The effects of estrogen and hormone replacement therapy on cardiovascular systems

2020 ◽  
Author(s):  
Mehrnoosh Hashemzadeh ◽  
Ryan Romo ◽  
Joseph M Arreguin ◽  
Mohammed Reza Movahed
Keyword(s):  
Hormone Replacement Therapy ◽  
Cardiovascular System ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Estrogen Replacement Therapy ◽  
Hormone Replacement ◽  
Future Research ◽  
Estrogen Replacement ◽  
Increased Risk ◽  
Cardiovascular Benefit

Postmenopausal women have an increased risk of cardiovascular disease, which is believed to correlate with lower estrogen level. There are conflicting data regarding hormone replacement therapy (HRT) based on the timing of this therapy. After large randomized trials showed no cardiovascular benefit of hormone replacement, estrogen replacement therapy was dramatically reduced even though starting hormone replacement in early postmenopausal period had shown significant benefit. There are hardly any reviews discussing in detail the effect of HRT on cardiovascular system while briefly discussing other effects of this therapy in postmenopausal women. The novelty of this review is the comprehensive discussion of this effect that can help researchers and clinicians to design future research or trials. In this manuscript, the effect of HRT on cardiovascular system in clinical trials and basic science will be reported and potentially erroneous conclusions drawn by various studies will be discussed. Furthermore, various noncardiovascular effect of HRT will be analyzed.

Progestogens are the problem in hormone replacement therapy: Time to reappraise their use

2019 ◽  
Vol 26 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Isaac Manyonda ◽  
Vikram S Talaulikar ◽  
Roxanna Pirhadi ◽  
Joseph Onwude
Keyword(s):  
Breast Cancer ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Estrogen Replacement Therapy ◽  
Hormone Replacement ◽  
Underlying Mechanism ◽  
Limiting Factor ◽  
Estrogen Replacement ◽  
Increased Risk ◽  
Reduce Breast Cancer Risk

Combined (estrogen and a progestogen) hormone replacement therapy (cHRT) is associated with an increased risk of breast cancer, while estrogen replacement therapy is not. Whatever the underlying mechanism, it is the progestogen in cHRT that seems to increase the risk. Fear of breast cancer is a major limiting factor in the use of hormone replacement therapy, and when women discontinue cHRT because of side effects, the latter are often attributable to the progestogen component. cHRT is given to women with an intact uterus to protect against the effects of un-opposed estrogen such as an increased risk of endometrial cancer. Estrogen replacement therapy suffices for women with a prior hysterectomy. There is a clear distinction in risk and side effect profile between cHRT and estrogen replacement therapy. Apart from being the most effective treatment for menopausal symptoms, estrogen prevents osteoporosis, and may also have a potential role in prevention of Alzheimer’s Dementia, now the biggest killer of women in the United Kingdom. Evidence also suggests that progestogens could compromise the dementia-preventative effect of estrogen. Given the immense therapeutic and preventative potential of estrogen, the use of progestogens in cHRT needs re-appraisal. The levonorgestrel intrauterine system (LNg-IUS) could reduce breast cancer risk while protecting the endometrium. Other approaches to the safe use of progestogens await research.

Lipoprotein Disorders in Women: Which Women are the Best Candidates for Hormone Replacement Therapy?

1997 ◽  
Vol 31 (1) ◽  
pp. 98-107 ◽  
Author(s):  
Susyn L Plushner
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Estrogen Replacement Therapy ◽  
Hormone Replacement ◽  
High Density ◽  
High Density Lipoproteins ◽  
Estrogen Replacement ◽  
Recent Trial ◽  
Lipoprotein Disorders

