Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study.

OBJECTIVES: The aim of this study was to assess if endometrial thickness could be used to select postmenopausal women on hormonal replacement therapy (HRT) at increased risk for endometrial abnormalities. The secondary aim was to assess if endometrial abnormalities were more likely to occur in patients with increased endometrial thickness or in patients with unexpected bleeding. METHODS: Bi-endometrial thickness was measured by transvaginal ultrasound (TVS) in postmenopausal patients on sequential or combined HRT regimens. Women following a sequential regimen underwent TVS examination immediately after their withdrawal bleed, always between 5 and 10 days after the last progesterone tablet. A hysteroscopy with endometrial biopsy was performed within 5 days after the TVS examination, when endometrial thickness was > or = 4 mm, or when unscheduled bleeding was observed. RESULTS: A total of 190 women were recruited. In 138 women on sequential regimens, the mean value of endometrial thickness was 3.6 mm +/- 1.5, and in 52 women on combined regimens it was 3.2 mm +/- 1.8 (P = n.s.) Twenty-eight patients (15%) had an endometrial thickness > 4 mm, 35 patients (18.4%) reported unexpected bleeding. The percentage of abnormal endometrial findings (9%; three of 35) in patients selected for unscheduled bleeding was significantly lower than the percentage of abnormal findings in patients selected for hysteroscopy for endometrial thickness > 4 mm (36%; 10 of 28) (P < 0.01). All patients with unexpected bleeding and endometrial thickness < or = 4 mm (24 cases) were found to have an atrophic endometrium. CONCLUSIONS: Endometrial thickness in patients on sequential HRT, measured soon after withdrawal bleeding, is not significantly different from thickness measured in patients on combined HRT. Patients on HRT with an endometrial thickness of > 4 mm could be considered for histological sampling. The prevalence of abnormal endometrial findings in patients with a thick endometrium is significantly higher than the prevalence observed in patients with unexpected bleeding.     

Normal uterine arterial blood flow in postmenopausal women assessed by transvaginal color Doppler sonography: the effect of hormone replacement therapy.

We used transvaginal color Doppler sonography to study the effect of hormone replacement on the uterine arterial blood flow for 203 postmenopausal women. The regimens studied involved estrogen replacement alone, continuous combined estrogen and progestogen, and estrogen followed sequentially by combined estrogen-progestogen. The mean pulsatility index fell to 65% +/- 9% and the mean resistive index fell to 87% +/- 4% of baseline during the first month of therapy (P < 0.0001). The addition of a progestogen did not alter the effect of estrogen alone (P > 0.5). Our findings suggest that the increase in vascular flow occurs even in women who begin therapy long after menopause.     

Hormone replacement therapy in postmenopausal asthmatic women

OBJECTIVES: Assessment of mean 24 h oestradiol (E2) and oestrone (E1) concentration and basic FSH secretion in postmenopausal asthmatic women, before and after HRT use, and to identify any connections between changes in hormone concentrations and patients' clinical state. SUBJECTS: Postmenopausal women (55 asthmatic and 20 healthy, aged 48-60 years). METHOD: Serum hormone concentration was assessed by radioimmunoassay before HRT and after 6 months of transdermal 17beta-E2 and medroxyprogesterone acetate treatment (cyclical method). Intensification of menopausal symptoms was assessed by Kupperman's index. RESULTS: Secretion of oestrogens was lower in postmenopausal women asthmatic women than in postmenopausal healthy women. HRT caused an increase in oestrogen concentration. The 24-h fluctuations of E1 and E2 in all studied groups before and after HRT did not differ significantly. A statistically significant decrease in the number of menopausal symptoms was found during the course of HRT. During the period of HRT, there was a reduction in the number of patients in whom it was necessary to use oral glucocorticoid therapy during exacerbation of asthma. CONCLUSION: A greater reduction in oestrogen secretion was found in postmenopausal asthmatic women than in postmenopausal healthy women. HRT resulted in normalization of serum oestrogen concentration in asthmatic women and diminishing psychosomatic symptoms of the menopause and symptoms of asthma.     

