Alternatives of menopausal hormone therapy

Introduction. It has been generally accepted that the benefits of menopausal hormone therapy outweigh the risks, but there are still some concerns about the administration of menopausal hormone therapy, which has introduced alternative treatments. Pharmacological Alternatives. Central alpha-2 agonist clonidine is only marginally more effective than placebo, and significantly less effective than estrogen. Antiepileptic drug gabapentin reduces hot flashes; however, it is less effective than estrogen. Selective serotonin reuptake inhibitors (paroxetine and fluoxetine) and selective noradrenaline reuptake inhibitors (venlafaxine) reduce vasomotor symptoms and improve depression, anxiety and sleep. Results of studies about dehydroepiandrosterone effects on menopausal symptoms are inconsistent and additional investigations are needed. Non-Pharmacological Alternatives. Stellatum ganglion blockade is a successful treatment for reducing vasomotor symptoms in patients with contraindications for menopausal hormone therapy. Efficacy of acupuncture, homeopathy and reflexology should be proved by adequate studies. Phytoestrogens could reduce vasomotor symptoms but to a lesser extent than conventional menopausal hormone therapy. However, they have not been proved yet to provide cardiovascular protection and prevention of osteoporosis, nor they could be recommended instead of traditional menopausal hormone therapy. There is a concern about their undesirable effects. Adequate diet, unchanging body weight within ideal values and adequate physical activities have beneficial long-term effects, first of all on preservation of bone density. Alternatives for Atrophic Changes of Vaginal Epithelium. Menopausal symptoms resulting from vaginal atrophy could be resolved by use of hydrophilic preparations, lubricants and topical lidocaine cream or 4% lidocaine water solution for dyspareunia. Conclusion. If there are contrain?dications to menopausal hormone therapy or patients are unwilling to take hormone therapy, alternative treatments, which can also solve menopausal symptoms, should be considered.

Download Full-text

Hormone Therapy for the Management of Menopausal Symptoms

Journal of Pharmacy Practice ◽

10.1177/0897190009360061 ◽

2010 ◽

Vol 23 (6) ◽

pp. 540-547 ◽

Cited By ~ 4

Author(s):

C. Brock Woodis

Keyword(s):

Hormone Therapy ◽

Dosage Form ◽

Hot Flashes ◽

Menopausal Symptoms ◽

Vasomotor Symptoms ◽

Controlled Trials ◽

Patient Evaluation ◽

Health Initiative ◽

Randomized Controlled ◽

Night Sweats

Nearly 50 million women each year are projected to reach menopause by 2030. Many of these women will experience vasomotor symptoms such as night sweats and hot flashes as they enter the menopausal transition. Up until the release of the findings of the Women’s Health Initiative (WHI) studies, women were frequently prescribed hormone therapy (HT) to alleviate bothersome and sometimes debilitating menopausal symptoms as well as to prevent osteoporosis and coronary heart disease (CHD). Although the WHI studies were the first large, randomized, controlled trials that contradicted what was historically believed about the benefits of HT in postmenopausal women, important limitations including baseline demographics of WHI participants and investigation of only one HT strength/dosage form exist. HT may be a reasonable pharmacotherapy option for the management of menopausal symptoms following complete patient evaluation by experienced clinicians. Updated recommendations addressing management of menopausal symptoms, a new HT product containing the spironolactone-analogue drospirenone (DRSP), and discontinuation methods of HT are also discussed in this review.

Download Full-text

Approach to the Patient with Menopausal Symptoms

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-1272 ◽

2008 ◽

Vol 93 (12) ◽

pp. 4567-4575 ◽

Cited By ~ 38

Author(s):

Kathryn Ann Martin ◽

JoAnn E. Manson

Keyword(s):