OBJECTIVE: To review the data examining hormone replacement therapy (HRT) in the treatment of lipoprotein disorders in women. DATA SOURCE: A MEDLINE search (1975–1995) of the English-language literature was performed to identify pertinent primary literature and review articles. Articles were also identified through bibliographies of selected articles. DATA EXTRACTION: Controlled and uncontrolled studies evaluating the effects of lipoprotein concentrations on coronary risk and the effects of estrogen and HRT on coronary heart disease and lipoprotein concentrations in women were evaluated. Trials pertaining to adverse effects of therapy were also examined. Emphasis was placed on recent clinical trials. DATA SYNTHESIS: The National Cholesterol Education Program's (NCEP's) 1993 report recommends estrogen replacement therapy as a treatment option in postmenopausal women with hyperlipidemia. Recent trials suggesting that triglycerides and high-density lipoproteins are more closely related to coronary risks in women necessitate an improved understanding of estrogen and progestin's effects on lipoprotein concentrations. A recent trial has clarified the lipoprotein effects of HRT in women with normal lipid concentrations and suggests that beneficial effects on low-density lipoproteins are maintained, although progestins attenuate beneficial changes in high-density lipoproteins and triglyceride elevations persist. The few trials evaluating estrogen use in women with hyperlipidemia suggest a beneficial effect as well. CONCLUSIONS: In the absence of contraindications, postmenopausal women with hyperlipidemia should be offered estrogen replacement therapy as conjugated equine estrogen 0.625 mg/d. Pending further information, NCEP's recommendations should be followed regarding goals of therapy.

Liver Abnormalities in Turner’s Syndrome – Effects of Estrogen Replacement Therapy

2021 ◽  
Author(s):  
Fedor István ◽  
Eva Zold ◽  
Zsolt Barta
Keyword(s):  
Replacement Therapy ◽  
Estrogen Replacement Therapy ◽  
Inflammatory Diseases ◽  
Hormone Replacement ◽  
Turner's Syndrome ◽  
Estrogen Replacement ◽  
Turner’S Syndrome ◽  
Estrogen Production ◽  
Organ Systems ◽  
Increased Risk

Abstract BackgroundTurner’s syndrome is one of the most frequently reported sex chromosomal abnormality, affecting approximately 40 in every 100,000 live female births. Due to insufficient estrogen production, induction of puberty and sexual development requires hormone replacement. The syndrome affects several organ systems with diverse clinical features (cardiovascular, reproductive, hepato-biliary). There is also an increased risk of developing immune-mediated inflammatory diseases (IMID). Hepatobiliary alterations embrace a broad spectrum of possible manifestations, from asymptomatic mild hypertransaminasemia to overt hepatitis and even cirrhosis. Although exogenous estrogen hormones might cause liver dysfunction, in Turner’s syndrome hormone replacement can even alleviate the derangement of laboratory values and might prove beneficial in preventing the progression of hepatic architectural alterations.FindingsWe report two patients, in whom cessation of estrogen replacement therapy lead to worsening of hepatic and cholestatic enzyme values. These changes were later alleviated by recommencing estrogen hormone administration. We aim to summarize the available literature on estrogen hormone replacement therapy in Turner’s syndrome. We also provide a brief overview on the role of estrogen hormones in the pathology associated with the syndrome. ConclusionsOur findings are confirming, that estrogen replacement therapy has beneficial effects on hepatic enzymes and liver related laboratory studies in Turner’s syndrome. Therefore it is recommended for physicians not to withdraw estrogen replacement, even with elevated concentrations of liver and cholestatic enzymes in Turner’s syndrome patients.

scholarly journals OCORRÊNCIA DOS CÂNCERES DE MAMA E ENDOMETRIAL EM MULHERES EM TERAPIA DE REPOSIÇÃO HORMONAL NA MENOPAUSA: UMA REVISÃO DE LITERATURA

2021 ◽  
Vol 7 (7) ◽  
Author(s):  
Gustavo Mariano Rodrigues Santos ◽  
Igor Antônio Galvão Vieira ◽  
Beatriz Costa ◽  
Maria Eduarda Boni Kist ◽  
Fernanda Alves Luz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endometrial Cancer ◽  
Hormone Replacement Therapy ◽  
Breast Neoplasms ◽  
Replacement Therapy ◽  
Estrogen Replacement Therapy ◽  
Hormone Replacement ◽  
Endometrial Neoplasms ◽  
Estrogen Replacement