Benefits of hormone replacement therapy in postmenopausal women

PURPOSE: To provide an overview of current research regarding hormone replacement therapy (HRT) and to assist healthcare providers to better educate patients about potential benefits of this therapy. DATA SOURCES: A systematic review of healthcare literature was conducted with 602 articles selected from CINAHL, Medscape, Pubmed, and Medline databases. Keywords directing the search included hormone replacement therapy, benefits of hormone replacement therapy and trends, hormone replacement therapy and osteoporosis, hormone replacement, and menopause symptoms. CONCLUSIONS: According to the literature, HRT can assist women with postmenopausal symptoms. In addition, research shows that HRT can help some postmenopausal women with selected comorbid conditions such as osteoporosis, type II diabetes, certain cardiovascular pathologies, and colorectal cancer. The decision as to who should use any form of HRT needs to be based on the individual woman's needs, quality of life, and potential risks versus benefits. IMPLICATIONS FOR PRACTICE: HRT has been a benefit to many women in the treatment of postmenopausal symptoms. Recent studies have shown that HRT, whether it is combined estrogen and progestin therapy, or estrogen-only therapy, can help postmenopausal women with osteoporosis and some selected comorbid conditions. Recent research indicates that some women are dying from comorbid conditions rather than breast cancer. Although the research regarding HRT in some areas may be limited, further research adds to existing knowledge and offers new ideas and possibilities in the treatment of postmenopausal symptoms and selected comorbid conditions. Certainly HRT can improve quality of life and possibly longevity for selected women. Ongoing research is needed to further validate such benefits, as well as to further explore the risks and benefits of long-term HRT. Increased knowledge about HRT will help healthcare providers better educate patients about the potential benefits of HRT, while providing documentation about who should take selected types of HRT or whether alternative treatment is preferred.     

经阴道彩色多普勒超声对绝经后期子宫血流动力学的研究

目的 建立绝经后期子宫各段动脉血流参数的正常参考值范围,方法 应用经阴道彩色多勒对46例正常绝经后妇女的子宫动脉（UTA）,弓状动脉（AA）,放射动脉（RA）以及螺旋动脉（SA）的血流分别进行检测,66例正常生育期子宫和5例子宫内膜癌分别作为对照,结果 绝经后期正常子宫内膜面不见血流信号;UTA和RA的阻力指数（RI）随绝经时间的延长而增加。结论 绝经后期的子宫血流灌注减少,且随绝经后时间的延长而更为明显。     

Normal uterine arterial blood flow in postmenopausal women assessed by transvaginal color Doppler ultrasonography.

We used transvaginal color Doppler sonography to study uterine artery blood flow velocity waveforms in 345 normal postmenopausal women who had never been on hormone replacement therapy. Our objective was to establish the standard baseline flow values for normal postmenopausal women. The mean pulsatility index was 3.38 +/- 1.04 and the mean resistive index was 0.93 +/- 0.09. There was a positive correlation between arterial blood flow impedance and number of years since menopause. We believe that these levels may become important screening parameters for the detection of endometrial carcinoma in postmenopausal women.     

Estrogen replacement therapy for Alzheimer disease in postmenopausal women

OBJECTIVE: To evaluate the clinical utility of oral conjugated equine estrogen in postmenopausal women with Alzheimer disease. DATA SOURCES: Literature was identified through MEDLINE (1997-January 2002). Key search terms included Alzheimer disease, estrogen replacement therapy, and treatment. DATA SYNTHESIS: Estrogen has been identified as a neuroprotective agent with possible application in degenerative disorders. Observational studies have demonstrated an association between estrogen replacement therapy and decreased incidence of Alzheimer disease. Two recent, controlled clinical trials have evaluated the role of oral conjugated estrogen in the treatment of Alzheimer disease. CONCLUSIONS: Clinical trials indicate that oral conjugated equine estrogen is not an effective treatment for Alzheimer disease in postmenopausal women.     

Homocysteine in postmenopausal women and the importance of hormone replacement therapy.

