Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0600142 (hot flushes)
 1,242 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Menopause is merely a clinically discernible clue symbolic of the multitude of changes preceding or following the cessation of menses by many years. Because of the time span involved, separating changes observed in the menopausal transition from other age-related maturational events presents serious methodologic problems. Of the host of psychologic and psychosomatic symptoms, only hot flushes and associated sweats occur more frequently in this epoch, while an interplay between hormonal and age-related maturational events presents serious methodologic problems. Of the host of psychologic and psychosomatic symptoms, only hot flushes and associated sweats occur more frequently in this epoch, while an interplay between hormonal and age-related effects is assumed in atrophic changes involving the genitourinary organs. The relation between menopause and osteoporosis is suggestive but by no means proven, as is the risk for cardiovascular disease. Empiric evidence points to the usefullness of estrogen for the management of vasomotor instability, the symptoms associated with atrophy of the genitourinary tract, and in the prophylaxis of osteoporosis, but not in the treatment of anxiety, depression, and other psychiatric disorders.
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PMID:Management of the Menopause. 7 6

Hormonal replacement therapy--usually involving estrogen with or without an added progestin--has been proposed as a treatment for a variety of changes associated with the perimenopausal years, including hot flushes, vaginal and urinary tract atrophy, sexual problems, aging skin, and a number of affective symptoms. It has also been studied as a preventive measure against osteoporosis and cardiovascular disease, with some researchers claiming a protective effect against breast cancer, although others cite it as a risk factor for breast cancer. This article reviews the literature in each of these areas, suggesting an individualized approach to hormone replacement therapy, determined by patient and practitioner, based on symptomatology and risk factors. Alternative therapies are briefly outlined.
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PMID:Perimenopausal hormone replacement therapy. Review of the literature. 200 94

The estradiol transdermal therapeutic system is a cutaneous delivery device which delivers estradiol into the systemic circulation via the stratum corneum at a constant rate for up to 4 days. Physiological levels of estradiol (the major estrogen secreted by the ovaries in premenopausal women) can therefore be maintained in postmenopausal women with low daily doses because first-pass hepatic metabolism is avoided. In short term clinical studies, the beneficial effects of transdermal estradiol on plasma gonadotrophins, maturation of the vaginal epithelium, metabolic parameters of bone resorption and menopausal symptoms (hot flushes, sleep disturbance, genitourinary discomfort and mood alteration) appear to be comparable to those of oral and subcutaneous estrogens, while the undesirable effects of oral estrogens on hepatic metabolism are avoided. As with oral or injectable estrogen replacement therapy, concomitant sequential progestagen is recommended for patients with an intact uterus during transdermal estradiol administration, in order to reduce endometrial stimulation. Transdermal estradiol has been well tolerated in clinical trials, with local irritation at the site of application being the most common adverse effect. The incidence of systemic estrogenic effects appears to be comparable to that observed with oral therapy. Thus, transdermal estradiol offers near-physiological estrogen replacement in postmenopausal women in a convenient low-dose form which may avoid some of the complications of higher dose oral therapy. Long term epidemiological studies are warranted to determine whether transdermal estradiol therapy provides protection against osteoporosis and fractures and cardiovascular disease equivalent to that offered by oral and injectable estrogens. However, despite the importance of such data, it seems reasonable to conclude at this stage of its development that transdermal estradiol represents an important advance in hormone replacement therapy.
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PMID:Transdermal estradiol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of menopausal complaints. 208 14

As America ages the menopausal woman is emerging as a principal focus in the health care system. Research efforts continue to define the mechanism for vasomotor instability, osteoporosis, and new and improved methods of estrogen administration. Though attenuation of symptoms of hot flushes, urogenital atrophy, and prevention of osteoporosis can be accomplished by judicious estrogen replacement therapy, the attendant risk of endometrial cancer can be minimized by concurrent administration of progestogen. Gallbladder disease must be considered as an additional risk. Surveillance for early detection of breast cancer is an integral part of care for the climacteric woman. Of greatest concern and potentially greatest impact is the evolution of data endorsing estrogen replacement as a preventive measure against cardiovascular disease. With the goal of maximizing the quality of the last third of each woman's life, individual assessment of signs and symptoms of the climacteric and, if indicated, prescription for a tailored hormone replacement schedule remain the mainstay of care.
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PMID:Menopause and estrogen replacement therapy. 265 4

