Serum estradiol level according to dose and formulation of oral estrogens in postmenopausal women

This study was performed to evaluate serum estradiol level in postmenopausal women using oral menopausal hormone therapy (MHT) with different doses and formulations of estrogens. A total of 344 postmenopausal women who received oral MHT was included in this cross-sectional study. Serum estradiol level was compared according to formulation (estradiol hemihydrate [EH] or valerate [EV], conjugated estrogen [CE]) and dose (estradiol 1 or 2 mg, CE 0.45 or 0.625 mg) of the estrogens. Mean age and years since menopause were 56.9 and 7.9 years, respectively. Mean duration of MHT was 27.4 months. Since serum estradiol levels were not significantly different at either dose, EH and EV at the same dose were combined for comparisons: estradiol 1 mg and 2 mg. The serum estradiol level with estradiol 2 mg (107.6 pg/mL) was significantly higher by 60% than with estradiol 1 mg (65.8 pg/mL) or CE 0.45 mg (60.1 pg/mL), and it was also significantly higher than with CE 0.625 mg (76.8 pg/mL). Our findings suggest that serum estradiol level is not directly proportional to estrogen dose. In terms of serum concentration, CE 0.45 mg is equivalent to estradiol 1 mg.

The Relationship Between Musculoskeletal Pains, Serum Estradiol Level and Climacteric Symptoms in Postmenopausal Women

Background: Due to the decrease of estrogen levels in postmenopausal females, menopause can be associated with musculoskeletal pains. This study was designed to assess the possible association between musculoskeletal pains, serum estradiol level, and climacteric symptoms in postmenopausal women.Methods: This cross-sectional study was conducted on 307 postmenopausal females selected by convenience sampling method. Data collection procedure lasted from October 2016 to September 2018. The required data were collected using the Menopause Rating Scale (MRS), Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), and a questionnaire containing personal data. The blood sample was taken to measure the estradiol level. Results: There was a direct relationship between musculoskeletal pains and menopause symptoms (p<0.001), age (p=0.03), parity (p=0.01), and BMI (p=0.03) and an indirect association between musculoskeletal pain and marriage age (p=0.009), age of first pregnancy (0.017), estradiol level (p<0.001) and education level (p=0.002). The regression analysis results showed that menopause symptoms were the strongest predictor of musculoskeletal pains among all the variables.Conclusions: The findings of the present study showed that although various parameters are associated with musculoskeletal pains, climacteric symptoms are the most important predictive parameters of musculoskeletal pains.

Elevated Levels of Monocyte Chemotactic Protein-1 in the Follicular Fluid Reveals Different Populations among Women with Severe Endometriosis

To determine if a modification of the cytokine profile occurs in the follicular fluid (FF) of women with endometriosis undergoing in vitro fertilization (IVF), we performed a prospective observational study from January 2018 to February 2019. In total, 87 women undergoing IVF were included: 43 for severe endometriosis-related infertility and 40 controls with other causes of infertility. The cytokine profile of the FF was determined by multiplex fluorescent-bead-based technology allowing the measurement of 59 cytokines. Monocyte Chemoattractant Protein 1 (MCP-1) was the only variable retained in the multivariate analysis. We identified two subgroups of patients in the endometriosis group: MCP-1-low group (n = 23), which had FF MCP-1 levels comparable to the control group, and MCP-1-high (n = 20), which had significantly higher FF levels. Only patients in the MCP-1-high group had a significantly altered cytokine profile in the FF, and had a significantly higher serum estradiol level (p = 0.002) and a significantly lower number of oocytes recovered (p = 0.01) compared to the MCP-1-low and the control group. Our study has shown an alteration of the oocyte microenvironment in women with endometriosis associated with high follicular fluid levels of MCP-1, allowing the identification of a subgroup of endometriosis patients with a potentially worse prognosis.

Could Obesity be a Triggering Factor for Endometrial Tubal Metaplasia to be a Precancerous Lesion?