Homocysteine (Hcy) has been shown to damage the vascular endothelial cells, contributing to atherothrombosis. The increase in plasma Hcy levels with natural menopause suggests a close relationship between Hcy metabolism and estrogen status and proposes one of the mechanisms through which menopause unfavorably affects cardiovascular disease risk in women. In addition to the prevention of osteoporosis, hormone replacement therapy (HRT) lowers Hcy levels in postmenopausal women. The first report by van der Mooren et al., demonstrated in an uncontrolled study a significant reduction (11%) in fasting serum Hcy level after 6 months of treatment with sequentially combined estradiol-dydrogesterone therapy in 21 healthy postmenopausal women. This effect was particularly evident in women with initially elevated baseline serum Hcy concentrations. Similar results were found in other studies in which women were treated with various transdermal as well as oral HRT regimens, although two studies could not confirm these findings. All these studies were uncontrolled, and three of them consisted of a relatively small number of participants. Therefore, they remained inconclusive. Three randomized controlled trials on HRT and Hcy were published to date, confirming that postmenopausal HRT reduces circulating levels of Hcy. Current and recent HRT use is associated with a slight increased risk of breast cancer. As a result of this, research has centered on finding compounds that can prevent the consequences of estrogen deficiency, without the potential risk of HRT. Raloxifene, referred to as a Selective Estrogen Receptor Modulator (SERM), has the potential as a viable alternative to HRT. Recently, two randomized controlled trials demonstrated that raloxifene lowers plasma Hcy levels in postmenopausal women, similar to the reduction obtained with HRT. Little is known about the mechanisms underlying the HRT-associated lowering of plasma Hcy. Proposed mechanisms relate to an increase in kidney methionine synthase activity or may be related to the transamination of methionine. We conclude that HRT decreases plasma Hcy levels in postmenopausal women and that the strongest reductions can be achieved in women with the highest concentrations.     

经阴道超声对绝经后子宫内膜变化与肥胖相关性研究

目的经阴道超声探讨与分析绝经后子宫内膜变化与肥胖的相关性。方法绝经和肥胖组80例．绝经和正常体重组80例,分别应用彩色多普勒阴道超声技术检测子宫内膜厚度。结合测量血雌二醇（E2）与内膜诊刮病理结果进行分析对照。结果绝经后肥胖组：子宫内膜厚度6－18mm。病理显示子宫内膜呈增生反映。部分腺上皮不典型增生。绝经后正常体重组子宫内膜厚度2—4mm。结论绝经后肥胖组子宫内膜均有不同程度增生。     

Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium.

OBJECTIVE: To evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography. METHODS: Ninety-one postmenopausal women (median age, 58 years; range, 47-83 years) presenting with uterine bleeding and a thickened endometrium (> or = 5-mm double-layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B-mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple-vessel pattern, Pattern B: single-vessel pattern and Pattern C: scattered-vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included. RESULTS: Histological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%. CONCLUSIONS: Transvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.     

雌激素替代治疗对绝经后妇女内皮功能的影响

目的观察雌激素替代治疗(ERT)对绝经后妇女内皮功能的影响。方法绝经组妇女32例每天口服结合雌二醇0.625mg,共两周;同期24名正常月经妇女为对照组。分别采集绝经组妇女服药前后和对照组妇女空腹静脉血标本测雌二醇(E2)、一氧化氮(NO)水平,并采用无创性高分辨超声法检测内皮依赖性血管舒张功能。结果绝经组ERT前血流介导的血管舒张(FMD)、NO及E2明显低于对照组(P<0.05),ERT后显著增加(P<0.05),而硝酸甘油介导的血管舒张(NMD)治疗前后差异无显著性意义;FMD与E2、NO相关(P<0.001),而NMD与NO、E2均无相关性(P>0.05)。结论女性绝经后存在显著的内皮依赖性血管舒张功能异常,进行雌激素替代治疗可明显改善甚至逆转上述变化,该作用可能是雌激素的心血管保护机制之一。     

Hormone replacement therapy may reduce high serum homocysteine in postmenopausal women

Abstract In a prospective study we investigated the possible changes in fasting serum total homocysteine concentrations during continuous micronized 17 β -oestradiol, 2 mg daily, in combination with cyclic dydrogesterone, 10 mg daily during the first 14 days of each 28 day cycle, in 21 healthy non-hysterectomized postmenopausal women. During the first six cycles mean serum homocysteine decreased by 10·9% ( P = 0·013), after which no further significant changes were found during the 2 years of treatment. A 16·9% decrease ( P = 0·017; n = 8) was found in women with high homocysteine concentrations, while in women with low homocysteine concentrations ( n = 13) no significant changes were observed. The observed decrease in high homocysteine concentrations in postmenopausal women may in part contribute to the decreased risk of developing cardiovascular disease during hormone replacement therapy.     