INTRODUÇÃO: O uso da Terapia de Reposição Hormonal (THR) é prescrito para tratamento de alguns sintomas decorrentes da menopausa. O uso indiscriminado dessa terapêutica parece elevar os riscos de determinadas neoplasias. METODOLOGIA: Trata-se de uma revisão integrativa de literatura, com busca na base de dados Pubmed. Utilizou-se os descritores "Estrogen Replacement Therapy", "Hormone Replacement Therapy", “Menopause”, "Breast Neoplasms", "Breast Cancer", "Endometrial Neoplasms", "Endometrial Cancer", associados aos operadores booleanos AND e OR. Incluíram-se publicações entre 2016 e 2021 nos idiomas português, inglês e espanhol. RESULTADOS: Foram selecionados 20 artigos publicados em periódicos internacionais, sendo 17 estudos de Coorte, dois de Caso-Controle e um Ensaio Clínico Randomizado duplo-cego. DISCUSSÃO: Os estudos analisados sugerem boa resposta no controle dos sintomas pós menopausa pela TRH. Porém, apresenta associação com risco de desenvolvimento de neoplasias de mama e endométrio, ao passo que o uso de estrogênio isolado demonstrou pouca associação. Quando comparados em relação a raça, mulheres brancas apresentam maior risco em relação a negras e asiáticas. CONCLUSÃO: Houve associação do uso de TRH com desenvolvimento das neoplasias estudadas. A duração da terapia, o tipo de hormônio, o momento de início, a via de administração e a população submetida ao tratamento, parecem impactar neste desfecho.

Increased C-reactive Protein Levels during Short-term Hormone Replacement Therapy in Healthy Postmenopausal Women

1999 ◽  
Vol 81 (06) ◽  
pp. 925-928 ◽  
Author(s):  
Marchien van Baal ◽  
Peter Kenemans ◽  
Marius van der Mooren ◽  
Hilda Kessel ◽  
Jef Emeis ◽  
...  
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Initial Increase ◽  
C Reactive Protein ◽  
Short Term ◽  
Short Term Treatment ◽  
Reactive Protein ◽  
Increased Risk

Summary Objective: To study the short-term effect of unopposed oestradiol (E2) and sequentially combined hormone replacement therapy (E2 + P) on C-reactive protein (CRP) in healthy postmenopausal women. Design: Prospective, randomised, placebo-controlled 12-week study. Sixty healthy, normotensive, non-hysterectomised postmenopausal women received either placebo (N = 16) or daily 2 mg micronised oestradiol, either unopposed (N = 16, E2 group) or sequentially combined with a progestagen on 14 days of each cycle (N = 28, E2+P group). Data were collected at baseline and at 4 and 12 weeks. Results: CRP levels increased significantly during the 12 weeks in the E2 and the E2+P groups compared to placebo. No differences were found between the E2 group and the E2+P group [E2 and E2+P group together (N = 44) versus placebo: P = 0.01; E2 versus E2+P: P = 0.75]. To give a quantitative estimate of the increase, the median change calculated from baseline in both treatment groups together was +87% (P = 0.02) at 4 weeks, and +114% (P = 0.08) at 12 weeks, as compared to the placebo group. Conclusion: In healthy postmenopausal women, short-term treatment with E2 or E2+P was associated with a rapid rise in CRP concentrations. These observations raise the possibility that the increased risk of cardiovascular events is related to an initial increase in CRP levels after starting hormone replacement therapy.

scholarly journals Hormone Replacement Therapy: Would it be Possible to Replicate a Functional Ovary?