The use of estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement therapy are reviewed, and recommendations regarding its use are made. Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy. Prevention of cardiovascular disease, aging changes of skin, and the occurrence of mental illness have also been suggested as indications, but beneficial effects of estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of estrogen replacement therapy include endometrial cancer, hypertension, gallbladder disease, and angina pectoris. Breast cancer may also be a risk factor, but a consensus of opinion has not been established. Pulmonary embolism, cerebral vascular accident, or myocardial infarction has not been associated with estrogen replacement therapy. The use of progesterone with estrogen replacement therapy has been shown to reduce the occurrence rate of endometrial carcinoma, but it does not prevent all the actions of estrogen. Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include progesterone for hot flashes and calcium for the prevention of osteoporosis. Other agents may also be effective but have not been tested critically.
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PMID:Estrogen replacement therapy. 702 79

Hormone replacement therapy (HRT) is used for relief of symptoms related to the menopause and for the prevention of postmenopausal osteoporosis and cardiovascular disease. Patterns of use of HRT are thought to be changing rapidly, but little is known about who is using the therapy, for what purpose or for what period of time. Telephone interviews were conducted in May 1991 with a randomly selected sample of 2001 Australian-born women aged 45 to 55 years living in Melbourne, as part of the Melbourne Women's Midlife Health Project. Questions related to use of HRT, health status, use of health services, sexual functioning, attitudes to menopause and aging, and sociodemographic characteristics. Twenty-one per cent of the sample were using HRT. Use was more prevalent among women 50 years and over (28 per cent) than those under 50 (15 per cent). Seventeen per cent of nonhysterectomised women, 31 per cent of hysterectomised women and 49 per cent of women who had undergone hysterectomy and bilateral oophorectomy were current users. Almost 60 per cent had been using the therapy for two years or less, and 34 per cent for one year or less. Just over half reported control of hot flushes as a benefit, and 10 per cent mentioned prevention of bone loss as a benefit. Logistic regression analysis identified differences between users and nonusers in experience of hot flushes, health status, use of preventive and treatment services, sexual functioning, wellbeing, attitudes to menopause and aging, and sociodemographic characteristics. These differences may relate to risk of later cardiovascular disease.
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PMID:Use of hormone replacement therapy by Melbourne women. 757 40

The menopause is defined as cessation of menstruation, ending the fertile period. The hormonal changes are a decrease in progesterone level, followed by a marked decrease in estrogen production. Symptoms associated with these hormonal changes may advocate for hormonal replacement therapy. This review is based on the English-language literature on the effect of estrogen therapy and estrogen plus progestin therapy on postmenopausal women. The advantages of hormone replacement therapy are regulation of dysfunctional uterine bleeding, relief of hot flushes, and prevention of atrophic changes in the urogenital tract. Women at risk of osteoporosis will benefit from hormone replacement therapy. The treatment should start as soon after menopause as possible and it is possible that it should be maintained for life. The treatment may be supplemented with extra calcium intake, vitamin D, and maybe calcitonin. Physical activity should be promoted, and cigarette smoking reduced if possible. Women at risk of cardiovascular disease will also benefit from hormone replacement therapy. There is overwhelming evidence that hormone therapy will protect against both coronary heart disease and stroke, and there is no increased risk of venous thrombosis or hypertension. A disadvantage of hormone replacement therapy is an increased risk of forming gall-bladder stones and undergoing cholecystectomy. Unopposed estrogen therapy gives a higher incidence of endometrial cancer in women with an intact uterus, but the contribution of progestins for about 10 days every month excludes this risk. Breast cancer in relation to estrogen-progestogen therapy has been given much concern, and the problem is still not fully solved. If there is a risk, it is small, and only after prolonged use of estrogen (15-20 years). The decision whether or not to use hormone replacement therapy should, of course, be taken by the individual woman in question, but her decision should be based on the available scientific information. It is the opinion of the authors that the advantages of hormone replacement therapy far exceed the disadvantages. We suggest that every woman showing any signs of hormone deprivation should be treated with hormone replacement therapy. This includes women with subjective or objective vaso-motor symptoms, genito-urinary symptoms, women at risk of osteoporosis (fast bone losers), and women at risk of cardiovascular diseases.
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PMID:Postmenopausal hormone replacement therapy--clinical implications. 819 55

