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

Cyclically administered estrogen helps prevent and treat vasomotor symptoms and atrophic changes in the genitourinary tracts of postmenopausal women. Administering exogenous estrogen may also help prevent postmenopausal bone loss and help treat severe postmenopausal osteoporosis. Although recent studies have indicated an association between estrogen replacement therapy and endometrial carcinoma, a true cause-and-effect relationship has not been established. Thus, estrogen replacement therapy should be administered carefully, considering the risk/benefit ration for each individual, and should use the smallest dose necessary to achieve the desired effect. If irregular bleeding occurs before or during estrogen administration, a complete gynecologic examination (including a histologic examination of the endometrium) is mandatory.
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PMID:Risks and benefits of postmenopausal exogenous estrogen. 60 92

Endometrial cancer occurs more than twice as frequently as cervical cancer. The main risk factors are age, estrogen use, and obesity. Increasing life expectancy and more liberal use of estrogen to prevent postmenopausal bone loss will probably increase the magnitude of the problem. Endometrial cancer is a heterogeneous disease. Good prognosis is associated with obesity and estrogen use and with carcinomas preceded by precancerous hyperplasia. A bad prognosis may be found in women without major risk factors and is associated with a normal or atrophic endometrium. Because of a high prevalence of asymptomatic disease (6.9 per 1,000) and because the group with a poor prognosis is usually asymptomatic, all postmenopausal women should be screened at least one time. For screening, the use of one of the cytologic instruments is recommended; these instruments are safe, easy to handle, and can be used in the office setting without anesthesia. Yields are comparable to dilation and curettage. Family physicians are encouraged to familiarize themselves with cytologic instruments and to use them for screening postmenopausal women in their office.
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PMID:Detection of and screening for endometrial cancer. 327 9

Symptoms due to estrogen deficiency begin in the perimenopausal years and progress as serum levels of this hormone decrease Vasomotor instability, manifested by hot flushes or night sweats, may persist for several months to a few years. Psychologic symptoms include anxiety, tension, depression, insomnia, palpitations, and headaches. Atrophy of the genital epithelium may result in senile vaginitis with symptoms of irritation, burning, pruritus, dyspareunia, and even vaginal bleeding. Even the lower urinary tract mucosa is dependent upon estrogen. Postmenopausal osteoporosis affects 25 to 50% of older women and increases the risk for vertebral, hip, and other fractures. Estrogen therapy for menopausal complaints has received adverse publicity because several reports have indicated that unopposed estrogens increase the risk of endometrial cancer. Added progestogen not only negates this risk but reduces the incidence of endometrial adenocarcinoma in estrogen-progestogen users to less than that observed in untreated women. Estrogen replacement therapy does not increase the risk of breast cancer; the incidence of this malignancy, however, was also less in the estrogen-progestogen users when compared with either the untreated women or from that expected from the national cancer surveys. In evaluating postmenopausal women for hormone replacement, the benefits of estrogen-progestogen therapy must be weighed against possible risks.
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PMID:The menopause. 351 23

Practicing physicians must constantly decide what is the best treatment for each patient. Their decisions are often influenced by prominent professors and by a climate of opinion created by the press and regulatory agencies. If these are wrong, because of pressure from 'consumer advocates', wrong interpretations, or the risks of litigation, physicians may be forced into making inactive decisions which can cause more harm than the treatment under attack. My attention was drawn to this problem by recent actions of the press and the FDA discouraging the use of estrogens because of a putative risk of endometrial cancer. Even if the danger were real, and I consider the evidence faulty, doctors would have to balance risks against benefits. We have 2,718 deaths each year, constant for ten years, from endometrial cancer and at least 50,000 female deaths because of preventable osteoporotic hip fractures. Recent data establish that the doses of estrogen needed to prevent postmenopausal bone loss are lower than those associated with any cancer. History abounds with similar examples. Semmelweis showed that handwashing prevented deaths from puerperal sepsis but was laughed into a madhouse. More recent examples are the long delays in the use of propranolol, cimetidine, bromcryptine, pulmonary surgery, antihypertensive therapy, poliomyelitis vaccination, penicillin and cardiac surgery. An approach to correction of this serious problem will be presented.
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PMID:Dead wrong--estrogens, osteoporosis cancer and public policy. 625 Nov 44

A women spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Many epidemiologic studies have examined the long-term effect of postmenopausal estrogen deprivation and of ERT. Since the 1970s, we have evaluated the risks and benefits of ERT in one population of older women in the California retirement community of Leisure World. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures by about 50%. The effect is greatest in longterm users, but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users have retained more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40%. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. One of the most feared aspects of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The risks and benefits of estrogen replacement therapy: Leisure World. 758 89

An adequate calcium intake is important to attain peak bone mass and to oppose that component of age-related bone loss due to insufficient intestinal calcium absorption. Calcium and appropriate vitamin D supplements are particularly important for preventing cortical bone loss and associated hip fractures in the elderly (Type II osteoporosis). Within the initial 5 years following menopause, there is an accelerated loss of trabecular bone from the spine and distal radius (Type I osteoporosis). At that time, estrogen replacement is most effective for preventing the rapid trabecular bone loss that could otherwise result in vertebral or Colles' fractures. During this early period of estrogen deficiency when excessive bone turnover is releasing large amounts of calcium into the circulation, supplemental calcium is ineffective. Progesterone, often given with estrogen to prevent endometrial carcinoma, may itself have a trophic influence on bone.
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PMID:Calcium, estrogen, and progestin in the treatment of osteoporosis. 798 85

