Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0007222 (cardiovascular disease)
 65,817 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For patients with previous endometrial cancer, ERT is not the accepted practice in the U.S. The therapeutic dictum that estrogen is contraindicated in patients with previous uterine adenocarcinoma is, however, not substantiated by clinical data. The relation of unopposed estrogen stimulation to endometrial hyperplasia and carcinoma, and the published studies relating ERT to endometrial cancer, have resulted in the clinical perception--and cautionary statements to that effect--that estrogen is contraindicated for patients with a history of endometrial carcinoma. The exact biologic effects of ERT on endometrial adenocarcinoma have not yet been studied adequately, however; the initial clinical data suggest that there is no increase in recurrence or mortality. In the meantime, the clinician is left with contradictory data as a basis for determining the proper management of symptomatic patients. The total impact of estrogen deficiency on the health of women and the ratio of benefits and risks of ERT are yet to be defined completely. The preponderance of evidence suggests that estrogen has a beneficial effect on the major cause of death in women, coronary heart disease, by increasing the high-density lipoprotein (HDL) fraction of cholesterol. It is established that estrogen prevents the demineralization of bone and delays the ravages of osteoporosis. No one has died from vaginal atrophy, bladder dysfunction, or hot flashes; the quality of life and marriage have been improved, however, by relieving these symptomatic conditions with ERT. Several studies have attempted to analyze with various statistical models the ratio of benefits to risks, and the majority of authors have concluded that the beneficial effect on cardiovascular disease alone clearly outweighs any known risk.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Estrogen-replacement therapy in patients with previous endometrial carcinoma. 240 7

Women are increasingly spending more years of their lives beyond the menopause, which places them at risk for various health problems due to estrogen deficiency. Tissues and organs with estrogen receptors such as the ovaries, endometrium, vaginal epithelium, hypothalamus, urinary tract, and skin are directly affected by a lack of estrogen production. Other tissues in which estrogen receptors have not been consistently identified, such as bone, are also affected by waning levels of estrogen. The postmenopausal woman frequently experiences neuroendocrine changes (hot flashes) that often dissipate over time and a steady rise in her risk of cardiovascular disease, which approaches that in men of comparable age.
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PMID:Biosynthesis and physiologic effects of estrogen and pathophysiologic effects of estrogen deficiency: a review. 269 Jun 34

This review briefly outlines the pharmacology of natural and synthetic estrogens, and synthetic progestins, and summarizes their beneficial and adverse effects for contraceptive and menopausal therapy. Currently, oral contraceptives contain 30-50 mc synthetic estrogen, and 1-5 mg nor-progestin; menopausal therapy may be either 0.625-1.25 mg natural estrogen or estrogen plus 10 mg medroxyprogesterone acetate daily if the woman has her uterus. The biologic effects of estrogens are : decrease in lipoproteins, increased blood coagulation factors, increased blood pressure, decreased glucose tolerance. Progestins increase blood lipids and increase insulin and glucose. Oral contraceptives increase the risk of cardiovascular disease, particularly in smokers and in women over 35, in proportion to dose. These studies should be recapitulated in more detail with the newer low-dose pills. Orals have far more beneficial effects, besides providing an inexpensive, effective method contraception. The death rate of users of oral contraceptives is 3.7/100,000 (1.8 in nonsmokers and 6.5 in smokers), but the risk is 5.5 times higher in nonusers exposed to pregnancy and childbirth. The risk for users of barrier methods backed up by abortion is lower, but pills are cheaper and more acceptable. If woman did not take oral contraceptives, they would not be protected from cancer of the breast, ovary, endometrium, and ovarian and breast cysts. Menopausal therapy puts woman at increased risk of endometrial cancer only if the estrogen is taken alone, not if progestin is combined with the estrogen. There are no other adverse effects except decreased glucose tolerance and possible comprise of lipoproteins if a norprogestin of menopausal estrogens effectively treat hot flashes, depression, vaginal atrophy and bones loss.
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PMID:The adverse effects of hormonal therapy. 351 31

The use of estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement therapy are reviewed, and recommendations regarding its use are made. Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy. Prevention of cardiovascular disease, aging changes of skin, and the occurrence of mental illness have also been suggested as indications, but beneficial effects of estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of estrogen replacement therapy include endometrial cancer, hypertension, gallbladder disease, and angina pectoris. Breast cancer may also be a risk factor, but a consensus of opinion has not been established. Pulmonary embolism, cerebral vascular accident, or myocardial infarction has not been associated with estrogen replacement therapy. The use of progesterone with estrogen replacement therapy has been shown to reduce the occurrence rate of endometrial carcinoma, but it does not prevent all the actions of estrogen. Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include progesterone for hot flashes and calcium for the prevention of osteoporosis. Other agents may also be effective but have not been tested critically.
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PMID:Estrogen replacement therapy. 702 79

