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Complications of Cholestasis. IN: Lindor, K.; Talwalkar, J., eds. Cholestatic Liver Disease. Totowa, NJ: Humana Press. 2008. pp 155-170.
This chapter on the complications of cholestasis is from a book that offers health care providers an overview of cholestatic liver disease; cholestasis is defined as a liver disorder characterized by impaired bile flow. The chapter covers osteoporosis, pruritus, dyslipidemia, and vitamin deficiencies. For each condition, the authors discuss prevalence, pathophysiology, and treatment options. Osteoporosis is extremely common in patients with cholestatic liver disease; treatment goals are to prevent further bone loss, thus reducing the risk of fracture. Biphosphonates, hormone replacement therapy, and vitamin K all increase bone mineral density (BMD) and can prevent further bone loss in cholestatic patients. Management of pruritus associated with cholestasis remains challenging because of incomplete understanding of the mechanisms involved and the limited therapies available. Current treatments include reducing bile acid concentration, reducing opioid tonicity, modulating serotonergic activity, and dialysis. The drug treatments commonly used for dyslipidemia remain controversial because of the long-term impact of therapy on vascular events. Because patients with advanced cholestatic liver disease are at risk for vitamin deficiencies, notably of vitamins A and D, screening and treatment are recommended. The authors stress the importance of recognizing the complications of cholestasis because of their prevalence and their pretransplant and posttransplant implications in this patient population. 3 tables. 81 references.
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Cardiovascular and Metabolic Disease in Menopause: Exploring the Mechanisms. Review of Endocrinology. 1(3): 32-34. July 2007.
This article discusses strategies for the prevention of cardiovascular disease (CVD) and metabolic disease in menopause, including diet, exercise, and soy protein supplementation. The authors note that morbidity and mortality rates from CVD increase after natural and surgical menopause, and the incidence of diabetes dramatically increases after menopause. The authors review the components of metabolic syndrome, including insulin resistance, dyslipidemia, inflammation, vascular function, and adiposity; the role of hormone replacement therapy (HRT); and the use of soy protein. The classic method for counteracting the decrease in energy expenditure with the subsequent increase in abdominal adiposity with aging and menopause is with caloric restriction and exercise; the use of soy protein as a specific dietary supplement shows some promise in preventing the development of risk factors for CVD and metabolic disease in this population. 1 table. 51 references.
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Impact of HRT, Resistance Training on Spine BMD. Review of Endocrinology. 1(2): 28-32. June 2007.
This article explores the impact of hormone replacement therapy (HRT) and resistance training on the spine bone mineral density (BMD) in postmenopausal women. The author reviews evidence that physical activity of sufficient loading can stimulate bone and muscle formation enough to reduce or attenuate age-related osteoporosis and sarcopenia. The author reports on a study that focused on two specific types of exercises, the squat and the deadlift, as ways to reduce bone resorption at the hip and spine. The study, undertaken to investigate the independent and combined effects of resistance training and HRT, examined the bone response to these two site-specific free-weight exercises performed 2 days per week, plus HRT, in early postmenopausal women. The study included four groups: resistance training without HRT (n = 35), resistance training with HRT (n = 37), HRT without resistance training (n = 35), and controls (n = 34). Results showed that, regardless of HRT status, free-weight squat and deadlift exercises performed 2 days per week prevented bone loss at the spine in this group of early postmenopausal women. The author concludes that regular participation in a resistance training program could potentially decrease the dosage of drugs required to induce bone formation in ways that enhance efficacy and also reduce the risk of side effects associated with drug therapies. 5 figures. 3 tables. 32 references.
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Pharmacological Prevention of Colorectal Cancer. Practical Gastroenterology. 31(10): 20-30, 35-36. October 2007.
This article reviews the current status of the pharmacological prevention of colorectal cancer (CRC). The authors note that CRC tends to develop through a multistep process that occurs over a period of years, permitting many opportunities for intervention and cancer prevention. The authors briefly discuss the natural history of adenomatous polyps and CRC, as well as the identification of individuals at risk for CRC, and address the use of chemoprevention. Chemoprevention involves the long-term use of nutritional or pharmaceutical agents that can delay, prevent, or even reverse the process of CRC development. The authors discuss the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as well as a new group of agents, the nitric-oxide-releasing NSAIDs (NO-NSAIDs). Other drugs discussed include HMG-CoA reductase inhibitors (statins), ursodeoxycholic acid, difluromethaylornitine (DMFO), and hormone replacement therapy (HRT). They note that, at present, the only approved drug for chemoprevention of CRC is celecoxib and that is indicated only in high-risk patients with familial adenomatous polyposis (FAP). Screening methods and surveillance continue to be the standard of care for high-risk patients with a history of CRC or adenomatous polyps and for the general population based on age. 64 references.
