Consensus conference TOS: abstract articoli, documenti
- Fournier A et al. Breast Cancer Res Treat 2008; 107: 103.
Unequal risks for breast cancer associated with different hormone replacement terapies: results from the E3N color study.
Large numbers of hormone replacement therapies (HRTs) are available for the treatment of menopausal symptoms. It is still unclear whether some are more deleterious than others regarding breast cancer risk. The goal of this study was to assess and compare the association between different HRTs and breast cancer risk, using data from the French E3N cohort study. Invasive breast cancer cases were identified through biennial self-administered questionnaires completed from 1990 to 2002. During follow-up (mean duration 8.1 postmenopausal years), 2,354 cases of invasive breast cancer occurred among 80,377 postmenopausal women. Compared with HRT never-use, use of estrogen alone was associated with a significant 1.29-fold increased risk (95% confidence interval 1.02-1.65). The association of estrogen-progestagen combinations with breast cancer risk varied significantly according to the type of progestagen: the relative risk was 1.00 (0.83-1.22) for estrogen-progesterone, 1.16 (0.94-1.43) for estrogen-dydrogesterone, and 1.69 (1.50-1.91) for estrogen combined with other progestagens. This latter category involves progestins with different physiologic activities (androgenic, nonandrogenic, antiandrogenic), but their associations with breast cancer risk did not differ significantly from one another. This study found no evidence of an association with risk according to the route of estrogen administration (oral or transdermal/percutaneous). These findings suggest that the choice of the progestagen component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone or dydrogesterone.
- North American Menopause Society. Menopause 2007; 14 (2): 168
Estrogen and progestogen use in peri-and postmenopausal women: March 2007 position statement of The North American Menopause Society.
OBJECTIVE: To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2004 regarding recommendations for estrogen and progestogen use in peri- and postmenopausal women. DESIGN: NAMS followed the general principles established for evidence-based guidelines to create this updated document. An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the 2004 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees. The position statements published by NAMS do not represent "practice standards" that would be codified and held up as standards by regulating bodies and insurance agencies. Rather, they are prevailing opinion pieces in a best effort attempt to incorporate current evidence into practical clinical recommendations. RESULTS: With the primary goal being to evaluate the risk-benefit ratio of peri- and postmenopausal estrogen therapy (ET) and estrogen-progestogen therapy (EPT) for both disease prevention and treatment of menopause-related symptoms, current evidence allowed for a clear distinction between areas of consensus and areas for which the Panel determined that there was inadequate evidence for any conclusion to be reached. The document lists all of these areas along with clear explanatory comments. A comprehensive list of key references is provided. The absence of evidence is also recognized in the list of needs for further research recommended by the Panel. CONCLUSIONS: Current evidence supports the use of ET or EPT for menopause-related symptoms and disease prevention in appropriate populations of peri- and postmenopausal women.
- Chiechi LM. Manuale di Ginecologia Etica. Bari: Ediself, 2007
Il presente manuale costituisce un cambiamento culturale radicale nella maniera di gestire la biologia femminile, gravidanza, parto, allattamento, contraccezione e menopausa.Esso è rivolto alle ostetriche, che di questa gestione sono le professioniste, ed una ginecologia diventa etica a cominciare dalla appropriatezza professionale; ma sicuramente è rivolto al medico, troppo innamorato dei principi della EBM e troppo compresso fra i numerosi conflitti di interesse ed un avvilente ruolo da impiegato sanitario.Ed è sicuramente rivolto alla donna ovviamente, che del suo corpo deve riprendere a farsi carico senza deleghe in bianco a nessuno, pretendendo da tutti gli operatori il pieno rispetto del fondamentale principio di autonomia.
- Secreto G et al. Maturitas 2004; 47 (1): 11
Soy isoflavones and melatonin for the relief of climacteric symptoms: a multicenter, double-blind, randomized study.
OBJECTIVE: To evaluate the effect of soy isoflavones and melatonin in relieving menopausal symptoms. METHODS: Double-blind, multicenter, randomized trial performed according to a 2 x 2 factorial design. Treatment groups: (1) soy isoflavones+melatonin; (2) soy isoflavones alone; (3) melatonin alone; (4) placebo. 80 mg of soy isoflavones, 3 mg of pure melatonin or placebo were supplemented to participants for 3 months. Severity of menopausal symptoms was recorded at baseline and after 3 months using the Greene Climacteric Scale. RESULTS: 388 consecutive women were screened: not eligible 98, refused informed consent 28. Randomized 262 and analyzed 232; twelve women withdrew because of adverse events. Median percent differences between basal and final scores were 39% in the isoflavones + melatonin group, 38% in the isoflavones alone group, 26% in the melatonin alone group and 38% in the placebo group. Placebo response was much higher than planned, making it meaningless to perform any statistical test. With regard to somatic and vasomotor symptoms, outcome was similar among the four groups, whereas improvement of psychological symptoms was higher in the isoflavones+melatonin group than in the other three. CONCLUSIONS: Present data do not show any advantage of isoflavones or melatonin over placebo for the relief of menopausal symptoms. However, the effect in psychological symptoms in the isoflavones + melatonin group should be further investigated.