Background & Aims. Endometrial tubal metaplasia (ETM) is mostly described in conjunction with unopposed estrogen levels, and its association with endometrial hyperplasia and endometrial carcinoma (EC) is striking. Obesity is a risk factor for endometrial hyperplasia and EC development. The aim of this study is to investigate the impact of BMI and serum estradiol level on expression of PAX-2, H-TERT, P16, Ki-67, and P53 in studied ETM in reference to benign endometrium and EC. Methods. The study was conducted on the following groups: group (1) consists of 57 cases that had endometrial biopsies with histologically demonstrable ETM (typical or atypical) and all were subjected to serum estradiol levelling and body mass index (BMI) evaluation; group (2) had adjacent benign endometrial tissue as control; group (3) consists of 52 cases of conventional endometrial carcinoma and 16 serous carcinoma paraffin blocks which were collected and reevaluated. All included groups were immunostained for PAX-2, H-TERT, p16, ki67, and p53. Results. The relation between BMI and serum estradiol level in group 1 and PAX-2, H-TERT, P16, and p53 was statistically significant, while their relation with atypia and ki67 expression was insignificant. Twenty-three ETM cases (40.4%) out of group 1 were all (100%) obese, 87% had high serum estradiol level, and 73.9% were postmenopausal and had a similar immunohistochemical profile as EC cases (group 3). Conclusions. The presence of ETM regardless of the histologic atypia in obese postmenopausal patients with high serum estradiol level is an alarming sign. This implies that ETM might not be as benign as generally accepted, as under certain clinical conditions, it may turn into a potential premalignant lesion.

THE INFLUENCE OF HYPERPROLACTINEMIA ON THE LEVEL OF ESTRADIOL AND PROGESTERONE IN WOMEN

Prolactin is a polypeptide hormone that is synthesized and secreted by specialized cells in the adenohypophysis called lactotrophs.Excretion of prolactin from lactotrophs is regulated by neurohormones or neurotransmitters who are secreted in the hypothalamus, and they have a stimulating or inhibiting role in its secretion.By maintaining a balance in the excretion of these factors, the level of prolactin concentration in the serum is within normal reference limits.Disruption of dopamine excretion as the strongest inhibitor of prolactin secretion increases the level of prolactin, a condition known as hyperprolactinaemia. A prolonged increase in prolactin levels in serum, in the absence of pregnancy or lactation is referred to as pathological hyperptopectinemia, which is most common in women. Physiological conditions in which an increased level of prolactin appears, and which are not a disease, are pregnancy, breast-feeding, nipple stimulation, physical activity, stress condition, longer-term sleep, and more.The aim of the study was to determine the level of prolactin in the group of patients with confirmed hyperprolactinaemia, compared with the control group of patients, and at the same time to analyze the influence of hyperprolactinemia on the level of ovarian steroids, estradiol, and progesterone in the hyperprolactinemic group of patients,in relation to the control group. Patients aged 25-35 years with pre-established hyperprolactinaemia were examined. Prolactin, estradiol and progesterone were examined. Patients were divided into three groups, a control group of patients with values for prolactin within the limits of the reference, a group of patients with diagnosed hyperprolactinaemia,that is an elevated level of prolactin and a group under the therapy with Bromergon or Dostinex.Our results suggest that in hyperprolactinemia the concentration of prolactin in patients is significantly increased in relation to the control group, but after treatment with Dostinex or Bromergon in the treated group of patients, the level of prolactin significantly decreases to concentrations close to the control group. In hyperprolactinemic patients, the serum estradiol level was significantly reduced with respect to the control group, but with the application of antiprolactin therapy the concentration significantly increased to levels close or higher compared to the control group. The value of progesterone in hyperprolactinemic patients is significantly reduced in relation to the control group, but in the treated group of patients with Bromergon or Dostinex there is a significant increase in progesterone in the serum to levels that are slightly higher compared to the values for progesterone from the control group.

Serum estradiol level on the day of ovulation trigger and pregnancy outcomes in in-vitro fertilisation-intracytoplasmic sperm injection cycles

Background: There is conflicting evidence with regards to the impact of supraphysiologic estradiol levels in in-vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles on pregnancy outcomes such as oocyte quality, implantation, and clinical pregnancy. The objective of our study was to evaluate the effect of serum estradiol levels on the day of ovulation trigger on pregnancy outcomes in IVF-ICSI cycles.Methods: We performed a retrospective cohort study, which included eighty-three women who underwent IVF-ICSI and experienced fresh embryo transfer (ET) over one year period. The women included in the study were divided into four groups according to the serum estradiol level on the day of ovulation trigger; Group I: <2000pg/ml, Group II: 2000-3000pg/ml, Group III: 3000-4000pg/ml and Group IV: >4000pg/ml. The outcome measures including number of oocytes retrieved, MII (metaphase II) oocytes, fertilization rate, embryo quality, overall pregnancy rate, implantation rate and clinical pregnancy rate were compared among these four groups.Results: The total number of oocytes, MII oocytes as well as good quality embryos significantly increased from group 1 to group 4. The implantation rate was lowest in group 4 compared to all other groups, although not statistically significant. There was no significant difference in overall and clinical pregnancy rate between the groups.Conclusions: Serum estradiol level shows a positive correlation with the number of oocytes retrieved and good quality embryos. A higher estradiol level does not have a significant negative impact on the implantation rate, overall or clinical pregnancy rate.