.7% of the women sought out HRT for hot flushes, 41.6% for fatigue and 41.5% for sleeplessness. Approximately one-third (35.9%) of the patients abandoned HRT during the following year. The reasons for stopping HRT were mainly fear of breast and uterine cancer (28.4%), reduced menopausal symptoms (22.9%) and the inconvenience of taking pills or seeing a doctor (17.9%). The factors related to HRT discontinuation were the age when HRT was initiated (odds ratio 1.59, 95% confidence interval 1.19–2.13) and education level (odds ratio 0.78, 95% confidence interval 0.62–0.98).Conclusions: The duration of HRT use in women in south China was short, and a high proportion of the women discontinued HRT. Given the high discontinuation rate and the low medical compliance, Chinese health-care providers still have much to do to let women know about the advantages and disadvantages of HRT and to encourage the use of HRT appropriately.

Knowledge, attitudes and management strategies in Scandinavia concerning hormone replacement therapy: A comparison between gynecologists in Denmark, Norway and Sweden

Hormonal replacement therapy (HRT) has been shown in the past to influence well being as well as several somatic features in menopausal women. The aim of this analysis was to study the effect of HRT on various biophysical properties of the skin of menopausal women. Two sub-samples were built to test the effect (1) of 'short-term' HRT in recently menopausal women (n=15), and (2) the effect of 'medium- and long-term' HRT in menopausal women (n=78). The analysis was performed on data from a study of 106 menopausal Caucasian women with apparent healthy skin. Self-report data on the menopausal status, the duration of the menopause, whether or not HRT has been taken and the duration of the HRT were collected. A series of biophysical measurements on the cheek, the forehead and the inner forearm were performed under controlled environmental conditions. Twenty women were menopausal for less than 5 years (eight with HRT for at least 1 year and seven who had never taken HRT) and 86 women for at least 5 years (35 with HRT for at least 5 years and 43 who had never taken HRT). Analyses of covariance with adjustment for age were performed. With regard to skin colour, the measurements in women treated for at least 1 year were significantly higher for red intensity (a*) and lower for brightness (L*) on the forearm as compared with the non-treated women. Furthermore, yellow intensity (b*) mean values were higher on the forehead and the forearm in women treated for at least 5 years compared with the non-treated women. Concerning sebum casual level, the mean values were significantly higher on the forehead and the cheek in women treated for at least 5 years. Regarding skin surface parameters reflecting hydration, the mean values for capacitance on the forehead and the cheek were significantly higher in women treated for at least 5 years. Finally, as regards with skin relief, parameters mean values for amplitude and roughness on the forehead were significantly higher in women treated for at least 5 years. The skin colour parameters showed a higher red intensity value in menopausal women who had been treated for at least 1 year. In menopausal women who had been treated for at least 5 years, the biophysical measurements were significantly higher for the parameters reflecting hydration and sebum secretion, which generally decrease after the menopause. These features were associated with higher values for the yellow intensity parameter and the skin relief parameters on the forehead. Our results support the subjective impression and the clinical evaluation concerning the impact of HRT on the development and the evolution of some skin properties after menopause.

