• Title/Summary/Keyword: Hormone Replacement Therapy(HRT)

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A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism (범뇌하수체저하증의 호르몬 대체요법 중단 후 발생한 스트레스 심근병증)

  • Nam, Seoung Wan;Lee, Jun-Won;Sim, Jeong Han;Pack, Hyun Sung;Im, Changjo;Lim, Jung Soo;Ahn, Sung Gyun
    • Journal of Yeungnam Medical Science
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    • v.33 no.2
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    • pp.125-129
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    • 2016
  • Stress induced cardiomyopathy (SC) is characterized by transient left ventricular (LV) dysfunction in the absence of coronary artery disease. We report on a patient with panhypopituitarism who developed SC resulting from withdrawal of hormonal replacement therapy (HRT). A 52-year-old male visited our hospital for progressively worsening dyspnea. The patient had discontinued HRT 7 days ago, which had been administered for 18 months after transsphenoidal adenomectomy for pituitary macroadenoma. Initial electrocardiogram showed marked sinus bradycardia. Transthoracic echocardiography showed apical ballooning with an LV ejection fraction of 25%. No significant obstructive lesions were observed on coronary angiography. With a clinical diagnosis of SC associated with panhypopituitarism, HRT was restarted, including glucocorticoid and thyroxine, along with standard heart failure management. His LV function had normalized at 2-month follow-up. He remains asymptomatic and administration of beta-blocker and angiotensin converting enzyme inhibitor were discontinued He currently only requires HRT.

Birth of a healthy infant after bone marrow-derived cell therapy

  • Patel, Nayana H;Jadeja, Yuvraj D;Patel, Niket H;Patel, Molina N;Bhadarka, Harsha K;Chudasama, Piyush N;Thakkar, Harmi R
    • Clinical and Experimental Reproductive Medicine
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    • v.48 no.3
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    • pp.268-272
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    • 2021
  • Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live birth with BMDC. This 27-year-old woman came to our center with endometrial atrophy and primary infertility. She had a past history of genital tuberculosis and amenorrhea. Her husband's semen quality was normal. The patient was counseled for hysteroscopy due to thin endometrium and advised in vitro fertilization (IVF) with donor eggs in lieu of poor ovarian reserve. Several attempts of IVF with hormone replacement therapy (HRT) were made, but the desired thickness of the endometrium was not achieved. Uterine artery injection of BMDC through interventional radiology was given, followed by HRT for three months, which resulted in improved endometrium. This was subsequently followed by IVF with donor egg. The treatment resulted in the conception and delivery of a 3.1-kg baby boy through lower segment caesarean section with no antenatal, intranatal or postnatal complications. Recently, there has been massive interest in stem cells as a novel treatment method for regenerative medicine, and more specifically for the regeneration of human endometrium disorders like Asherman syndrome and thin endometrium, which was the reason behind using this strategy for treatment.

Current Medical Therapies for Osteoporosis and Its Alternative Treatments Using Natural Products (골다공증 치료법과 천연물을 이용한 대체요법)

  • Oh, Seunghoon;Ahn, Soon-Cheol
    • Journal of Life Science
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    • v.25 no.1
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    • pp.113-120
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    • 2015
  • Osteoporosis is a major bone disorder defined as having bone mineral density (BMD) of 2.5 standard deviations or more below the peak bone mass. Osteoporosis will increasingly be a major disorder that faces the aging mankind. It is the result of an imbalance in the bone remodeling system, where bone constantly undergoes a cycle of resorption by osteoclasts and formation by osteoblasts. Estrogen deficiency in women following menopause is identified as the predominant reason that causes disparity in this system. Current medical treatments for osteoporosis include hormone replacement therapy (HRT), biphosphonates, and teriparatide, but have various side effects that raise questions concerning their medical safety and practicality. Alternative treatments involving natural product sources are under study to find a safer therapy. Many natural sources including lactoferrin and isoflavones and numerous traditional herbal medicines exhibit anti-resorptive or anabolic effects on bone and thus show promises to provide therapeutic agents in treating osteoporosis. Unfortunately, the majority of natural product treatments are still in its preliminary stages to prove their efficacy even though the development pace of treatment for osteoporosis is astounding in the past few decades. Further progress in pre-clinical studies and the subsequent clinical studies will someday lead to a breakthrough that takes us another step forward in science.

