CHANGE OF MINERAL DENSITY OF BONE TISSUE IN WOMEN IN PRE - AND POSTMENPAUSA AND ITS CORRECTION

87 patients aged 40-69 years in the period of pre- and postmenopause were examined. In the analysis of age-related dynamics of bone mineral density (BMD) It was found that densitometry indicators corresponding to osteoporosis directly correlate with age and duration of the postmenopausal period. It is advisable in women of this age group with a decrease in bone mineral density, the combined appointment of menopausal hormone therapy (MGT) and non-hormonal therapy affecting bone metabolism (calcitonin). For the purpose of MGT in premenopausal women, the use of femostone 2/10 is effective, in postmenopausal women - femostone 1/10 and femostone 1/5, which does not cause withdrawal bleeding. If there are contraindications to menopausal hormone therapy, the prevention and treatment of osteoporosis should be guided by the appointment of nonhormonal drugs, in particular, calcitonin.

Menopause modulates the circulating metabolome: evidence from a prospective cohort study

Aims: We studied the changes in the circulating metabolome and their relation to the menopausal hormonal shift in 17β-oestradiol and follicle-stimulating hormone levels among women transitioning from perimenopause to early postmenopause. Methods and Results: We analysed longitudinal data from 218 Finnish women, 35 of whom started menopausal hormone therapy during the study. The menopausal transition was monitored with menstrual diaries and serum hormone measurements. The median follow-up was 14 months (interquartile range: 8–20). Serum metabolites were quantified with targeted nuclear magnetic resonance metabolomics. The model results were adjusted for age, follow-up duration, education, lifestyle, and multiple comparisons. Menopause was associated with 84 metabolite measures. The concentration of apoB (0.17 standard deviation [SD], 99.5% confidence interval [CI] 0.03–0.31), VLDL triglycerides (0.25 SD, CI 0.05–0.45) and particles (0.21 SD, CI 0.05–0.36), LDL cholesterol (0.17 SD, CI 0.01–0.34) and particles (0.17 SD, CI 0.03–0.31), HDL triglycerides (0.24 SD, CI 0.02–0.46), glycerol (0.32 SD, CI 0.07–0.58) and leucine increased (0.25 SD, CI 0.02–0.49). Citrate (-0.36 SD, CI -0.57 to -0.14) and 3-hydroxybutyrate concentrations decreased (-0.46 SD, CI -0.75 to -0.17). Most metabolite changes were associated with the menopausal hormonal shift. This explained 10% and 9% of the LDL cholesterol and particle concentration increase, respectively. Menopausal hormone therapy was associated with increased medium-to-large HDL particle count and decreased small-to-medium LDL particle and glycine concentration. Conclusions: Menopause is associated with proatherogenic circulating metabolome alterations. Female sex hormones levels are connected to the alterations, highlighting their impact on women's cardiovascular health.

Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial

Background: Greater trochanteric pain syndrome (GTPS) is a debilitating chronic condition, most prevalent in postmenopausal women. A positive association between high estrogen levels and tendon health may exist, and postmenopausal women have reduced estrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. Purpose: To determine the effect of MHT and exercise on tendon pain and function in postmenopausal women with GTPS. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Postmenopausal women (N = 132; n = 12, lost to follow-up) with GTPS were randomized into MHT and placebo transdermal cream groups combined with tendon-specific or sham exercise. All groups received education about avoiding gluteal tendon compression and load management throughout 12 weeks of intervention. The primary outcome was the Victorian Institute of Sport Assessment for gluteal tendinopathy (VISA-G), and secondary outcomes were measured at baseline and at 12 and 52 weeks. The Global Rating of Change was assessed at 12 and 52 weeks. A linear mixed-effects model was used to assess differences. Body mass index (BMI) was included as a covariate. Results: All participant groups improved over time (baseline vs 12 weeks, P < .001; baseline vs 52 weeks, P < .001). There was no difference among exercise groups measured by all outcomes (VISA-G: baseline, P = .97, mean difference [MD] = 0.10; 12 weeks, P = .49, MD = 2.15; 52 weeks, P = .32, MD = −3.08). There was a significant interaction effect between cream and BMI; therefore, the population was stratified by BMI levels (<25, <30, ≥30). The MHT groups (with exercise and education) had significantly better VISA-G outcomes (baseline, P = .04, MD = −11.20, 95% CI = −21.70 to −0.70; 12 weeks, P < .001, MD = −20.72, 95% CI = −31.22 to −10.22; 52 weeks, P = .002, MD = −16.71, 95% CI = −27.21 to −6.22) and secondary measure scores as compared with placebo at all time points when BMI was <25. Conclusion: MHT or placebo combined with tendon-specific or sham exercise plus education reduced pain and increased function for this population. For women with a BMI <25, MHT with any exercise plus education was better than placebo. A targeted exercise or sham exercise strategy is effective when prescribed with education about avoiding gluteal tendon compression and load management. Registration: ACTRN12614001157662 (Australian New Zealand Clinical Trials Registry).

