OBJECTIVE:

To evaluate the putative benefits of combined continuous hormone replacement therapy for postmenopausal women.

DATA SOURCES:

A Medline search was performed for relevant English-language studies published during 1981-1995.

METHOD OF STUDY SELECTION:

Forty-two studies were identified, all using a continuous daily regimen of an estrogen and a progestin given to postmenopausal women with intact uteri.

DATA EXTRACTION AND SYNTHESIS:

Each study was reviewed for the design, number of subjects enrolled, duration of protocol, and type and dosage of medications used. Data were extracted from texts, tables, figures, or personal communications regarding the effects of treatment on patient compliance (ie, drop-out rates), the occurrence of vasomotor symptoms, uterine bleeding patterns, endometrial histology, and lipid and bone density measurements. These data were then arranged in tabular form for the purpose of comparing and identifying trends. The lipid data from six randomized, double-blind studies that compared sequential and combined continuous regimens of conjugated equine estrogen and medroxyprogesterone acetate were further analyzed by meta-analysis. Findings revealed compliance rates of approximately 80% (range 35-100). Vasomotor symptoms improved almost universally. Irregular uterine bleeding was noted to be a common problem in the first 6 months of treatment; thereafter, most studies reported rates of amenorrhea of 75% or greater. In patients undergoing endometrial biopsy, rates of atrophic endometrium were noted to be 90-100%, and rates of endometrial hyperplasia were less than 1%. Adenocarcinoma of the endometrium was documented in two patients with a history of atypical endometrial hyperplasia and bleeding after established amenorrhea. The effects of treatment on lipid levels varied from study to study, but a meta-analysis revealed the combined continuous and sequential regimens to produce a treatment-associated decline in total and low-density lipoprotein cholesterol and an increase in high-density lipoprotein cholesterol. Studies examining bone density documented either no change or an increase with treatment.

CONCLUSION:

Combined continuous hormone replacement is well accepted by patients in clinical trials, effective in relieving vasomotor symptoms, and produces amenorrhea (though often after an initial period of irregular bleeding), an atrophic endometrium, and favorable changes in circulating lipids as well as maintaining bone density. Data on the impact of this regimen on long-term patient compliance, cardiovascular disease risk, and urogenital atrophy are lacking.

OBJECTIVE:

We aimed to study the influence of chemotherapeutic regimens and aging of breast cancer patients on chemotherapy-induced amenorrhea(CIA) and to guide the further selection of drugs for endocrine therapy.

METHODS:

We retrospectively studied the chemotherapy-induced amenorrhea(CIA) of the premenopausal breast cancer patients and compare the difference in CIA between the patients who received different chemotherapies or at different aging periods.

RESULTS:

One hundred and three women were followed up.The difference in the rate of CIA was not statistically significant between the women who received anthracycline-based chemotherapy and docetaxel-based chemotherapy(70.6% vs 61.1%,P=0.719).The occurrence rate of CIA was significantly higher in older women(45 years) than young women(≤45 years,P0.001).CIA occurred more lately in young women than old women(P=0.001).

CONCLUSION:

Age is an important factor for the CIA.Chemotherapy has less influence on the menstruation of younger women(≤45 years) and most amenorrhea is reversible.For these patients aromatase inhibitors are not recommended for adjuvant endocrine therapy.The effect of docetaxel on menstruation is not greater than anthracycline.

Background: The objective of this study was to compare bleeding patterns of women using a contraceptive combination of 30 mcg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) continuously or cyclically. Menstrual-related symptoms were also evaluated. Study Design: This open, prospective, randomized study evaluated 78 women using the EE/DRSP combination continuously for 168 days or for six 28-day cycles, each followed by a 7-day hormone-free interval. A diary with pre-established scales was used to assess the frequency and intensity of bleeding and menstrual-related symptoms. Results: Amenorrhea increased with continuous use; 62.2% of women with continuous use were amenorrheic at the end of treatment (95% CI.: 46.6-77.8%). Dysmenorrhea, headache, acne, nausea, edema and increased appetite improved significantly in the continuous-use group, and mastalgia and edema in the cyclic-use group (p<.05). Six subjects in the continuous-use group (15.4%) and three in the cyclic-use group (7.7%) discontinued due to adverse events. Conclusions: Continuous use was associated with amenorrhea and fewer menstrual-related symptoms compared to cyclic use. © 2010 Elsevier Inc. All rights reserved.