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American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Menopause. Endocrine Practice. 12(3): 315-337. May-June 2006.
This article presents the position statement of the American Association of Clinical Endocrinologists (AACE) on the diagnosis and treatment of menopause. The authors first review the current role of hormone replacement therapy (HRT) for management of menopause, discussing the treatment of symptomatic women, the effect of HRT on bone mass and preventing fractures, cancer related to HRT, vascular and thromboembolic disease, dementia, nonhormonal therapy, androgen therapy, the indications and contraindications for HRT, and administration and dosage of estrogens and progestogens. The guidelines then outline the risks associated with short-term and long-term HRT, including venous thromboembolic disease, endometrial cancer, breast cancer, and stroke. HRT may also prevent some of the consequences of aging and menopause, including osteoporosis, dementia, and cardiovascular disease. The guidelines then consider nonhormonal therapy for menopause, notably for the management of vasomotor symptoms, or hot flashes, and androgen deficiency in postmenopausal women. The authors conclude that in selected, symptomatic, postmenopausal women, estrogen replacement alone may not be adequate therapy but should be implemented first. Combined estrogen-androgen therapy may be used in those patients who continue to have symptoms.
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Menopause Transition And Postmenopausal Hormone Therapy. IN: Jameson, J.L., ed. Harrison's Endocrinology. Columbus, OH: McGraw Hill. 2006. pp 225-232.
This chapter on the menopause transition and postmenopausal hormone therapy is from a textbook that offers a comprehensive, practical look at the field of endocrinology. The authors define menopause as the permanent cessation of menstruation; perimenopause refers to the time period preceding menopause, when fertility wanes and menstrual cycle irregularity increases. The chapter covers the physiology, symptoms, and appropriate diagnostic tests of perimenopause; menopause and postmenopausal hormone therapy; and the benefits and risks of postmenopausal hormone replacement therapy (HRT). Low-dose oral contraceptives are a therapeutic mainstay in perimenopause, whereas postmenopausal HRT has been a common method of symptom alleviation after menstruation ceases. A patient care algorithm for identifying candidates for HRT use is included. 2 figures. 1 table. 8 references.
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Radioiodine Therapy. Jacksonville, FL: American Association of Clinical Endocrinologists (AACE). 2006. 2p.
This fact sheet reviews the use of radioactive iodine, or radioiodine, used to treat thyroid cancer or an overactive thyroid gland, called hyperthyroidism. The fact sheet briefly reviews the physiology of the thyroid gland and the development of radioiodine as a treatment. The fact sheet then reviews how radioiodine is used in people who have hyperthyroidism to destroy the diseased thyroid gland. This results in the intentional development of an underactive thyroid state, called hypothyroidism, which is easily, predictably, and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. The fact sheet goes on to explain what people with thyroid cancer can expect after removal of their thyroid and during follow-up. The remainder of the fact sheet answers common questions about radioiodine therapy, including what happens to the radioiodine after a treatment, breast-feeding during treatment, future pregnancies after radioiodine treatment, outpatient versus hospital treatment, and exposure to others after treatment with radioiodine. Readers are referred to www.thyroidawareness.com for more information.
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Hormonal Influences on the Gastrointestinal Tract and Irritable Bowel Syndrome. Practical Gastroenterology. 29(5): 62-75. May 2005.
Irritable bowel syndrome (IBS) is a disorder characterized by abdominal pain and discomfort, associated with a change in bowel habits (constipation, diarrhea, or a combination of both). This article considers the role of hormonal influences on the gastrointestinal tract in general and on IBS. The authors note that IBS is more often found in women than men. Often symptoms of IBS appear to be related to hormone status (e.g., menstruating, pregnant, menopausal, taking oral contraceptives, or hormone replacement therapy). In some women, symptoms come and go in tandem with their menstrual cycle. The authors describe the growing body of evidence that supports a role for sex hormones in the pathophysiology and symptom presentation of IBS. The authors call for additional research on IBS that includes categorization and selection of patients based on sex and hormone status to help determine whether sex or hormone status has an impact on the effectiveness of standard management approaches for IBS. 1 figure. 9 references.