Influence of Mammographic Screening on Breast Cancer Incidence Trends in South Australia

  • Beckmann, Kerri Rose;Roder, David Murray;Hiller, Janet Esther;Farshid, Gelareh;Lynch, John William
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.7
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    • pp.3105-3112
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    • 2014
  • Purpose: To examine breast cancer (BC) incidence trends in relation to mammographic screening and risk factor prevalence in South Australia (SA). Materials and Methods: Trends in annual BC incidence rates were calculated using direct standardisation and compared with projected incidence derived from Poisson regression analysis of pre-screening rates. Annual percentage change and change time points were estimated using Joinpoint software. Biennial mammography screening participation rates were calculated using data from BreastScreen SA. Trends in overweight/obesity, alcohol use and hormone replacement therapy (HRT) use were examined using 1991-2009 Health Omnibus Survey data. Trends in total fertility were examined using data from the Australian Bureau of Statistics. Results: BC incidence increased around the time BreastScreen commenced and then stabilised in the mid-1990s. However rates have remained higher than projected, even though the proportion and age distribution of first time screening attendees stabilised around 1998. A decrease in BC incidence was observed among women aged 50-59yrs from the late-1990's but not among older women. Obesity and alcohol use have increased steadily in all age groups, while HRT use declined sharply from the late-1990s. Conclusions: BC incidence has remained higher than projected since mammography screening began. The sustained elevation is likely to be due to lead time effects, though over-diagnosis cannot be excluded. Declining HRT use has also impacted incidence trends. Implications: Studies using individual level data, which can account for changes in risk factor prevalence and lead time effects, are required to evaluate 'over-diagnosis' due to screening.

Vitamin D Proliferates Vaginal Epithelium through RhoA Expression in Postmenopausal Atrophic Vagina tissue

  • Lee, Arum;Lee, Man Ryul;Lee, Hae-Hyeog;Kim, Yeon-Suk;Kim, Jun-Mo;Enkhbold, Temuulee;Kim, Tae-Hee
    • Molecules and Cells
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    • v.40 no.9
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    • pp.677-684
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    • 2017
  • Postmenopausal atrophic vagina (PAV) is the thinning of the walls of the vagina and decreased lugae of the vagina. PAV is caused by decreased estrogen levels in postmenopausal women. However, the harmful effects of hormone replacement therapy (HRT) have resulted in considerable caution in its use. Various estrogen agonist treatment options are available. Vitamin D is influences the regulation of differentiation and proliferation of various cells, especially tissues lining stratified squamous epithelium, such as the vaginal epithelium. In this study, we hypothesized that vitamin D could provide an alternative and a safe treatment option for PAV by promoting the proliferation and differentiation of the vaginal epithelium. Thirty six patients were enrolled in this case-control study. Vitamin D associated proteins in a vitamin D and sex hormone treated vaginal epithelial cell line as well as normal and PAV tissues were measured. To confirm of cell-to-cell junction protein expression, cell line and tissue studies included RT-PCR, immunohistochemistry staining, and immunoblot analyses. The expression of cell-to-cell junction proteins was higher in women with symptoms of atrophic vagina tissue compared to women without the symptoms. Vitamin D stimulated the proliferation of the vaginal epithelium by activating p-RhoA and Erzin through the vitamin D receptor (VDR). The results suggest that vitamin D positively regulates cell-to-cell junction by increasing the VDR/p-RhoA/p-Ezrin pathway. This is the first study to verify the relationship of the expression of RhoA and Ezrin proteins in vaginal tissue of PAV.

Evaluation of Estrogenic Activity of Extract from the Herbal Mixture Cynanchum wilfordii Hemsley, Phlomis umbrosa Turczaninow, and Angelica gigas Nakai

  • Kim, Se Jong;Jin, Sun Woo;Lee, Gi-Ho;Kim, Yong An;Jeong, Hye Gwang
    • Toxicological Research
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    • v.33 no.1
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    • pp.71-77
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    • 2017
  • Hormone replacement therapy (HRT) consists of highly effective prescription medications for treating menopausal symptoms; however, these agents have exhibited side effects including the risk of estrogen-induced carcinogenesis. Therefore, interest in phytotherapy-based materials as a natural source of alternatives to estrogen therapy has increased. However, some of these herbal medicines have been reported to increase the risk of estrogen-induced cancer. Herbal formulations composed of a combination of Cynanchum wilfordii Hemsley (CW), Phlomis umbrosa Turczaninow (PU), and Angelica gigas Nakai (AG) extracts (CPAE) have been used for treating menopausal symptoms. Therefore, in this study, we aimed to examine the safety of CPAE by determining its potential adverse estrogenic activity using the Organization for Economic Cooperation and Development (OECD) test guideline 455 (TG455) in a stably transfected transcriptionally activated human estrogen receptor ${\alpha}$ ($hER{\alpha}$)-HeLa9903 cell model. We found that CPAE did not how any estrogenic activity or stimulate promoters containing estrogen response elements in MCF-7 cells. In addition, CPAE showed no significant selective activity against $hER{\alpha}$ and $hER{\beta}$, non-selective activity against the ER, or effects on ER target gene expression. Furthermore, CPAE did not significantly induce MCF-7 cell proliferation and uterine weight increase in ovariectomized rats. These results demonstrate that CPAE can be used as beneficial herbal drug for prevention and therapeutic intervention of estrogen carcinogenesis in menopausal women.

