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)

This review addresses many of the unanswered questions existing relative to the use of exogenous estrogens and progestins in postmenopausal women (PMW). The literature in the field is reviewed and summarized, with a particular effort to identify key questions of major concern. The effect of selection bias on conclusions reached from retrospective studies involving hormone replacement therapy (HRT) has not been examined. Less is actually known about the effects of progestins than estrogens. Many of the endocrine changes that occur with aging remain poorly defined. Effects of estrogens and progestins on the breast and on breast cancer are unclear. Estrogens have recognized beneficial effects and progestins have detrimental effects on lipoprotein metabolism. Estrogens also have direct effects on the vasculature and may impact on cardiovascular risk in other ways. Although estrogens are the only agents known to eliminate hot flushes, the mechanism by which flushes arise is not known. Estrogens may have ameliorating effects on mood and behavior and may improve dementia, but research in this area has been limited to date. Lastly, the preferred estrogens and progestins, their dosages and routes of administration, remain to be more completely defined.
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PMID:Unanswered questions in hormonal replacement therapy. 792 63

In the menopause transition, ovarian steroid production is gradually inhibited and around 35% of women will seek medical help for postmenopausal symptoms. The hot flush is a characteristic manifestation occurring in about 70% of women; it is associated with oestrogen withdrawal and disappears with oestrogen-based hormone replacement therapy. The exact mechanism behind it is still unclear but is probably related to heat loss mechanisms. The flush often occurs in parallel to changes in skin temperature, blood flow, pulse rate and pulses of luteinizing hormone (LH). These are probably secondary to a disturbance in the thermoregulatory centre of the CNS, which is anatomically close to neurons containing gonadotropin-releasing hormone. Depression is no more frequent in the menopausal transition than at other times in life. After surgical menopause, however, oestrogen improves low mood over placebo. In women with premenstrual syndrome, an increased feeling of well-being is associated with the pre-ovulatory oestrogen peak. Progestogens are associated with negative mood changes during the menstrual cycle, oral contraception and postmenopausal replacement therapy. Certain progesterone metabolites are anaesthetic and have anti-epileptic and anxiolytic properties, effects which are mediated via the type A gamma-aminobutyric acid (GABAA) receptor. Oestrogen is associated with increased sensory perception, locomotory activity, limb coordination and balance: this may help explain the increased frequency of bone fractures in the early postmenopausal period. Oestrogen improves memory and performance in patients with mild Alzheimer's dementia and increases epileptic activity in patients with partial epilepsy. These effects can be related to amplifying effects of oestrogen on excitatory amino acids in the CNS.
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PMID:Symptoms related to the menopause and sex steroid treatments. 858 96

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

In the menopause transition, around 35% of women will seek medical help for menopausal symptoms. At the climacteric, various symptoms such as forgetfulness, anxiety, depressive neurosis, abnormal sensation, hot flush and sleeplessness are often observed due to hypofunction of the ovaries. There is some indication that women become more anxious during times of relatively low level of estrogen and progesterone such as premenstrual syndrome, premenstrual dysphoric disorder, maternity blues and menopausal state. The exact mechanism behind it is still unclear but is probably related to the decrease of ovarian hormones, which may be triggering psychiatric mood disorders. It is known that ovarian hormones act on specific areas of the brain and appear to act as anxiolytics. Certain progesterone metabolites are anesthetic and have antiepileptic and anxiolytic properties. These steroids modulate the type A gamma-aminobutyric acid (GABAA)/benzodiazepine receptor. This may help explain the increased frequency of anxiety disorders and mood disorders in the early postmenopausal period. In addition, estrogen also improves memory and performance in patients with mild Alzheimer's dementia. These effects can be related to amplifying effects of estrogen on excitatory amino acids in the brain. This is suggested that gonadal steroidal hormones seemed to be one of the essential substances for the maintenance of the limbic system and forebrain function which regulated anxiety, mood, memory and cognitive functions in menopausal women.
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PMID:[Menopause and anxiety: focus on steroidal hormones and GABAA receptor]. 1087 12

This article is part of a Special Issue "Estradiol and cognition". Prior to the publication of findings from the Women's Health Initiative (WHI) in 2002, estrogen-containing hormone therapy (HT) was used to prevent age-related disease, especially cardiovascular disease, and to treat menopausal symptoms such as hot flushes and sleep disruptions. Some observational studies of HT in midlife and aging women suggested that HT might also benefit cognitive function, but randomized clinical trials have produced mixed findings in terms of health and cognitive outcomes. This review focuses on hormone effects on cognition and risk for dementia in naturally menopausal women as well as surgically induced menopause, and highlights findings from the large-scale WHI Memory Study (WHIMS) which, contrary to expectation, showed increased dementia risk and poorer cognitive outcomes in older postmenopausal women randomized to HT versus placebo. We consider the 'critical window hypothesis', which suggests that a window of opportunity may exist shortly after menopause during which estrogen treatments are most effective. In addition, we highlight emerging evidence that potential adverse effects of HT on cognition are most pronounced in women who have other health risks, such as lower global cognition or diabetes. Lastly, we point towards implications for future research and clinical treatments.
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PMID:Postmenopausal hormone therapy and cognition. 2593 28

Severity and duration of menopausal symptoms varies markedly. Eight out of ten women experience symptoms and on average these last four years, with one in ten women experiencing symptoms for up to 12 years. A recent study found that women whose vasomotor symptoms started before the menopause suffered longest, median 11.8 years. Women whose hot flushes and night sweats started after the menopause had symptoms for a median of 3.4 years. Menopausal symptoms can begin years before menstruation ceases. Menopausal status needs to be evaluated based on history and symptoms. Testing for FSH levels should only be considered in women aged 40-45 with menopausal symptoms or those under 40 with suspected early menopause. In general, the benefits of short-term HRT outweigh the risks in the majority of symptomatic women, especially in those under 60. There is no evidence that HRT confers any cardiovascular protection (or harm) or protection against the development of dementia. Cardiovascular risk should be assessed. Women with cardiovascular disease are not necessarily unsuitable for HRT but need their cardiovascular health optimised. In those women with a high risk of venous thromboembolism a thrombophilia screen should be considered (although even if this is negative, it does not absolve risk). If there is a history of arterial disease a lipid profile should be considered. If there is a high risk of breast cancer, counsel the woman with regards to her risk and consider referring for mammography.
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PMID:Managing debilitating menopausal symptoms. 2721 75