It is estimated that in the future, in industrialized countries, physicians will spend the majority of their time treating women over 65. In terms of the individual female patient, women may expect to live one-third of their lives after menopause. The hot flashes that are experienced by most postmenopausal women, in many cases for 5 years or more, are the most common indications for estrogen replacement therapy, and there are studies showing lower levels of estradiol and estrone in women severely afflicted than in those who are not. A long-range indication for estrogen replacement therapy is osteoporosis, which in the U.S. causes 700,000 bone fractures annually, of which 300,000 are femoral neck (hip) fractures. Another common fracture in this group is vertebral fracture, which is six to ten times as common in postmenopausal women as it is in men of middle or old age. Another condition thought by a majority of researchers to benefit from estrogen replacement therapy is cardiovascular disease. In fact, it is well demonstrated that there is significant reduction of cardiovascular risk in healthy users and in women with other risk factors. Atrophy of mucosal surfaces of the genitourinary tract is treated both by systemic administration of estrogen and by topical administration of estrogen-containing cream. Certain conditions, grouped together as the "menopausal syndrome," may also be indications for estrogen replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical management of the menopausal woman. 849 55

Menopause is marked by the permanent cessation of menstrual bleeding. Deprivation of ovarian hormones due to decreasing ovarian activity causes widespread physiological effects. Disturbances in menstrual pattern and hot flashes are major reasons for hormone replacement therapy (HRT), but prevention of osteoporosis and cardiovascular disease are other considerations. Despite the large number of different hormone treatment regimens available, such problems as continued bleeding and concern about side effects engenders low compliance. To enhance compliance, it is important to ensure that post-menopausal women and their physicians are aware of the probable risks and benefits of hormone therapy before deciding whether or not to use preventive HRT.
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PMID:Physiological effects of ovarian hormones: clinical aspects and compliance. 886 78

Ovarian failure is a common consequence of chemotherapy and radiotherapy in women undergoing bone marrow transplantation. The longer survival in these women has raised, during the past years, the need for a better quality of life. The objective of the present study has been to evaluate perspectively the potential benefit of hormonal replacement therapy in 24 women who underwent bone marrow transplantation. The data obtained indicated that hormonal replacement therapy results effective in preventing and/or relieving the multiple manifestations of gonadal failure, including amenorrhea, hot flashes, atrophy of genital apparatus, osteoporosis and cardiovascular disease.
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PMID:[Efficacy of estrogen-progestin replacement therapy after bone marrow transplantation]. 899 81

To obtain information to guide future health care planning, data from government and other sources on the demographic and medical characteristics of menopausal Taiwanese women were reviewed. The average age at menopause, according to a 1995-96 study of 386 menopausal women in Taipei, is 49.5 +or- 2.3 years. In 1994, women aged 50 years and over comprised 18.3% of Taiwan's female population and 8.9% of the total population. 68% of menopausal women in the 1995-96 study reported lower back pain; other common symptoms included fatigue (59%), decreased memory (55%), vaginal dryness (50%), hot flashes (49%), insomnia (46%), loss of libido (46%), dry skin (41%), and depression (40%). After menopause, the prevalence of hypertension and coronary heart disease becomes higher among women than men. In addition, bone mineral density decreases markedly and 19.8% of women 65 years of age and over have experienced vertebral fractures. About 60% of malignant neoplasms diagnosed in 1992 involved women aged 50 years and older. By age 60 years, women's risk of cancer begins to increase substantially. An estimated 80% of Taiwanese women initiate hormone replacement therapy for relief of menopausal symptoms, prevention of cardiovascular disease, and prevention and treatment of osteoporosis. Since 30% of menopausal women in Taiwan are currently widowed or unmarried, there is a need to design programs that offer psychosocial support as well as comprehensive medical care.
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PMID:Demographic characteristics and medical aspects of menopausal women in Taiwan. 934 80

ERT/HRT is clearly of use in relieving menopausal symptoms such as hot flashes and genitourinary changes. ERT/HRT also clearly reduces the risks of osteoporotic fracture, of cardiovascular events and deaths, and of developing colon cancer. ERT and, perhaps even more, HRT are, however, associated with an increased risk of developing breast cancer. This effect becomes more marked with long-term use (> or = 10 years); ERT/HRT use for more than 10 years is also associated with an increase in deaths from breast cancer. Because the underlying mortality risk for the average woman is, however, much greater from cardiovascular disease (approximately 22%) than from breast cancer (approximately 3.3%), the reduction in risk of cardiovascular death associated with ERT/HRT (from 22% to 15%) much outweighs the increase in risk of death from breast cancer (from 3.3% to 4.1%). Thus, overall, the average woman will gain more year(s) of life than she will lose by taking ERT/HRT. Even for a woman with a high risk of breast cancer and a low risk of cardiovascular disease, there will still be a net, although lower, gain in year(s) of life. Thus, the use of ERT/HRT would seem well worth considering for a well woman at the time of menopause.
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PMID:Estrogen/hormone replacement therapy and the etiology of breast cancer. 992 44

Hormone replacement therapy (HRT) is considered the standard of care for managing the acute (e.g., hot flashes, vaginal dryness) and long-term (e.g., increased risk of cardiovascular disease, osteoporosis) sequelae of menopause. A group of synthetic nonsteroidal compounds, which act on the estrogen receptor, have been promoted for use as an alternative to hormonal therapy for postmenopausal women. Originally called antiestrogens because of their ability to antagonize the action of estrogen, these compounds possess both agonist and antagonist properties of estrogen action. They are now referred to as selective estrogen receptor modulators (SERMs). This article reviews the mechanism of action and the efficacy and safety data for SERMs currently used for clinical purposes. These data may indicate why the use of SERMs is a controversial alternative to HRT.
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PMID:Selective estrogen receptor modulators: a controversial approach for managing postmenopausal health. 1032 87


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