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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was undertaken to investigate the effect of various forms of hormone replacement therapy (HRT) upon postmenopausal women while controlling as many variables as possible. It was felt that the age, duration of amenorrhoea and the general health of the patients should be as comparable as possible and that each patient should provide her own pretherapy and post-therapy control data. In addition, it was felt that any placebo effect should be investigated and the patients were therefore randomly allocated to placebo tablets or one of six available forms of HRT. The age/sex registers of two large general practices were scrutinized and all women between 49 and 54 years of age were asked to cooperate; for a variety of reasons only 56 women were suitable and willing to take part in the project, yielding 8 women for each of the seven possible therapy groups. Blood samples were taken at 7-day intervals three times before therapy was given and the mean of the three values was used as the control value. The women returned on day 21 of each subsequent therapy cycle for six consecutive months and finally three months after discontinuing therapy. From the data the following broad conclusions can be drawn: (i) some women have classic symptoms of hot flushes and sweating despite high endogenous oestrogen concentrations; (ii) vaginal cytology is a relatively poor indicator of endogenous oestrogen status; (iii) while follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations are reduced on HRT neither is decreased to anywhere near premenopausal values while prolactin is unaffected; (iv) plasma cholesterol levels are reduced on HRT, the pulse rate is slower and both systolic and diastolic blood pressure are reduced to a small but significant extent; (v) there is no adverse effect upon blood clotting; and (vi) most women experience significant or complete relief of symptoms on all forms of HRT as do some women taking a placebo. The combined preparations containing an oestrogen and progestogen produced vaginal bleeding in only 80 per cent of the women. Thus protection by regular endometrical shedding may not be afforded to all women. As vaginal bleeding is unacceptable to most women if they can achieve the same symptomatic relief without inducing menstruation, it is suggested that women have a low dose oestrogen preparation prescribed cyclically for 6 to 12 months. If therapy is to be maintained for a longer time, uterine curretage should be undertaken at regular intervals to exclude the possibility of endometrial carcinoma developing.
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PMID:A prospective, controlled trial of six forms of hormone replacement therapy given to postmenopausal women. 39 99

The spectrum of progestin therapy has changed and expanded during the last few years. 1. The drug-therapy of choice in endometriosis is the medication of progestins for at least six months, for instance ethinyl-testosterone. If a patient wants additional children the "more gentle" dydrogesterone should be considered. 2. In the treatment of dysmenorrhea combination pills should be given, sequentials should be avoided. In the case of incompatibility of estrogens or in danger of oversuppression syndrome dydrogesterone should be applicated. 3. Dysfunctional bleedings should lead to an intense search for their cause. The treatment consists in an estrogen-progestin combination for 9 days and in cyclic continuation of this therapy for at least a further three months. In the case of hemorrhagic diathesis progestin treatment should be continued. 4. Cyclic adequate progestins have proofed to be successful in handling of hirsutism. The choice of the preparation depends on the patient's wish for children. 5. The progestin test is still the first step in diagnosis of amenorrhea. 6. Progestin therapy is indicated in progressive endometrial carcinoma. Some medical centres treat carcinoma of the mamma successfully with progestins. 7. Nowadays fast and early hormonal pregnancy tests are available. The progestin-pregnancy-test is limited to cases of premenopause. 8. The so-called short luteum phase has received considerable attention as a possible cause of infertility. In these cases a substitutional therapy of progestins should follow. Clomiphene or HCG-therapy is advisable. In short luteum phase and premenstrual spottings potent progestins should be given. 9. High dosage of progestins are in common use in the treatment of abortus imminens. 10. Combination pills and sequentials are widely used, the possible methods of a pure progestin contraception are: minipills, three-month-injections, implanted silastic capsules with progestional compounds, progestin impregnated intrauterine devices, vaginal silastic rings impregnated with progestional compounds. 11. Carcinogenesis of progestins was not detectable. 12. Some progestins are teratogenic.
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PMID:[Current status of gestagen administration. 2. Gestagen therapy in the area of reproduction]. 55 11