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Risk Factors for Inflammatory Bowel Disease in the General Population. Alimentary Pharmacology and Therapeutics. 22(4): 309-316. August 15, 2005.
The etiology (cause) of inflammatory bowel disease (IBD, including ulcerative colitis and Crohn’s disease) remains largely unknown. This article reports on a comprehensive assessment of the potential risk factors associated with the occurrence of IBD. The authors identified a cohort of patients 20 to 84 years old between 1995 and 1997 registered in the General Practitioner Research Database in the United Kingdom. A total of 444 new cases of IBD were found and validated with the general practitioner. Analyses showed incidence rates for ulcerative colitis (UC) were 11 cases per 100,000 person-years, for Crohn’s disease were 8 cases per 100,000 person-years, and for indeterminate colitis were 2 cases per 100,000 person-years. Among women, long-term users of oral contraceptives were at increased risk of developing UC. Similarly, long-term users of hormone replacement therapy (HRT) had an increased risk of CD, but not UC. Current smokers experienced a reduced risk of UC along with an increased risk of CD. Prior appendectomy was associated with a decreased risk of UC. Depression and anxiety were associated with a small increased risk of UC. This association was also present among patients with a long-standing (2 years or more) history of these conditions, which supports a hypothetical role of psychological factors in the occurrence of UC. Diabetes and rheumatoid arthritis are independent risk factors of UC and CD, respectively. 1 figure. 3 tables. 14 references.
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Thyroid Hormone Treatment. Falls Church, VA: American Thyroid Association. 2005. 2 p.
This fact sheet describes thyroid hormone treatment, which is used to replace the function of a nonworking thyroid gland or to prevent further growth of thyroid tissue. The goal of thyroid hormone treatment is to closely replicate normal thyroid function. Written in nontechnical language, the fact sheet reviews the definition of thyroid hormone replacement therapy, the details of taking this type of therapy, and the different types of thyroid hormone therapy in use, answering common questions in each section. Specific topics include the dose of thyroid hormone, FDA-approved products for this type of therapy, interactions between thyroid hormone and other medications, taking thyroid hormone while pregnant, concerns about the use of desiccated animal thyroid, the indications for thyroid hormone suppression therapy, and treatment of thyroid cancer. Readers are referred to the American Thyroid Association website (www.thyroid.org) for additional information.
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Bone Disease in Inflammatory Bowel Disease. Alimentary Pharmacology and Therapeutics. 20 (Suppl 4): 43-49. October 2004.
This review article considers the association between inflammatory bowel disease (IBD, including Crohn's disease and ulcerative colitis) and an increased incidence of osteoporosis (abnormal loss of bone density). Osteoporosis with osteoporotic pain syndromes, fragility fractures and osteonecrosis accounts for significant morbidity and impacts negatively on the quality of life. The author stresses that there is a need to increase awareness for IBD-associated osteoporosis. However, the best ways in which to identify at-risk patients, the epidemiology of fractures and an evidence-based rational prevention strategy remain to be established. The overall prevalence of IBD-associated osteoporosis is 15 percent, with higher rates seen in older and underweight subjects. The incidence of fractures is about 1 per 100 patient years, with fracture rates dramatically increasing with age. While old age is a significant risk factor, disease type (Crohn's disease or ulcerative colitis) is not related to osteoporosis risk. Corticosteroid use is a major variable influencing IBD-associated bone loss; however, it is difficult to separate the effects of the corticosteroids from those of disease activity. The recommendations in IBD are similar to those for postmenopausal osteoporosis, with emphasis on lifestyle modification, vitamin D and calcium supplementation, and hormone replacement therapy. The author concludes with a brief discussion of newer therapeutic options, including bisphosphonates, osteoanabolic substance parathyroid hormone, and osteoprotegerin.
