Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures - The Women's Health Initiative randomized trial
ABSTRACT The effects of continuous combined hormone therapy on gynecologic cancers have not been investigated previously in a randomized trial setting.
To determine the possible associations of estrogen plus progestin on gynecologic cancers and related diagnostic procedures.
Randomized, double-blind, placebo-controlled trial of 16 608 postmenopausal women, who had not had a hysterectomy at baseline and who had been recruited from 40 US clinical centers between September 1993 and October 1998 (average follow-up, 5.6 years).
One tablet per day containing 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate (n = 8506) or placebo (n = 8102).
Incident invasive cancer of the ovary and endometrium.
In 5.6 years of follow-up, there were 32 cases of invasive ovarian cancer, 58 cases of endometrial cancer, 1 case of nonendometrial uterine cancer, 13 cases of cervical cancer, and 7 cases of other gynecologic cancers. The hazard ratio (HR) for invasive ovarian cancer in women assigned to estrogen plus progestin compared with placebo was 1.58 (95% confidence interval [CI], 0.77-3.24). The HR for endometrial cancer was 0.81 (95% CI, 0.48-1.36). No appreciable differences were found in the distributions of tumor histology, stage, or grade for either cancer site. The incidence of other gynecologic cancers was low and did not differ by randomization assignment. More women taking estrogen plus progestin required endometrial biopsies (33% vs 6%; P<.001).
This randomized trial suggests that continuous combined estrogen plus progestin therapy may increase the risk of ovarian cancer while producing endometrial cancer rates similar to placebo. The increased burden of endometrial biopsies required to assess vaginal bleeding further limits the acceptability of this regimen. These data provide additional support for caution in the use of continuous combined hormones.
- SourceAvailable from: Neveen Shereef[Show abstract] [Hide abstract]
ABSTRACT: Background: Postmenopausal period is associated with a high incidence of symptoms in the lower urinary tract. Aim: to investigate the beneficial effect of defatted flaxseed (FS), as a natural alternative to hormonal therapy, on the deterioration of urinary bladder in experimentally menopaused albino rats in view of the health risks associated with hormones. Methods: Thirty 3-month old non pregnant female albino rats were randomized into five equal groups: Group I (Sham-operated), Group II (Sham-operated with FS), Group III (ovariectomized), Group IV (ovariectomized + estrogen) and Group V (ovariectomized + FS). The experimental period lasted for 12 weeks. Animals' bladders were processed for light and scanning electron microscopic examination. In addition, quantitative assessments of collagen fiber content as well as estrogen receptor α (ER-α), estrogen receptor ß (ER-ß) and desmin immunoexpression were performed. Results: Our results revealed a significant protective effect of defatted flaxseed on the urinary bladder of ovariectomized rats. These beneficial effects of flaxseed were mainly due to its estrogenic action, upregulating ER-ß expression. Conclusion: Defatted flaxseed has promising effects on improvement of altered structure of the urinary bladder in ovariectomized rats. This may provide a potential therapeutic approach for lower urinary symptoms among menopaused women. © 2014 AENSI Publisher All rights reserved. To Cite This Article: Abeer E. El-Mehi and Neveen M. El-Sherif., Protective effect of defatted flaxseed on urinary bladder of ovariectomized albino rats. Aust. J. Basic & Appl. Sci., 8(18): 686-698, 2014
- [Show abstract] [Hide abstract]
ABSTRACT: Endometrial cancer is clearly a hormonally-responsive tumor, with a critical role played by estrogens unopposed by progestins. Numerous epidemiologic studies have shown substantial risk increases associated with use of unopposed estrogens, especially among thin women. This risk, however, can be reduced if progestins are added to the therapy. The manner in which progestins are prescribed is a critical determinant of risk. Most studies show that women who have ever used progestins continuously (>25 days/months) are at somewhat reduced risk relative to non-users (meta-analysis relative risk, RR, based on observational studies=0.78, 95 confidence intervals, CI, 0.72-0.86). The reduced risk in greatest among heavy women. In contrast, women who have ever used progestins sequentially for <10 days each month are at increased risk, with meta-analysis results showing on overall RR of 1.76 (1.51-2.05); in contrast, progestins given for 10-24 days/month appear unrelated to risk (RR=1.07, 0.92-1.24). These risks were based on varying patterns of usage, with little information available regarding how endometrial cancer risk is affected by duration of use, type and/or dose of estrogen or progestin, or mode of administration. Effects may also vary by clinical characteristics (e.g., differences for type I vs. II tumors). Further resolution of many of these relationships may be dependent on pooling data from multiple studies to derive sufficient power for subgroups of users. With changing clinical practices, it will be important for future studies to monitor a wide range of exposures and to account for divergent effects of different usage patterns.The Journal of steroid biochemistry and molecular biology 05/2013; 142. DOI:10.1016/j.jsbmb.2013.05.001 · 4.05 Impact Factor
- Osteoporosis, 02/2012; , ISBN: 978-953-51-0026-3