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

Osteoporosis is a major health problem in postmenopausal women. Although estrogen replacement in adequate dosage can slow or even prevent bone loss, only a small percentage of postmenopausal women receive such therapy; many who do fail to comply with the prescribed regimen because of the fear of cancer and the occurrence of withdrawal bleeding, irregular bleeding, or both, and other side effects. Use of lower estrogen dosages has been suggested as a means of improving compliance and enhancing safety without compromising efficacy. Compared with standard therapy, low-dosage estrogen may minimize the increased risk of both endometrial hyperplasia and endometrial cancer. Most women find low-dosage estrogen more acceptable than higher dosages because they experience less bleeding and are more likely to become amenorrheic. Low-dosage estrogen along with sufficient calcium intake effectively maintains bone density in postmenopausal women. In the recent study of unopposed estrogen therapy described here, micronized 17 beta-estradiol in the range of 0.5 to 2.0 mg, given with dietary and supplemental calcium to ensure a minimum of 1500 mg/day, effectively maintained spinal trabecular bone density. None of the women who received the lowest dosage of 0.5 mg/day micronized 17 beta-estradiol experienced vaginal bleeding, and after 18 months the incidence of endometrial hyperplasia in this dosage group (17%) tended to be lower than those in the 1.0-mg and 2.0-mg dosage groups (29% and 22%, respectively). There was a trend toward fewer vasomotor symptoms among women who received the 0.5-mg and 1.0-mg dosages of micronized 17 beta-estradiol compared with those who received placebo. The 2.0-mg dosage group had a significantly lower incidence of vasomotor symptoms (P = 0.02) than the placebo group. Micronized 17 beta-estradiol (0.5 mg/day) with an adequate intake of dietary or supplementary calcium (1500 mg/day) is an appropriate choice for postmenopausal women in whom low-dosage estrogen therapy is indicated. This regimen, while proving efficacious in the prevention of bone loss, may be especially helpful for women who wish to minimize the bleeding that accompanies usual-dosage hormone-replacement regimens and should enhance compliance with the prescribed therapy.
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PMID:Use of low-dosage 17 beta-estradiol for the prevention of osteoporosis. 811 15

The treatment of menopause must meet efficacy, safety, simplicity and adaptability criteria. To achieve optimal benefit-to-risk ratio, treatment must be instituted and followed up with consideration to 1) the patient herself and 2) the type of treatment: molecule, dose, route of administration, sequence, duration, etc. The stage of menopause must be determined, since the deficiency, and hence replacement therapy, involves progestins in the years just before menopause, and estrogens in postmenopausal women. Cellular contra-indications (history of breast or endometrial cancer) concern all estrogens, whereas metabolic or thromboembolic contra-indications concern only oral estrogens. Which progestin? there is a consensus in favor of progesterone or one of its close derivatives (dydrogesterone, pregnane or norpregnane). Continuous or discontinuous treatment? Discontinuous treatment, closer to normal physiology, causes menstrual bleeding in 15 to 20% of patients, whereas continuous treatment, proposed to avoid menstruations, leads to irregular bleeding in 30 to 70% of the cases, bleeding which calls for additional and constraining investigations, and would be dangerous to ignore! Among the proposed formulations, the best will be the one which allows for individually tailored adjustment according to signs of estrogen overdosage or underdosage. Treatment may be instituted at any age of post-menopause, and need not be limited over time, unless a contra-indication develops.
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PMID:[Therapeutic scheme of menopause: criteria of choice]. 814 67

The aim of the study was to determine the presenting symptoms of endometrial carcinoma (EC) patients and to assess their possible correlation with some of the standard prognostic factors and with survival. A review of the presenting symptoms of 181 EC patients indicated that 69.6% presented with postmenopausal bleeding while the remaining women presented with irregular bleeding (21.0%), abdominal pain (3.9%) and other (5.5%) symptoms. A significantly (p < 0.001) higher percentage of patients presenting with abdominal pain and other symptoms were diagnosed with advanced stage disease and they had a lower survival than those presenting with post-menopausal or irregular bleeding. Patients presenting with irregular bleeding had a significantly (p = 0.002) better survival than those presenting with postmenopausal bleeding. However, this effect disappeared once age was accounted for in a multivariate analysis. Our findings indicate that the type of presenting symptoms may occasionally serve as a preliminary prognostic indicator.
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PMID:Presenting symptoms of patients with endometrial carcinoma. Effect on prognosis. 875 May 11

