Individualizing Hormone Therapy to Minimize Risk: Accurate Assessment of Risks and Benefits

Shoupe, Donna

doi:10.2217/whe.11.42

Cited by 14 publications

(14 citation statements)

References 62 publications

(91 reference statements)

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“…121,122 Direct brain effects of LH and human choriogonadotropin although demonstrable in the rodent, are not inferable in women. 123 Likewise, whereas high FSH levels contribute to osteopaenia in ovariectomized and aged mice, 124,125 this concept does not seem to apply in women, in whom age, weight, ethnicity, inflammation and oestrogen availability are the confirmed crucial factors.…”

Section: Lh and Fsh Secretion In Ageingmentioning

confidence: 99%

Changes in pituitary function with ageing and implications for patient care

Veldhuis

2013

Nat Rev Endocrinol

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The pituitary gland has a role in puberty, reproduction, stress-adaptive responses, sodium and water balance, uterine contractions, lactation, thyroid function, growth, body composition and skin pigmentation. Ageing is marked by initially subtle erosion of physiological signalling mechanisms, resulting in lower incremental secretory-burst amplitude, more disorderly patterns of pituitary hormone release and blunted 24 h rhythmic secretion. Almost all pituitary hormones are altered by ageing in humans, often in a manner dependent upon sex, body composition, stress, comorbidity, intercurrent illness, medication use, physical frailty, caloric intake, immune status, level of exercise, and neurocognitive decline. The aim of this article is to critically discuss the mechanisms mediating clinical facets of changes in the hypothalamic–pituitary axis during ageing, and the extent to which confounding factors operate to obscure ageing effects.

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Section: Lh and Fsh Secretion In Ageingmentioning

confidence: 99%

Changes in pituitary function with ageing and implications for patient care

Veldhuis

2013

Nat Rev Endocrinol

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“…The importance of these trials is reflected in the national guidelines which note that HRT provides no benefit for stroke risk reduction and should be reserved for the acute treatment of peri-menopausal symptoms (Lisabeth and Bushnell, 2012; Sacco et al, 2006). The timing, duration, dosage, and route of administration (ie., transvaginal, oral, transdermal) are critical parameters in determining a HRT regimen and must individualized to minimize risk (Shoupe, 2011). Postmenopausal or disease-related changes in estrogen receptor expression patterns and genetic variation in ERE binding sites may also influence the actions of estrogen (Higaki et al, 2012; Wang et al, 2012; Yu et al, 2011).…”

Section: Therapeutic Potential Of Hormone Therapy In Ischemic Brain Imentioning

confidence: 99%

Sex, stroke, and inflammation: The potential for estrogen-mediated immunoprotection in stroke

Ritzel

Capozzi

McCullough

2013

Hormones and Behavior

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Stroke is the third leading cause of death and the primary cause of disability in the developed world. Experimental and clinical data indicate that stroke is a sexually dimorphic disease, with males demonstrating an enhanced intrinsic sensitivity to ischemic damage throughout most of their lifespan. The neuroprotective role of estrogen in the female brain is well established, however, estrogen exposure can also be deleterious, especially in older women. The mechanisms for this remain unclear. Our current understanding is based on studies examining estrogen as it relates to neuronal injury, yet cerebral ischemia also induces a robust sterile inflammatory response involving local and systemic immune cells. Despite the potent anti-inflammatory effects of estrogen, few studies have investigated the contribution of estrogen to sex differences in the inflammatory response to stroke. This review examines the potential role for estrogen-mediated immunoprotection in ischemic injury.

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“…A transdermal method of administrating hormones has been chosen as it combines an efficacious use of oestrogen replacement with the safest route of administration [66]. Additionally it is the gold standard for menopausal hormone replacement therapy, as it has a lower risk of venous thromboembolism than oral administration [67]; it is easily formulated and titrated; and has an additional safety benefit of avoiding the hepatic 'first pass' effect associated with oral administration, thus avoiding changes in clotting factors and sex hormone-binding globulin [68].…”

Section: Discussionmentioning

confidence: 99%

Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial

et al. 2016

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Background: Greater trochanteric pain syndrome (GTPS) is pathology in the gluteus medius and minimus tendons and trochanteric bursa that causes debilitating tendon pain and dysfunction, particularly in post-menopausal women. Limited evidence in clinical studies suggests hormone changes after menopause may have a negative effect on tendon. This protocol describes a randomised controlled trial comparing the effectiveness of menopausal hormone therapy (MHT) and exercise therapy in reducing pain and dysfunction associated with GTPS in post-menopausal women.Method: One hundred and sixteen post-menopausal women will be recruited and randomised to receive one of two exercise programs (sham or targeted intervention exercise) and transdermal creams (MHT cream containing oestradiol 50mcg and norethisterone acetate 140mcg or placebo cream). Interventions will be 12-weeks in duration and outcomes will be examined at baseline, 12-weeks and 52-weeks. The primary outcome measure will be the VISA-G questionnaire and secondary outcomes measures will include three hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, Lateral Hip Pain questionnaire), a global change in symptom questionnaire (using a 15-point Likert scale) and a quality of life measure (AQoL-8D questionnaire). Data will be analysed using the intention to treat principle. Discussion: This study is the first randomised controlled trial to compare the effectiveness of menopausal hormone therapy therapy alone, and with the combination of exercise therapy, to treat pain and dysfunction associated with GTPS. This study has been pragmatically designed to ensure that the interventions in this study can be integrated into policy and clinical practice if found to be effective in the treatment of GTPS in post-menopausal women. If successful, there is potential for this treatment regimen to be explored in future studies of other persistent tendon conditions in the post-menopausal population.

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Individualizing Hormone Therapy to Minimize Risk: Accurate Assessment of Risks and Benefits

Cited by 14 publications

References 62 publications

Changes in pituitary function with ageing and implications for patient care

Changes in pituitary function with ageing and implications for patient care

Sex, stroke, and inflammation: The potential for estrogen-mediated immunoprotection in stroke

Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial

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