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Post Menopausal Hormone Replacement Therapy (HRT). [La Terpia de Reemplazo Hormonal Postmenopausica (TRH)]. Arlington, VA: American College of Gastroenterology. 2004. 2 p.(EN) 1 p.(SP)
At menopause, the protective effects of estrogen are lost, increasing the risk of heart disease and thinning of the bones (osteoporosis) while causing dryness of the vaginal walls and changes of the urinary tract. This brief patient education fact sheet, from a series on common gastrointestinal (GI) and medical problems in women, considers post menopausal hormone replacement therapy (HRT). The fact sheet reviews important facts about HRT, what to expect during menopause, the use of HRT to manage some of the symptoms of menopause, the benefits of HRT, patients who are candidates for HRT treatment, risks associated with HRT, and gastrointestinal disorders that may be prevented or that may worsen with HRT. The fact sheet is available in English or Spanish.
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Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. 503 p.
This textbook provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The editors compiled contributions from many experts who specialize in the treatment of pelvic floor disorders. The text includes 27 chapters on the epidemiology and etiology of incontinence and voiding dysfunction; diagnostic evaluation of the female patient; bladder physiology and neurophysiological evaluation; diagnosis and assessment of female voiding function; radiological evaluation; urodynamic evaluation of pelvic floor dysfunction; injectable agents for the treatment of stress urinary incontinence in females; transabdominal procedures for the treatment of stress urinary incontinence; transvaginal surgery for stress urinary incontinence; laparoscopic approaches to female incontinence, voiding dysfunction, and prolapse; diagnosis and management of obstruction following anti-incontinence surgery; pediatric dysfunctional voiding in females; nonsurgical treatment of urinary incontinence; sacral nerve root neuromodulation or electrical stimulation; musculoskeletal evaluation for pelvic pain; diagnosis and management of interstitial cystitis (IC); abdominal approach to apical prolapse; the types and choice of operation for repair of vaginal prolapse; colpocleisis for the treatment of vaginal vault prolapse; technique of vaginal hysterectomy; urethral diverticulum; evaluation and management of urinary fistulas; iatrogenic urological trauma; surgical treatment of rectovaginal fistulas and complex perineal defects; pessaries; menopause and hormone replacement therapy; and diagnosis of female sexual dysfunction. Each chapter includes black and white photographs and charts and concludes with a list of references. A subject index concludes the volume.
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Menopause and Hormone Replacement Therapy. In: Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 417-474.
This chapter on menopause and hormone replacement therapy (HRT) is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The authors introduce menopause and discuss the factors that influence the age of menopause onset. They also discuss the transition to menopause; symptoms of menopause, including those of the central nervous system, skin, and genitourinary tract, osteoporosis, and cardiovascular disease; the use of estrogen in menopausal women for both primary and secondary prevention of cardiovascular disease; the risks of HRT, including endometrial cancer, breast cancer, venous thromboembolic events, and alternative benefits of HRT; regimens for HRT, including the supplementation with calcium and vitamin D; and alternative therapies for symptoms of menopause. The authors conclude that the menopause is a normal life event that carries with it an increased risk of morbidity and mortality. The use of HRT can be beneficial in obtaining preventive health benefits. Whether a woman chooses HRT or an alternative, the decision should be based on factual information about the risks and benefits of a given treatment. 5 figures. 11 tables. 266 references.
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Osteoporosis: How Women With Diabetes Are Affected. Diabetes Forecast. 56(5): 41-42. May 2003.
Osteoporosis is a bone condition characterized by low bone mass and poor bone quality. Regardless of age or type of diabetes, many women may be experiencing bone loss, already have osteoporosis and not know it, or both. This article helps women with diabetes to know their risk factors and understand strategies to help prevent osteoporosis. The author reviews normal bone physiology and the impact of type 1 and type 2 diabetes on that bone metabolism. The author also considers how body mass index (BMI) influences bone mass density, the role of hormone replacement therapy (HRT), and various risk factors that can put women at risk for developing fractures.
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Hormone Replacement Therapy and Its Relationship to Lipid and Glucose Metabolism in Diabetic and Nondiabetic Postmenopausal Women. Diabetes Care. 25(10): 1675-1680. October 2002.