0757 Evidence suggests that hormone replacement therapy (HRT) in combination with resistance training may promote greater increases in bone mass (BMD) and strength than either resistance training or HRT alone. PURPOSE: To investigate the interactive effects of HRT and a 1-yr site-specific resistance-training program (two free weight exercises squat and deadlift) two days per week a strategy to increase strength and reverse or attenuate accelerated bone loss at the spine in early postmenopausal women. METHODS: Participants from a group of self selected HRT or no-HRT (n = 148) early postmenopausal women were randomly assigned to either 1) no HRT plus resistance training (n = 28); 2) HRT plus resistance training (n = 33); 3) HRT no resistance training (n = 32); or 4) control (no HRT no resistance training group (n = 29). Mean age and months post menopause did not differ between groups (52.1 + 3.0 yr and 25.8 + 9.9 months, respectively). Body composition and bone mineral density (BMD) of the spine were assessed by Dual Energy X-Ray Absorptiometry (Hologic), and upper and lower body peak force by isokinetic dynamometry (KinCom 500H, Chattex Corp.), at baseline and month 12. Data were analyzed using a 4 (group: no HRT plus exercise, HRT plus resistance training, HRT no resistance training, no HRT no resistance training) × 2 (time: baseline and month 12) repeated measures multivariate analysis of variance. Multivariate analysis revealed main effects for group (P <. 007), time, (P <. 001), and the group by time interaction (P <. 001) (Table 1). RESULTS: One year of resistance training produced changes in spine BMD of + 0.43% and + 0.56%, lower body strength of + 35.4% and + 25.4%, upper body strength of + 37.3% and + 41.1% and lean mass of +3.9% and + 4.2% for the no HRT plus resistance training and HRT plus resistance training groups, respectively. In contrast, women in the HRT no resistance training and no HRT no resistance training experienced declines in spine BMD of −1.4% and −3.6%, lower body strength of – 2.2% and −7.1%; respectively, and increases in upper body strength of + 11.8% and + 7.8%, and lean mass of + 2.6% and +1.2% respectively. CONCLUSION: Regardless of HRT status, free weight squats and deadlifts performed two days per week reversed bone loss at the spine. Moreover, resistance training was more effective than hormone replacement therapy in preventing bone loss at the spine and increasing lower and upper body strength and lean mass in Vol. 36 No. 5 Supplement this group of early postmenopausal women. Funded by: American Federation for Aging Research and Erkkila Foundation

In 1993, individuals with a hereditary predisposition to venous thromboembolism whose plasmas exhibited a poor response to activated protein C (APC) in an activated partial thromboplastin time assay were identified.1 The molecular basis for this laboratory phenotype of resistance to APC was a guanine to adenine mutation at nucleotide 1691 in the factor V gene.2 This results in the replacement of arginine (R) at position 506 by glutamine in the resulting protein, a defect which has been termed factor V Leiden. R506 is the first of three sites at which APC normally cleaves and inactivates procoagulant factor Va. The Q506 substitution causes factor Va to be inactivated approximately l0-fold more slowly than normal, thereby making the cofactor relatively resistant to the anticoagulant action of APC.3 This allows for increased factor Va availability within the prothrombinase complex, thereby enhancing thrombin generation and the development of a hypercoagulable state. See page 1012 Factor V Leiden is the most common inherited risk factor for venous thromboembolism, increasing the risk of venous thrombosis by 4- to 10-fold in heterozygotes and 50- to 100-fold in homozygotes.4,5⇓ Heterozygosity can be identified in 12% to 20% of unselected white patients presenting with venous thrombosis and 40% to 50% of patients with a strong positive family history. Approximately 3% to 7% of normal white patients are heterozygous carriers of factor V Leiden, but the mutation is rare in …

Menopause is an important stage in the life of every woman. Hot flashes are the most common climacteric symptom and a major cause of suffering in postmenopausal women. Licorice is one of the plants that is used to relieve menopausal symptoms. The present study was undertaken to evaluate the effects of licorice on hot flash symptoms in menopausal women. The participants of this randomized, double blind, clinical trial study were 60 menopausal women randomly allocated to licorice or hormone replacement therapy (HRT) groups. The participants in this trial received licorice (1140 mg/day) or HRT (a conjugated estrogen 0.312 mg/day and Medroxyprogesterone 2.5 mg/day) for 90 days. In this study we observed that licorice is not very different from hormones in terms of reducing the number and duration of hot flashes, but that HRT can reduce the severity of hot flashes significantly better than licorice can. In addition, there was no significant difference between age, education level, marital status, occupation, income, number of pregnancies, time from cessation of menstruation, and severity of hot flashes in the two groups. We observed that licorice seems more effective than HRT in improving hot flash duration, but that HRT can reduce the duration and severity of hot flashes more than licorice.