Oral contraceptive and menopausal hormone therapy use and risk of pituitary adenoma: cohort and case-control analyses

Background No prospective epidemiologic studies have examined associations between use of oral contraceptives (OC) or menopausal hormone therapy (MHT) and risk of pituitary adenoma in women. Methods We evaluated the association of OC/MHT with risk of pituitary adenoma in the Nurses’ Health Study and Nurses’ Health Study II by computing multivariable-adjusted hazard ratios (MVHR) of pituitary adenoma by OC/MHT use using Cox proportional hazards models. Simultaneously, we carried out a matched case-control study using an institutional data repository to compute multivariable-adjusted odds ratios (MVOR) of pituitary adenoma by OC/MHT use. Results During 6,668,019 person-years, 331 participants reported a diagnosis of pituitary adenoma. Compared to never-users, neither past (MVHR=1.05, 95%CI:0.80-1.36) nor current OC use (MVHR=0.72, 95%CI:0.40-1.32) was associated with risk. For MHT, compared to never-users, both past (MVHR=2.00, 95%CI:1.50-2.68) and current use (MVHR=1.80, 95%CI:1.27-2.55) were associated with pituitary adenoma risk, as was longer duration (MVHR=2.06, 95%CI:1.42-2.99 comparing &gt;5 years of use to never, p-trend=0.002). Results were similar in lagged analyses, when stratified by BMI, and among those with recent healthcare utilization. In the case-control analysis, we included 5,469 cases. Risk of pituitary adenoma was increased with ever use of MHT (MVOR=1.57, 95%CI 1.35-1.83) and OC (MVOR=1.27, 95%CI:1.14-1.42) compared to never. Conclusion Compared to never use, current and past MHT use and longer duration of MHT use were positively associated with higher risk of pituitary adenoma in two independent datasets. OC use was not associated with risk in the prospective cohort analysis and was associated with only mildly increased risk in the case-control analysis.

The effect of menopausal hormone therapy on gastrointestinal cancer risk and mortality in South Korea: a population-based cohort study

Background The effect of menopausal hormone therapy (MHT) on gastrointestinal (GI) cancers is controversial, and no research has been conducted in the East. This study investigates the association between MHT and GI cancer risks in South Korea. Methods A prescription-based cohort study was conducted using the NHIS Sample Cohort (2002–2013) of Korea. We used 1:5 propensity score matching, and 22,577 MHT users and 111,113 non-users were selected. Kaplan–Meier survival curves with log-rank tests were used. Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Landmark analysis was used to determine dose–response relationship. Results The median follow-up was 79.6 of months. Kaplan–Meier survival curve showed less frequent GI cancer diagnoses in MHT users compared to non-users (0.13 vs. 0.16 per 100,000 person-years). Menopausal hormone therapy was associated with decreased incidence of GI cancer (HR = 0.809, 95%CI = 0.691–0.946) and colorectal cancer (CRC) (HR = 0.757, 95%CI = 0.577–0.995). Gastric cancer (GC) incidence showed marginal significance (HR = 0.787, 95%CI = 0.605–1.023). The mortality from GI cancer was lower in MHT users than in non-users (HR = 0.737, 95%CI = 0.547–0.993). The relationship between MHT and GI cancer was stronger with increasing MHT dose in terms of both incidence (Ptrend = 0.0002) and mortality (Ptrend = 0.0064). Conclusions The association between MHT use and reduced risks of GI cancers was attributed to CRC and GC and showed a dose–response relationship in a population-based cohort study.