Among postmenopausal women, those with diabetes experience more cardiovascular diseases than those without diabetes. In this study, the authors examined the relationship of hormone replacement therapy (HRT) with indicators of lipid and glucose metabolism using a national sample of postmenopausal women with and without diabetes. The authors used data from the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994. A total of 2,786 postmenopausal women aged 40 to 74 years participated in an oral glucose tolerance test (OGTT), had blood drawn for lipid (fats) assessment, and responded to HRT questions. The results showed that postmenopausal women with diabetes had increased dyslipidemia compared with nondiabetic women. Among diabetic women, current users of HRT had significant different lipid and glucose control levels than never users of HRT for the following variables: total cholesterol, non-HDL, apoA, fibrinogen, glucose, insulin, and glycosylated hemoglobin. The authors conclude that women with diabetes and nondiabetic postmenopausal women currently taking HRT had better lipoprotein profile than never or previous users of HRT. Women with diabetes currently taking HRT had better glycemic control than never or previous users of HRT. 3 tables. 29 references.
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Hormone Replacement Therapy, Insulin Sensitivity, and Abdominal Obesity in Postmenopausal Women. Diabetes Care. 25(1): 127-133. January 2002.
This article reports on a study undertaken to determine whether insulin sensitivity differs between postmenopausal women taking estradiol, women on estrogen plus progesterone hormone replacement therapy (HRT), and women not on HRT and whether differences are explained by the differences in total or abdominal adiposity and fat deposition in the muscle. The authors studied 28 obese, sedentary postmenopausal Caucasian women. Women taking oral estrogen (n = 6) were matched for age, weight, and body mass index (BMI) with women not on HRT (n = 6). Eight women taking oral estrogen plus progesterone were matched with eight different women not on HRT for age, weight, and BMI. Maximal aerobic capacity, percentage of fat, total body fat mass, and fat-free mass (FFM) were similar between groups. Visceral fat, subcutaneous abdominal fat, sagittal diameter, and mid thigh low density lean tissue (intramuscular fat) did not differ by hormone status. Basal carbohydrate and fat utilization was not different among groups. Fasting plasma glucose and insulin did not differ by hormone use. Glucose utilization (M) was measured; postmenopausal women taking oral estrogen had a 31 percent lower M than women not on HRT. M was 26 percent lower in women taking estrogen plus progesterone than women not on HRT. M per I, the amount of glucose metabolized per unit of plasma insulin (I), an index of insulin sensitivity, was 36 percent lower in women taking estrogen compared with matched women not on HRT and 28 percent lower in women taking estrogen plus progesterone compared with matched women not on HRT. The authors conclude that postmenopausal women taking oral estrogen or those taking a combination of estrogen and HRT are more insulin-resistant than women not on HRT, even when women are of comparable total and abdominal adiposity. 1 figure. 3 tables. 49 references.
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HRT for Hearts?: Research Raises New Questions. Diabetes Forecast. 55(3): 46-48. March 2002.
Hormone replacement therapy (HRT) has long been advocated for the prevention of osteoporosis and other symptoms associated with menopause. Until recently, HRT was also recommended for the prevention of heart disease after menopause, but a recent study has failed to confirm this benefit. This article reports on this recent research and helps readers with diabetes understand how HRT may or may not fit into their own health care situation. HRT provides a low dose of estrogen, often in combination with progesterone, another female hormone, to compensate for the loss of these hormones as a result of menopause. The author discusses how HRT works; the possible interplay between estrogen and heart disease, including the positive impact of HRT on cholesterol levels; determining risk factors for heart disease; and HRT for other symptoms of menopause. The author concludes by encouraging readers to stay informed about the latest research and to keep in mind that there are alternatives to help protect bones and the heart while treating the discomforts associated with menopause.
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Menopause: The Latest on Hormone Replacement Therapy. Diabetes Self-Management. 19(4): 90, 92, 95-97. July-August 2002.
Hormone replacement therapy (HRT) is a medical therapy option that can alleviate and treat both the short-term symptoms and some of the long-term consequences of menopause. HRT can also increase the risk for certain health problems, so a menopausal woman and her physician need to consider her individual risk factors before starting HRT. This article discusses the benefits, risks, and alternatives to HRT for women with diabetes. Other topics include common symptoms of perimenopause and menopause, the long-term consequences of menopause, the effects of menopause on diabetes, the different types of HRT, the effects of HRT on diabetes, and alternative treatments.
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Diabetes and Arterial Stiffness. In: Johnstone, M.T. and Veves, A. Diabetes and Cardiovascular Disease. Totowa, NJ: The Humana Press, Inc. 2001. p. 343-360.