A total of 363 women undergoing legal abortion at < 63 days of amenorrhoea were allocated by a patient-centered, partially randomized study design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration (performed under general anaesthesia). The aim of the study was to compare the efficacy and complications of the two procedures. Main outcome measures included efficacy rates, medical complications within 21 days of abortion and unplanned family doctor consultation rates within 8 weeks following abortion. Sequelae such as pain, vaginal bleeding and recovery time were assessed by the change in haemoglobin level, the time taken to return to work or normal activity and the analgesic use. Results were gestation-related; at 50 days of amenorrhoea there was little to choose between the two procedures. At 50-63 days of amenorrhoea medical abortion becomes more painful and less effective, whereas vacuum aspiration retains high tolerance and efficacy. Women who are unsure which method to use are likely to find vacuum aspiration more acceptable at longer gestations.

OBJECTIVE:

To investigate the difference of long-term amenorrhea rate in patients with menorrhagia treated by endometrial laser intrauterine thermal therapy (ELITT), a new nonhysteroscopic endometrial ablation procedure, versus transcervical hysteroscopic endometrial resection (TCRE).

DESIGN:

Randomized clinical study. Healthy volunteers in an academic research environment.

SETTING:

Academic teaching hospital.
PATIENT(S): Premenopausal women with abnormal uterine bleeding.
INTERVENTION(S): Fifty-eight patients were treated with the ELITT procedure and 58 patients with TCRE; both groups were treated with GnRH agonists before the procedure.
MAIN OUTCOME MEASURE(S): Bleeding status and patient satisfaction after treatment were evaluated as well as the intraoperative complication rate.
RESULT(S): At 12 months, the amenorrhea rate was 56% in the ELITT group and 23% in the TCRE group. At 36 months, the figures were 61% for ELITT and 24% for TCRE. No significant complications were recorded for either procedure.
CONCLUSION(S): Results of this randomized study demonstrate that both procedures are equally effective in the treatment of menorrhagia. However, the ELITT procedure has proven to be superior in inducing amenorrhea.

To date, the predominant mechanism underlying menstrual disturbances in exercising women supports an underlying energy deficiency-related aetiology, in which a failure to compensate dietary intake for the energy cost of exercise suppresses reproductive function. Increasing evidence demonstrates that energy deficiency plays a causal role in the induction of amenorrhoea in exercising women, and consistent with this mechanism are findings of glucoregulatory perturbations such as low triiodothyronine, reduced insulin secretion and elevated cortisol, growth hormone and ghrelin levels. The menstrual disturbance that may differ in its energetic characteristics and, perhaps in its androgenic and ovarian steroid environment, is oligomenorrhoea. We conducted a systematic review of the literature to begin to understand whether oligomenorrhoea in exercising women is a mild subclinical phenotype of polycystic ovarian syndrome (PCOS) in which exercise is conferring beneficial effects in protecting women from the classic PCOS phenotype, or whether oligomenorrhoea is part of the spectrum of menstrual disturbances caused by an energy deficiency that is often reported in exercising women with menstrual disturbances. We included observational, randomized controlled trials and cross-sectional studies that reported clinical, hormonal and metabolic profiles in exercising women with amenorrhoea or oligomenorrhoea and in women with PCOS. Previous studies examining the underlying mechanisms and consequences of exercise-associated menstrual disturbances have grouped exercising amenorrhoeic and oligomenorrhoeic women into a single group, and have relied primarily on self-reported menstrual history. Although scarce, the data available to date suggest that hyperandrogenism, such as that observed in PCOS, may likely be associated with oligomenorrhoea in exercising women, and may not always represent hypothalamic inhibition secondary to an energy deficiency. It is critical to closely examine the metabolic and endocrine status of women with menstrual disturbances because the treatment strategies for energy deficiency-related menstrual disturbances differ from that of disturbances traceable to hyperandrogenaemia. Further investigation is necessary to explore whether different endocrine aetiologies underly menstrual disturbances, particularly oligomenorrhoea, in physically active women.

ANTECEDENTES:

Los anticonceptivos combinados inyectables proporcionan un método altamente eficaz y reversible para la prevención del embarazo, y no requieren administración diaria o uso en el momento del coito. Aunque se utilizan en muchos países, su aceptabilidad puede limitarse por las características del método, como la necesidad de una inyección mensual o cambios en el tipo de hemorragia.

