Hormonal therapy in the patient with surgical menopause

Article Abstract:

Removal of the ovaries (oophorectomy) in premenopausal women was more common formerly than today, in part because the female hormones produced by the ovaries are now known to exert preventive effects on cardiovascular disease and osteoporosis (bone density loss). Bilateral oophorectomy is rarely recommended for premenopausal women or for women around the time of menopause because it induces ''surgical menopause''. There are situations, however, when bilateral oophorectomy may be performed because of other threats to a woman's health. A review is provided of the effects of surgical menopause. Ovarian hormones appear to affect low- and high-density lipoprotein (LDL and HDL) cholesterol levels, which, in turn, are associated with mortality from cardiovascular causes. Evidence is presented regarding the effects of bilateral oophorectomy on mortality and osteoporosis. Estrogen therapy, taken orally or as an implant, reverses both of these effects. Since the uterus produces prostacyclin, a substance that causes blood vessel dilatation and prevents blood clotting, its removal may also allow the development of coronary artery disease (the vessels that supply blood to the heart muscle). The role of the uterus in preventing cardiovascular disease has not been determined. Patients who have undergone hysterectomy do not need supplementation with progestin (progestational hormones, another type of female hormone), which is usually given with estrogen to prevent cancer of the uterine lining (endometrium). Whether estrogen alone leads to an increased incidence of breast cancer requires further study. Women who receive both estrogen and androgenic (male) hormones after menopause seem to have fewer somatic, psychosomatic, and psychological complaints than those who receive only estrogen. Patients who have had endometrial or breast cancer are almost never given estrogen replacement therapy, for fear of increasing their cancer risk. However, if the risk of cardiovascular disease or osteoporosis is sufficiently great, hormone therapy could be considered, but issues related to informed consent must be handled appropriately. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Osteoporosis, Ovariectomy

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Cardiovascular implications of estrogen replacement therapy

Article Abstract:

After menopause, women become vulnerable to cardiovascular disease, and mortality from this cause in 70-year-old females is approximately the same as in males of the same age. Women with premature menopause or bilateral oophorectomy (removal of both ovaries) are at much higher risk of cardiovascular disease than those who undergo menopause naturally. Estrogen (a female hormone that declines after menopause) exerts a protective effect on the cardiovascular system. The physiologic mechanisms for this are reviewed. Women have lower cholesterol levels than men before menopause, but afterwards, their levels increase more than levels in aging men. It has been estimated that every one percent increase in total blood cholesterol is associated with a two percent increase in the risk of heart attack. Estrogen decreases one form of cholesterol (low-density lipoprotein, or LDL, cholesterol) and increases another (high-density lipoprotein, or HDL, cholesterol). LDL cholesterol is the ''villain'' of the cholesterol scenario, with a possible role in atherosclerosis (the deposition of fatty plaques on arterial walls). When estrogen replacement therapy is instituted, coronary heart disease (disease of the coronary arteries, the vessels that supply blood to the heart itself), and mortality from related causes, decline by at least 50 percent. A mathematical model that describes the reduction in cardiovascular disease mortality is presented. The negative effects (abnormal glucose tolerance, blood clotting) associated with estrogen in oral contraceptives are not the result of natural estrogen, but of synthetic estrogen, often in combination with progestogens (other female hormones, also called progestational hormones). The ways estrogen can be administered are reviewed, as are its possible direct effects on blood vessel walls. When estrogen replacement therapy is undertaken, administration of progestogen is necessary to protect the uterine lining (endometrium) from undergoing changes that can lead to cancer. Balancing the correct doses of these two hormones is an essential, but difficult, clinical task. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Progestational hormones

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Sexuality and menopause

Article Abstract:

Most women notice changes in sexual functioning during the years just before and just after menopause, including discomfort during intercourse (dyspareunia), loss of desire, decreased sexual activity, dysfunctional male partners, and reduced responsiveness. Many of the biological aspects of sexuality are regulated by estrogen (a female hormone), acting via receptors located on a variety of cell types. For instance, the nerve cells that carry sensory information into the brain bear estrogen receptors; when estrogen levels decline, as they do during menopause, sensation may be altered. In addition, the hormone promotes cell growth and division, and affects the activity of neurotransmitters (the chemicals that mediate electrical transmission between nerve cells). Estrogen, through its effect on the muscle layer of arteries, can also influence blood flow to the genitals; one study showed that, after administration of an estrogen compound, blood flow to the vulva (the external female genitalia) increased by 50 percent. The hormone can prevent atherosclerotic disease (deposition of fatty plaques on the walls of arteries) in cerebral and coronary vessels (that supply blood to the brain and heart, respectively). Results from studying problems of sexual function among menopausal women are presented. One study, of 178 married, white British women, who were on average 5 years postmenopausal, found that only 14 percent said they had no sexual difficulties. While menopause may affect only the woman in a couple, more commonly, both report problems. A man may feel inhibited by rejection or anger, fear of hurting the woman, or experience performance anxiety. Some men cannot maintain their erections long enough for menopausal women to become sufficiently aroused. Health care professionals can help in such cases, often by restoring the woman to estrogen balance. After administration of estrogen, most women in one study had increased sexual desire and activity. Many problems of menopausal women, formerly thought to lie within the province of psychiatric illness, can be treated by estrogen replacement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexual disorders, Research, Sex (Biology)

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