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

The pathophysiology of primary osteoporosis and the various therapeutic regimens that have been used are reviewed. Osteoporosis is a major public health problem because the incidence of hip, wrist, and vertebral fractures associated with bone loss is high. Postmenopausal women are at increased risk for developing osteoporosis because bone mineral content is lower in women than in men, dietary calcium intake is frequently insufficient, intestinal absorption of calcium decreases with age, and the rate of bone loss accelerates at menopause. The efficacy of many single and combination therapies in preventing or treating osteoporosis has been studied. Differences in study design and diagnostic techniques and the heterogeneous nature of osteoporosis make evaluation of clinical trials difficult. Exercise helps to maintain skeletal mass, but amenorrhea caused by vigorous activity may be harmful. The efficacy of estrogen replacement therapy is documented best; many studies have shown that estrogens slow the rate of bone loss and reduce the incidence of fractures, but the association of estrogen use with endometrial cancer and breast cancer is of concern. Progesterones may protect against endometrial cancer, but undesirable effects of oral contraceptives have resulted in a hesitancy to use combination hormonal therapy. All adults should meet daily nutritional requirements for calcium, but this intake may be insufficient for elderly persons and is below recommended doses for treating osteoporosis. A daily intake of at least 1000-1500 mg of elemental calcium has been shown to slow the rate of bone loss. Nutritional requirements for vitamin D should be met, but benefits from pharmacologic doses have not been demonstrated. The role of fluoride, calcitonin, anabolic steroids, and vitamin D metabolites is unclear. Fluoride has the potential to increase bone mass, but effects on bone histology and fracture rates require further study. The major goals for the management of osteoporosis are maintenance of bone mass and prevention of fractures. An adequate intake of calcium and regular weight-bearing exercise are important preventive measures. Despite the documented effectiveness of estrogens, risks associated with long-term use are of concern.
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PMID:Pathogenesis and management of primary osteoporosis. 352 28

Prescription of oral contraceptives is reviewed by giving practical tips on the absolute contraindications, timing of the first dose, dose of estrogen, choice of type of progestin, reasons for changing the combination, and a list of benefits of oral contraceptives. The major risk in taking orals is cardiovascular disease, but actual risks are clustered in subsets of women. Those at high risk are women over 45, smokers over 35, and smokers of any age with cardiovascular risk factors. Generally women should start with a 30 or 35 mcg estrogen combined pill, and perhaps consider taking a higher estrogen dose if they experience breakthrough bleeding or amenorrhea. The 1st cycle can be started at any time up to 6 days after Cycle Day 1 or after spontaneous or induced abortion. Women taking bromocriptine should also begin contraception soon after delivery. Signs of potential major complications are abdominal pain, chest pain or dyspnea, headache or neurologic symptoms, visual or speech problems, or leg pain or weakness. Benefits of oral contraception include menstrual regulation, decreased menstrual flow, prevention of functional ovarian cysts, protection against ovarian and endometrial cancer by half, against benign breast disease, and possibly against pelvic inflammatory disease.
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PMID:Oral contraceptives. Who, which, when, and why? 362 38

A 54-year-old woman with hyperprolactinemia and amenorrhea that occurred with phenothiazine and tricyclic antidepressant use developed a stage IBG2 endometrial adenocarcinoma. This is believed to be the first case reported of endometrial carcinoma associated with drug-induced hyperprolactinemia.
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PMID:Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia. 394 69

In this discussion of Depo-Provera (DMPA) attention is directed to the following: pharmacology and mode of action; clinical considerations; cervical dysplasia; breast cancer; and endometrial carcinoma. DMPA, a microcrystalline suspension of medroxy-progesterone acetate, is used widely around the world as a contraceptive, particularly in developing countries. MPA (medroxy-progesterone acetate) is a synthetic progesterone which in its mycrocrystalline depot form can be delivered by simple intramuscular injection or jet injector to that depending on the dose administered plateau contraceptive blood levels will be maintained for 90-180 days when doses of 150 mg and 300 mg respectively are used. The effect of DMPA in suppressing ovulation is at the hypothalmic level where it inhibits the gonadotrophic release responsible for the midcycle surge in luteinizing hormone responsible for ovulation. When 150 mg is administered every 3 months pregnancy rates range from 0.0-1.2/100 women years. The pregnancy rates range from 0.0-3.8/100 women years when 300 mg is administered every 6 months. The drug is usually administered initially in the first 7 days of the menstrual cycle to avoid possible effects on an established pregnancy. Menstrual disturbances are the major reason for discontinuation of DMPA. The usual side effects are amenorrhea, irregular but infrequent bleeding, and a few instances of prolonged or heavy bleeding. There is no evidence to suggest that DMPA increases the risk of invasive cancer of the cervix, but the evidence regarding the incidence of cervical dysplasia is ambiguous. There have not been any cases of breast cancer that can be related to DMPA use, but DMPA toxicology studies on beagle bitches revealed an increased incidence of benign and malignant breast tumors. It is well established that in adenocarcinoma of the endometrium DMPA is effective in causing regression and preventing recurrence of this tumor.
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PMID:Depo provera in perspective. 646 84