Hormone Therapy ◽

Selective Serotonin Reuptake Inhibitors ◽

Cardiovascular Health ◽

Hot Flashes ◽

Estrogen Therapy ◽

Menopausal Symptoms ◽

Systemic Absorption ◽

Term Therapy ◽

Common Symptom ◽

Short Term

Many women experience menopausal symptoms during the menopausal transition and postmenopausal years. Hot flashes, the most common symptom, typically resolve after several years, but for 15–20% of women, they interfere with quality of life. For these women, estrogen therapy, the most effective treatment for hot flashes, should be considered. The decision to use hormone therapy involves balancing the potential benefits of hormone therapy against its potential risks. Accumulating data suggest that initiation of estrogen many years after menopause is associated with excess coronary risk, whereas initiation soon after menopause is not. Therefore, most now agree that short-term estrogen therapy, using the lowest effective estrogen dose, is a reasonable option for recently menopausal women with moderate to severe symptoms who are in good cardiovascular health. Short-term therapy is considered to be not more than 4–5 yr because symptoms diminish after several years, whereas the risk of breast cancer increases with longer duration of hormone therapy. A minority of women may need long-term therapy for severe, persistent vasomotor symptoms after stopping hormone therapy. However, these women should first undergo trials of nonhormonal options such as gabapentin, selective serotonin reuptake inhibitors, or serotonin norepinephrine reuptake inhibitors, returning to estrogen only if these alternatives are ineffective or cause significant side effects. Low-dose vaginal estrogens are highly effective for genitourinary atrophy symptoms, with minimal systemic absorption and endometrial effects.

Download Full-text

The role of orexin A in pathophysiological mechanisms of sleep disorder in postmenopausal women

GYNECOLOGY ◽

10.26442/20795696.2020.1.200038 ◽

2020 ◽

Vol 22 (1) ◽

pp. 50-54

Author(s):

Zukhra Kh. Ebzieva ◽

Svetlana V. Yureneva ◽

Tatiana Yu. Ivanets

Keyword(s):

Hormone Therapy ◽

Sleep Disorder ◽

Postmenopausal Women ◽

Menopausal Hormone Therapy ◽

Reproductive Age ◽

Vasomotor Symptoms ◽

Women Of Reproductive Age ◽

Orexin A ◽

Group 1

Aim. To conduct a comparative analysis of serum orexin A levels in women of different age periods with and without sleep disorder and vasomotor symptoms. To evaluate the dynamics of orexin A levels under menopausal hormone therapy. Materials and methods. The study included 50 postmenopausal women and 30 women of reproductive age with a regular menstrual cycle. Using block randomization, patients are divided into 3 groups: group 1 (main group), n=25, -STRAW+ 10 (+1b and +1c), patients with sleep disorder and vasomotor symptoms; group 2 (comparison group), n=25, STRAW+ 10 (+1b and +1c), patients with vasomotor symptoms without sleep disorder; group 3 (control group), n=30, STRAW+ 10 (-4), women of reproductive age without sleep disorder. Group 1 patients were given menopausal hormone therapy. A comparative analysis was carried out using the questionnaire for assessing menopausal symptoms severity by the Greene Scale (the Greene Climacteric Scale) and Rating Scale for subjective sleep characteristics. After 12 weeks of treatment, a control examination was performed. Results. In group 1 women, the serum orexin A levels were significantly higher compared to the women without the symptoms. The link between the orexin A levels and menopause syndrome severity was established. A significant decrease in the menopausal symptoms severity after 12 weeks of menopausal hormone therapy was shown. It was accompanied by a 1,3-fold decrease in orexin A levels. Conclusions. The obtained data indicate the possible role of orexin A and the orexin neuropeptide system in the pathogenesis of sleep disorder and vasomotor symptoms in postmenopausal women.

Download Full-text

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001217 ◽

2020 ◽

Vol 30 (4) ◽

pp. 428-433 ◽

Cited By ~ 1

Author(s):

Margaret Rees ◽

Roberto Angioli ◽

Robert L Coleman ◽

Rosalind M Glasspool ◽

Francesco Plotti ◽

...

Keyword(s):

Hormone Therapy ◽

Gynecological Cancer ◽

Gynecologic Cancer ◽

Germ Cell Tumors ◽

Disease Free Survival ◽

Position Statement ◽

Menopausal Symptoms ◽

Menopausal Hormone Therapy ◽

Cervix Uteri ◽

Low Grade

Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and vagina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

Download Full-text

Menopausal hormone therapy: Characterising users in an Australian national cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0253725 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0253725

Author(s):

Louiza S. Velentzis ◽

Sam Egger ◽

Emily Banks ◽

Karen Canfell

Keyword(s):