Hormone replacement therapy (HRT) used to treat hot flashes has side effects, such as an increased risk of coronary heart disease and breast cancer. There are ongoing controversies regarding the risk of ovarian cancer associated with HRT. HRT is best avoided in conditions such as liver or gallbladder disease and gastrointestinal disorders. Evening primrose oil (EPO) has been used as an alternative treatment for hot flashes. We conducted a systematic review of randomized controlled trials and controlled clinical trials, following the PRISMA guidelines, to compare EPO with placebo or other interventions in alleviating hot flashes in menopausal women. We analyzed the data using Review Manager version 5.3, in conjunction with the Cochrane Collaboration tool. The severity of hot flashes was lower when EPO was administered for less than 6 months compared to placebo. However, there was no significant difference in the frequency and duration of hot flashes between EPO and placebo. Participants who received EPO complained of mild nausea and headache. EPO did not show any significant difference in the severity of hot flashes compared to black cohosh at 4 weeks; but the hot flashes were more severe at 8 weeks in the EPO group compared to black cohosh. The current evidence is insufficient to draw firm conclusions regarding the benefits of EPO in alleviating hot flashes. We hope that more research is conducted to provide sufficient evidence for menopausal women considering the use of EPO.

The discordance in coronary heart disease (CHD) outcome between randomized, controlled trials and observational studies of hormone replacement therapy (HRT) is likely the result of the dissimilar cohorts studied. This observation led to the formation of the timing hypothesis that benefits and risks of HRT depend upon age of HRT initiation and/or time of HRT initiation in relation to menopause. This hypothesis has been supported with data from large, randomized, controlled trials that have studied HRT and selective estrogen receptor modulators (SERMs) in the prevention of CHD. Initiation of HRT in women <60 years of age and/or within 10 years of menopause reduces both CHD and total mortality; SERMs have been shown to reduce CHD in women <60 years. What has become clear from the cumulated literature is that in young postmenopausal women who initiate HRT in close proximity to menopause, the adverse effects of HRT are rare and no greater than those of other commonly used pharmacological agents and that the primary prevention benefits for CHD are at least equivalent to those of other commonly used therapies. Additionally, the literature indicates that the duration of HRT confers greater CHD benefit especially in women <60 years who initiate therapy. The cumulated literature dispels misperceptions concerning HRT and CHD.

This review summarises current evidence for therapeutic options for hyperlipidaemia in post menopausal women. The two situations in which treatment is recommended are: 1. Primary prevention, which requires assessment of total risk factors for coronary heart disease. a) Statins. AFCAPS/TEXCAPS is the only randomised controlled trial (RCT) to include women. Fewer coronary heart disease (CHD) events, but no difference in mortality was found. b) Hormone replacement therapy (HRT). While there are numerous reports of positive observational epidemiological studies for HRT, there are no completed RCTs. There is little evidence for statin use in women except for familial hypercholesterolaemia. HRT is therefore not only appropriate for its multiple effects on lipoproteins, vascular function and insulin sensitivity but also for prevention of osteoporosis. 2. Secondary prevention, to achieve target total and low density lipoprotein (LDL) cholesterol. a) Statins. The major measurable effect of these drugs is to reduce total and LDL cholesterol. In the RCTs 4S, CARE and LIPID, where 20% of subjects were female, CHD events, but neither CHD mortality nor total mortality were significantly reduced in women. b) HRT. Data available from two RCTs using conjugated equine oestrogens and medroxyprogesterone acetate show no benefit. Other studies of HRT have been observational and positive. The effects of treatment on lipoproteins with statins, HRT and the combination have been investigated. In secondary prevention for hyperlipidaemic women to achieve cholesterol &lt;5 and LDL&lt;3 mmol/L statins will be first choice, with HRT a possible addition for its other benefits on cardiovascular risk factors. Choice of HRT medication. The route of administration will affect specific risk factors, eg, oral oestrogen reduces Lp(a) and LDL, increases HDL, while the transdermal route is less effective at reducing Lp(a) and LDL but does not increase triglyceride. Both routes reduce fibrinogen, factor VII and adhesion molecules and improve blood flow. The choice of progestogen will also affect cardiovascular risk factors. The most important lipid risk factors in women are HDL, triglyceride and Lp(a). The risk associated with raised triglyceride and LDL is offset by high HDL. Thus, in women with risk factors in primary prevention, theoretically oral HRT with a non-androgenic progestogen is likely to be of most benefit. However, since long-term adherence to therapy is important in reducing cardiovascular risk, the individual's choice of route and type of HRT is paramount.