Reproductive Aging in Female Rodents (암컷 설치류에서의 생식 노화)

  • Lee, Sung-Ho
    • Development and Reproduction
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    • v.11 no.1
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    • pp.13-20
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    • 2007
  • In all female mammals, reproductive system is one of the first biological systems to show age-related decline. Female mammals in reproductive aging, though the phenomena is somewhat species-specific, start to show declining fertility and changes of numerous physiological functions. This review will present a current information on the aging of the female reproductive hormonal axis and introduce three useful rodent models for studying this field. Middle age($8{\sim}12$ months old) in female rats and mice is comparable to the stage prior to the entry of menopause in human. In this period pulsatile and surge GnRH secretion from hypothalamus gradually attenuated, then reduced pulsatile and surge LH secretion is followed consequently. This age-related defects in GnRH-LH neuroendocrine axis seem to be highly correlated with the defects in brain signals which modulate the activities of GnRH neuron. Many researchers support the idea which the age-related hypothalamic defects are the main cause of reproductive aging, but some ovarian factors such as inhibin response also could contribute to the induction of reproductive senescence. Some rodent models are quite valuable in studying the reproductive aging. The follitropin receptor knockout(FORKO) mice, both of null and haploinsufficient state, could produce depletion of oocyte/follicle with age. Dioxin/aryl hydrocarbon receptor(AhR) knockout mice also show severe ovarian defects and poor reproductive success early in their life compared to the age-matched normal mice. Further studies on the reproductive aging will be a great help to evaluate the benefits and risks of hormone replacement therapy(HRT) and to improve the safety of HRT.

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An Analysis of the Relationship between Climacteric Symptoms and Management of Menopause in Middle-aged Women (일 지역 중년여성의 폐경증상과 폐경관리와의 관계에 대한 연구)

  • Song, Ae-Ri
    • The Journal of Korean Academic Society of Nursing Education
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    • v.7 no.2
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    • pp.308-322
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    • 2001
  • The purpose of this study was to investigate the relationship between climacteric symptoms and management of menopause of middle -aged women. The subjects of this study were 261 women(40 to 60 years old). Data were collected from Jun. 1 to Jul. 15, 2001 by a structured questionnaire. The instruments employed were : 1) The Climacteric Symptoms Scale developed by Aeri Song and Eun soon Chung(1998). 2) The Management of Menopause Scale developed by Aeri Song(1997). The data were analyzed by the SPSS p.c. program using t-test, ANOVA and Pearson correlation coefficient. The results of the study were as follows : 1. Mean score of climacteric symptoms was $2.18{\pm}0.39$(Maximum 4, Minimum 1). The mean scores among the categories of climacteric symptoms, in descending order, were : a) physical and physiological reactions ($2.62{\pm}0.53$), b) social and family relationships ($2.23{\pm}0.50$), c) psychiatric and psychological reactions ($2.08{\pm}0.49$), d) relationship with sexual partner($1.73{\pm}0.54$), e) genitourinary reactions ($1.72{\pm}0.55$). 2. Mean score of management of menopause was $1.79{\pm}0.45$ (Maximum 4, Minimum 1). The mean scores among the categories of management of menopause, in descending order, were : a) dietary management($2.57{\pm}0.52$), b) self control ($2.24{\pm}0.57$), c) management of exercise and physical activity($2.14{\pm}0.75$), d) management of sex life($1.71{\pm}0.47$), e) management of professional health maintenance($1.61{\pm}0.59$). 3. There were statistically significant differences in the score of middle-aged women's self reported climacteric symptoms according to : a) occupation (t=-2.79, p<0.001) b) marriage state (t=-2.29, p<0.05) c) age of menarche (F=4.66, p<0.001) d) method of Sanhujori (post natal care & treatment) (F=4.22, p<0.001) e) hormone replacement therapy (t=-3.09, p<0.05). From the above statistics, several significant findings were noted : a) There were more climacteric symptoms from those who were unemployed, those who had no partner or were divorced and those who started a menarche earlier. b) There were less climacteric symptoms reported from those on hormone replacement therapy and those who followed their parents or parents-in-law advice regarding Sanhujori (postnatal care) 4. There were statistically significant differences in the score of middle-aged women's self reported management of menopause according to : The educational background (F=7.63, p<0.001), religion (F=3.74, p<0.001), income (F=3.65, p<0.001), number of parity (F=4.87, p<0.001), method of Sanhujori(postnatal care) (F=5.73, p<0.001), period of Sanhujori (postnatal care) (F=2.81, p<0.05), hormone replacement therapy (t=3.81, p<0.001). Women with higher educational background, strong religion, higher income, large number of parity, managed their post natal care well, were on HRT, managed their menopause significantly better than the others who took part in the survey. 5. It will be noted from the above that women's degree of climacteric symptoms showed a negative correlation to the management of menopause(r=-0.2146, p<0.001). The findings shown above suggest the need to develop a variable management of menopause, in order to improve climacteric symptoms of middle-aged women. It is hoped that the above findings will stimulate more detailed research into this matter, and thereby enable guidance to be given to women going through the menopause to cope with it in a less stressful way.

