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

Oral administration of conjugated estrogens, estradiol valerate and micronized estradiol--but not the percutaneous application--in the postmenopause modifies the plasmic lipoprotein profile by lowering, dose-dependently, LDL and elevating HDL (HDL2). In parallel, the cardiovascular mortality is decreased by 50-66%, with smokers also benefiting to the same extent. On account of the increased risk for endometrial carcinoma associated with postmenopausal estrogen monotherapy, combination with a lowest-dose gestagen is imperative. However, the very numerous synthetic gestagens can antagonize the favorable effects of the estrogen on lipoprotein metabolism. This applies in particular to the gestagens of the 19-nortestosterone type, such as norethisterone acetate and, in particular, levonorgestrel, but less so the 17-hydroxyprogesterone derivatives medroxyprogesterone acetate and medrogestone with their very low androgenic effect.
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PMID:[Lipoprotein metabolism in menopause. Effect of hormonal substitution therapy]. 191 55

Substitution of hormones does not only serve to alleviate vasomotor and psychic imbalance but mainly to prevent osteoporosis and cardiovascular disease. Essential prerequisites are good tolerance, minimal risk, compliance and low cost. Natural estrogens, in contrast to ethinyl estradiol, without effect on the coagulation system when dosed appropriately are preferred. Sequential or continuous addition of progestogens lowers the incidence of endometrial cancer. Derivatives of progesterone appear to be more suited than 19-nortestosterone derivatives because they do not affect the plasma lipid profile significantly and do not jeopardize the estrogen-induced increase in vasoprotective HDL. Dosing of estrogens follows clinical requirements and minimally effective activity against osteoporosis. Progestogens are dosed according to their endometrial activity. According to current experience only long term treatment is successful.
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PMID:[Principles of hormone substitution in the postmenopause period]. 203 41

Current research on lipid alterations and the risk of ischemic cardiopathy is reviewed, and the relationship of such cardiopathy to exogenous hormonal treatment is examined. Most large epidemiological and intervention studies have focused on men. Men and women share some risk factors, including high serum cholesterol levels, adverse lipoprotein profile, smoking, hypertension, diabetes, obesity, advanced age, and according to some studies sedentary life style. Additional factors that may affect women more than men are elevated serum triglyceride levels, natural or surgical menopause, use of oral contraceptives (OCs), and possibly hormonal substitution therapy. Studies have revealed a characteristic female profile of lipids and lipoproteins that follows a predictable course with age and menopause. Average total cholesterol and LDL cholesterol are higher in men than in premenopausal women, but women's levels rise after menopause until they eventually exceed those of men. According to epidemiological study and clinical trials over the past 2 decades, the principal determinants of serum lipid levels and hyperlipidemia are similar for both sexes and include diet, smoking, physical exercise and other habits, and genetic factors. Lipid levels in women are also affected by endogenous estrogens, high-dose OCs, estrogen replacement therapy, and menopause. Several studies have shown that high serum concentrations of total and LDL cholesterol and relatively low levels of HDL cholesterol are correlated with development of atherosclerotic lesions and increased cardiovascular risk in men, and that lowering cholesterol reduces the risk. Thus far there are no conclusive studies demonstrating the benefits of reduced cholesterol levels for women, but studies that included women along with men suggested that they share the benefits. Low levels of HDL cholesterol and elevated serum triglyceride levels appear to be important predictors of ischemic cardiopathy in women. The coronary risk in former OC users does not appear to be higher than that of women who never used OCs. It is likely that the lower-dosed formulations now in use will mitigate the risk. The adverse effect of OCs on lipid levels appears to be related to the androgenicity of the progestin. Most of the progestins used in combined pills are related to the 19-nortestosterone group which tends to decrease HDL level and increase LDL and triglyceride levels. Many studies have demonstrated that postmenopausal use of estrogens alone result in a decrease in LDL and an increase in HDL levels. Most but not all studies have shown that hormonal substitution reduces risks of coronary disease. But the longterm effects of estrogen/progestin use, now recommended to avoid increased risk of endometrial cancer, are not known.
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PMID:[Women and ischemic cardiopathy]. 269 94