HRT and the primary prevention of cardiovascular disease

Effect of hormone replacement therapy on bone and lipid metabolism in women oophorectomized for the treatment of gynecologic malignancies

Long-term effects of treatment on quality of life in schizophrenia patients: A comparison between WHOQoL and EuroQoL (EQ-5D)

Many trials on the use of hormone replacement therapy (HRT) have provided contradictory results on its risks and benefits in post-menopausal women. The use of HRT declined globally following publication of the first data from the Women’s Health Initiative (WHI) trial in 2002, with the revelation that there was an increased risk of breast cancer and coronary heart disease (CHD) in postmenopausal women taking HRT. Following this, other leading studies published results that were consistent with these findings, which reduced enthusiasm for HRT use. However, recent publications from the International Menopause Society indicate that HRT is the first-line and most effective treatment for menopausal symptoms. Moreover, when the full results of the WHI trial were subsequently published, it appeared that HRT may confer benefits for CHD prevention below age 60. The statements from the British Menopause Society and the International Menopause Society (IMS) published in 2008 also supported this opinion. These revelations renew interest in HRT use. This paper analyzes the effects of combination versus unopposed HRT on osteoporosis, breast and CHD, endometrial cancer induction, venous thromboembolic disease, lipids and lipoproteins, neuroprotection, and cognitive function in post-menopausal women.

Introduction Menopause is marked by the cessation of menstruation caused by declining ovarian function, diagnosed after twelve months of amenorrhoea. Symptoms can include hot flushes and fatigue. 80% of women will experience one or more symptoms, likely over many years, significantly impacting their lives [1]. Hormone replacement therapy (HRT) is the main treatment for menopause. Despite increasing awareness of HRT, women still face problems when seeking treatment. To provide better care, understanding women’s experiences of using HRT to treat their symptoms is important. Aim To explore the lived experiences of women using HRT for the management of their menopause symptoms. Methodology Ethical approval was received from the University of Reading’s School of Food and Pharmacy Research Ethics Committee (Study number 27/2024). The study involved using photo elicitation in interviews. Participants were recruited by sending emails containing study information to local businesses in one region in England. Women using HRT aged between 45 to 70 years were eligible to take part. Participants were loaned digital cameras and asked to take photos of anything that reminded them of their experiences of using HRT. These photos were used as visual cues in one-to-one interviews held in October to November 2024. Reflexive thematic analysis was used to analyse the data [2]. Results Ten women using HRT were interviewed and all participants took photos. All were of similar ethnic background. Four themes were developed from the analysis: 1) Life before HRT, 2) Navigating the pathway to HRT, 3) HRT is a magic bullet; or is it? and 4) Believing in HRT. Participant’s symptoms and responses to treatment varied. All viewed HRT as an essential part of managing their menopause, even when its benefits were unclear. Women's experiences with healthcare professionals (HCPs) influenced their HRT journey, with some feeling empowered by supportive interactions while others felt dismissed. There was a fundamental belief in HRT being something women should take, even if benefits were unclear. Discussion This study provided unique insights into women’s experiences using HRT for menopause aided by photo elicitation. Comparison to literature supported this study’s findings with regards to menopause having a profound impact on women’s lives. The findings have important implications for HCPs and women using HRT; they can use these findings to shape conversations they have around HRT, improving prescribing confidence and shared decision making, ultimately improving health outcomes for menopausal women. A study limitation was all participants having similar demographics therefore their experiences might not reflect those using HRT in other areas. Future research could focus on recruiting more diverse populations, to determine whether this study’s findings are consistent across different participant demographics. This is because studies show that women from different ethnic and lower socio-economic backgrounds are less likely to be using HRT compared to Caucasian and more affluent women [3]. Additionally, theoretical frameworks could help explain specific behaviours linked to HRT use, such as why some women persist with HRT despite limited apparent benefits. Such insights could inform the development of improved support systems for women making decisions about menopause management and HRT treatment.