Estrogen replacement therapy (ERT) is very effective in relieving many menopausal symptoms such as hot flushes, night sweats, urogenital atrophy and psychological disturbances. Moreover, it is effective in the prevention of postmenopausal osteoporosis and has a favourable effect on some risk factors for cardiovascular disease in the long term, via several mechanisms including mediating effects on the lipid profile. Most of these beneficial effects are maintained with transdermal estradiol therapy, involving the use of a cutaneous delivery system attached to the skin which delivers a controlled rate of estradiol over a period of up to 4 days. However, the clear demonstration of a favourable effect on some risk factors for cardiovascular disease remains to be established. Transdermal administration of estradiol appears to be at least as effective as oral conjugated estrogen therapy on most of the end-points which have been evaluated, but allows a lower dose to be used, avoiding some of the metabolic adverse effects experienced with oral treatment. Endocrinological adverse effects, such as breast tenderness, breakthrough bleeding and fluid retention, are similar in both treatments, and can be minimised by dose adjustments in most cases. The most common adverse effects related to transdermal therapy are local skin reactions at the site of application. These are usually mild and transient in nature, and can be overcome by changing the site of application. Serious risks of transdermal therapy appear to be the same as those for other forms of ERT, namely an increased risk of endometrial hyperplasia and cancer with estrogen therapy alone. However, combination therapy involving the sequential administration of a progestogen has been shown to substantially reduce the risk of endometrial proliferation. The potential increased risk of breast cancer has been controversial and appears to be minimal with ERT. The role of progestogens on breast cancer risk remains controversial, but the data to date do not indicate any significant change in risk when progestogens are added to ERT.
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PMID:A risk-benefit appraisal of transdermal estradiol therapy. 828 Apr 4

As life expectancy increases and members of the postwar generation settle into their fifth decade of life, hormone replacement therapy--estrogen or an estrogen-progestin combination--has become a major research interest. An extensive, but often confusing and even contradictory, literature exists on the uses of hormone replacement for the treatment and prevention of a multitude of difficulties that may be associated with the perimenopausal and postmenopausal periods. These include hot flushes, vaginal changes, urinary tract changes, changes in sexuality, affective or emotional symptoms, changes in the oral mucosa and skin, loss of memory and Alzheimer's disease, bone loss and osteoporosis, and cardiovascular disease. This article reviews the literature in each of these areas. It also reviews studies relating to possible side effects of hormone therapy, including endometrial cancer, gall bladder disease, and breast cancer. The article outlines principles for practitioners to follow in assisting women to make informed and individualized decisions about this therapy. Part II of this article, which will appear in the May/June 1996 issue of the Journal of Nurse-Midwifery, will cover specific therapeutic regimens and their management, as well as alternative therapies and preventive measures.
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PMID:Perimenopausal and postmenopausal hormone replacement therapy. Part 1. An update of the literature on benefits and risks. 870 9

Postmenopausal estrogen deprivation is a major cause for vasomotor and psychic complaints and for urogenital dysfunction, it is also a risk factor for osteoporosis, hip fracture, cardiovascular disease and possibly dementia. Hormone replacement therapy is highly effective in improving hot flushes, insomnia, depression and genital atrophia, but it prevents bone mineral loss and coronary heart disease as well. The potential risk for thromboembolism remains small and there is no final proof for a significant increase of breast cancer. Hysterectomized women may be treated with unopposed estrogens, otherwise progestogens must be added in a cyclic or continuous manner in order to protect the endometrium. Natural estrogens are to be preferred, they may be administered orally, percutaneously or vaginally. Long acting subcutaneous implants are also gaining interest. Prolonged treatment for many years is essential in order to be preventive. Compliance by motivation and comprehensive care is therefore indispensable.
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PMID:[Hormone substitution in menopause]. 938 Oct 46


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