Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Postmenopausal bleeding is an episode of bleeding 12 months or more after the last menstrual period. It occurs in up to 10% of women aged over 55 years. All women with postmenopausal bleeding should be referred urgently. Endometrial cancer is present in around 10% of patients; most bleeding has a benign cause. The peak incidence for endometrial carcinoma is between 65 and 75 years of age. Causes of postmenopausal bleeding include: endometrial carcinoma; cervical carcinoma; vaginal atrophy; endometrial hyperplasia +/- polyp; cervical polyps; hormone-producing ovarian tumours; haematuria and rectal bleeding. The aim of assessment and investigation of postmenopausal bleeding is to identify a cause and exclude cancer. Assessment should start by taking a detailed history, with identification of risk factors for endometrial cancer, as well as a medication history covering use of HRT, tamoxifen and anticoagulants. Abdominal and pelvic examinations should be carried out to look for masses. Speculum examination should be performed to see if a source of bleeding can be identified, assess atrophic changes in the vagina and look for evidence of cervical malignancy or polyps. Ultrasound scan and endometrial biopsy are complementary. Ultrasound scan can define endometrial thickness and identify structural abnormalities of the uterus, endometrium and ovaries. Endometrial biopsy provides a histological diagnosis. The measurement of endometrial thickness aims to identify which women with postmenopausal bleeding are at significant risk of endometrial cancer. If the examination is normal, the bleeding has stopped and the endometrial thickness is < 5 mm on transvaginal ultrasound scan, no further action need be taken.
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PMID:Postmenopausal bleeding should be referred urgently. 2266 14

Hypoestrogenism is the primary etiologic factor for osteoporosis and related fractures, as well as for a number of clinical symptoms that can reduce the quality of life in postmenopausal women. Alternative to classical hormone replacement therapy (HRT) are needed for women that cannot or don't want to be treated with hormones. Selective estrogen receptor modulators (SERMs) are compounds that lack the steroid structure of estrogens, but interact with estrogen receptors (ERs) as agonists or antagonists depending on the target tissue. Tamoxifen, the first generation of SERMs, has been used for decades in the primary prevention and treatment of breast cancer. Tamoxifen exerts positive estrogenic effect on bone protecting bone mineral density (BMD). However, tamoxifen acts as agonist also on the endometrium, leading to an increased risk of endometrial hyperplasia and cancer. In addition, tamoxifen administration is associated with significantly increased risks of stroke, venous thromboembolism, including both deep-vein thrombosis and pulmonary emboli. Thus, these actions, in addition to the increased risk of and hot flushes, prevent the use of tamoxifen for the prevention of osteoporosis. Further generations of SERM, Raloxifene and bazedoxifene were developed for the prevention and treatment of postmenopausal osteoporosis and are now licensed for this indication. In addition. Raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer. On the other hand, the available data indicate that Bazedoxifene exerts a greater anti-fracture activity than Raloxifene. At variance of tamoxifen, both raloxifene and bazedoxifene reduce the risk of endometrial hyperplasia and cancer. However, they are associated with a significant increase the risks of venous thromboembolic events. Although raloxifene and Bazedoxifene prevent postmenopausal osteoporosis, they have not been associated with reductions in climacteric symptoms, particularly hot flushes. In order to find a new approach for menopausal management, SERMs have been combined with estrogens, creating a tissue selective estrogen complex (TSEC) to achieve a favorable clinical profile based on the blended tissue selective activity profiles of the components. Bazedoxifene in association with conjugated estrogens (BZA/CE) is the first TSEC evaluated in an extensive clinical program. BZA/CE administration decreases bone turnover, with an increase in lumbar spine and total hip BMD. The magnitude of these effects are similar to those exerted by HRT and greater than that observed with Raloxifene and Bazedoxifene alone. In addition, BZA/CE significantly reduced the severity and frequency of hot flushes and improved measures of vaginal atrophy and quality-of-life scores, including that for sleep likewise HRT. BZA/CE administration prevents endometrial proliferation, with high rates of amenorrhea over one year. Taken together, all the available data indicate that BZA/CE combination is effective and safe for the treatment for climacteric women, improving the overall quality of life, while protecting the skeleton. The high amenorrhea rate may increase compliance, avoiding the bleedings and side effects related to progestin administration. Further studies are needed to evaluate the ultimate effects of BZA/CE combination on clinical outcomes, such as CVD events, breast and endometrial cancer.
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PMID:Selective estrogen modulators in menopause. 2434 50

Postmenopausal bleeding can be the result of numerous etiologies including endometrial carcinoma, vaginal atrophy, and endometrial polyps. Manifestation of a hematologic disease, such as acute myeloid leukemia (AML), is a rare occurrence. A 65-year-old woman with pancytopenia and postmenopausal bleeding was diagnosed with AML. Endometrial biopsy following dilation and curettage of the uterus revealed extensive mononuclear cell infiltrate consistent with AML. The patient was a poor surgical candidate and subsequently underwent treatment with chemotherapy, hormonal therapy, pelvic radiation, and uterine artery embolization to control her vaginal bleeding. A multi-disciplinary approach is necessary for treatment of post-menopausal bleeding resulting from AML infiltration of the endometrium.
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PMID:Postmenopausal Bleeding Resulting from Acute Myeloid Leukemia Infiltration of the Endometrium. 2628 20

The results of large clinical trials have led physicians and patients to question the safety of hormone therapy for menopause. In the past, physicians prescribed hormone therapy to improve overall health and prevent cardiac disease, as well as for symptoms of menopause. Combined estrogen/progestogen therapy, but not estrogen alone, increases the risk of breast cancer when used for more than three to five years. Therefore, in women with a uterus, it is recommended that physicians prescribe combination therapy only to treat menopausal symptoms such as vasomotor symptoms (hot flashes) and vaginal atrophy, using the smallest effective dosage for the shortest possible duration. Although estrogen is the most effective treatment for hot flashes, nonhormonal alternatives such as low-dose paroxetine, venlafaxine, and gabapentin are effective alternatives. Women with a uterus who are using estrogen should also take a progestogen to reduce the risk of endometrial cancer. Women who cannot tolerate adverse effects of progestogens may benefit from a combined formulation of estrogen and the selective estrogen receptor modulator bazedoxifene. There is no highquality, consistent evidence that yoga, paced respiration, acupuncture, exercise, stress reduction, relaxation therapy, and alternative therapies such as black cohosh, botanical products, omega-3 fatty acid supplements, and dietary Chinese herbs benefit patients more than placebo. One systematic review suggests modest improvement in hot flashes and vaginal dryness with soy products, and small studies suggest that clinical hypnosis significantly reduces hot flashes. Patients with genitourinary syndrome of menopause may benefit from vaginal estrogen, nonhormonal vaginal moisturizers, or ospemifene (the only nonhormonal treatment approved by the U.S. Food and Drug Administration for dyspareunia due to menopausal atrophy). The decision to use hormone therapy depends on clinical presentation, a thorough evaluation of the risks and benefits, and an informed discussion with the patient.
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PMID:Hormone Therapy and Other Treatments for Symptoms of Menopause. 2792 71


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