Evidence-based review of therapies at the menopause. Effects of low-dose, continuous combined estradiol and noretisterone acetate on menopausal quality of life in early postmenopausal women. Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention. Increase of estrogen dose deteriorates mood during progestin phase in sequential hormonal therapy. Impact of menopausal hormone-replacement therapy on clinical and laboratory characteristics of breast cancer. Relative antidepressant efficacy of venlafaxine and SSRIs: sex-age interactions. Transdermal nicotine use in postmenopausal women: does the treatment efficacy differ in women using and not using hormone replacement therapy? [Clinical effects of hormone replacement therapy with estradiol valerate and cyproterone acetate in perimenopausal women]. Hormonal and psychological treatment: therapeutic alternative for menopausal women? Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women. Randomized trial of osteoporosis screening. Use of hormone replacement therapy and quality-of-life results. Endometrial response to IVF hormonal manipulation: Comparative analysis of menopausal, down regulated and natural cycles Physical training and hormone replacement therapy reduce the decrease in bone mineral density in perimenopausal women: a pilot study Efficacy and safety of acupuncture for hypertension: An overview of systematic reviews. Estradiol and the addition of progesterone increase the sensitivity to a neurosteroid in postmenopausal women Effects of 5 years of hormonal replacement therapy on menopausal symptoms and blood pressure-a randomised controlled study. Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause Elevated levels of sE-selectin in post-menopausal females are decreased by hormone replacement therapy to levels observed in pre-menopausal females. Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition. Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy. Effects of exercise training and hormone replacement therapy on lean and fat mass in postmenopausal women. Health related quality of life after combined hormone replacement therapy: randomised controlled trial
Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought , for example , systematic review s of r and omised controlled trials ( RCTs ) . Results There is reasonable evidence that some symptoms are modified by lifestyle , for example , cessation of smoking , exercise , reduction of alcohol , diet and alleviation of psychosocial stress . No complementary medicine , for example , phytoestrogens , black cohosh , herbal or homeopathic medicines or complementary therapies , for example , acupuncture , yoga , chiropractic manipulation , reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs . Some have potential side-effects . So-called ' bioidentical hormones ' have no evidence -base and potential for harm . None of the above therapies have evidence of efficacy and long-term safety . Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo . The most effective therapy for menopausal ( oestrogen ) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies ( HRT ) . Compared with placebo HRT is highly effective in relieving hot flushes , night sweats , dry vagina and dyspareunia . It also improved joint pains , sexuality and sleeplessness and reduced subsequent fractures in RCTs . The increased risk of oral HRT for thromboembolism is small around menopause , for those without thrombotic risk factors , and is not elevated with non-oral routes . Cardiovascular disease may be reduced when HRT is initiated near menopause . Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 ( < 0.1 % ) . No increase in breast cancer risk was seen with oestrogen-only HRT OBJECTIVES To describe the effects of low dose hormonal replacement therapy ( LD-HRT ) on quality of life in early postmenopausal women , since the postmenopausal estrogen deprivation in mid age women often brings along a series of changes and symptoms , which may greatly affect quality of life . METHODS Fifty normal postmenopausal women were recruited and r and omly treated with LD-HRT , 17beta-estradiol ( 1 mg/day ) and norethisterone acetate ( 0.5 mg/day ) ( LD-HRT ) or calcium supplement ( controls ) . No significant differences in age , age at menopause , the presence of chronic diseases and socio-economic status were present in the two groups . The Women 's Health Question naire ( WHQ ) , a vali date d quality -of-life instrument for perimenopausal and postmenopausal women , was administered at baseline and after 6 and 12 weeks of treatment in both groups . RESULTS At baseline no significant differences in WHQ scores were present in the two groups . In the control group the scores in all different areas showed no significant modification either after 6 and 12 weeks of observation . Conversely , the LD-HRT group showed a significant decrease in the scores of vasomotor symptoms , somatic symptoms , anxiety/fear , depressed mood and sleep problem items . No effects on