Lipid metabolic changes under oral treatment with medroxyprogesterone acetate (MPA) were investigated in four groups of patients: group I; 10 patients aged 25-45 (mean 38) years received 50 mg MPA daily for pelvic endometriosis. Group II; 21 patients aged 55-77 (mean 62) years received 200 mg MPA daily for surgically treated endometrial carcinoma stage I. Group III; 14 praemenopausal patients aged 37-52 (mean 47) years received 1000 mg MPA daily for metastasized breast cancer. Group IV; 27 post-menopausal patients aged 53-78 (mean 68) years were treated with 1000 mg MPA daily for metastatic breast cancer as well. A fifth group of initially 86 patients aged 40-86 (mean 63) years after surgery for endometrial carcinoma stage I served as untreated control for groups II and IV. Cholesterol and triglyceride concentrations were measured enzymatically lipoproteins were determined by quantitative electrophoresis and precipitation and apolipoproteins A1 and B were quantified by kinetic rate nephelometry. Whereas in patients of group I no changes of lipid and lipoprotein parameters were observed, daily oral doses of 200 mg MPA and more led to a marked fall in alpha-lipoprotein-, HDL-cholesterol and apolipoprotein A1 levels. beta-Lipoprotein-, LDL-cholesterol and apolipoprotein B concentrations rose significantly in Groups III and IV. The relevance of these findings in terms of athero-genicity is discussed.
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PMID:Medroxyprogesterone acetate and lipid metabolic changes. 295 58

The effect of high dose medroxyprogesterone acetate (MPA) on serum lipids, on adipose tissue lipoprotein lipase (LPL) and serum lecithin cholesterol acyltransferase activities were studied in 15 postmenopausal patients with endometrial cancer. After 2 weeks of MPA treatment total cholesterol decreased by 14% (P less than 0.001) and HDL cholesterol by 33% (P less than 0.01) from the respective pretreatment values; correspondingly the ratio of HDL to total cholesterol decreased (P less than 0.05). The decrease of HDL2 cholesterol was 35% (P less than 0.01) and that of HDL3 cholesterol 15% (P less than 0.01). The levels of serum triglycerides decreased significantly (P less than 0.05) during the treatment period. Serum LCAT activity was significantly lower (P less than 0.05) after treatment than before, but adipose tissue LPL activity was not altered. The mean serum testosterone level decreased significantly (P less than 0.001) from the pretreatment values. Significant positive correlations were present between LPL activity and MPA concentrations and between LPL activity and testosterone concentrations after the drug treatment.
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PMID:Effects of high dose progestin on serum lipids and lipid metabolizing enzymes in patients with endometrial cancer. 315 2

Serum levels of triglycerides, total cholesterol, and HDL-cholesterol were determined in 57 patients who were undergoing treatment for stage I endometrial carcinoma. The patients belonged to a clinical trial where group A (control) was treated with surgery plus intravaginal irradiation, whereas group B in addition was treated with hydroxyprogesterone caproate (5000 mg i.m. as a loading dose followed by 1000 mg every 2 weeks for one year). In group B patients followed during the first 13 weeks of treatment, the level of serum triglycerides remained stable, whereas the level of total cholesterol and HDL-cholesterol increased significantly. This increase could not, however, have been caused by the progestogen treatment, as similar changes were seen in group A patients followed for the same period of time. Long-term effects were looked for in patient groups examined 3-12 months after the start of treatment and in groups examined 3-6 months after the hormone therapy was stopped. In neither group could any significant difference in cholesterol or HDL-cholesterol be found. It is concluded that this type of progestogen treatment causes no significant change in the levels of triglycerides, cholesterol, and HDL-cholesterol.
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PMID:Serum lipids and lipoproteins in patients with endometrial carcinoma receiving adjuvant treatment with hydroxyprogesterone caproate. 388 71

Twenty-one women were given depot-medroxyprogesterone acetate (DMPA) 1000 mg/wk for 6 mth as part of the treatment for endometrial carcinoma in either clinical stage I or II. Total and free cholesterol, triglycerides and phospholipids were analysed in serum and in the ultracentrifugally separated lipoprotein fractions VLDL, LDL and HDL (very low, low and high density lipoproteins). Previous studies have shown little effect on lipoprotein metabolism after lower doses of MPA, unlike progestins of the 19-nor-testosterone series, after which an 'androgenic' lipoprotein pattern is seen, i.e., a decrease in HDL-cholesterol and in triglycerides in serum and VLDL. After this massive DMPA dose, only a slight decrease in HDL-cholesterol was seen, as well as a rise in triglycerides in serum and VLDL. We interpret the latter finding as secondary to an influence on carbohydrate metabolism.
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PMID:High-dose depot-medroxyprogesterone acetate (DMPA) - effects on lipid and lipoprotein metabolism. 622 6