There are an estimated 8-10 million oral contraceptive (OC) users in the U.S. Investigation of the effects of OCs on neoplasia is not easy; currently 4 investigative methods are used: 1) case reports, 2) disease rate and trends, 3) case-control studies, which are the main source of careful retrospective information, and 4) cohort studies, which compare the incidence of disease in patients exposed to suspected environmental factors, and in those who are not exposed. Major risk factors for carcinoma of the breast are female sex, age, genetic predisposition, previous benign breast disease, and previous cancer of one breast; undetected breast cancer may be present for many years before diagnosis, and risk is increased in patients with chronic cystic mastitis or fibrocystic disease of the breast. Clinical observations have suggested a strong association between endocrine influence and the incidence or progression of breast cancer; current evidence tends to support the role of estrogens in the etiology of carcinoma of the breast with respect to long-term estrogen administration, but this evidence is not valid for young patients who are on combined OCs. Most studies have documented a decreased risk of benign breast disease with length of OC use persisting for 4 years; these studies, however, did not analyze lesions by histologic type. Studies that show a protective effect on benign disease do not show the same protective effect for breast cancer. Data from cohort studies show no association of OCs with breast cancer. Since 1972 a number of reports have associated OCs with liver tumors, stating that risk increases with duration of use. A national survey revealed that the frequency of malignant tumors increased with age, but that the frequency of benign lesions had a peak in the 26-30 age group which corresponds to increased use of OCs. Benign tumors are dangerous because they tend to rupture spontaneously. The association between pituitary adenoma, causing postpill amenorrhea, and OC use is very controversial. OC use may also cause endometrial hyperplasia; postmenopausal estrogen use has also been associated with endometrial carcinoma, although the causal relationship has never been proven; progestogens may be useful in the therapy of some endometrial carcinomas. Carcinoma of the cervix seems to be more influenced by age at 1st intercourse and by multiple sexual partners than by OC use; several case-control studies have shown that there is no significant difference between incidence among OC users and nonusers. Data about the association between OCs and ovarian carcinoma are reassuring but incomplete. OCs should not be used in patients with positive chorionic gonadotropin titers who have been treated for hydatidiform mole.
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PMID:Neoplasia and hormonal contraception. 702 11

In Canada depot medroxyprogesterone acetate (DMPA) (Depo-Provera, Upjohn Company of Canada) has been cleared for use in the management of endometriosis in the nonpregnant woman and for palliation of advanced endometrial cancer. There remains some question as to whether physicians are authorized to use this drug for other clinical conditions. The health protection branch of the Department of National Health and Welfare, after a review of the world literature and data on the clinical use of this drug for indications other than those mentioned, has concluded that the available clinical experience with DMPA shows a favorable risk/benefit ratio and that the drug does not present an undue health hazard. Since the 1st clinical studies began in the early 1960s experience with DMPA for contraception has totalled more than 10 million women years. It is estimated that over 1.2 million women in various countries are currently using DMPA for contraception and that several thousand women have used it for 10 years or longer. Available data indicate that the risk/benefit ratio for DMPA in a appropriately selected population is as favorable as that for oral contraceptives (OCs) or IUDs. These statements have been supported by many international organizations concerned with family planning. The special advisory committee on reproductive physiology of the health protection branch reviewed the October 1981 publication concerning the use of DMPA in the Ontario government facilities for the mentally retarded. Its authors considered "of borderline significance" the finding of 3 deaths from carcinoma of the breast in 533 women treated with DMPA at some time during their lives. The evidence for a causal relationship was very tenuous. The composition of the study cohort and the control group as well as the incomplete data collection made the statistical evaluation questionable. Also the higher prevalence of carcinoma of the breast in mentally retarded individuals and in patients with epilepsy and the fact that the other medications many of these patients must have taken were not reported or commented upon further confuse the issue and invalidate the inferences. From a review of the world literature it was learned that among 11,500 DMPA users in the US there have been only 4 reported cases of carcinoma of the breast, for a rate that is lower than that expected in a Canadian control population. The committee reaffirms its opinion tha DMPA is safe in the management of specific clinical problems. It is believed that there is no undue health hazard when DMPA is used to produce amenorrhea in physically or mentally handicapped individuals unable to cope satisfactorily with menstrual hygiene.
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PMID:Should depot medroxyprogesterone acetate be considered for additional uses? 713 35

Menopause is an endocrinopathy characterized by hypoestrogenism. Estrogen can be replaced easily. Available preparations can be taken by mouth, intramuscularly, transdermally, or transvaginally. Unopposed estrogens increase the risk of endometrial cancer, which can be overcome by the concomitant administration of a progestin agent. The progestin can be administered cyclically either every month, resulting in a monthly menses, or every 3 months, resulting in menses every 3 months. The progestin can also be administered every day, which achieves amenorrhea in over half of the patients; the remainder have breakthrough bleeding. Abnormal bleeding can be assessed by either endometrial biopsy or transvaginal ultrasound.
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PMID:Practical aspects of hormone replacement therapy. 749 85