While many physicians still conceive of diabetes as essentially an endocrine disease, even in light of data reinforcing the concept of diabetes as a vascular disease. There is mounting evidence that disruption of normal endothelial (the cells that line the body cavity and cardiovascular system) function and increased vascular stiffness may play an important role in the process of atherosclerosis. This chapter on diabetes and arterial stiffness is from a textbook that offers physicians practical knowledge about cardiovascular disease and diabetes. The authors focus on the association between diabetes mellitus and increased arterial stiffness, an emerging additional and important risk factor for cardiovascular disease. The authors review the use of pulse wave analysis as a means of assessing arterial stiffness, and explore the possible relationship between endothelial dysfunction and increased arterial stiffness. Finally, the authors discuss novel therapeutic strategies for cardiovascular risk reduction in diabetes, using arterial stiffness as a surrogate endpoint. Therapeutic interventions discussed include vitamin C, fish oil, blood pressure regulation, hormone replacement therapy (HRT), and lipid lowering treatment. 5 figures. 1 table. 107 references.
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Hormone Replacement Therapy Is Associated with Better Glycemic Control in Women with Type 2 Diabetes. Diabetes Care. 24(7): 1144-1150. July 2001.
This article describes a study that examined whether glycosylated hemoglobin (HbA1c) levels varied by current hormone replacement therapy (HRT) among women with type 2 diabetes. The population for the study was drawn from the Northern California Kaiser Permanente Diabetes Registry. Among women with type 2 diabetes, the 15,435 women who had HbA1c measured at least once became the final cohort for all analyses in the study. HRT and HbA1c were assessed by reviewing records in the health plan's computerized laboratory and pharmacy systems. Sociodemographic and clinical information was collected by survey. Among the cohort, 3,852 were currently using HRT before the HbA1c test. Among women currently using HRT, 62 percent were using unopposed estrogens, 36 percent were using opposed estrogen, and 2 percent were using progestins alone. Women currently using HRT were younger, leaner, better educated, and more likely to be non-Hispanic whites than women not using HRT. Mean HbA1c levels were significantly lower in women currently using HRT than in women not using HRT, and these differences increased after adjusting for age. No differences in HbA1c level were observed between women using unopposed estrogens and women using opposed estrogens. In a Generalized Estimating Equation model, which took into account patient clustering within physician and was adjusted for age, ethnicity, education, obesity, hypoglycemic therapy, diabetes duration, self monitoring of blood glucose, and exercise, HRT remained significantly and independently associated with decreased HBA1c levels. The article concludes that HRT was independently associated with decreased HbA1c level. Clinical trials will be necessary to understand whether HRT may improve glycemic control in women with diabetes. 1 figure. 2 tables. 37 references. (AA-M).
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Hormone Replacement Therapy or Prophylaxis in Postmenopausal Women with Recurrent Urinary Tract Infection. Journal of Infectious Diseases. 183(Supplement 1): S74-S76. March 1, 2001.
Urinary tract infection (UTI) is the most common bacterial infection in women, and it occurs with much greater frequency among elderly than among younger women and with increasing frequency among postmenopausal women. This article explores the role of hormone replacement therapy (HRT) as prophylaxis (preventive therapy) in postmenopausal women with recurrent UTI. The author reviews the related literature and concludes that estrogen replacement is effective not only in the treatment of urogynecological symptoms related to menopause but also in the prevention of recurrent UTIs. Younger postmenopausal women can benefit from oral hormonal therapy, which improves clinical symptoms related to menopause and helps avoid osteoporosis and ischemic heart disease; the use of vaginal estrogen should be limited to women older than 60 years for the treatment of atrophic vaginitis, recurrent UTIs, and urge incontinence. The use of HRT, including vaginal therapy, is contraindicated in women with active venous thromboembolism, severe active liver disease, and endometrial and breast carcinoma (cancer) but can be administered to women with diabetes, gallstones, and other relative contraindications. The author calls for additional studies evaluating the safety and comparative efficacy of oral and vaginal estriol. 1 figure. 10 references.
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Managed Menopause. Diabetes Forecast. 54(5): 69-70. May 2001.
This article reviews evidence on the use of hormone replacement therapy (HRT) for older women with diabetes. Although some evidence suggests that HRT may be useful for women with diabetes, other research shows that HRT has mixed effects on blood lipids. However, the overall consensus that is emerging is that postmenopausal women with diabetes should be considered for HRT, as long as the risks and benefits are carefully weighed. Contraindications include a personal or family history of breast, endometrial, or uterine cancer. However, HRT may be beneficial for women with a personal or family history of heart disease or osteoporosis. HRT can take the form of pills or patches. When menopause begins, HRT can cause unexplained hypoglycemia that can be managed with adjustment to insulin doses. Once menopause is established, HRT can help maintain hormone levels in a stable range. The decision to start HRT is an intensely personal one, and women should talk with their health care providers to help them make this decision.
