Relation between hot flushes and endothelial dysfunction in postmenopausal women

Background: Compared with men, women have more evidence of myocardial ischemia in the setting of no obstructive coronary artery disease (CAD). While low endogenous estrogen levels are associated with endothelial dysfunction, the role of low dose hormone therapy has not been fully evaluated in women suffering from myocardial ischemia and no obstructive CAD. Objective: This WISE ancillary trial evaluated the effect of low dose hormone therapy in postmenopausal women with myocardial ischemia and no obstructive CAD on: endothelial dysfunction, assessed by brachial artery reactivity, physical functional disability assessed by exercise testing, and quality of life assessed by cardiac symptoms and psychological questionnaires. Methods: Using a multicenter, randomized, placebo-controlled design, seventy-four participants with normal/minimally diseased epicardial coronary arteries (<50% luminal diameter stenosis) who fulfilled the inclusion criteria were planned to be randomized to receive either 1 mg norethindrone/10 mcg ethinyl estradiol (1/10 NA/EE) or placebo for twelve weeks. Baseline and exit brachial artery reactivity (BART), exercise stress testing, WISE psychosocial questionnaires, SF-36, blood lipids and hormone levels were evaluated. Results: Recruitment was closed prematurely due to failure to recruit in the year following publication of the Women’s Health Initiative hormone trial results. Of the 37 women randomized, 35 completed the study. While there was no difference in the frequency of chest pain between groups at the baseline visit, at study exit there was less frequent chest pain in the 1/10 NA/EE group compared to the placebo group (p=0.02). Women taking 1/10 NA/EE also showed a trend to improved BART and exercise tolerance, and had significantly fewer hot flashes/night sweats (p=0.003), less avoidance of intimacy (p=0.05), and borderline differences in sexual desire and vaginal dryness (p=0.06). Conclusion: Among postmenopausal women with myocardial ischemia and no obstructive CAD, hormone therapy with 1/10 NA/EE is associated with reduced chest pain symptoms, menopausal symptoms and improved quality of life with trends for improved endothelial function and exercise performance.

Download Full-text

Soy Phytoestrogens Improve Endothelial Dysfunction in Postmenopausal Women

Menopause The Journal of The North American Menopause Society ◽

10.1097/00042192-199906040-00106 ◽

1999 ◽

Vol 6 (4) ◽

pp. 352-353 ◽

Cited By ~ 1

Author(s):

R DuBroff ◽

P Decker

Keyword(s):

Endothelial Dysfunction ◽

Postmenopausal Women

Download Full-text

Gabapentin shows efficacy comparable to estrogen for the treatment of hot flushes in postmenopausal women,

Inpharma Weekly ◽

10.2165/00128413-200615480-00031 ◽

2006 ◽

Vol &NA; (1548) ◽

pp. 13

Author(s):

&NA;

Keyword(s):

Postmenopausal Women ◽

Hot Flushes

Download Full-text

Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials

Medicina ◽

10.3390/medicina55090554 ◽

2019 ◽

Vol 55 (9) ◽

pp. 554

Author(s):

Gaetano Riemma ◽

Antonio Schiattarella ◽

Marco La Verde ◽

Giuseppina Zarobbi ◽

Simone Garzon ◽

...

Keyword(s):

Clinical Trials ◽

Postmenopausal Women ◽

Sleep Disturbances ◽

Low Dose ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Hormonal Treatment ◽

Significant Heterogeneity ◽

Hot Flushes ◽

Night Time

Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.

Download Full-text

Efficacy and tolerability of continuous combined hormone replacement therapy in early postmenopausal women

Menopause International: The Integrated Journal of Postreproductive Health ◽

10.1258/175404507781605596 ◽

2007 ◽

Vol 13 (3) ◽

pp. 124-131 ◽

Cited By ~ 6

Author(s):

L A Mattsson ◽

S Skouby ◽

M Rees ◽

J Heikkinen ◽

M Kudela ◽

...

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Dose Regimen ◽

Hormone Replacement ◽

Secondary Outcome ◽

Estradiol Valerate ◽

Hot Flushes ◽

Double Blind ◽

Early Postmenopausal Women

Objective. Continuous combined hormone replacement therapy (ccHRT) based on estradiol valerate (E2V) and medroxyprogesterone acetate (MPA) is effective for relief of menopausal symptoms three years or more after the menopause. This study was undertaken to examine the efficacy and tolerability of ccHRT in early postmenopausal women (last menstrual period 1.3 years before study entry). Study design. This was a 52-week, randomized, double-blind, multinational study of ccHRT comprising three different dose combinations of E2V/MPA in 459 early postmenopausal non-hysterectomized women experiencing 30 or more moderate to severe hot flushes a week and/or vasomotor symptoms requiring treatment. Main outcomes measures. The primary endpoint was change in frequency and severity of moderate to severe hot flushes at 12 weeks. Secondary outcome measures included number of bleeding days and evaluation of tolerability. Results. The frequency of hot flushes was reduced by ≥70% after one month ( P<0.001 for all doses at week 2 onwards), with little evidence of statistically different dose effects. Severity of flushing was also attenuated by ccHRT. Mean number of bleeding days fell to <1 per 28-day cycle at 52 weeks. Rates of amenorrhoea approached 80–90% at the end of the study, but were significantly lower at several time points with the highest-dose regimen (2 mg E2V + 5 mg MPA) than with the lower-dose options (1 mg E2V + 2.5 mg MPA and 1 mg E2V + 5 mg MPA; P<0.05). Adverse events declined in frequency over time with all regimens but throughout the study were more numerous with the highest-dose regimen than with lower doses ( P= 0.0002). Conclusions. Continuous combined HRT was effective for the relief of climacteric symptoms in early postmenopausal women and was well tolerated.

Download Full-text