|
KMID : 0377619910560010005
|
|
Korean Jungang Medical Journal
1991 Volume.56 No. 1 p.5 ~ p.6
|
|
|
THE POSTMENOPAUSE
|
|
Schneider, H.P.G
|
|
|
Abstract
|
|
|
With respect to general menopausel symptoms, the clearly demonstrated benefits of estrogen therapy are related to hot flushes, insomnia, vaginal dryness, irritability, poor memory, anxiety, "worry about age", headache, urinary frequency and good spirits. Many of these beneficial effects are maintained and enhanced by prolonged therapy including those directly related to hot flushes such as dizziness, nausea, palpitations, diaphoresis and "night sweats". Many of these symptoms disappear in a reasonable period of time without any kind of therapy. Therapeutic indifference must not be afforded with regard to postmenopausal osteoporosis, cardiovascular disease, endometrial and breast cancer; these potentially life threatening diseases are of central concern for physicians. Responsibility for women without endogenous ovarian function, be they postmenopausal or without cyclic ovarian function at younger age such as secondary amenorrhea, anorexia nervosa or gonadal dysgenesis, has emerged as a key issue of preventive medicine.
Once a woman has established osteoporosis with nonreversible changes in body stature, chronic pain and substantial fracture risk, no treatment is currently available to restore normal bone architecture. The only effective therapy for the prevention of osteoporosis is early estrogen replacement; fracture risk is clearly reduced. The most effective doses of oral estrogens are 0.625 mg conjugated estrogens or 2 mg estradiol per day, preventing 95 % of trabecular and 50 % of cortical bone loss in almost all women.
The incidence of coronary disease and mortality is substantially reduced by about 60 % in all postmenopausal women, this effect being more pronounced in bilaterally ovariectomized women. A reduction of 50 % for cardiovascular mortality may be achieved by a daily dose of 0.625 mg conjugated estrogens. Even in smoking postmenopausal women in whom increased cardiovascular mortality is well known, conjugated estrogens have been reported to yield a reduction of 80 % in comparison to nonsmoking untreated postmenopausal women. A slight increases in HDL2 is promoted by oral doses between 1 and 4 mg micronized estradiol or estradiol valerate per day and 0.625 or 1.25 mg conjugated estrogens. Oral or vaginal estradiol, percutaneous administration of estradiol or vaginal application of conjugated estrogens do not exert considerable changes in lipid metabolism. Norethisterone and norgestre reduce concentrations of HDL and apolipoprotein A-1. Total cholesterol often remains unchanged because LDL is increased. Oral or parenteral medroxyprogesterone acetate has no negative effects on lipid metabolism. The influence on lipid is dependent on type and doses of the selected estrogen.
Unopposed estrogen therapy is known to promote endometrial cancer in a small percentage of postmenopausal women. The addition of a progestogen is the only realistic means to control endometrial morbidity. The incidence of breast cancinoma in the estrogenprogestogen replaced postmenopausal women in long-term perspective studies was found to be significantly lower than in nonusers estrogenic monotherapy apparently does not alter the risk. Progesterone, rather than estrogen, seems to be the crucial sex steroid in the development of breast cancer. Biochemical data concerning cell mitosis rates during the normal menstrual cycle strongly suggest that endogenous progesterone during the secretary phase does not depress breast deoxyribonucleic acid synthesis, therefore the administration of progesterone in addition to estrogen for replacement therapy in hysterectomies women in order to reduce breast cancer risk cannot yet be regarded as mandatory.
The nowadays available estrogen-progestogen replacement therapies bring about a substantial restoration of quality of life. Estrogens do not substitute for eternal female youth, but they abolish or alleviate most of the psychic or somatic climacteric complaints. Therefore life expectancy apparently increases. Estrogen replacement therapy offers the opportunity to smooth a woman´s transitional years from potential fertility to old age.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|