Hereditary angioedema: Special considerations in women

2020 ◽  
Vol 41 (6) ◽  
pp. S47-S50
Author(s):  
Elizabeth Yakaboski ◽  
Tina Motazedi ◽  
Aleena Banerji
Keyword(s):  
Breast Cancer ◽  
Hereditary Angioedema ◽  
Estrogen Replacement Therapy ◽  
Acute Attack ◽  
C1 Inhibitor ◽  
Estrogen Replacement ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Vaginal Deliveries

There are several challenges that arise in caring for women with hereditary angioedema (HAE). Most notably, the disease course during pregnancy is unpredictable, but studies show that plasma-derived C1-inhibitor is effective and safe for treatment of attacks as well as long-term prophylaxis (LTP) in select patients. Vaginal deliveries are preferred to caesarean sections, and epidural anesthesia is preferred to general anesthesia in lowering the risk of an acute attack. Lactation postpartum may increase HAE attacks. With regard to contraception, combined oral contraceptive pills that contain estrogen exacerbate symptoms. Similarly, estrogen-replacement therapy in menopause may increase attacks and is contraindicated. Fertility is not impacted by HAE itself or by HAE medications. The risk of breast cancer and female reproductive cancer in women with HAE is comparable with that of the general population, but, in patients with HAE and breast cancer, LTP with androgens is contraindicated. Estrogen modulators, e.g., tamoxifen, should be used with caution. Here, we reviewed these special considerations and others that are vital to providers in caring for women with HAE.

scholarly journals A case of hereditary angioedema due to C1-inhibitor deficiency with recurrent abdominal pain diagnosed 40 years after the occurrence of the initial symptom

2021 ◽  
Author(s):  
Daisuke Honda ◽  
Isao Ohsawa ◽  
Keiichi Iwanami ◽  
Hisaki Rinno ◽  
Yasuhiko Tomino ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hereditary Angioedema ◽  
Recurrent Abdominal Pain ◽  
Acute Attack ◽  
Severe Abdominal Pain ◽  
Initial Symptom ◽  
C1 Inhibitor ◽  
Self Administration ◽  
C1 Inhibitor Deficiency ◽  
Appropriate Treatment

AbstractHereditary angioedema due to C1-inhibitor deficiency (HAE-C1-INH) is a rare disease, which induces an acute attack of angioedema mediated by bradykinin. HAE-C1-INH can cause serious abdominal pain when severe edema develops in the gastrointestinal tract. However, because it takes a long time, 13.8 years on average in Japan, from the occurrence of the initial symptom to the diagnosis due to low awareness of the disease, undiagnosed HAE-C1-INH patients sometimes undergo unnecessary surgical procedures for severe abdominal pain. We herein present a 56-year-old patient with HAE-C1-INH, who underwent numerous abdominal operations. He frequently needed hospitalization with the administration of opioid due to severe abdominal pain. However, after he was accurately diagnosed with HAE-C1-INH at 55 years of age, he could start self-administration for an acute attack with icatibant, a selective bradykinin B2 receptor antagonist. Consequently, he did not need hospitalizing for ten months after the beginning of the treatment. A series of an accurate diagnosis and appropriate treatment for HAE-C1-INH improved his quality of life. Thus, HAE-C1-INH should be considered, when we meet patients with unidentified recurrent abdominal pain. This case highlights significance of an early diagnosis and appropriate treatment for HAE-C1-INH.

Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy.

1995 ◽  
Vol 13 (11) ◽  
pp. 2737-2744 ◽  
Author(s):  
R J Couzi ◽  
K J Helzlsouer ◽  
J H Fetting
Keyword(s):  
Breast Cancer ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Cancer Patients ◽  
Estrogen Replacement Therapy ◽  
Uterine Cancer ◽  
Emotional Problem ◽  
Vasomotor Symptoms ◽  
Breast Cancer Patients ◽  
Estrogen Replacement

PURPOSE To determine the prevalence and severity of vasomotor, gynecologic, and other symptoms among breast cancer patients, their health concerns, beliefs about estrogen replacement therapy (ERT), and willingness to take estrogen under medical supervision. MATERIALS AND METHODS A questionnaire was mailed to 320 women aged 40 to 65 years and diagnosed with in situ or invasive locoregional breast cancer in the years 1988 to 1992. RESULTS Of 222 eligible respondents, 190 were postmenopausal. The prevalence of symptoms among the postmenopausal women was as follows: hot flashes, 65%; night sweats, 44%; vaginal dryness, 48%; dyspareunia, 26%; difficulty sleeping, 44%; and feeling depressed, 44%. The latter two symptoms increased in frequency with increasing severity of vasomotor symptoms (P for trend < or = .001). Forty-one percent of menopausal women perceived that they had experienced, since their breast cancer diagnosis, a physical or emotional problem related to menopause. Of these women, 50% felt they needed treatment. Overall, 31% of postmenopausal women would consider taking estrogen. Those who perceived that they had experienced a menopausal problem were more likely to consider estrogen than those who did not (42% v 22%, P = .003). The proportions willing to take estrogen increased with increasing severity of symptoms, particularly feelings of depression and sleep disturbance (P for trend = .008 and .007, respectively). Awareness that estrogen decreases the risks of heart disease and osteoporosis was not associated with an increased willingness to take it. However, beliefs that estrogen increases the risks of recurrent breast cancer and uterine cancer were associated with a decreased willingness to take it (P = .003 and .08, respectively). CONCLUSION Vasomotor symptoms have a significant impact on the quality of life of breast cancer patients. Clinical trials to determine the safest and the most effective ways to relieve these symptoms are needed.

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