Stress activates the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal axis (HPAA). Based on a systematic literature review of the impact of endogenous and exogenous exposure with natural progesterone on the stress response in healthy premenopausal and postmenopausal women, the following conclusions can be drawn: the HPAA activity was not relevantly affected by endogenous progesterone exposure across the menstrual cycle, but might be reduced by exogenous micronized progesterone application; in contrast, the ANS has a sympathetic predominance in the (progesterone-dominated) luteal phase of the menstrual cycle. Future studies should assess various stress biomarkers under various hormonal conditions to, for example, allow for cardiovascular risk stratification in hormone users.
Menopausal hormone therapy (MHT) is considered to be the most effective treatment for disturbing menopausal symptoms such as vasomotor symptoms and sleeping disturbances. 1 MHT is prescribed in various forms, doses and regimens of oestrogens with (uterus present) or without (post-hysterectomy) progestogen. The onset of natural menopause at an average age of 51 years coincides with increasing risks for non-communicable diseases and some types of cancer, for example colon cancer. Before the publication of the Women's Health Initiative in 2002, MHT was commonly prescribed for primary prevention of cardiovascular disease, osteoporosis, cognitive impairment and some types of cancers in women with and without menopausal symptoms. 2 Colorectal cancer (CRC) is the second most frequently diagnosed cancer in women worldwide and therefore a substantial health risk. CRC incidence and mortality can be reduced by detection and removal of precancerous lesions through CRC screening, as well as adjustment of modifiable risk factors, such as diet, alcohol consumption, tobacco smoking and physical activity. 3 Whereas these factors are accepted modifiable risk factors for CRC, the debate about the potential protective role MHT on CRC remains controversial. 3 Thus, the purpose of this review was to update and synthesize the current evidence on the role of MHT on CRC risk. Study outcomes were differentiated by the risk for colorectal adenoma, risk for colorectal cancer, colon and rectal cancer, tumour stage and invasiveness, tumour grade, molecular and histologic characteristics, colon cancer site and mortality.
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