memory/concentration and menstrual symptoms areas were evident . CONCLUSION Although quality of life is also and may be mainly influenced by socio-economic and cultural factors , LD-HRT definitively can improve not only vasomotor symptoms , but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women BACKGROUND The decision to take hormone replacement therapy ( HRT ) is a choice many women encounter when entering menopause . The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause . METHODS The Women 's Healthy Lifestyle Project is a r and omized clinical trial design ed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause . Participants ( N = 535 ) completed question naires and were interviewed regarding menopausal symptoms , menopausal status , hot flashes , and  HRT  use at baseline and 54 months . RESULTS The intervention was successful in preventing risk elevation through the 54-month visit . At the final visit , there was no difference between the intervention and control groups in the percentage who had become postmenopausal ( 32.9 % vs 35.0 % , respectively ) , there was no difference between control and intervention with  HRT  use , with 31.2 % reporting use of HRT , and there was no difference between groups with menopausal symptoms . The women started HRT an average of 6 months after they missed a period . Baseline risk factors did not predict HRT use at the 54-month visit . CONCLUSIONS A sizable number of women reported HRT use . The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk , and these women started HRT very early in the peri- to postmenopause . Further , weight loss in the perimenopause did not affect menopausal symptoms Previous studies have indicated that the addition of progestins during sequential  hormonal replacement therapy ( HRT ) causes negative mood and physical symptoms . History of premenstrual syndrome , type of progestin , and dose of progestin have thus far been shown to influence the progestin-induced adverse mood symptoms during HRT . The aim of this study was to compare adverse mood effects of two different doses of estradiol , in combination with a progestin , during postmenopausal HRT . Twenty-eight perimenopausal women were included in this r and omized , double-blind , crossover study comparing 2- or 3-mg continuous estradiol , with an addition of 10 mg medroxyprogesterone acetate on d 17 - 28 during each treatment cycle . The main outcome measures were mood and physical symptoms kept on a daily rating scale . Together with the progestin , the higher dose of estrogen caused significantly more negative mood symptoms than the lower dose . Tension , irritability , and depressed mood were all significantly augmented during the progestin phase of cycles with 3 mg estradiol ( P < 0.001 ) . Physical symptoms also increased during the progestin phase of 3-mg estradiol cycles ( P < 0.001 ) , whereas positive mood symptoms were less affected . The only positive mood that changed with estrogen dose was friendliness , which decreased during the progestin phase of high estradiol cycles compared with cycles with lower estradiol ( P < 0.05 ) . Our conclusion is that an increase of the estrogen dose accentuates negative mood and physical symptoms during the progestin phase of sequential hormonal therapy Hormone-replacement therapy ( HRT ) is widely used by post-menopausal women . Although this treatment may slightly increase the incidence of breast cancer , more and more cases are diagnosed while women are taking HRT . The purpose of this study was to ascertain the influence of HRT on prognostic factors and outcome of breast cancer . Data on all breast-cancer patients , including precise information on HRT  , was prospect ively and systematic ally recorded in a data base . From 1985 to 1995 , 1379 post-menopausal women fulfilled the eligibility criteria for this study . All were treated by us ( P.B. and L.P. ) in our ward of a large public hospital of Marseilles , France . The clinical features , laboratory findings and survival rates in 142 HRT users who developed breast cancer while being treated were compared with those of 284 matched never user breast-cancer patients . Patients who developed breast cancer during HRT had fewer locally advanced cancers and smaller and better-differentiated cancers . Lymph-node involvement was significantly less frequent in the user group than in the non-user group ( non-significant ) . Estradiol receptivity was both qualitatively and quantitatively lower in users . There was no significant difference with regard to recurrence and metastasis-free survival and overall survival . We conclude that HRT does not affect the prognosis of breast cancer . Regular surveillance during HRT allows early detection of smaller lesions . The higher number of well-differentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones OBJECTIVE To investigate whether differences in antidepressant efficacy are moderated by an interaction of age and gender . METHODS A pooled data