After exploring the possible mechanism of action of oral contraceptives through an estrogen progestin combination, as well as by means of the sequential method, the pathophysiologic and side effects of the pill, as it appears in the literature, is explored in depth. Thromboembolitic disease is the only condition in which there is a definite association with the use of oral contraceptive pill, and there is some doubt as to how strong the association really is. Some studies suggest that mortality from thromboembolic disorders which can be attributed to the pill is about 3/100,000 per year. Studies have also shown that mortality trends from thromboembolitic disease among women of childbearing ages were parallel to the increased use of oral contraceptives among this group of women, however the data may be weak. Data from various sources indicate that the estrogenic component of the pill are primarily responsible for the thrombogenic effect, with estrogen increasing platelet adhesiveness and enhancing coagulability. Progestogens, on the other hand, enhance fibroinolysis and do not alter platelet function or coagulation. Other side effects of the pill such as naseau, headaches, and weight gain are usually not of any serious consequence. According to 1 study, amenorrhea after cessation of the pill has occurred in very small numbers, but 98% of the women are ovulatory within 3 months after cessation of the pill. The oral contraceptive pill may actually have beneficial effects on genital and endometrial cancer due to the pill's progesterone content. Estrogens have shown both a positive and negative influence on cancer of the uterus and breast, depending on the menopausal status of the women. It is generally agreed that the best dosage of hormones in the pill is the lowest possible varying with the size and body weight of the woman, among other factors. Some studies have shown that in Puerto Rico, IUD users have a higher continuation rate than characteristics than the pill users, thereby making the 2 groups incomparable.
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PMID:Oral contraceptives: a review of the literature. 109 15

Certain epidemiologic, histologic, and biochemical data on the effects of estrogens and progestogens on the endometrial, physical, psychological, and lipid status of postmenopausal women are reviewed. Unopposed estrogen replacement increases the risk of endometrial cancer not only while treatment is being taken but also for many years after it is discontinued. Strategies must be developed for posttreatment surveillance. The addition of a cyclic progestogen reduces this risk, but it is not clear whether the reduction is to, or below, that observed in an untreated population. Protective doses of C-19 (norethindrone) and C-21 (medroxy-progesterone acetate) progestogens are suggested. All progestogens may cause physical, psychological, and metabolic side effects. In addition, most women taking cyclic progestogens experience regular withdrawal bleeding. Continuous/combined therapy has been introduced to minimize these side effects and induce amenorrhea. Published data on the efficacy and safety of continuous combined therapy are few. Although the regimen is effective in relieving menopausal symptoms and inducing endometrial atrophy in most patients, side effects of progestogen are common and there is a high incidence of bleeding in the first few months, which is unacceptable to many patients. In our view, the effect of continuous combined therapy on lipids and lipoproteins has not been properly addressed. Based upon the available literature, we believe that the enthusiasm for continuous combined therapy is premature and we urge caution in its use until further, more conclusive, data become available.
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PMID:The role and use of progestogens. 217 92

Oral contraceptive (OCs) of high efficacy containing estroprogestins (EP) were introduced in the 1960's and since then more than 250 million used them. Their benefits include regular menstrual cycles and protection against genital tumors. Dosage seems to be directly related to risks and benefits, therefore new types of low-dose progestins have been developed. Their mechanism of action is based on hypothalamic- hypophysic control, EP suppress the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Their effects are as follows: the cervical mucus becomes more viscous providing a barrier against spermatozoa, regressive (atrophy) modifications and proliferative alterations of the endometrium, and metrorrhagia induced by estrogens and amenorrhea provoked by progestins. The sequential pill requires administration of estrogens in the 1st phase and estroprogestins in the 2nd phase. They minimize physiological and hormonal effects, but the failure rate is 2-3% per woman year. Combined methods of monophasic, biphasic, and triphasic design are used from the 1st to 5th day of menstruation. They block ovulation with a high degree of efficacy, but the stimulating action of EP on the endometrium produces spotting, premature or late metrorrhagia, and amenorrhea. OCs protect against malignant epithelial tumors of the ovaries. It is estimated that 1700 ovarian carcinomas and 2000 endometrial carcinomas are averted each year by the use of the pill in the US. Endometrial cancer risk is halved by EP. 7 epidemiological studies have found no association between the pill and breast cancer, and the risk of benign mammary lesions is also reduced. Accurate anamnesis is mandatory for prescribing safe OCs including screening for coagulation, hepatic function and glycemia tests, and colposcopic examination. Smoking and the pill as well as age under 16 and over 36 increase risks. Nonetheless, the benefits of EP contraceptives outweigh the risks.
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PMID:[Hormonal contraception using estroprogestins]. 218 66