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Mayo Clinic on Managing Diabetes. Rochester, MN: Mayo Clinic. 2001. 194 p.
This book provides practical and easy to understand information on controlling diabetes and preventing complications of the disease. Part one provides facts about diabetes. Topics include types of diabetes, the signs and symptoms of diabetes, the risk factors for diabetes, and the criteria and tests for diagnosing diabetes. In addition, the issue of diabetic complications is addressed, focusing on hypoglycemia, diabetic hyperosmolar syndrome, diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, heart and blood vessel disease, and increased risk of infection. Part two deals with the components involved in controlling the disease. Chapters discuss monitoring blood glucose, eating a healthy diet, getting daily exercise, and maintaining a healthy weight. Part three examines medical therapies for managing diabetes. Chapters provide information on the use of insulin to manage type 1 and type 2 diabetes; the use of sulfonylureas, meglinitides, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and drug combinations to manage type 2 diabetes; and pancreas and islet cell transplantation as possible cures for diabetes. Part four addresses issues related to living well with diabetes. One chapter focuses on important tests every person who has diabetes should be getting, including the glycosylated hemoglobin test, lipid tests, the serum creatinine test, and the urine microalbumin test. Another chapter discusses self care issues, including having annual physical examinations, visiting a dentist regularly, caring for feet, avoiding smoking, monitoring blood pressure, and managing stress. A third chapter explores sexual health issues for both men and women. Topics include the affect of the menstrual cycle and menopause on blood glucose, hormone replacement therapy, pregnancy, and impotence. Each chapter concludes with a question and answer section. The book also includes a list of additional resources. 17 figures. 1 table.
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Risks and Monitoring of Elevated Parathyroid Hormone in Chronic Renal Failure (A Review). Dialysis and Transplantation. 30(3): 147-148, 150-152, 154-155. March 2001.
Elevated serum parathyroid hormone (PTH) levels are common in patients with chronic renal (kidney) failure (CRF). If excess PTH secretion is not treated, it leads to full blown secondary hyperparathyroidism. Secondary hyperparathyroidism is associated with many damaging effects in patients with CRF, and PTH has been suggested as an important toxin of uremia. The article reviews the risks and monitoring of elevated PTH in CRF. Elevated PTH blood levels are best treated by therapeutic administration of vitamin D compounds, but therapy must be monitored carefully to avoid oversuppression of PTH. Monitoring PTH levels is complicated because of the variety of different PTH tests available, the limitations of these tests, and the necessity of interpreting PTH results on a number of variables. Regardless of the methodology, regular and frequent determinations of serum PTH, calcium, and phosphate levels are important in the management of CRF patients, especially if the patients are receiving vitamin D hormone replacement therapy. Titrating the dose of vitamin D based on PTH levels has been suggested as a useful practice to further ensure positive patient outcomes and reduce costs in the long run by preventing many of the more costly interventions necessary when advanced secondary hyperparathyroidism develops. 46 references.
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Role of Estrogen Supplementation in Lower Urinary Tract Dysfunction. International Urogynecology Journal. 12(4): 258-261. 2001.
The female lower urinary and genital tracts both arise from the primitive urogenital sinus and develop in close anatomical proximity. Sex hormones have a substantial influence on the female urinary tract throughout adult life, with fluctuations in their levels leading to macroscopic, histological, and functional changes. Urinary symptoms may therefore develop during the menstrual cycle, in pregnancy, and following menopause. This article explores the role of estrogen supplementation in lower urinary tract dysfunction. Estrogen deficiency, particularly when prolonged, is associated with a wide range of urogenital complaints, including frequency, nocturia (urinating at night), incontinence (involuntary loss of urine), urinary tract infections (UTIs), and the 'urge syndrome.' Estrogen supplementation subjectively improves urinary stress incontinence, but there is no objective benefit when given alone; however, estrogen given in combination with phenylpropanolamine may be clinically more useful. Hormone replacement therapy (HRT) does appear to treat postmenopausal irritative urinary symptoms such as frequency and urgency, possibly by reversing urogenital atrophy, and there is also evidence to suggest that estrogens can provide prophylaxis against recurrent urinary tract infections. However, the 'best' type of estrogen, route of administration, and duration of therapy are at present unknown. 1 figure. 36 references.