set from eight r and omized , controlled trials of patients with major depressive disorder ( MDD ) was reanalyzed to compare remission rates following therapy with venlafaxine  ( n = 851 ) , one of several selective serotonin reuptake inhibitors ( SSRIs )  ( n = 748 ) , or placebo  ( n = 446 ) . Remission was defined as a final Hamilton Rating Scale for Depression ( HAM-D ) score < or = 7 . Pairwise comparisons were conducted using stepwise multiple logistic regression models with main effect and interaction terms for treatment , sex , and age ( younger : < 50 ; older : > or = 50 ) . Among older women , the impact of hormone replacement therapy ( HRT ) on remission rates also was examined . RESULTS Remission rates on venlafaxine therapy were not affected by age , sex , or HRT use . Among women , but not men , there was a significant interaction reflecting poorer SSRI response in the older age group ( Wald chi-square = 4.21 , df = 1 , p = 0.04 ) ; HRT appeared to eliminate this difference . Whereas the advantage in remission rates favoring venlafaxine was modest for men and younger women ( 6%-9 % ) , the difference among older women not taking HRT was 23 % . CONCLUSIONS These findings provide further evidence that age , gender , and HRT moderate response to antidepressant medications This study of postmenopausal female smokers ( N = 94 ) asked : During short-term smoking abstinence , do the beneficial effects of transdermal nicotine replacement therapy ( NRT ) on acute symptomatology ( i.e. , withdrawal , cigarette craving , smoking urges , mood , depressive symptoms , motor speed , and reaction time ) differ in women who use and do not use hormone replacement therapy ( HRT )  ? Participants were recruited according to HRT and non-HRT use ( self- selecting ) , then r and omized within strata to active nicotine or placebo nicotine patch . After 1 baseline week of smoking , participants quit smoking for 2 weeks . Women received cessation counseling and were monitored for abstinence . Dependent measures were collected during five clinic visits . Two-way analysis of covariance ( ANCOVA ) were run on change scores for dependent variables , with nicotine patch group ( active/placebo ) and HRT group ( HRT/non-HRT ) as independent variables and age as a covariate . No interactions were found between HRT and patch condition , but both showed specific effects . During the first abstinent week , women on active nicotine patch ( compared with placebo ) experienced less severe withdrawal , greater reductions in cigarette cravings , and lower ( more favorable ) Factor 1 scores on the Question naire of Smoking Urges . During the second abstinent week , women using HRT ( compared with the non-HRT group ) exhibited better mood ( Profile of Mood States scores ) and less depression ( Beck Depression Inventory scores ) . These results suggest the following : First , the efficacy of transdermal nicotine replacement is not adversely modified by women 's HRT use ; second , ovarian hormones might influence women 's responses to smoking cessation , and thus should be considered in developing effective strategies for women to quit smoking BACKGROUND In perimenopause many women complain of psychogenic and organic disorders often connected with initial and increasing levels of hypoestrogenism . In this study we evaluated the effects of hormone replacement therapy ( HRT ) in symptomatic women in perimenopause . METHODS We enrolled 100 healthy and symptomatic women who were r and omly distributed to two groups for a 12-month study . Group A : 50 patients received HRT with estradiol valerate and cyproterone acetate ( Pausene(R ) ) ; Group B : 50 patients were used as a control group ( treated with Cacit Vitamin D30(R ) ) . A number of clinical and instrumental tests were performed at 0 , 6 and 12 months to evaluate any changes in vasomotor and urogenital symptoms , bone and serum homeostasis and possible sexual disorders . The statistical analysis was performed using the c2 test . RESULTS The group of women receiving HRT showed a significant reduction in vasomotor clinical symptoms ( p<0.001 ) and sexual disorders ( p<0.002 ) ; this was not reflected in the control group where libido decreased steadily with apparent slight improvements only at the end of the study . The urogenital disorders disappeared almost completely in Group A , whereas they diminished in Group B. HRT patients also showed a slight increase ( p<0.001 ) in the initial value of BMD ( bone mineral density ) , a reduction in the marker for bone turnover and an improved lipid profile ( p<0.05 ) . These changes were unfortunately not noted in Group B. CONCLUSIONS On the basis of these results we conclude that HRT appeared to have a beneficial effect on perimenopausal clinical symptoms over the 12-month period , leading to marked improvements in the psychophysical wellbeing of symptomatic women in perimenopause The purpose of this study was to determine whether psychological support associated with  hormone replacement therapy ( HRT )  was more beneficial than replacement therapy alone . Our findings showed that HRT alone was more effective against vasomotor symptoms than HRT with psychological treatment ( PT ) . While the combination of both treatment modalities ( HRT + PT ) was more effective against insomnia , nervousness , melancholy , fatigue , palpitations , and vertigo .  