Safety and efficacy of hormonal therapy in menopausal kidney-allograft recipients.
ABSTRACT A higher risk of premature menopause and osteoporosis has been observed in female kidney-allograft recipients, providing particular indications for hormonal therapy. We have summarized our 10-year-experience with hormonal therapy in menopausal kidney transplant recipients.
From 1995 to 2004, hormonal therapy was administered to 54 kidney transplant recipients. At onset of therapy the ages of the women ranged from 31 to 52 years, and the period from transplantation from 3 months to 13 years. The mean time on therapy was 4.2 years. All patients received transdermal estradiol (E(2)) in combination with oral progestin.
Total regression of climacteric symptoms was reported in 75% of patients. After 3 months of the therapy follicle stimulating hormone (FSH) and E(2) levels normalized: FSH from 129 +/- 30.1 IU/L to 38.3 +/- 26.1 IU/L and E(2) from 18.5 +/- 5.8 pg/mL to 98.6 +/- 33.2 pg/mL. No significant change was noted in serum creatinine. Eleven patients developed abnormal uterine bleeding but none had premalignant or malignant lesions of the uterus on endometrial curettage. No incidence of breast cancer was noted during mean treatment period of 5.2 years. Seventeen patients discontinued therapy for medical indications: one for profound thrombophlebitis and 16 for significant deterioration of liver function. Twelve women made their own decision to discontinue therapy.
Hormonal replacement therapy was effective with no negative impact either on graft function or sex organs among kidney transplant recipients. Liver parameter monitoring seemed to be essential for safe continuation of treatment.
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ABSTRACT: Background Current use of oral contraceptives (OCs) is a well-recognised risk factor for venous thrombosis and consequent pulmonary embolism (PE). Little is known about residual effects of past OC use. Furthermore, few epidemiological studies have assessed the relation between postmenopausal use of hormones and thrombotic disease. Methods In this prospective study information was obtained through questionnaires sent every 2 years (1976–92) to 112 593 women aged 30–55 in 1976. We excluded women with previously diagnosed cardiovascular disease or cancer in 1976 and at the beginning of each subsequent 2-year follow-up period. Findings From self-reports and medical records, we documented 123 cases of primary PE (no identified antecedent cancer, trauma, surgery, or immobilisation). Current users of postmenopausal hormones had an increased risk of primary PE (relative risk adjusted for multiple risk factors 2·1 [95% CI 1·2–3·8]). However, past use showed no relation to PE (1·3 [0·7–2·4]). In current users of OCs the risk of primary PE was about twice that in non-users (2·2 [0·8–5·9]), but this finding was based on only five cases who were current OC users. Users of OCs in the past had no increase in risk of PE (0·8 [0·5–1·2]). These relations were consistent irrespective of cigarette-smoking status. Interpretation Primary PE was uncommon in this cohort. The risk was increased by current though not past use of postmenopausal hormones or OCs.Obstetrical and Gynecological Survey 04/1997; 52(5):295-296. · 2.51 Impact Factor
- Clinical Obstetrics and Gynecology 07/2004; 47(2):485-8. · 1.84 Impact Factor