Menstrual abnormalities, such as menometrorrhagia and amenorrhea, occur with great frequency before liver transplantation due to chronic liver disease. This study of 19 patients, of whom 2 had prior hysterectomies and 6 had regular cycles, reported that only two 41 year old women still had irregular menstrual patterns after transplantation. There was no endometrial carcinoma. Thirteen had regular menstrual cycles with a median of 8 weeks afterwards, and two had a secondary amenorrhea at the ages 38 and 41. Also, two patients received cervical conization due to carcinoma, and two had healthy babies even though one had some cholestasia between the 36 and 38th weeks. Preoperative procedures included 5 curettages for menometrorrhagia, 1 prolapsis operation and tubal sterilization. The 12 patients over 45 years, of whom 1 had a hysterectomy, never regained a menstrual cycle after transplantation. Other preoperative procedures included 4 curettages for menometrorrhagia and postmenopausal blood loss, 1 cervix conization, 1 prolapsis operation, and 2 tubal sterilizations. It is suggested that contraception be used for the 1st year following transplantation, and that sterilization is not necessary when transplantation is an option; this would minimize the high rate of hysterectomy in primary biliary cirrhosis.
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PMID:Normalization of menstrual pattern after liver transplantation: consequences for contraception. 228 99

The patient with androgen excess may present with amenorrhea, oligomenorrhea, painless metromenorrhagia, or infertility. Adrenal and ovarian tumors, though uncommon, must be excluded in the workup. The long-term sequelae of untreated anovulation includes adenomatous hyperplasia and cancer of the endometrium. Treatment can range from uncomplicated follow-up with cosmetic advice to the use of potent drugs that induce ovulation.
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PMID:Gynecologic problems of androgen excess. 235 85

Most patients who have a change in menstruation can be evaluated and treated on the basis of a brief history, a physical examination, and a few laboratory tests. Because menstrual dysfunction can cause worry and inconvenience, patients should be promptly treated. Pregnancy must be excluded as a cause of amenorrhea in the initial evaluation. Other possible causes that must be ruled out include hypothalamic or pituitary tumors and severe thyroid disease. Amenorrhea should be treated to avoid possible complications such as osteoporosis, cardiovascular disease, and uterine or endometrial cancer. Treatment methods depend on whether the lack of menstruation is caused by an excessive estrogen level or estrogen deficiency.
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PMID:Solving the mystery of menstrual dysfunction. 265 5

Endometrial carcinoma in young women is a rare but well-documented clinicopathologic entity. Four cases revealed some unusual clinical and pathologic features. Patient 1 was the first recorded case of a young woman (aged 24) on maintenance peritoneal dialysis for chronic renal failure who developed endometrial carcinoma with nonvirilizing oligoovulatory polycystic ovarian enlargement. Following subtotal proctocolectomy for familial polyposis coli complicated by a colonic and rectal carcinoma, patient 2 developed, at age 24, a grade 3 endometrial carcinoma in the absence of any risk factors; she was still alive three years postoperatively despite the subsequent development of a grade 3 astrocytoma in the left temporal region. Patient 3 presented at age 32 after ten years of amenorrhea with the clinical features of the Stein-Leventhal syndrome and abnormal uterine bleeding related to a grade 1 endometrial carcinoma; she also had focal dysplasia and adenocarcinoma in situ of the endocervix. Patient 4, who had no risk factors, developed a grade 2 endometrial carcinoma at age 34 despite constant use of combined oral contraceptives for one year and intermittent exposure to them for the previous ten years. Endometrial carcinoma is a rare but important cause of abnormal uterine bleeding in young women; the prognosis can be improved only by prompt diagnosis and appropriate therapy.
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PMID:Endometrial carcinoma in young women. A report of four cases. 279 70

The value of transvaginal sonography in detecting gynecologic disease currently is being defined. To evaluate transvaginal depiction of the endometrium, transvaginal sonograms were compared with conventional transabdominal scans in 29 patients whose sonograms revealed endometrial abnormalities. The two techniques were compared for image quality and ability to provide unique diagnostic information. Sonographic findings included fluid collections (16), thickened and/or echogenic endometria (10), endometrial irregularities (two), and echogenic foci (two). Clinical diagnoses included early intrauterine pregnancies (five), pseudogestational sacs of ectopic pregnancy (one), intrauterine contraceptive devices (two), endometrial carcinoma (one), and intrauterine synechiae with amenorrhea (Asherman syndrome) (two). In most cases (77%), diagnostic information was obtainable by either transabdominal or transvaginal sonograms, although in 23% transvaginal scanning provided unique diagnostic information not available with the transabdominal technique. In no case did transabdominal sonography contribute diagnostic information not provided transvaginally. The quality of the transvaginal image was judged to be better than that of the transabdominal image in 63% of cases; image quality was the same in 33% of cases and worse in 3% of cases. The results show that transvaginal sonography is often superior to transabdominal scanning in the evaluation of endometrial abnormalities. Transvaginal sonography may be the preferred technique in these cases.
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PMID:Endometrial abnormalities: evaluation with transvaginal sonography. 327 46


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