A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome

Article Abstract:

When women undergo hysterectomy (removal of the uterus) for cancer, they must decide whether the surgeon should also remove their ovaries (oophorectomy); the rationale for this is the desire to avoid ovarian cancer, which has a poor prognosis. It is often assumed that the ovarian hormones lost by such a procedure are easily replaced with medication. This may not be the case, however, if patients do not take their medication as prescribed (are not compliant), and known information concerning deviations from compliance should be considered before such a decision is made. To explore the effects of drug compliance and associated disease risks on health policy recommendations for oophorectomy, a decision analysis model was constructed. Included are the probabilities of diseases that are affected by estrogen use: for instance, the risk of hip fracture is reduced by estrogen therapy. Against this must be balanced the probability of ovarian cancer. A range of compliance levels (proportions of women who take the estrogen as prescribed) is assumed. The model shows that, overall, oophorectomy results in increased life expectancy if compliance with estrogen therapy recommendations is perfect. However, when actual patient compliance, as detailed in published reports, is considered, retaining the ovaries increases survival more than removing them among women aged 35 to 45. The analysis is based on data from white women, and other ethnic groups may have different compliance rates, as well as different estrogen-related disease patterns. Probable patient compliance should be considered by both physician and patient when deciding whether to have oophorectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Management, Risk assessment, Patient outcomes, Mortality, Women, Patient compliance, Estrogen, Estrogens, Ovariectomy

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Adrenal and ovarian steroid hormone responses to gonadotropin-releasing hormone agonist treatment in polycystic ovary syndrome

Article Abstract:

Polycystic ovary syndrome is characterized by irregular menstruation, mild obesity, and hirsutism, which usually begins at puberty and tends to worsen with time. Adrenal glands of affected patients produce excessive androgens (male sex hormones), but the mechanism underlying this is unclear. Half of the women with this syndrome have high blood levels of dehydroepiandrosterone sulfate (DHA-S), an androgenic steroid that is a precursor to testosterone. Gonadotropin-releasing hormone (GnrH) is the hormone produced by the hypothalamus that regulates production of pituitary reproductive hormones, which themselves affect ovarian production of steroid sex hormones. GnRH treatment suppresses production of pituitary and ovarian hormones, but the effect on DHA-S levels has not been assessed. The effects of GnRH on hormone production in 10 women with polycystic ovary syndrome (half with high DHA-S levels) were evaluated and compared with five healthy women. After one month of treatment, pituitary hormone levels dropped in women with the syndrome; pituitary hormone levels approached those of healthy women, whose levels dropped little. Ovarian estrogens (female sex hormones) dropped significantly in all groups, as did most progesterone-related hormones and androgens. In subjects with high DHA-S levels, DHA-S concentrations dropped slowly, but significantly; however, they did not reach normal levels. Ovarian steroids may induce a deficiency of an adrenal enzyme, which metabolizes DHA to other steroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Gonadotropin releasing hormone, Gonadorelin, Stein-Leventhal syndrome, Polycystic ovary syndrome, Steroids (Drugs)

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Oral contraceptives and arterial and venous thrombosis: a clinician's formulation

Article Abstract:

Oral contraceptives are safe and effective as long as women are tested for various conditions that could raise their risk of adverse effects. Estrogen can increase the production of blood clotting factors, leading to an increased risk of stroke, heart attack and other blood clotting disorders. However, most oral contraceptives contain much lower doses of estrogen and also contain a progestin. Women with no cardiovascular disease risk factors should be able to use contraceptives safely. However, women with hypertension or other risk factors such as smoking should be cautioned against their use.

Causes of, Blood clotting disorders, Blood coagulation disorders, Oral contraceptives

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