2018 ◽  
Vol 19 (10) ◽  
pp. 3160 ◽  
Author(s):  
Swati Agarwal ◽  
Faisal Alzahrani ◽  
Asif Ahmed
Keyword(s):  
Stem Cells ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Delivery System ◽  
Hormone Replacement ◽  
Ovarian Hormones ◽  
Controlled Vocabulary ◽  
Future Research ◽  
Free Text

Background: Throughout history, menopause has been regarded as a transition in a woman’s life. With the increase in life expectancy, women now spend more than a third of their lives in menopause. During these years, women may experience intolerable symptoms both physically and mentally, leading them to seek clinical advice. It is imperative for healthcare providers to improve the quality of life by reducing bothersome menopausal symptoms and preventing disorders such as osteoporosis and atherosclerosis. The current treatment in the form of hormone replacement therapy (HRT) is sometimes inadequate with several limitations and adverse effects. Objective and rationale: The current review aims to discuss the need, efficacy, and limitations of current HRT; the role of other ovarian hormones, and where we stand in comparison with ovary-in situ; and finally, explore towards the preparation of an HRT model by regeneration of ovaries tissues through stem cells which can replicate a functional ovary. Search methods: Four electronic databases (MEDLINE, Embase, Web of Science and CINAHL) were searched from database inception until 26 April 2018, using a combination of relevant controlled vocabulary terms and free-text terms related to ‘menopause’, ‘hormone replacement therapy’, ‘ovary regeneration’, ‘stem cells’ and ‘ovarian transplantation’. Outcomes: We present a synthesis of the existing data on the efficacy and limitations of HRT. HRT is far from adequate in postmenopausal women with symptoms of hormone deprivation as it fails to deliver all hormones secreted by naïve ovarian tissue. Moreover, the pharmacokinetics of synthetic hormones makes them substantially different from natural ones. Not only does the number and type of hormones given in HRT matter, but the route of delivering and their release in circulation are also imperative. The hormones are delivered either orally or topically in a non-physiological uniform manner, which brings along with it several side effects. These identify the need for a hormone delivery system which replicates, integrates and reacts as per the requirement of the female body. Wider implications: The review outlines the strengths and weaknesses of HRT and highlights the potential areas for future research. There is a tremendous potential for research in this field to understand the collective roles of the various ovarian hormones and to devise an auto-regulated hormone delivery system which replicates the normal physiology. Its clinical applications can prove to be transformative for postmenopausal women helping them to lead a healthy and productive life.

scholarly journals Clinical Impact of Hormone Replacement Therapy on Atrial Fibrillation in Postmenopausal Women: A Nationwide Cohort Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5497
Author(s):  
Jaehoon Lee ◽  
Yuntae Kim ◽  
Hyunji Park ◽  
Changsoo Kim ◽  
Sihyun Cho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Multivariable Analysis ◽  
National Sample ◽  
Population Based ◽  
Increased Risk

Individuals with atrial fibrillation (AF), especially women, have an increased risk of stroke and death. Although hormone replacement therapy (HRT) is widely used in postmenopausal women, the association between HRT use and AF risk is unclear. We aimed to investigate the association between various types of HRT and AF. This was a population-based retrospective cohort study from The Korean National Health Insurance Service-National Sample Cohort (2004–2015). Participants were aged 45–60 years and were free from cardiovascular disease and AF at baseline. Overall, 13,452 (64.03%) women had never received HRT, 5671 (26.99%) had received HRT, and 1885 (8.98%) were currently receiving HRT. In multivariable analysis, the relative hazards for AF were significantly higher among current users (p < 0.001) and lower among past users (p = 0.069). Current users—except those using estradiol-only HRT—had significantly elevated AF risk. Among past users, only estradiol plus progestin HRT users had a reduced AF risk after adjusting for covariates (p = 0.027). Ongoing HRT posed an increased risk of AF. The degree of risk varied based on the specific type of estrogen and progestins co-administration. These findings indicate that, with respect to AF risk, oral estradiol-containing HRT is superior to HRT containing oral conjugated equine estrogen or tibolone.

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