Hormonal treatment alone and HRT with psychological treatment had little effect against paresthesia or tingling . Neither HRT alone nor HRT with psychological treatment was effective against joint and muscle pain or headache BACKGROUND AND AIM OF THE STUDY The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle ( smoking , use of alcohol , physical activity ) and body mass index ( BMI ) . MATERIAL AND METHODS Health 2000 is a nationally representative population -based study of Finnish adults . Data were collected by home interview , three self-administered question naires and a clinical examination by a physician . This study included women aged 45 - 64 years ( n=1427 ) . All symptoms included menopause-specific symptoms . Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group . Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors ( age , education , smoking , alcohol use , physical activity , BMI , use of hormonal replacement therapy ( HRT ) and chronic disease status ) . RESULTS Over one-third ( 38 % ) of the premenopausal , half of the perimenopausal , and 54 % of both postmenopausal and hysterectomized women reported bothersome symptoms . The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes . Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle . Smoking was not related to vasomotor symptoms . CONCLUSION Bothersome symptoms are common in midlife , regardless of menopausal status . Inverse association between physical activity and menopausal symptoms needs to be confirmed in r and omized trials BACKGROUND Screening perimenopausal women for low bone density has yet to be tested in a r and omized trial . The effect of screening on the use of hormone replacement therapy ( HRT ) and the subsequent quality of life in these women is unknown . The purpose of this study was to assess the effect of a screening program on HRT use of quality of life . METHODS A r and om sample of women aged 45 to 54 years and living within 32 km of Aberdeen , Scotl and , was selected from the community health index . Subjects were further r and omized to  screening or no screening using the design of Zelen . Two years after r and omization , a question naire follow-up was mailed to both groups to assess  HRT use and quality -of-life scores . RESULTS Use of HRT was higher in the screened group ( 30 % vs 24 % ; difference , 6 % ; 95 % confidence interval , 1%-11 % ; P = .02 ) . A multivariate analysis indicated that the odds of using HRT for a screened woman whose measurement for bone mineral density was in the lowest quartile was 2.54 ( 95 % confidence interval , 1.74 - 3.71 ) greater than that of an unscreened woman . Screening and subsequent HRT use did not have any detectable effects-positive or adverse-on women 's quality of life . CONCLUSION Screening for low bone density significantly increases the use of HRT in this population but without any immediate adverse or positive effects on quality of life Background Uterine luminal epithelial cell response to different hormonal strategies was examined to determine commonality when an endometrium attains a receptive , stimulated , morphological profile that may lead to successful implantation . Methods Endometrial biopsies from 3 cohorts of patients were compared . The tissue sample s taken from these patients were categorized into 8 different groups according to their baseline and the hormone regime used . Results Pre-treatment natural cycle tissue was variable in appearance . Downregulation with a GnRH analogue tissue appeared menopausal in character . HRT after downregulation result ed in tissue uniformity .  HRT in menopause result ed in a ' lush ' epithelial surface .  HST in the natural cycle improved the morphology with significant difference in secretion between the two regimes examined . Conclusions Down regulation plus HRT st and ardized surface appearance but tissue response is significantly different from the natural cycle , natural cycle plus HRT or menopause plus HRT . HRT in menopause reinstates tissue to a state similar to a natural cycle but significantly different from a natural cycle plus HST . HST with a natural cycle is similar to tissue from the natural cycle but significant differences reflect the influence of the particular hormones present ( at any point ) within the cycle The effects of physical training and hormone replacement therapy ( HRT ) on bone mineral density in perimenopausal women were studied . Sixty perimenopausal women were r and omized to either physical training ( n=20 ) , HRT ( n=20 ) , or control group ( n=20 ) . The study period was 18 months . Bone mineral density ( BMD ) in the femoral neck and lumbar spine was measured using dual-energy X-ray absorptiometry ( DXA ) . DXA was performed before treatment and after 6 and 18 months . Blood sample s for analysis of the bone markers U-deoxypyridinoline and osteocalcin were collected at the same time points . After 18 months , BMD in the spine had not decreased in either the training group or in the HRT group . In the control group , spine BMD had significantly decreased ( p=0.0014 ) . U-Deoxypyridinoline and osteocalcin were increased significantly in the control group ( p=0.0198 , p=0.0295 , respectively ) . No significant changes in bone marker levels were found in the training group or the HRT group . We found that both HRT and physical training can prevent loss of spine BMD in perimenopausal women over a period of 18 months . HRT remains a cornerstone in the treatment of vasomotor symptoms and preservation of BMD . However , HRT can only be used for limited periods of time due to the potential serious adverse effects . This study indicates a beneficial effect of physical activity on spine BMD in the perimenopausal period , and highlights its potential as an alternative to HRT during this period BACKGROUND AND PURPOSE Acupuncture is widely used in the treatment of hypertension , yet its efficacy and safety for hypertension remain controversial . This overview aim ed to summarize the evidence on acupuncture for hypertension . METHODS Eight data bases were search ed . The Assessment of Multiple Systematic Review s ( AMSTAR ) tool and the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach were performed . RESULTS Fifteen systematic review s ( SRs ) were identified . Method ological quality and quality of evidence were unsatisfactory . Acupuncture combined with Western medicine ( WM ) was superior to WM in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , efficacy rate , and traditional Chinese medicine ( TCM ) syndrome .  Acupuncture was more effective in treating SBP and DBP than sham acupuncture plus WM . Evidence regarding the benefit of acupuncture alone for SBP and DBP , efficacy rate and TCM syndrome was inconsistent . No serious adverse effects were identified . CONCLUSION High- quality SRs and r and omized controlled trials ( RCTs ) are required The aim of this study was to compare the pharmacodynamic response to a neuroactive steroid , pregnanolone , before and during different hormonal setting s of postmenopausal hormone replacement therapy ( HRT ) , using natural progesterone . A second aim was to investigate whether the response to pregnanolone was associated with cyclicity in negative mood symptoms during treatment . Twenty six postmenopausal women with climacteric symptoms were administered HRT in a r and omized , double blinded , placebo-controlled , crossover study . The women received 2 mg oral estradiol ( E(2 ) ) continuously during two 28-day cycles and 800 mg of vaginal progesterone or placebo sequentially for the last 14 days of each treatment cycle . Pharmacodynamic response to pregnanolone was assessed before treatment , and during the last week of each treatment cycle , by comparing the effects of intravenous pregnanolone ( 3alpha-hydroxy-5beta-pregnan-20-one ) on saccadic eye velocity ( SEV ) , saccade acceleration , saccade latency and self-rated sedation . Throughout the study daily symptom rating scales were kept . According to the daily symptom rating scales , patients were divided into two groups ; one group who displayed a significant variance in negative mood symptoms during HRT ( cyclicity ) and one group with no cyclical changes in negative mood symptoms during treatment . During treatment with either E(2 ) alone or E(2)+progesterone the response in saccadic eye movement parameters and in self-rated sedation to pregnanolone was enhanced compared to pretreatment values . The SEV , saccade acceleration and sedation responses to pregnanolone was also increased in women expressing cyclicity in negative mood symptoms compared to women with no cyclical changes in negative mood during HRT . In conclusion , during treatment with either E(2 ) alone , or E(2)+progesterone , pregnanolone  sensitivity was increased . Women expressing cyclicity in negative mood symptoms were more sensitive to pregnanolone than women without symptom cyclicity during HRT OBJECTIVES To study the effects of hormonal replacement on hot flushes , other symptoms linked to menopause , and blood pressure . METHODS The study included 1006 early postmenopausal women aged 45 - 58 years , participating in the Danish Osteoporosis Prevention Study ( DOPS ) r and omised to Hormonal replacement therapy ( HRT )  ( n=502 ) or no HRT  ( n=504 ) in an open label trial . Symptom scores were recorded at baseline , after 6 month , 1 , 2 , and 5 years on a modified Greene scale ( range 0 - 4 with 0 equalling no symptoms , and 4 maximal symptoms ) . RESULTS HRT efficiently alleviated hot flushes ( mean+/-S.E.M. score 0.48+/-0.04 in HRT vs. 0.83+/-0.05 in no HRT