The managed care pharmacy perspective. (9/121)

Despite the important reproductive and noncontraceptive benefits of hormonal therapy, both oral contraceptives (OCs) and hormone replacement therapy (HRT) are underutilized, with only a small portion of eligible women receiving therapy. Increased use of hormonal therapy will result in greater pharmacy costs, a concern in the present era of cost containment that is reflected in the wide variability in coverage of hormonal therapy provided by managed care organizations. However, pharmacoeconomic research demonstrates that relatively small expenditures in pharmacy costs for hormonal therapy result in significantly lower healthcare costs per patient, through the prevention of unintended pregnancy with OCs and the noncontraceptive health benefits of both OCs and HRT.  (+info)

Managing the transition from oral contraceptives to hormone replacement therapy. (10/121)

Oral contraceptives provide multiple benefits for perimenopausal women; their use results in considerable economic savings by managing vasomotor symptoms, preventing pregnancy, and improving future outcomes. Hormone replacement therapy provides many health benefits for menopausal women; a recently introduced constant estrogen/intermittent progestin regimen takes advantage of receptor dynamics and the extended half-life of norgestimate to provide a continuous progestational effect on the endometrium. The lower progestin dose may also decrease progestin-related side effects and contribute to increased adherence and treatment continuation.  (+info)

Patient communication and counseling on contraception and hormone replacement therapy. (11/121)

Many women are unaware of the wide range of benefits resulting from hormonal therapy. Clinicians need to improve their ability to counsel patients about the benefits and risks of oral contraceptives (OCs) and hormone replacement therapy to improve patient compliance and willingness to continue therapy. For reproductive-age women, choosing the lowest effective estrogen/progestin dose will reduce the side effects and bleeding irregularities that are major reasons for patient discontinuation. Analysis has shown that compared with OCs the new transdermal contraceptive system, which is expected to be on the market in 2002, has better outcomes and lower costs at all ages.  (+info)

Male andropause: myth, reality, and treatment. (12/121)

A progressive decrease in androgen production is common in aging men. The physiological causes for this phenomenon seem to be multifactorial. The magnitude of the decline in testosterone with age and the prevalence of older men with low testosterone levels have not been well established. The extent to which an age-dependent decline in androgen levels leads to health problems that might affect or alter the quality of life remains under debate. In men older than middle age, total testosterone levels may be misleading because of an increase in sex hormone-binding globulin levels. The mechanism of the age-associated decrease of the endocrine testicular function is also essentially due to primary testicular failure, but important changes occur at the hypothalamopituitary level. The most prominent endocrinological alterations with aging are related to the sex steroids, but others, such as growth hormone, melatonin cortisol, and thyroxine, are also affected. The clinical picture of andropause syndrome is characterized by diminished sexual desire and erectile capacity, decrease in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density that results in osteoporosis, and increase in visceral fat and obesity. Current medical treatments for androgen supplementation include oral tablets, intramuscular injections, and scrotal and nonscrotal patches. Unfortunately, none of these preparations mimic the circadian rhythm, even if some of them may approximate the circadian rhythm by dose adjustments. Moreover, the androgen supplementation could have adverse effects on different organs, namely, the liver, lipid profile, cardiovascular disease, prostate, sleep disorders, and emotional behavior. Clinical response is a better guide to dose requirements, regardless of serum testosterone levels. This important field must be actively investigated by the medical, behavioral, and social sciences.  (+info)

Self-adjusted postmenopausal hormone replacement therapy: effects on the biological and immunological profile of FSH and correlation to climacteric symptoms. (13/121)

