RESUMEN
The threat that women may develop breast cancer is the major reason why both physicians and women are afraid to use menopausal hormone therapy (MHT). The fear pertains to estrogen-progestin replacement therapy (EPRT) as estrogen-alone replacement therapy has no, or even a reduced, breast cancer risk. We reviewed the way breast cancer risk with EPRT was reported in some major publications since 2002 and tried to put the use-risk association in context. We hope this will make it easier for the physician and the menopausal woman to understand the risk involved and allow more confident and more informed decision-making regarding MHT use. We conclude that there are five interrelated reasons why physicians and women should no longer be afraid of the breast cancer risk with EPRT. We submit that breast cancer related to EPRT use is rare because the risk is very low; the reported increase in breast cancer risk with EPRT is not relevant to current practice; modifiable lifestyle factors, not EPRT, are the real risks for breast cancer; breast cancer-specific mortality is reduced in women who develop breast cancer while on EPRT; and avoiding MHT use when indicated puts a woman in harm's way.
Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama/inducido químicamente , Neoplasias de la Mama/epidemiología , Terapia de Reemplazo de Estrógeno/efectos adversos , Estrógenos , Miedo , Femenino , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Menopausia , Factores de RiesgoRESUMEN
This review aims to draw a clearer clinical picture of postmenopausal endometriosis. Based on limited literature, postmenopausal endometriosis emerges as an infrequent entity but with a clinical picture significantly unlike that of premenopausal endometriosis. In contrast to the premenopausal disease, postmenopausal endometriosis occurs in a state of ovarian estrogen deficiency, appears to have a greater predisposition to malignant change, may have a greater tendency to spread to extragonadal organs and develop into constrictive and/or obstructive lesions, and is preferably treated surgically. The need to use hormone therapy for the management of menopausal symptoms that may concomitantly affect women with postmenopausal endometriosis is an unresolved therapeutic dilemma. This is mainly because the relationships of menopausal hormone therapy to recurrence of endometriosis and, more importantly, to increased risk of malignant degeneration, remain unclear.
Asunto(s)
Endometriosis/epidemiología , Endometriosis/terapia , Posmenopausia , Anciano , Terapia de Reemplazo de Estrógeno , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/epidemiología , Recurrencia , RiesgoRESUMEN
Recently published data demonstrate major demographic changes and disease trends evolving in the Asia-Pacific. These portentous developments will have far-reaching social and economic implications in terms of income security, social welfare and medical services. The region is now home to more than half of the world's population and includes some of the richest and most developed countries alongside some of the poorest and least developed ones. In the coming decades, the number of older persons (aged 60 years or over) and the number of the oldest-old (aged ≥80 years) in the region will increase rapidly. The Asia-Pacific is first in rank in terms of the number of urban dwellers. Despite persisting levels of underweight in some countries in the Asia-Pacific, overweight and obesity have become endemic for almost the entire region. Hypertension, hyperlipidemia and metabolic syndrome are highly prevalent. The Asia-Pacific has the largest diabetes burden in the world. A smoking epidemic is developing in the region. As a consequence of these exacerbations in cardiovascular risk factors, already half of the world's cardiovascular burden occurs in the Asia-Pacific. Additionally, osteoporosis is becoming a serious public health issue in the Asia-Pacific and dementia is reaching epidemic proportions. The mix of a rapidly increasing, aging and urbanized population and a developing epidemic of chronic diseases will result in an enormous, health, social and economic burden and is threatening to overwhelm the health-care systems of less developed countries in the Asia-Pacific.
Asunto(s)
Epidemiología/tendencias , Anciano , Anciano de 80 o más Años , Asia/epidemiología , Enfermedades Cardiovasculares/epidemiología , Demografía , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hiperlipidemias/epidemiología , Hipertensión/epidemiología , Masculino , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Islas del Pacífico/epidemiología , Población UrbanaRESUMEN
OBJECTIVES: Significant differences in the prevalence of menopausal symptoms and in lipid profiles have previously been reported for nine ethnic groups of postmenopausal Asian women participating in the Pan-Asia Menopause (PAM) study. Based on these findings, we tested the hypothesis that reproductive hormone profiles differ among the nine ethnic groups under investigation in the PAM study. METHODS: Baseline serum samples from postmenopausal women (n=1020) representing nine ethnic groups were analyzed at a central laboratory by electro-chemiluminescence immunoassay methods. Hormone concentrations were measured for estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH). RESULTS: The hormone levels for the overall study population (mean+/-SD) were: E2=74.1+/-125.1 pmol/l (n=1015); FSH=81.2+/-31.4 IU/l (n=1013); LH=36.8+/-15.6 IU/l (n=1015). Estradiol levels ranged from 50.0 pmol/l in Chinese women to 106.8 pmol/l in Vietnamese women; FSH ranged from 68.2 IU/l in Korean women to 90.8 IU/l in Malay women; and LH ranged from 30.7 IU/l in Korean women to 44.1 IU/l in Malay women. There was an inverse correlation between log E2 and FSH levels and a positive correlation between FSH and LH levels. The concentrations of E2, FSH and LH were significantly associated with ethnicity after adjustment for age and body mass index. Additionally, the concentrations of all three hormones were significantly associated with body mass index, whereas E2 and LH levels were associated with age, but FSH levels were not. CONCLUSION: The levels of FSH, LH and particularly of E2 differ substantially among ethnic groups of postmenopausal Asian women. The clinical significance, if any, of these differences remains to be investigated. The inverse correlation of E2 and FSH levels suggests that E2 at the postmenopausal state still affects pituitary FSH output.
Asunto(s)
Envejecimiento/sangre , Estradiol/sangre , Etnicidad , Hormona Folículo Estimulante/sangre , Hormona Luteinizante/sangre , Posmenopausia/sangre , Asia , Índice de Masa Corporal , Femenino , Humanos , Mediciones Luminiscentes , Persona de Mediana Edad , Obesidad/metabolismo , Salud de la MujerRESUMEN
The aging male is fast becoming a global concern. The problem is predicted to become a major health issue that should be addressed immediately in order to prevent disability, morbidity, and, more importantly, mortality. As part of its commitment to increase awareness and create interest in the care of Filipino aging males, The Philippine Society for the Study of the Aging Male Foundation, Inc. (PhiSSAM), a multi-specialty society established in 2000, embarked on a survey among Filipino physicians to determine their knowledge, attitudes, and practices regarding male aging. Results showed that the majority of doctors (about 87%) thought that men may experience andropause. Most would diagnose patients based on symptoms alone, while only 20-30% used testosterone levels to make a diagnosis of andropause. Decreased libido and less strong erections were the symptoms very closely associated with low testosterone. Of those doctors responding, 89% agreed that andropause can affect the quality of a man's life as much as menopause can affect a female; only 38% had already prescribed/instituted treatment for andropause. Of the 62% non-prescribers, 58% said they were either very likely or fairly likely to institute treatment in the future if there were more clinical trials, more medical information, and more information on drugs. Major concerns on testosterone replacement therapy included prostate cancer, benign prostatic hypertrophy, and heart disease. The findings in this pilot survey indicate a need among the doctors in the Philippines for education about andropause and the available treatments.