The aim of this study was to estimate neovascularisation in hyperplasia and carcinoma of the endometrium using a "power" angio-Doppler technique. One hundred and eighty-two postmenopausal patients with irregular bleeding from the sexual organs were investigated. Age of the patients ranged between 46 and 78 years. No neovascularisation in a control group of women with normal histopathological results of the endometrium was observed. The sensitivity of this method with reference to the diagnosis of hyperplasia and cancer of the endometrium was 12.2% and 81.2%, respectively. The specificity and positive prediction values were equal to 100% each in both pathologies. The values of the analysed flow indices in the neovascular arteries in endometrial cancer were significantly lower (p<0.05) (properly PI-0.92+/-0.12; RI-0.46+/-0.08) in comparison to the corresponding values in hyperplasia of the endometrium (PI-1.38+/-0.28 and RI-0.66+/-0.18). In conclusion, using a "power" angio-Doppler technique irregular vascularity of the endometrium in a group of patients with hyperplasia was observed in 12.2% of all patients and in 81.2% of those with cancer of the endometrium. The analysis of the values of the blood flow qualitative parameters in the neovascularisation areas in the endometrium at the significance level of PI < or = 1.0; RI < or = 0.5 and TAMV > 18.0 cm can help determine the essential element in the differential diagnosis of benign and malicious lesions. Transvaginal ultrasonography with a "power" angio-Doppler technique can be a valuable diagnostic method in hyperplasia and cancer of the endometrium, especially useful in the early stages of these pathologies.
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PMID:Estimation of neovascularisation in hyperplasia and carcinoma of endometrium using a "power" angio-Doppler technique. 1105 96

(1) For symptoms of oestrogen deficiency linked to the menopause, the standard treatment is an oestrogen-progestogen combination. Various dose strengths and formulations are available for continuous or sequential administration. (2) Marketing authorization has been granted in France for continuous tibolone monotherapy (without a progestogen). Tibolone, a synthetic steroid with progestogenic, oestrogenic and androgenic properties, has been available in some countries for more than 10 years. (3) The available clinical file mainly comprises data from trials with a low level of evidence. The largest trial, involving 437 patients, showed no difference in symptom relief between tibolone and continuous oestrogen-progestogen administration. (4) The most frequent short-term side effects of tibolone are irregular bleeding (in approximately 30% of women), oedema, breast tension and nausea. (5) No long-term data on the risk of breast cancer are available, and data on the risks of endometrial cancer are inadequate. The androgenic lipid profile induced by tibolone is unfavourable (reduction in HDL-cholesterol). Tibolone has a positive effect on bone density, but subsequent effects on the risk of fracture have barely been assessed. (6) In practice, tibolone has no particular advantages over oestrogen-progestogen combinations. On the contrary, it bears a poorly assessed risk of severe adverse reactions. Oestrogen-progestogen combinations remain the reference treatment for treating menopausal symptoms.
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PMID:Tibolone: new preparation. Menopausal symptoms: oestrogen-progestogen combinations are still the reference treatment. 1206 42

Women 30 years or older have 4 reversible contraceptive methods that are at least as effective as sterilization: oral contraceptives (OCs), the IUD, Norplant implants, and the injectable, Depo-Provera. Physicians have not done a good job educating women about these contraceptive options. 80-95% of women do not know about the key noncontraceptive benefits of OCs. Women delay childbearing longer than did their predecessors. Women who have completed their families and have not reached menopause face 4 key issues about contraceptive selection: risk for unplanned pregnancy, increase in incidence and severity of many gynecologic problems (e.g., irregular bleeding), increased risk of breast cancer and/or ovarian and endometrial cancers; and reduced bone mass with decline in ovarian function. Each woman of advanced reproductive age should be fully aware of all contraceptive options, the benefits and risks linked to each, and the effect of each on her future health, when she chooses her own contraceptive method. Women in their late 20s or early 30s who are not 100% sure that they do not want anymore children should not choose tubal sterilization because it is more or less permanent. Physicians should provide to women considering sterilization information about reversible methods as well. Healthy, nonsmoking women over 40 can safely use OCs. They also derive noncontraceptive health benefits from OC use, e.g., reduced incidence of endometrial and ovarian cancers and of severe rheumatoid arthritis and good menstrual cycle control. The IUD is an option for smokers 35 and older. A copper IUD can be used for up to 10 years. Long-acting progesterone methods (implants and injectables) are linked to an increase of clinical side effects. Depo-Provera is associated with a reduced risk of endometrial cancer. Motivation is required for condom use and periodic abstinence.
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PMID:Contraception in the later reproductive years: a valid aspect of preventive health care. 1228 79