OBJECTIVE: The purpose of the present study was to evaluate the hormonal profile of patients of postmenopausal age during estrogen replacement therapy (ERT) with special reference to the serum levels of biologically active FSH (B-FSH) in a self-adjusted ERT model. DESIGN: The hormonal values found have been correlated to climateric symptoms reported by the patients (scored by the Kupperman menopausal index (KI)). METHODS: B-FSH was measured using an assay based on a cell system transfected permanently with FSH receptor cDNA. All women (n=32) applied estradiol percutaneously using 1 mg estradiol-17beta (E(2)) as an initial dose and were encouraged to increase the daily dose until they felt comfortable according to a specific scheme. Twelve of the 32 women were hysterectomized and treated, accordingly, with ERT only; 20 women received megestrol acetate monthly for 10 days. RESULTS: The initial average KI was 30 (range 10-54). A high degree of correlation (r=0.83; P<0.001) was observed between B-FSH and immunologically active FSH (I-FSH). Serum I-FSH and E(2) correlated negatively (r=-0.21; P<0.001); similarly, a negative correlation (r=-0.15; P<0.01) was observed between serum B-FSH and E(2) levels. Serum I-FSH and KI showed modest but significant positive correlation (r=0.13; P<0.01); a somewhat higher degree of correlation (r=0.19; P<0.005) was observed when B-FSH and KI were compared. E(2) showed positive correlation to serum sex-hormone binding globulin levels (r=0.22; P<0.001). CONCLUSIONS: This study shows that the transdermal self-adjusted hormone replacement therapy (HRT) model introduced is suitable for studies on endocrine changes during postmenopausal ERT. The finding of poor correlation between serum E(2) levels and KI emphasizes the importance of hormonal measurements during postmenopausal HRT.  (+info)

Dietary soy isoflavones and bone mineral density: results from the study of women's health across the nation. (14/121)

Isoflavones are naturally occurring selective estrogen receptor modulators, with potential bone protective effects. To study the relation between soy isoflavone intake and bone mineral density (BMD), the authors analyzed baseline data from the Study of Women's Health Across the Nation, a US community-based cohort study of women aged 42-52 years. Their 1996-1997 analysis included African-American (n = 497), Caucasian (n = 1,003), Chinese (n = 200), and Japanese (n = 227) participants. Genistein and daidzein intakes were highly correlated (r = 0.98); therefore, analyses were conducted by using genistein. Median intakes of genistein (measured in micrograms/day) by African Americans and Caucasians were too low to pursue relational analyses further. For Chinese and Japanese women, median genistein intakes were 3,511 and 7,151 microg/day, respectively. Ethnic-specific, linear models were used to predict BMD as a function of energy-adjusted tertile of intake, controlled for relevant covariates. For Chinese women, no association between genistein and BMD was found. Premenopausal, but not perimenopausal, Japanese women whose intakes were greater had higher spine and femoral neck BMD. Adjusted mean spinal BMD of those in the highest tertile of intake was 7.7% greater than that of women in the lowest tertile (p = 0.02); femoral neck BMD was 12% greater in the highest versus the lowest tertile (p < 0.0001).  (+info)

Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. (15/121)

Our aim was to evaluate the prevalence of bacterial vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of bacterial vaginosis (assessed as a Nugent score of >or=7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for bacterial vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no bacterial-vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4*, and this group was considered separately from the intermediate flora group. A score of 4* was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in bacterial-vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of bacterial vaginosis in postmenopausal women.  (+info)

Iron indexes and total antioxidant status in response to soy protein intake in perimenopausal women. (16/121)

BACKGROUND: Elevated iron stores, oxidative stress, and estrogen deficiency may place postmenopausal women at greater risk of heart disease and cancer than premenopausal women. OBJECTIVE: The objective was to determine the effect of soy-protein isolate (SPI) intake and iron indexes on plasma total antioxidant status (TAS) in perimenopausal women after control for other contributing factors. DESIGN: Perimenopausal women (n = 69) were randomly assigned (double blind) to treatment: isoflavone-rich SPI (SPI+; n = 24), isoflavone-poor SPI (SPI-; n = 24), or whey protein (control; n = 21). Each subject consumed 40 g soy or whey protein daily for 24 wk. Plasma TAS, serum ferritin, serum iron, transferrin saturation, and hemoglobin were measured at baseline, week 12, and week 24. RESULTS: No significant time-by-treatment interactions on iron indexes or TAS were observed, whereas time had an effect on serum ferritin (P < or = 0.0001) and hemoglobin (P = 0.004) but not on TAS. Multiple regression analysis showed that at week 12, 48% (P < or = 0.0001) of the variability in TAS was accounted for by baseline TAS, alcohol intake, soy intake (soy compared with control; P = 0.016), plasma lipoprotein(a), and dietary iron. At week 24, 47% of the variability in TAS was accounted for by baseline TAS, serum ferritin, serum estrone, dietary zinc, and dietary meat, fish, and poultry. CONCLUSIONS: SPI intake had no significant effect on iron status, but our results suggest that dietary soy protein and low iron stores may protect perimenopausal women from oxidative stress.  (+info)