OBJETIVOS:

Evaluar la eficacia anticonceptiva, los tipos de hemorragia, la interrupción, las preferencias de los usuarios y los efectos secundarios de los anticonceptivos combinados inyectables.

ESTRATEGIA DE BÚSQUEDA:

Se realizaron búsquedas en las bases de datos electrónicas para identificar ensayos controlados aleatorios de anticonceptivos combinados inyectables.

CRITERIOS DE SELECCIÓN:

Se consideraron elegibles los ensayos controlados aleatorios informados en cualquier idioma, que comparasen un anticonceptivo combinado inyectable con otro método anticonceptivo (por ejemplo, un segundo anticonceptivo combinado inyectable, un anticonceptivo inyectable con sólo progestina, otro anticonceptivo hormonal o método de barrera) o placebo. La revisión se limitó a los anticonceptivos combinados inyectables que se comercializan actualmente.

RECOPILACIÓN Y ANÁLISIS DE DATOS:

El revisor principal evaluó todos los títulos y resúmenes identificados a partir de las búsquedas bibliográficas para una potencial inclusión. Dos revisores de forma independiente extrajeron los datos de los ensayos elegibles. Los datos sobre la eficacia anticonceptiva, los tipos de hemorragia, la continuación y los efectos secundarios se introdujeron y analizaron con RevMan 4.2.

RESULTADOS PRINCIPALES:

Los anticonceptivos combinados inyectables incluyen 25 mg de acetato de medroxiprogesterona de liberación prolongada (DMPA) más 5 mg de cipionato de estradiol (EC); 50 mg de enantato de noretisterona (NET-EN) más 5 mg de valerato de estradiol (EV). Estos anticonceptivos combinados inyectables resultaron en tasas más bajas de interrupción temprana del estudio por amenorrea u otros problemas de hemorragias, pero mostraron tasas más altas de interrupción por otras razones en comparación con los anticonceptivos de sólo progestina.
Los estudios que compararon dos anticonceptivos combinados inyectables hallaron que 50 mg de NET-EN más 5 mg de EV resultó en una menor interrupción temprana en general y una menor interrupción por amenorrea o hemorragia prolongada que 25 mg de DMPA más 5 mg de EC. Sin embargo, estas diferencias no se detectaron en todos los ensayos que estudiaron esta comparación. El grupo de NET-EN más EV también presentó más hemorragias cíclicas (regulares) y menos períodos de referencia de hemorragias prolongadas que el grupo de DMPA más EC. No hubo diferencias en las tasas de amenorrea entre los grupos.

CONCLUSIONES DE LOS AUTORES:

Aunque las tasas de interrupción pueden considerarse una medida de aceptabilidad del método, los resultados deben interpretarse con cuidado ya que las tasas de interrupción dependen de muchos factores. La investigación futura debe orientarse a intervenciones que mejoren la aceptabilidad de los anticonceptivos combinados inyectables, como la colocación de inyecciones en ámbitos más convenientes que los clínicos, los métodos para que las mujeres se coloquen sus propias inyecciones y el asesoramiento sobre los posibles cambios en el tipo de hemorragia.

PURPOSE:

To evaluate the treatment-induced menstrual changes in very young (< 35 years old) breast cancer patients.

METHODS AND MATERIALS:

We retrospectively examined the clinical records of 160 patients, ranging in age from 18 to 34 years old (median age, 32 years), treated between June 1992 and December 2002. One hundred twenty patients underwent mastectomy and 40 underwent breast conserving surgery. Postoperatively, 80 patients were treated with alkylating agent-based chemotherapy regimens (CMF) and 80 with anthracycline-based regimens (AD). In addition, 57 patients received adjuvant radiotherapy, and 77 received anti-estrogen therapy. Treatment-induced menstrual changes and present menstrual status were evaluated from hospital records and by one-to-one interviews. The median follow-up period was 54 months (range, 29-156 months).

RESULTS:

Treatment-induced menstrual change (amenorrhea) was occurred in 59 (36.9%) patients, 25 (31.3%) of those treated with CMF and 34 (42.5%) with AD (p=0.142). Amenorrhea occurred after a median 2 cycles of chemotherapy (range, 1-6 cycles). Menstruation resumed in 49 (83.1%) patients, 20 (80%) of those treated with CMF and 29 (85.3%) with AD (p=0.6). Median time to resumption of menstruation was median 3.5 months (range, 1-18 months) after amenorrhea. Disease recurred in 10 (16.9%) patients who experienced treatment-induced menstrual changes and in 18 (17.8%) of those who did not (p=0.89).