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A Study on the Methodology of Acupuncture Clinical Trial on the Postmenopausal and Perimenopausal Hot Flashes (갱년기 안면홍조에 대한 침 임상시험 방법론 연구)

  • Roh, Jin-Ju;Kim, Dong-Il
    • The Journal of Korean Obstetrics and Gynecology
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    • v.21 no.4
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    • pp.193-206
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    • 2008
  • Purpose: In spite of many arguments on the result of WHI (Women's Health Initiative) study, no one can deny the necessity for researches on the alternative treatment to HRT (hormone replacement therapy). In this study, the author wanted to investigate the method of precedent acupuncture RCTs (randomized controlled trials) to make out the appropriate acupuncture study design on postmenopausal and perimenopausal hot flashes in Korea. Methods: Precedent studies were investigated using Pubmed search and key-words "acupuncture and hot flash", "acupuncture and menopause", "acupuncture and vasomotor", limited to RCT, from 2000 to 2008 April. Results: As a result. 10 studies were searched. In the hereafter studies, multi-center clinical trials which consist of population group of postmenopausal and perimenopausal women that would be pre-stratified and more than 50 patients per treatment arm seem adequate. Sham control study can make out the proper consequence because many people are get used to acupuncture in Korea. Flexible choice of acupoints addressed an individual's symptoms using standardized algorithm is recommended. Treatment consist of 4 weeks' observation, 11 acupuncture sessions during 7 weeks, follow-up of 3 months or more after treatment and hot flash score as a primary outcome measure seem appropriate. After all, higher level of description according to global standard must be obtained in the study report and publishing. Conclusion: The researchers should develope the methodology of acupuncture clinical trial on the postmenopausal and perimenopausal hot flashes.

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The Effect of Ecklonia cava Extracts on Bone Turnover Markers in Ovariectomized Rats (갱년기 유도 흰쥐에서 감태 추출물이 골 대사 지표물질의 변화에 미치는 영향)

  • Kang, Sung-Rim;Kim, Mi-Hyang
    • Journal of Life Science
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    • v.19 no.12
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    • pp.1841-1846
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    • 2009
  • Menopause is often associated with the incidence of several chronic diseases including osteoporosis, cardiovascular disease, and obesity. Hormone replacement therapy (HRT) is an effective regimen that has been found to prevent these diseases in postmenopausal women. However, HRT is accompanied by an increased risk of unfavorable outcomes. Therefore, this study was conducted to evaluate the effects of Ecklonia cava, a kind of seaweed, extract on bone turnover markers in symptomatic menopausal women. For this study, the following four groups of 9-week-old Sprague-Dawley rats were evaluated over 6 weeks: normal rats (SHAM), ovariectomized rats (OVX-CON) and ovariectomized rats that were treated with Ecklonia cava extracts. The optimum extraction temperature and solvent of Ecklonia cava were found to be $80^{\circ}C$ and 80% ethanol. We measured the osteocalcin and CTx content, enzyme ALP activity in serum and collagen content in the cartilage, bone, skin and lungs. We found that the levels of indicators of bone metabolism such as ALP, osteocalcin and CTx were lower in rats in the Ecklonia cava extract group than the OVX-CON group. In addition, the collagen contents in the bone, cartilage, skin and lungs decreased in response to ovariectomy, but the levels of collagen were greater in the bone of rats that were treated with Ecklonia cava extract than in the bone of rats in the OVX-CON group. According to these results, we were able to know the effects of Ecklonia cava extract on bone aging in ovariectomized rats. Consequently, we expect Ecklonia cava extract to have an effect on bone aging in postmenopausal women.