after 5 years , P<0.01 by repeated measures ANOVA ) , sleeping difficulties associated with hot flushes ( 0.21+/-0.60 vs. 0.37+/-0.86 , P<0.01 ) , vaginal dryness ( 0.45+/-0.04 vs. 0.73+/-0.05 , P<0.01 ) , dyspareunia ( 0.27+/-0.04 vs. 0.39+/-0.04 , P<0.01 ) , and libido ( 0.48+/-0.05 vs. 0.59+/-0.05 , P=0.08 ) . In the untreated group the occurrence of mood swings ( from 0.77+/-0.05 at baseline to 0.45+/-0.04 after 5 years , 2P<0.01 ) and oedemas ( from 0.59+/-0.04 to 0.43+/-0.04 , 2P=0.02 ) decreased with age while the occurrence of incontinence increased ( from 0.43+/-0.03 to 0.52+/-0.04 , 2P<0.01 ) . These changes were not influenced by HRT . Furthermore , HRT had no influence on presence of headache ( 0.54+/-0.05 vs. 0.58+/-0.05 after 5 years ) , voiding pattern ( 0.49+/-0.04 vs. 0.53+/-0.04 ) , or blood pressure ( mean systolic pressure 123+/-18 vs. 123+/-19 , diastolic pressure 77+/-10 vs. 77+/-11 ) . CONCLUSIONS HRT is efficient in controlling hot flushes and vaginal dryness , and symptoms related to these conditions . However , no effect on blood pressure or other menopause symptoms was recorded Objective Pueraria lobata ( PL ) is used as a traditional Chinese herbal remedy for menopausal symptoms , as well as an ingredient in preparations for conditions affecting menopausal women , such as osteoporosis , coronary heart disease , and some hormone-dependent cancers . The scientific basis for its action may be its action as a phytoestrogen . Design To examine the effects of PL in comparison with hormone replacement therapy ( HRT ) on lipid profile , sex hormone levels , bone turnover markers , and indices of cognitive function . For the study , 127 community-living , postmenopausal women aged 50 to 65 years were r and omized to receive HRT ( n = 43 ) , PL ( equivalent to 100 mg isoflavone ; n = 45 ) , or no treatment ( n = 39 ) for 3 months . The following measurements were carried out at baseline and after 3 months for all participants : menopausal symptoms question naire ; neuropsychological tests covering memory , attention , motor speed , and word-finding ability ; quality of life ( SF36 ) ; lipid profile ; urinary deoxypyridinoline ; dietary phytoestrogen intake and urinary phytoestrogen ; estradiol ; follicle-stimulating hormone ; and luteinizing hormone . Results Only participants in the HRT group showed a mean reduction in cholesterol and low-density lipoprotein cholesterol that was significantly different from that of the control group . No significant changes in lipid profile or follicle-stimulating hormone and luteinizing hormone were observed in the PL group compared with the controls . However , both the HRT and PL groups showed an improvement in Mini-Mental State Examination score and attention span compared with the case of participants receiving no treatment . HRT and PL had different effects on cognitive function ;  HRT improved delayed recall , whereas flexible thinking seemed improved in the PL group . Conclusions This study was unable to demonstrate a scientific basis for the use of PL for improving the health of postmenopausal women in general . However , the effect of PL on cognitive function deserves further study Observational epidemiological studies have shown that mortality from coronary heart disease is reduced in post-menopausal women by hormone replacement therapy ( HRT ) . The aim of this study was to measure sE-selectin levels in post-menopausal females before and after HRT  and to compare these with pre-menopausal females and aged matched males . Post-menopausal females ( n = 70 ) were given HRT or no treatment to act as a control group . sE-selectin levels were significantly lower in the pre-menopausal ( n = 36 ) when compared with the post-menopausal females ( n = 70 ) ( p = 0.027 ) , whereas no difference between two age matched male groups was found ( n = 40 ) . Oral and transdermal HRT significantly decreased sE-selectin levels ( p<0.0001 and p = 0.0005 respectively ) with no change in the control group . The reduction in the levels of this marker of endothelial activation after HRT , may reflect a decrease in leucocyte/endothelial interaction which may reduce atherosclerotic risk in post-menopausal females ABSTRACT Background Sexual desire is affected by endocrine and psychosocial factors . Menopausal hormonal changes are relevant to the causes of sexual dysfunction during reproductive aging . Aim To evaluate the effects of different types of hormonal replacement therapy ( HRT ) on sexual function , frequency of sexual intercourse , and quality of relationship in early postmenopausal women . We recruited 48 healthy postmenopausal women aged 50–60 years ( mean age 54.5 ± 3.3 years ) . Women with climacteric symptoms were uniformly r and omized into three groups receiving either dehydroepi and rosterone ( DHEA 10 mg ) daily , or daily oral estradiol ( 1 mg ) plus dihydrogesterone ( 5 mg ) , or daily oral tibolone ( 2.5 mg ) for 12 months . Women who refused hormonal therapy were treated