CONCLUSION:

Although the overall incidence of treatment-induced menstrual change in breast cancer patients under age 35 was similar to that reported elsewhere, the rate of recovery from these change is higher. We observed no difference between CMF and AD treated patients in rates of amenorrhea or recovery from these changes.

ANTECEDENTES:

La hiperprolactinemia es un trastorno endocrino común que puede estar asociado con una morbilidad significativa. Se realizó una revisión sistemática y meta-análisis de los resultados de pacientes hiperprolactinémicos, incluyendo microadenomas y macroadenomas, para proporcionar recomendaciones basadas en la evidencia a los profesionales. Mediante esta revisión, se buscó comparar la eficacia y efectos adversos de medicamentos, cirugía y radioterapia en el tratamiento de la hiperprolactinemia.

MÉTODOS:

Se realizaron búsquedas en bases de datos electrónicas, se revisó la bibliografía de los artículos incluidos, y se contactó expertos en el tema. Los estudios elegibles proveyeron un seguimiento longitudinal de pacientes con hiperprolactinemia y evaluaron resultados de interés. Se recolectó datos descriptivos, de calidad y de los resultados (crecimiento tumoral, defectos del campo visual, infertilidad, disfunción sexual, amenorrea/oligomenorrea y niveles de prolactina).

RESULTADOS:

Después de la revisión, 8 estudios aleatorios y 178 no aleatorios (más de 3000 pacientes) cumplieron los criterios de inclusión. En comparación con ningún tratamiento, los agonistas dopaminérgicos redujeron significativamente el nivel de prolactina (diferencia de medias ponderada, -45; intervalo de confianza del 95%, -77 a -11) y el likelihood de hiperprolactinemia persistente (riesgo relativo: 0.90; intervalo de confianza del 95%, 0.81 to 0.99). La cabergolina fue más eficaz que la bromocriptina en la reducción de la hiperprolactinemia persistente, amenorrea/oligomenorrea, y galactorrea. Una gran cantidad de literatura no comparativa mostró que agonistas dopaminérgicos mejoraban otros resultados importantes para los pacientes. Evidencia de baja a moderada calidad apoya mejores resultados con cirugía y radioterapia en comparación con ningún tratamiento en pacientes que son resistentes o intolerantes a agonistas dopaminérgicos.

CONCLUSIÓN:

Los resultados proporcionan evidencia que apoya el uso de agonistas dopaminérgicos en la reducción de los niveles de prolactina e hiperprolactinemia persistente, con cabergolina resultando más eficaz que bromocriptina. La radioterapia y la cirugía son útiles en pacientes con resistencia o intolerancia a agonistas dopaminérgicos.

PURPOSE:

To determine the effect of oral contraceptives (OC) on bone mass and stress fracture incidence in young female distance runners.

METHODS:

One hundred fifty competitive female runners ages 18-26 yr were randomly assigned to OC (30 microg of ethinyl estradiol and 0.3 mg of norgestrel) or control (no intervention) for 2 yr. Bone mineral density (BMD) and content (BMC) were measured yearly by dual x-ray absorptiometry. Stress fractures were confirmed by x-ray, magnetic resonance imaging, or bone scan.

RESULTS:

Randomization to OC was unrelated to changes in BMD or BMC in oligo/amenorrheic (N=50) or eumenorrheic runners (N=100). However, treatment-received analyses (which considered actual OC use) showed that oligo/amenorrheic runners who used OC gained about 1% per year in spine BMD (P<0.005) and whole-body BMC (P<0.005), amounts similar to those for runners who regained periods spontaneously and significantly greater than those for runners who remained oligo/amenorrheic (P<0.05). Dietary calcium intake and weight gain independently predicted bone mass gains in oligo/amenorrheic runners. Randomization to OC was not significantly related to stress fracture incidence, but the direction of the effect was protective in both menstrual groups (hazard ratio [95% CI]: 0.57 [0.18, 1.83]), and the effect became stronger in treatment-received analyses. The trial's statistical power was reduced by higher-than-anticipated noncompliance.

CONCLUSION:

OC may reduce the risk for stress fractures in female runners, but our data are inconclusive. Oligo/amenorrheic athletes with low bone mass should be advised to increase dietary calcium and take steps to resume normal menses, including weight gain; they may benefit from OC, but the evidence is inconclusive.