Left ventricular diastolic function assessment by tissue Doppler echocardiography in relation to hormonal replacement therapy in postmenopausal women with diastolic dysfunction

The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.     

Markers of bone turnover in postmenopausal women receiving hormone replacement therapy.

We investigated the effects of hormone replacement therapy (n = 27) on biochemical markers of bone turnover in a cross-sectional study of 127 postmenopausal women (according to WHO guidelines 18 patients had normal bone mineral density and 109 suffered from bone loss). Urinary excretion of free deoxypyridinoline and C- or N-telopeptide fragments of type I collagen served as bone resorption markers, serum osteocalcin as a bone formation marker. In women with no hormone replacement therapy, only C- and N-telopeptides correlated significantly with the lumbal T-score as an index for bone mineral density. Patients with bone loss receiving hormone replacement therapy exhibited significantly lower C-telopeptide, N-telopeptide and osteocalcin levels than those with no therapy (mean -45%, -43% and -26%, respectively), while deoxypyridinoline showed no significant differences. Among the markers investigated, C- and N-telopeptides seemed to be more reliable to detect therapeutic effects on bone metabolism. We present a preliminary model to evaluate bone turnover and resorption/formation rate.     

Clinical pain perception and hormone replacement therapy in postmenopausal women experiencing orofacial pain

OBJECTIVE: The purpose of this study was to examine the magnitude of the relation between a postmenopausal woman's hormonal replacement status and clinical pain report in a sample of women experiencing orofacial pain. DESIGN: To accomplish this, pain ratings were collected during a routine chronic pain evaluation at an orofacial pain clinic from a sample of 87 postmenopausal women. RESULTS: Results of ANCOVA (controlling for pain duration) demonstrated that postmenopausal women receiving hormone replacement therapy (HRT) reported higher levels of pain than postmenopausal women not taking HRT. Numeric pain rating scales revealed large effect sizes for worst pain report (0.62), moderate differences for average (0.48) and current (0.39) pain levels, and trivial differences for least pain (0.04). Effect sizes for the McGill Pain Questionnaire indicated somewhat smaller differences (0.35-0.24) between the two groups. CONCLUSIONS: This study is among the first to examine the relation between a woman's hormonal status and clinical pain perception and is the first to investigate the role of HRT in a postmenopausal woman's orofacial pain report in a clinical treatment setting. This area of inquiry is particularly salient given the high percentage of women who choose to initiate HRT either after hysterectomy or with the onset of menopause.     

绝经后骨质疏松症的激素替代疗法益处与风险评估

目的:对激素替代疗法(hormonereplacementtherapy,HRT)在防治绝经后骨质疏松症作用机制,以及HRT与骨密度、心血管病、乳腺癌等方面的关系作一综述,为绝经后骨质疏松症患者应用激素替代疗法治疗提供理论依据。资料来源:应用计算机检索Medline1997-01/2004-06期间的相关文章,检索词“Hormonereplacementtherapy,Postmenopausalwomen,osteo-porosis”,并限定文章语言种类为English。同时手工检索/或计算机检索《中国临床康复》杂志1990-01/2001-04期间的相关文章,限定文章语言种类为中文,检索词“激素替代疗法;绝经;骨质疏松”。资料选择:对资料进行初审,选取试验包括激素替代治疗对绝经后妇女骨密度、心血管病、乳腺癌等方面的文献,筛除明显不随机的临床试验的研究,对剩余的文献查找全文进一步判断是否为随机对照临床试验。纳入标准为①随机对照临床试验(RCT),无论是单盲,双盲或非盲法。②试验包含对照组和治疗组。资料提炼:共收集到45篇关于HRT的随机和未随机试验,33个试验符合纳入标准。排除的12篇试验中,7篇系重复的同一研究,5篇为Meta分析研究。资料综合:33个试验包括1176336例绝经后妇女,对应用HRT防治绝经后骨质疏松症者分别对骨密度、心血管病和乳腺癌等方面作了评估。结论:HRT要严格挑选适应证,个