Many otherwise healthy women will experience a significant disruption in lifestyle from abnormal uterine bleeding. Most of those seeking medical attention will not be at risk for developing anemia. In each case, a thorough search for underlying systemic, hormonal, and organic causes should be instituted. The use of blind endometrial sampling to evaluate the uterine cavity, by itself, is an inaccurate technique for diagnosing pathologic conditions commonly associated with menorrhagia, such as endometrial polyps, submucous myomata, and focal endometrial abnormalities including adenocarcinoma and its precursors. The supplementary application of diagnostic hysteroscopy with directed biopsy will ensure the recognition of these intracavitary lesions. The majority of women found to have endometrial polyps and submucous myomata can gain a successful reduction in their menstrual flow without hysterectomy by undergoing hysteroscopic removal of these lesions. Those without other uterine or pelvic pathology and who are closer to perimenopause are more likely to sustain long-lasting relief from these procedures. Medical therapy should be the first line of treatment for premenopausal women who are found to have no obvious cause for their abnormal uterine bleeding. Many of those who do not respond to, are unable to tolerate, or are unwilling to attempt this approach will undergo hysterectomy as the final answer. The absence of uterine pathology in most of these cases places an absolute demand on our specialty to innovate, and, whenever suited, to use more conservative surgical solutions. Our efforts to alter this behavior will undoubtedly be closely monitored by agents of managed care aiming to reward measures that reduce cost and improve the quality of care. The use of hysteroscopic ablation and resection to treat women suffering from intractable menorrhagia can safely and effectively reduce menstrual blood flow and should significantly curtail the performance of unnecessary hysterectomy. The comparative benefits and long-term advantages of these techniques beyond hysterectomy await the results of further studies. Furthermore, the risks of these hysteroscopic procedures to produce iatrogenic adenomyosis or to conceal or delay the usual signs of adenocarcinoma have yet to be ascertained. Vigilance for endometrial disease must not dwindle in the face of amenorrhea, as evidenced by a recent case report describing the development of endometrial carcinoma after 5 years of amenorrhea following endometrial electrocoagulation. Future methods of endometrial destruction for the control of abnormal uterine bleeding may include the nonhysteroscopic use of radio frequency, thermal transfer, hyperthermia, and photodynamic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:What is the role of hysteroscopy in the management of abnormal uterine bleeding? 755

The selection of contraception for women over the age of 35 presents significant problems. The popular IUD is often contraindicated on account of producing pathological cervical and/or uterine changes. In such women the suitable contraceptives are pure gestagen pills and injectables (Depo-Provera and norethindrone enanthate). Depo-Provera contains the active ingredient medroxyprogesterone acetate (DMPA), which imitates the activity of endogenic progesterone and increases the activity of 17-hydroxyprogesterone 6- or 7-fold. Its mechanism of action on the uterine epithelium consists of antiestrogenic and antiandrogenic activity. In 1995 approximately 3.5 million women were using DMPA. Its contraceptive effectiveness amounts to 0-1.2 pregnancies per 100 women in the course of 1 year. In a 1987 multi-centered trial it was observed that the use of 250 and 500 mg of DMPA every 9 months produced a higher incidence of pregnancy than the use of 150 mg every 3 months. The causes of discontinuation of DMPA use are irregular bleeding (10.5%), reduction of libido (1.6%), and weight gain (1.4%). A 1984 clinical study of 3905 women showed that 54% of them had no untoward effects while using DMPA. The frequency of development of amenorrhea with DMPA use varies from 8% to 72%. Its hematological parameters are good and some studies showed that DMPA does not increase the risk of development of cancer of the endometrium, ovaries, and cervix. A 1991 study suggests that the relative risk of breast cancer may increase after 4 years of use of DMPA in women under 35, however, according to a 1994 study, above this age the risk is minimal. DMPA use lowers the risk of endometrial cancer, and this protective effect lasts for 8 years after cessation of use. Higher doses of DMPA treat endometrial cancer. After halting DMPA use the average time for conception to occur is 5.5 months. DMPA use in the first trimester does not produce adverse effects on the newborn or on lactation.
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PMID:[Contraception with injectable long-acting preparation depo-provera]. 765 32

In patients with intrauterine adhesions severe enough to produce amenorrhoea, biologically active endometrium can undergo malignant change. To our knowledge, this is the first reported case of endometrial carcinoma arising within intrauterine synechiae. A 71-year-old woman receiving unopposed estrogen developed post-menopausal bleeding. At endovaginal sonography we detected a polypoid mass. Extensive intrauterine synechiae within the uterus were noted during hysteroscopy, and a polypoid lesion was seen adjacent to a synechia. Biopsy demonstrated endometrial adenocarcinoma arising from a synechia. Hysterectomy and bilateral salpingo-oophorectomy were performed. A well-differentiated adenocarcinoma of the endometrium was demonstrated. Asherman syndrome and endometrial adenocarcinoma can exist simultaneously. In such cases, hysteroscopy is essential for diagnosis of synechiae and for target biopsy.
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PMID:Endometrial carcinoma arising within extensive intrauterine synechiae. 780 69


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