North American Menopause Society. Estrogen and progesterone use in postmenopausal women: 2010 position statement of the North American Menopause Society

Menopause (Impact Factor: 3.36). 01/2010; Vol 17(2):242-255. DOI: 10.1097/gme.0b013e3181d0f6b9
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    ABSTRACT: Hormone therapy (HT) is used for controlling menopausal symptoms. It has also been used for the management and prevention of chronic diseases such as cardiovascular disease, osteoporosis and dementia in older women. The present review assessed the clinical effects of using HT for a year or more. Twenty-three randomised double-blind studies (involving 42,830 women aged 26 to 91 years) compared HT (all oestrogens, with or without progestogens, administered by oral, transdermal, subcutaneous or intranasal routes) with placebo when taken for at least one year. Most participants were postmenopausal American women, and the mean age in most studies was over 60 years. No study focused on perimenopausal women. In relatively healthy postmenopausal women (14 studies), combined continuous HT significantly increased the risk of obstruction of a vein by a blood clot (venous thrombo-embolism), fatal or nonfatal heart attack (after one year's use), stroke (after three years' use), breast cancer, gallbladder disease, death from lung cancer, and dementia in women over 65 years. Long term oestrogen alone significantly increased the risk of venous thrombo-embolism, stroke and gallbladder disease. Among postmenopausal women with cardiovascular disease (six studies) long term use of combined HT significantly increased the risk of venous thrombo-embolism, particularly in the first two years of use, and of gallbladder disease. HT offered the benefit of a significant reduction in the risk of bone fracture but only after four or five years' treatment with HT, while the highest risk of cardiovascular events with combined HT occurred in the first year of use. There was no convincing evidence that HT prevents colorectal cancer.
    No preview · Article · Feb 2009 · Cochrane database of systematic reviews (Online)
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    ABSTRACT: The rapid decline in endogenous estrogen production that occurs during menopause is associated with significant bone loss and increased risk for fragility fracture. While hormone therapy (HT) is an effective means to re-establish endogenous estrogen levels and reduce the risk of future fracture, its use can be accompanied by undesirable side effects such as stroke and breast cancer. In this paper, we revisit the issue of whether HT can be both safe and effective for the prevention of postmenopausal bone loss by examining standard and alternative doses and formulations of HT. The aim of this paper is to continue the dialogue regarding the benefits and controversies of HT with the goal of encouraging the dissemination of-up-to date evidence that may influence how HT is viewed and prescribed.
    Full-text · Article · Jun 2010 · Journal of Osteoporosis
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    ABSTRACT: Cognitive function is multidimensional and complex, and research in multiple species indicates it is considerably impacted by age and gonadal hormone milieu. One domain of cognitive function particularly susceptible to age-related decrements is spatial memory. Gonadal hormones can alter spatial memory, and they are potent modulators of brain microstructure and function in many of the same brain areas affected by aging. In this paper, we review decades of animal and human literature to support a tertiary model representing interactions between gonadal hormones, spatial cognition and age given that: 1) gonadal hormones change with age, 2) age impacts spatial learning and memory, and 3) gonadal hormones impact spatial learning and memory. While much has been discovered regarding these individual tenets, the compass for future aging research points toward clarifying the interactions that exist between these three points, and understanding mediating variables. Indeed, identifying and aligning the various components of the complex interactions between these tenets, including evaluations using basic science, systems, and clinical perspectives, is the optimal approach to attempt to converge the many findings that may currently appear contradictory. In fact, as discoveries are being made it is becoming clear that the findings across studies that appear contradictory are not contradictory at all. Rather, there are mediating variables that are influencing outcome and affecting the extent, and even the direction, of the effects that gonadal hormones have on cognition during aging. These mediating variables are just starting to be understood. By aligning basic scientific discoveries with clinical interpretations, we can maximize the opportunities for discoveries and subsequent interventions to allow individuals to "optimize their aging" and find their own map to cognitive health as aging ensues.
    Full-text · Article · Sep 2010 · Molecules
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