Logistic Regression ◽

Hormone Therapy ◽

Multinomial Logistic Regression ◽

Personal Characteristics ◽

Cross Sectional Study ◽

Menopausal Symptoms ◽

Menopausal Hormone Therapy ◽

Bilateral Oophorectomy ◽

Cross Sectional Survey ◽

Cross Sectional

Menopausal hormone therapy (MHT) is effective for menopausal symptoms, however, its use is also associated with risks of serious health conditions including breast, ovarian and endometrial cancer, stroke and venous thromboembolism. MHT-related health risks increase with longer durations of use. In Australia, while overall MHT use fell when risk-related findings were published in 2002, a significant number of women continue using MHT long-term. We aimed to examine socio-demographic, health-related and lifestyle characteristics in relation to post-2002 MHT use, and to compare use for <5 and ≥5 years. Data from 1,561 participants from an Australian, national, cross-sectional survey of women aged 50–69 in 2013 were analysed. Odds ratios (ORs) were calculated using logistic regression for characteristics related to overall MHT use post-2002 and multinomial logistic regression for associations between MHT duration of use [never/<5 years/≥5 years] and personal characteristics, adjusting for sociodemographic, reproductive, health and lifestyle factors. Post-2002 MHT use was associated with increasing age (p-trend<0.001), hysterectomy versus no hysterectomy (OR:2.55, 95%CI = 1.85–3.51), bilateral oophorectomy vs no oophorectomy (OR:1.66, 95%CI = 1.09–2.53), and ever- versus never-use of therapies other than MHT for menopausal symptoms (OR:1.93, 95%CI = 1.48–2.57). Women with prior breast cancer (OR:0.35, 95%CI = 0.17–0.74) and with more children (p-trend = 0.034) were less likely than other women to use MHT. Prior hysterectomy was more strongly associated with MHT use for ≥5 years than for <5 years (p = 0.004). Ever-use of non-MHT menopausal therapies was associated with MHT use for <5 years but not with longer-term use (p = 0.004). This study reinforces the need for MHT users and their clinicians to re-evaluate continued MHT use on an ongoing basis.

Download Full-text

The Effect Combination of Leonurus japonicus Houtt, Eclipta prostrata L., and Pueraria lobata Ohwi Extract on Menopause Symptoms in an Ovariectomized Rat Model

Current Developments in Nutrition ◽

10.1093/cdn/nzab037_040 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 330-330

Author(s):

Eun Young Kang ◽

Hyun Kyung Kim ◽

Gwang-woong Go

Keyword(s):

Rat Model ◽

Hot Flashes ◽

Menopausal Symptoms ◽

Vasomotor Symptoms ◽

Type I ◽

Pueraria Lobata ◽

Female Rat ◽

Mineral Density ◽

Eclipta Prostrata ◽

Menopausal Depression

Abstract Objectives Menopause causes ovarian hormone decline, followed by symptoms including weight gain, bone loss, hot flashes, and menopausal depression. We had a purpose that a combination of Leonurus japonicus Houtt, Eclipta prostrata L., and Pueraria lobata Ohwi (LEPE) would alleviate menopausal symptoms in an ovariectomized menopausal rat model. Methods Female rat underwent surgery to resect bilateral ovarian and were randomly assigned to five groups: (1) Sham, (2) Vehicle, negative control, (3) LEPE (100 mg/kg bw), (4) LEPE (200 mg/kg bw), and (5) Estradiol (E2, 3 μg/kg bw). LEPE was orally gavaged daily for 12 weeks. Results There is no effect on growth performance, including body weight and feed intake, or body composition, including lean mass and fat in tissue. LEPE did not cause hepatotoxicity (aspartate aminotransferase and alanine aminotransferase) and endocrine disturbance (estradiol, follicle-stimulating hormone levels, and uterine weight). Despite decreasing type I collagen (CTX-1), LEPE did not affect bone mineral density and osteocalcin. LEPE supplement reduced the tail temperature and increased the rectal temperature, improving menopause-associated vasomotor symptoms such as hot flashes and night sweat. Furthermore, LEPE relieved behavior related to menopausal depression, including in forced swimming and tail suspension tests. Conclusions These findings suggest that LEPE ameliorates menopausal symptoms via improving menopause-associated vasomotor symptoms and depression behavior in a female rat model of surgical menopause. Funding Sources This research was funded by Nong Shim.