The effect of high dose medroxyprogesterone (MPA) on serum lipids was studied in 31 postmenopausal patients with endometrial cancer. After 3 months of MPA treatment, total cholesterol decreased by 18% (P less than 0.001), LDL cholesterol by 16% (P less than 0.01) and HDL cholesterol by 38% (P less than 0.001) from the respective pretreatment values; correspondingly, the ratio of HDL to total cholesterol decreased (P less than 0.001). Similar changes were found as early as 2 weeks after start of treatment. In the 15 controls receiving no progestin treatment, full dose intracavitary radiotherapy and gynecological surgery had no effect on these serum lipids.
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PMID:Effect of high dose progestin on serum lipids. 687 Sep 84

After reviewing the pathophysiology of the menopause, attention is directed to a review of the benefits of estrogen progestogen replacement therapy (vasomotor symptoms, urogenital atrophy, psychosomatic complaints, osteoporosis, cardiovascular disease, lipid metabolism); the risks of estrogen progestogen replacement therapy (endometrial cancer, endometrial hyperlasia, breast cancer, coagulation factors, gallbladder disease); and evaluation for estrogen therapy (nonoral estrogen administration). This author regards the menopause to be a hormonal deficiency state, and, like all endocrinopathies, should be managed as vigorously as need be, and without a necessary limitation of time. A wide variety of physical changes and symptoms have been associated with the climacteric. Some patients may only experience cessation of menses; others experience severe reactions that are occasionally disabling. Several factors may influence development of symptoms during the postmenopausal years, and the most important factor is probably the degree of estrogen depletion and the rate at which estrogen levels decrease. Additional factors may be an inherited or acquired propensity to withstand or succumb to the aging process and the psychologic impact of aging and the woman's ability to accept or deny the emotional changes of the menopause. The proven and almost universally accepted benefits of estrogen replacement therapy include relief of vasomotor symptoms, prevention of atrophic vaginitis, and prevention of osteoporosis. Estrogens may also help alleviate some of the psychogenic manifestations that menopause aggravates. Decreasing the risk of cardiovascular disease, particularly in oophorectomized young women may be another benefit by estrogen increased HDL cholesterol. 10 days of cyclic progestogen reduces the risk of endometrial cancer by preventing or treating estrogen induced endometrial hyperplasia. The risk of breast cancer has not been shown to be increased with estrogen therapy, and progestogens may provide additional protection for this tumor. The prognosis for breast carcinoma developing in hormone users is improved, most likely because of an earlier detection. Estrogens prevent demineralization of bone, and the addition of progestogen apparently promotes new bone formation. An increased risk of gallbladder disease may be associated with estrogen therapy, but this risk is minimal and has not been observed in all studies. There is no evidence that either estrogens or progestogens, in the small doses needed for menopause, increase the risk of thromboembolic disease. Newer routes of estrogen administration may further reduce the risks and increase the benefits.
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PMID:The menopause: benefits and risks of estrogen-progestogen replacement therapy. 704 Jan 16

The incidence of coronary heart disease (CHD) rises after menopause. Hormonal replacement therapy (HRT) reduces cardiovascular morbidity and mortality. Plasma lipoproteins are modified by oral estrogen treatment: LDL are lowered while HDL and VLDL are augmented. The cardioprotective effect of oral HRT may be partially due to the reduction in the LDL/HDL ratio. Optimal changes in lipid profile are achieved with doses that usually prevent bone mass loss. Progestogens tend to blunt the increment of HDL induced by estrogens, but this depends on the type of agent and its dose. Unlike oral estrogen, HRT by the transdermal route does not always modify the lipid profile. When it does, changes are similar to those observed under the oral route in that the LDL/HDL ratio is diminished, but VLDL do not rise. Possible explanations for this discrepancy are discussed. At present there is no clear evidence that combined estrogen/progestogen treatment or transdermal estrogen alone could reduce CHD's incidence. Women with an intact uterus should receive a progestogen in addition to estrogen for prevention of endometrial carcinoma. Estrogen alone is preferable for hysterectomized women. When beneficial and adverse effects of HRT are considered simultaneously, the overall result is considered favorable, principally as a consequence of its cardioprotective properties.
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PMID:[Postmenopause, plasma lipoproteins, and hormone replacement therapy]. 820 20


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