A study conducted by the World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction with the collaboration with the University of Otago Medical School in Dunedin, New Zealand, and the Fred Hutchinson Cancer Research Center in Seattle, Washington, reveals that the injectable contraceptive DMPA (depot-medroxyprogesterone acetate) does not increase the overall risk of developing breast cancer, especially in women who have used DMPA for long periods in the past. Women who began using DMPA within the last 5 years may face a 2-fold increased risk of developing breast cancer, however. Enhanced detection of breast tumors or an acceleration of the growth of pre-existing tumors may explain this increased risk in recent or current users of DMPA. The researchers concluded that providers should not restrict DMPA on the grounds of breast cancer risk. The study reaffirmed the known link of increased risk of breast cancer with early menarche, being single, late age at birth of first child, nulliparity, family history of breast cancer, and history of benign breast disease. The study data originated from New Zealand, the US, Kenya, Mexico, and Thailand. Disadvantages of DMPA include: irregular bleeding, that it is provider-dependent, and slow return to fertility after DMPA use ceases. Advantages include high contraceptive effectiveness, no effect on blood clotting factors, and a protective effect against endometrial cancer.
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PMID:Long-term use of hormonal contraceptive DMPA not linked to breast cancer. 1228 77

Among 30-40 year old women, 40% of pregnancies are unplanned, which is indicative of the unreliability of the birth control methods they are using. The 1992 Ortho Birth Control Study interviewed almost 7000 women, of whom 8% listed withdrawal and 4% listed the rhythm method. These two methods have failure rates of 24% and 19%, respectively. Birth control methods often disappoint the users and increasingly they turn to sterilization. 48% of married women aged 15-44 had themselves been sterilized or had a sterilized partner in the Ortho survey. Although reversal of tubal ligation succeeds in 43-88% of cases, conception cannot be guaranteed. For women over the age of 30 who are healthy and do not smoke, low-estrogen or no-estrogen oral contraceptive pills are considered safe. Taking the pill also helps prevent ovarian and endometrial cancer. The failure rate is 6%. Barrier methods also offer protection from sexually transmitted diseases including HIV. Condoms are favored by 33% of unmarried women and 19% of married women. Sexually active 40-44 year old unmarried women run a 14-19% risk of contracting a sexually transmitted disease (STD) in a 12-month period. Diaphragms offer some protection against STDs, but their failure rate is 18%. IUDs are regaining popularity, but only 1% of women use them (ParaGard T380A or Progestasert). Pelvic inflammatory disease is the reason: a 1992 study showed that 0.97% of women developed it within 20 days of use. Norplant is a long-term implant containing levonorgestrel with a failure rate of 0.5%. A 1993 study followed 1253 implant users over 12 months and found a very low rate of pregnancy, but 75% experienced some side effects during the first year. About half of the women using Norplant removed it after 2.5 years because of irregular bleeding. Depo-Provera is an injectable administered every 3 months, but after removal it can take up to a year for ovulation to return. Side effects may include hair loss and weight gain; and links to breast cancer have also been suggested.
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PMID:Birth control over 30. 1229 85