Download Full-text

Results of a phase Ib study of Q-122 treatment of vasomotor symptoms in breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.99 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 99-99 ◽

Cited By ~ 1

Author(s):

Wendy Painter ◽

April L. Speed ◽

Kiwita Phillips ◽

Priscilla Pemu ◽

Alice Robertson ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Phase 1 ◽

Hot Flashes ◽

Menopausal Symptoms ◽

Vasomotor Symptoms ◽

Breast Cancer Patients ◽

Open Label ◽

Dose Escalation Study ◽

Drug Free

99 Background: Breast cancer patients taking tamoxifen (TAM) or an aromatase inhibitor (AI) often develop severe vasomotor symptoms (VMS) yet the only FDA approved non-hormonal treatment for VMS, 7.5 mg paroxetine, has a warning against concomitant use with TAM. Q-122, an orally-available small molecule, is being developed to address this unmet medical need. Results from the Phase 1b study, Q-1001, are presented. Methods: Q-1001 was a Phase 1 open-label, two-dose, dose-escalation study of the safety and preliminary effectiveness of Q-122 in females with breast cancer currently taking TAM or an AI and experiencing an average of at least 7-8 moderate to severe hot flashes per day. Key exclusion criteria included significant renal or hepatic disease, untreated hyperthyroidism and clinically significant abnormal laboratory findings. The study period included a 2 week drug-free screening phase, 28 day treatment phase, and 2 week drug-free follow-up period. Subjects were initially enrolled into Group 1 (100 mg Q-122) followed by Group 2 (200 mg Q-122). Safety was assessed by review of adverse events (AEs), physical findings and laboratory values. The primary efficacy endpoints were mean changes in frequency and severity (hot flash severity score, HFSS) of moderate and severe hot flashes from baseline to Week 4. Menopausal symptoms were assessed using the Greene Climacteric Scale (GCS). Results: 10 and 11 subjects received 100 and 200 mg Q-122 respectively; 8 subjects in each group completed the study. At the end of treatment for groups 1 and 2 respectively, the daily average frequency of hot flashes was reduced from 9.9 to 4.1 and from 8.6 to 3.2, and the mean HFSS was reduced by 62% and 68% from baseline values. Menopausal symptoms assessed using the GCS were significantly reduced from baseline (psychological: -82%; somatic: -65%; vasomotor: -65%). All AEs (n = 29) were either mild (79%) or moderate (21%) in severity and only 3 (all in one subject) were considered possibly related to study drug. Conclusions: Treatment with Q-122 resulted in significant reduction in the frequency and severity of VMS and improvement in menopausal symptoms as assessed by the GCS. No safety issues associated with the use of Q-122 were identified in this study.

Download Full-text

EFFECTIVENESS OF AN INTRAUTERINE CONTRACEPTIVE CONTAINING LEVONORGESTREL (MIRENA) IN THE TREATMENT OF HEAVY MENSTRUAL BLEEDING

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2021-23-7-80-85 ◽

2021 ◽

pp. 80-85

Author(s):

Kalinkina O.B.

Keyword(s):

Quality Of Life ◽

Hormone Therapy ◽

Hot Flashes ◽

Abnormal Uterine Bleeding ◽

Menopausal Hormone Therapy ◽

Heavy Menstrual Bleeding ◽

Menstrual Bleeding ◽

First Line Therapy ◽

Intrauterine Contraceptive

Levonorgestrel-containing intrauterine system Mirena refers to the first-line therapy of heavy menstrual bleeding (OMC) according to the recommendations of different countries. The efficacy, acceptability, and quality of life of women using Mirena are similar to those in the surgical treatment of abnormal uterine bleeding, including endometrial ablation and hysterectomy. The clinical case presented in this study of the management of a patient with heavy menstrual bleeding allowed us to demonstrate the effectiveness of the levonorgestrel-containing Mirena intrauterine system in OMC. The patient was observed in the consultative polyclinic of the V. D. Seredavin State Medical University. At the initial treatment, she complained of heavy menstruation, decreased performance, weight gain, and periodic increases in blood pressure. After a comprehensive clinical examination, taking into account heavy menstruation, a decrease in the quality of life, as well as the need for contraception, the introduction of the Mirena IUD was recommended. A year after the introduction of the IUD, the patient had amenorrhea. 5 years after the introduction of the Mirena IUD, the patient developed hot flashes, increased sweating, vaginal dryness, mood swings, sleep disorders, accompanied by an increase in FSH levels. The intrauterine system was removed and a new IUD - Mirena-was installed as a component of menopausal hormone therapy. After 2 months from the beginning of therapy, the complaints were completely stopped, the state of health is satisfactory, dryness in the vagina does not bother. Thus, the use of the LNG – IUD Mirena was effective for the relief of heavy menstrual bleeding, in addition, in women of this age group, it is possible to continue using the levonorgestrel-containing intrauterine system Mirena as a component of menopausal hormone therapy.

Download Full-text