A woman spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Since the 1970s, we have evaluated the long-term risks and benefits of ERT in one population of women, the Leisure World retirement community. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures about 50 %. The effect is greatest in long-term users but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users retain more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40 %. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. A most feared aspect of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk both increaseng dose and decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation. The most important potential risk of ERT is breast cancer. In Leisure World, women who had used a total accumulated estrogen dose of 1500 mg or more had nearly twice the risk of breast cancer compared with nonusers. Short-term low-dose users showed no substantial increased risk. The Leisure World Study shows risks and benefits of ERT similar to other reports in the literature. For postmenopausal women generally, the benefits of ERT--preventing osteoporotic fractures, reducing heart disease, decreasing mortality, and possibly reducing risk of Alzheimer's disease-out-weigh the risks of endometrial and breast cancers. A woman must be fully informed of the risks and benefits of hormone therapy and play an important role in deciding whether to take hormones and which regimen to use.
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PMID:Estrogen replacement therapy in the elderly. 870 21

Oestrogen deficiency is by far the major factor contributing to the high rate of osteoporotic fractures in women. The anti-osteoporotic effect of estrogen may be explained by its property to regulate cytokine secretion and thus balance bone remodeling. In oestrogen deficiency, increased resorption and remodeling will occur leading to osteoporosis. It has been extensively shown that oestrogen replacement therapy (ERT) prevents postmenopausal bone loss and reduces fracture risk by half, provided that an appropriate dose is used. In order to optimize osteoporosis prevention, ERT should be started a early as possible in menopause and be maintained as long as possible. ERT may also be effective in elderly osteoporotic patients in preventing bone loss and, reducing fracture risk. The acceptance of ERT, however, at an older age has not been thoroughly evaluated. A reduction of cardiovascular disease and of climateric symptoms are among other benefits of ERT. So far, only few postmenopausal women are treated with ERT. ERT without progestins has been repeatedly found associated with an increased risk of developing endometrial cancer, but the cyclic addition of progestins protects from endometrial hyperplasia and carcinoma. Combined oestrogen-progestin therapy is as efficient as estrogen therapy alone, but not more so. Since progestins may oppose some of the beneficial effects of estrogens, the lowest dose with the least metabolic impact should be prescribed. Women who have had a hysterectomy, should probably be treated by estrogen replacement therapy only. Meta-analyses concerning breast cancer associated with ERT found a very moderately increased risk (RR = 1.06). Therefore ERT prescription should be discussed openly with women considering all risks and benefits. In women who have suffered from breast cancer, a bone sparing effect of tamoxifen has been shown.
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PMID:Osteoporosis prevention and treatment with sex hormone replacement therapy. 884 55

The incidence of osteoporosis and of cardiovascular disease increases in women after menopause. Although theses diseases can be prevented by estrogen replacement therapy, this treatment is associated with an increased risk of endometrial cancer and perhaps also with an increased risk of breast cancer. Thus, a therapy that could prevent postmenopausal bone loss and lower serum cholesterol concentrations without stimulating reproductive tissues would be desirable. Selective estrogen receptor modulators (SERMs), such as raloxifene and tamoxifen, produce beneficial estrogen-like effects on bone and lipid metabolism, while antagonizing estrogen in reproductive tissue. Both agonist and antagonist activities are mediated via high affinity interaction with the estrogen receptor (ER). Both types of ER (alpha and beta) may be involved in the mechanism by which SERMs produce tissue-selective pharmacology. This review will discuss the roles of ER alpha and ER beta in novel signal transduction pathways.
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PMID:[Estrogen receptor and selective estrogen receptor modulators (SERMs)]. 1036 56

Selective estrogen receptor modulators (SERMs) act exclusively through estrogen receptors and possess tissue-specific agonistic or antagonistic properties. The effects of all referred SERMs in bone and cardiovascular system are estrogenic, namely they inhibit postmenopausal bone loss and favorably influence plasma lipoproteins and some coagulation factors. The aim of this paper is to review the effects of SERMs on estrogen-dependent breast tissues and on the endometrium. There are two types of SERMs in clinical use, based on their chemical structure: the triphenylethylenes and the benzothiophenes. The prototype of the SERMs with triphenylethylene structure is tamoxifen. Tamoxifen, like all other SERMs, is an estrogen antagonist in the breast and is widely used for adjuvant treatment of breast cancer. A recent study suggests that tamoxifen also may prevent breast cancer in patients at risk. Because of the partial estrogenic activity of tamoxifen in the endometrium, its clinical use is associated with uterine hypertrophy and an increased risk of endometrial cancer. Other triphenylethylene SERMs, droloxifene, toremifene, and idoxifene, also show efficacy in the treatment of breast cancer, in a manner similar to tamoxifen. A better toxicology profile and a decreased endometrial estrogen agonism may be advantages of the new triphenylethylene SERMs. Raloxifene is a SERM with a chemical structure different from triphenylethylenes. Raloxifene, a benzothiophene, possesses an estrogen-antagonistic effect in the breast similar to triphenylethylenes. Clinical studies on postmenopausal osteoporotic women on raloxifene as compared with placebo show a significant decrease in the rate of newly diagnosed breast cancers. In clinical studies, in contrast to tamoxifen, no stimulatory effect in the endometrium could be observed with raloxifene.
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PMID:[Effect of selective estrogen receptor modulators on estrogen-sensitive tissues]. 1062 80


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