Injectable hormonal contraception with 2 longacting steroidal preparations--norethisterone enanthate (NET-EN) and depot medroxyprogesterone acetate (DMPA)--provides an effective means of fertility regulation and has become an important method of family planning. DMPA and NET-EN have several advantages which make them particularly appropriate for some women and acceptable in family planning programs. A single injection can provide highly effective contraception for 2 or more months, delivery is simple, independent of coitus, and ensures periodic contact with medical or other trained health personnel. Currently, DMPA is registered as a therapeutic agent in nearly all countries and as a contraceptive agent in over 80 developed and developing countries. NET-EN is registered as a contraceptive in 40 countries. Administered by intramuscular injection in an aqueous microcrystalline suspension, DMPA exerts its contraceptive effect primarily by suppression of ovulation, but its effects on the endometrium, the uterine tubes, and the production of cervical mucus may also play a role in reducing fertility. DMPA as a contraceptive agent is generally given at a dosage of 150 mg every 90 days. NET-EN when administered as an intramuscular injection of an oil preparation at a dose of 200 mg inhibits ovulation. It should be administered at 8 weekly intervals for the 1st 6 months of use, then at intervals of 8 or 12 weeks. Longterm animal studies with DMPA have been completed mainly on beagle bitches and rhesus monkeys, and similar studies with NET-EN are nearing completion. None of the findings in beagles is considered applicable to human populations because the beagle responds differently than humans to steroidal hormones. None of the deaths among rhesus monkeys was attributable to effects of the drug. Endometrial carcinoma was found in 2 of the replacement monkeys but the number of animals was too small for statistically significant studies, and it is not possible to conclude whether DMPA or NET-EN caused these cancers or instead failed to prevent them. Despite more than 18 years of use and an estimated 13 million women who have ever used DMPA or NET-EN, no case has been recorded of an endometrial malignancy in women so exposed. There is no evidence at this stage of a causal association, either anecdotal or scientific. No evidence of an increased risk of malignant and premalignant disease of the uterine cervix has been found in DMPA users. There is sufficient evidence from investigations in several countries that DMPA and NET-EN may increase both milk production and the duration of lactation. The only clinical metabolic effect attributed to DMPA is weight gain. NET-EN and DMPA are associated with disruption of the menstrual cycle and irregular bleeding.
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PMID:Statement on injectable contraception. 1233 11

Endometrium is a tissue which is in permanent changes in the active gynaecological period of a female. This can be followed-up through histological, custological and histochemical changes. In determining the morphologic changes and disturbances in endometrium, pathohistological examinations were and still are necessary and irreplaceable in defining the real causes of this phenomenon. The aim of our work is to show the pathohistological results of the material obtained by explorative curettage in metrorrhagia, to determine the aetiology of the pathological process in endometrium, which provokes irregular bleeding, and to check the possible increase in precancerogenic and malignant endometrial conditions over a period of three years. The examinations covered 786 patients who asserted that bleeding was the main symptom of their illness. In all of them explorative curettage was performed mainly in diagnostic and often in therapeutic purposes. The number of examinations are in constant increase. The age of the largest number of patients was from 41 to 50 years, a period when the anovulary cycle is most frequent which, in turn, causes changes in endometrium which results in irregular bleeding i.e. in metrorrhagia (Tables 1, 2 and 3). The most frequent histopathological changes were manifested by adenomatic hyperplasia (160), then glandular (136) and cystic hyperplasia (92). Eleven cases of endometrial carcinoma were detected. In two of these patients the finding was not confirmed by pathohistological result after the operation or repeated explorative currettage. In 64 patients atypical hyperplasia i.e. Ca in situ was found. Acute endometritis followed by irregular bleeding was observed during inflammatory process of the internal genital organs. In 35 patients chronic endometritis was found after curettage following the extraction of the intrauterine device (in one case after 40 years of carrying). In 103 patients with hyperplasia myomatous changes were noted; this finding correlated with hyperoestrogenism, which is usually present in both disorders. All authors agree that pathohistological examination of endometrium is the most reliable in the search for a correct diagnosis. Despite of all modern diagnostic and technical means, difficulties always arise in the assessment of malignant potential of endometrial hyperplasia. Therefore, the patients with recurrent bleeding caused by hyperplasia should be under intensive gynaecological control.
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PMID:[Results of histopathologic findings of endometrial changes in metrorrhagia]. 1275 Nov 62


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