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Secondary Hyperparathyroidism and Vitamin D Hormone Replacement Therapy: New Treatment Perspectives. Dialysis and Transplantation. 30(2): 109-111, 125. February 2001.
Secondary hyperparathyroidism (SHPT) affects nearly all patients with chronic renal (kidney) failure (CRF). Recent evidence indicates that complications of SHPT are systemic, and not merely limited to renal bone disease. The link between SHPT and these co morbid conditions has prompted clinicians to make SHPT management a higher patient care priority. This article reviews the development of SHPT, the historical lack of appropriate treatment, and how vitamin D hormone replacement therapies could be used to prevent or limit its effects. In recent years, two vitamin D analogs that have been shown to be less calcemic, paricalcitol (Zemplar IV) and doxercalciferol (Hectorol oral and IV), have been approved for the treatment of SHPT in renal patients. Paricalcitol is active upon administration, with similar pharmacokinetic (how the drug works in the body) characteristics. However, doxercalciferol is a prohormone that, like endogenous vitamin D, must undergo metabolic transformation in the liver in order to form the active vitamin D hormone. This results in a pharmacokinetic profile that, at normal doses, provides blood levels of active vitamin D hormones that peak in 8 hours and remain in the physiologic range for more than 40 hours. This mimics the body's natural metabolism of vitamin D hormone, the ideal treatment for vitamin D hormone deficiency. 19 references.
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Growth Hormone Use in Adults. Today’s Dietitian. 9(4): 50-53. April 2007.
This article reviews the use of growth hormone replacement therapy (GHRT) in adults with a growth hormone deficiency. GHRT can help patients have increased muscle mass, decreased fat content, improved bone density and mood, lowered cholesterol, strengthened heart function, and increased quality of life. Most adult patients with a growth hormone deficiency have pituitary disease from known causes, including pituitary tumor, pituitary surgical damage, hypothalamic disease, irradiation, trauma, or reconfirmed childhood growth hormone deficiency. The author addresses the problem of misuse and mislabeling of growth hormone creams and pills advertised as ‘antiaging’ therapy, stressing that the only effective and approved method of application for growth hormone is through injections, and those are only appropriate in a carefully selected population of patients with documented growth hormone deficiency. The author reviews symptoms and diagnosis of growth hormone deficiency in children and adults, the administration and dosage of growth hormone, side effects that may be experienced at the beginning of GHRT, and where readers can find additional information and support. 1 figure. 3 references.
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Women and Diabetes: Staying Healthy in Body, Mind, and Spirit. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. 230 p.
This newly revised and updated book presents an approach to diabetes designed exclusively for women. The book explores different times of a woman's life and ways to deal with the situations and emotions likely to be encountered. The book includes stories of women who encountered dilemmas and made choices that are involved in living as a woman with diabetes. Chapter one asks readers to determine whether they are treating their diabetes as separate from themselves, as the dominant force in their life, or as part of their life and explains how women can develop a healthy relationship with diabetes. Chapter two helps readers become more aware of the choices they have already made and reveals some other choices that they can make for themselves. Chapter three helps women who have diabetes discover where they are on their journey in dealing with diabetes, handling life challenges, and coping with overall health issues. The chapter also helps the reader weave these three pathways of a life journey together to see how they interact to shape her life experience as a woman with diabetes. Chapter four focuses on relationships. Topics include understanding the impact of one's personality on relationships, dealing with other people, using social skills for maintaining health and wellness, and negotiating for agreements that meet one's needs. Chapter five discusses the impact of diabetes on the mind, body, and soul and offers tips on having a healthy relationship with one's mind, body, and soul. Chapter six explains how diabetes and one's physical health are interconnected, focusing on issues that are common to all women and some that are unique to women who have diabetes. Topics include sexuality, menses, contraception, pregnancy, breastfeeding, menopause, hormone replacement therapy, breast health, osteoporosis, and heart disease. Chapter seven focuses on life practices and explains how women can bring new practices into their life. Personal accounts are presented throughout the book to illustrate the topics being discussed. 1 table.
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