Conjugated estrogen is an effective option to manage chronic GI bleeding in a patient with atrial fibrillation and end-stage renal disease

A clinical decision report appraising: Livio M, Mannucci PM, Viganò G, Mingardi G, Lombardi R, Mecca G, Remuzzi G. Conjugated estrogens for the management of bleeding associated with renal failure. N Engl J Med. 1986;315:731-735 https://doi.org/10.1056/NEJM198609183151204 for a patient with chronic GI bleeding and complicated pro- and anti-coagulation needs.

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.

TREATMENT OF MENOPAUSAL SYMPTOMS : A COMPARATIVE STUDY

Menopause is permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Women suffer many troublesome problems after menopause resulting from estrogen deficiency. Aim of this study is to compare symptomatic response in Indian women using different medicine preparations for treatment of menopausal symptoms. It is an observational prospective study conducted in PMCH Gynae OPD from October 2017 to September 2019. Two hundred women were enrolled and assigned to different treatment groups. There was 90.32% decrease in hot flushes in E2V group while it was 87.09% in CEE group. Psychosomatic symptoms reduced by 75% and 70% in E2V and CEE group respectively. Sexual and urinary symptoms also got more improved when treated with estrogen preparations. Both estradiol valerate and conjugated estrogen were effective in reducing severity of hot flushes, psychosomatic symptoms, sexual and urinary symptoms as compared to isoflavones and placebo. Isoflavones had very little advantage over placebo

Timing and regimen of puberty induction in children with hypogonadism: a survey on the practice in Arab countries

ObjectivesThere are some variations in the practice of puberty induction between different regions; however, data from Arab countries are lacking. We aimed to survey the practice of pediatric endocrinologists in Arab countries on the timing and regimen for puberty induction in girls and boys with hypogonadism.MethodsAn online questionnaire was emailed to physicians registered in the Arab Society for Paediatric Endocrinology and Diabetes.ResultsIn total, 106 replies from 17 countries were received. In non Turner syndrome (TS) girls, puberty was induced by 49.4% of participants at 12–13 years and by 32.5% at ≥14 years. Ethinyl estradiol and conjugated estrogen were the most popular preparations used (29.7 and 16.6%, respectively). Of the participants, 60% introduce progesterone either at 2–3 years after starting estrogen or following a significant breakthrough bleeding on estrogen. In girls with TS, 84.2% of participants prescribed estrogen to those aged 11 years and older (51.5% at 11–12 years) and 5.3% prescribed it to those at the prepubertal age. In boys, 57.3% of participants induce at ≥14 years, 80.6% use intramuscular testosterone and 46.5% start with 50 mg/kg/month. Human chorionic gonadotropin is more used in non-Gulf Arab countries (18.2 vs. 2.9%; p 0.036) with a trend of using oral testosterone undecanoate in Gulf states (12.2 vs. 2.0%; p 0.051).ConclusionsWe describe the approach to puberty induction in boys and girls among pediatric endocrinologists in Arab countries. The observed variation in practice would be useful in developing regional consensus guidelines on puberty induction in children with hypogonadism.