- Chiechi LM et al. Maturitas 2003; 45 (4): 241
The effect of a soy rich diet on the vaginal epithelium in postmenopause: a randomized double blind trial.
BACKGROUND: A traditional asiatic phytoestrogen-rich diet is associated with a lower incidence of estrogen-dependent cancers and clinical consequences of postmenopausal estrogen deficiency. First Wilcox in 1990, showed an increase of the vaginal cell maturation with phytoestrogens on postmenopausal women, but this has not been confirmed in some subsequent studies. METHODS: In this study, we analyzed the effects of a 6-month soy-rich diet on the vaginal epithelium of asymptomatic postmenopausal women in a randomized clinical trial. 187 women were recruited for the study and divided into three groups: a phytoestrogen rich diet group; a hormonal replacement group, and a control group. A vaginal sample for hormonal cytology was taken before and at the end of the study, and sent unnamed to a cytologist. RESULTS: The karyopycnotic index (KI) increased significantly in the diet group and in the HRT group but not in the control group. The maturation value (MV) had an identical trend to the KI. CONCLUSION: We conclude that a soy rich diet is efficacious in increasing the maturation indices of vaginal cells. This effect could be a useful marker of the efficacy of a dietary intervention with phytoestrogen rich foods, and should be considered during preventive interventions against menopausal effects and vaginal atrophy.
- Chiechi LM et al. Curr Opin Investig Drugs 2003; 4 (4): 439.
Hormone replacement therapy and health protection
Menopause is potentially a cause of concern and hormone-related diseases. Hormone replacement therapy (HRT) is considered to be an effective treatment strategy to relieve menopausal symptoms and prevent related diseases, however, knowledge on HRT and its benefits and risks is still evolving. For many climacteric women, HRT is the ideal choice to treat symptoms, prevent diseases and improve quality-of-life, while for others it can cause concerns and problems. Thus, the appropriate role of HRT has still to be fully defined. An individualized, patient-tailored approach to HRT, based on the current evidence of risk factors for hormone-related diseases and treatments, is essential to maximize the benefits and minimize the risks.
- Chiechi LM et al. Clin Exp Obstet Gynecol 2002; 29 (3): 187
Postmenopausal osteoporosis and celiac disease.
Individualizing risk factors is the most important tool to prevent late consequences of menopause. Celiac disease is a predisposing condition not very considered for some postmenopausal diseases, such as postmenopausal osteoporosis. In this review the authors examine climacteric conditions that could be heightened by a celiac status especially if disregarded and untreated.
- Chiechi LM et al. Maturitas 2002; 41 (2): 97
The effects of a soy rich diet on serum lipids: the Menfis randomized trial
OBJECTIVE: To assess beneficial effects of a soy rich diet on the main biomarkers of cardiovascular health in menopause, compared with the effects of the hormone replacement therapy (HRT). METHODS: 187 healthy asymptomatic postmenopausal women, aged 39-60, were recruited and randomized into three groups: a soy rich diet group, a HRT group, and a control group. Lipid profile, body mass index, blood pressure, endometrial thickness, uterine artery resistance index (RI), were evaluated in all the participants at the baseline, after 6 months, and at the end of the study. RESULTS: After a 6-month intervention period, the lipid profile in the soy rich diet group showed a favourable outcome, similar to that observed in the HRT group, but compliance to the diet was low. CONCLUSION: Soy products may be used in the prevention of cardiovascular risk in postmenopausal women because of their efficacy in contrasting the negative effects of menopause on the cardiovascular system, but our findings should be confirmed; moreover, suitable strategies to improve the compliance have to be considered.
- Chiechi LM et al. Maturitas 2002; 42 (4): 295
Efficacy of a soy rich diet in preventing postmenopausal osteoporosis: the Menfis randomized trial
OBJECTIVES: To compare the effect of a soy rich diet and hormone replacement therapy (HRT) on the main biomarkers of bone turnover and bone mineral density (BMD) at postmenopausal age. METHODS: 187 healthy asymptomatic postmenopausal women, aged 39-60, were recruited and randomized into a soy rich diet group, a HRT group, and a control group. Bone biomarkers and BMD were evaluated at baseline and after 6 months at the end of the study. RESULTS: Diet is not as effective as HRT in reducing the postmenopausal turnover; however diet stimulates bone osteoblastic activity, as evidenced by significant increase in osteocalcin concentrations. BMD decreases significantly only in the control group, but not in the intervention groups.
CONCLUSIONS: Our data suggest that soy products could be effective in reducing the risk of osteoporosis in asymptomatic postmenopausal women, but our findings should be confirmed before recommending the diet as a valid alternative to HRT.
Inserito da redazione il Lun, 03/12/2007 - 18:24