with oral vitamin D ( 400 IU ) . Efficacy was evaluated using the McCoy Female Sexuality Question naire before treatment and after 12 months . We evaluated the hormonal profile before treatment and after 3 , 6 and 12 months . Results The groups receiving DHEA or HRT reported a significant improvement in sexual function compared to baseline ( p < 0.001 and p < 0.01 , respectively ) using the McCoy total score . The quality of relationship was similar at baseline and after 3 , 6 and 12 months of treatment . There were significant increases in the numbers of episodes of sexual intercourse in the previous 4 weeks in women treated with DHEA , HRT and tibolone in comparison with the baseline value ( p < 0.01 , p < 0.05 , p < 0.01 , respectively ) . No changes in the McCoy score occurred in women receiving vitamin D. Conclusions Daily oral DHEA therapy at the dose of 10 mg , HRT and tibolone all provided a significant improvement in comparison with vitamin D  in sexual function and in frequency of sexual intercourse in early postmenopausal women BACKGROUND The antidepressant effect of estrogen in women undergoing the menopause transition is hypothesized to be mediated by central nervous system effects of increasing estradiol on mood or through a pathway involving suppression of hot flashes and associated sleep disturbance . Estrogen therapy ( ET ) and the hypnotic agent zolpidem were selected as interventions in a three-arm , double-blind , placebo-controlled trial to distinguish the effects of estradiol , sleep , and hot flashes on depression . METHODS Women with depressive disorders , hot flashes , and sleep disturbance were r and omly assigned to transdermal 17β-estradiol 0.05 mg/d , zolpidem 10 mg/d , or placebo for 8 wk . Changes in serum estradiol , perceived sleep quality , objective ly measured sleep , and hot flashes were examined as predictors of depression improvement [ Montgomery-Åsberg Depression Rating Scale ( MADRS ) ] using multivariate linear regression . RESULTS Seventy-two peri/postmenopausal women with depression disorders were r and omized to 17β-estradiol ( n = 27 ) , zolpidem ( n = 31 ) , or placebo ( n = 14 ) . There was no significant difference between groups in depression improvement ( overall MADRS decrease 11.8 ± 8.6 ) . Increasing estradiol ( P = 0.009 ) and improved sleep quality ( P < 0.001 ) predicted improved mood in adjusted models but reduced hot flashes ( P = 0.99 ) did not . Post hoc subgroup analyses revealed that the therapeutic effect of increasing estradiol levels on mood was seen in perimenopausal ( P = 0.009 ) , but not postmenopausal , women . CONCLUSIONS For women with menopause-associated depression , improvement in depression is predicted by improved sleep , and among perimenopausal women , by increasing estradiol levels . These results suggest that changes in estradiol and sleep quality , rather than hot flashes , mediate depression during the menopause transition . Therapies targeting insomnia may be valuable in treating menopause-associated depression OBJECTIVE To estimate the risk of recurrence after administration of hormone replacement therapy ( HRT ) among women who have had endometriosis and who underwent bilateral salpingo-oophorectomy ( BSO ) .  DESIGN Prospect i ve r and omized trial ( 115 women receiving HRT and 57 not receiving HRT ) .  SETTING ; Public university hospital . PATIENT(S ) Women with a histologic diagnosis of endometriosis in whom BSO was performed ; 91.8 % had a total hysterectomy . INTERVENTION(S ) Periodical clinical examination , vaginal ultrasound , and CA-125 levels ; surgical evaluation and histologic study . MAIN OUTCOME MEASURE(S ) Recurrence rate , prognostic factors , and a mean follow-up time of 45 months . RESULT ( S ) There was no recurrence among women who did not receive HRT , versus a 3.5 % rate ( 4 out of 115 ) , or 0.9 % per year , in women who received HRT . Two recurrences required abdominal surgery . There was one additional patient who required surgery , but the relationship to the endometriosis recurrence was controversial . Among women receiving HRT , the following risk factors were detected : peritoneal involvement > 3 cm ( 2.4 % recurrence per year vs. 0.3 % ) and incomplete surgery ( 22.2 % per patient vs. 1.9 % ) . CONCLUSION ( S ) Patients with a history of endometriosis in whom total hysterectomy and bilateral salpingo-oophorectomy have been performed have a low risk of recurrence when HRT is administered . In those patients , HRT is a reasonable option . However , in cases with peritoneal involvement > 3 cm , the recurrence rate makes HRT a controversial option ; if HRT is indicated , it should be monitored closely BACKGROUND Menopause is associated with decreases in lean mass and increases in fat mass . Serum hormone levels and hormone replacement therapy ( HRT ) may modify the effects of exercise training on body composition in postmenopausal women . METHODS We assessed the changes in total body and regional lean soft tissue and fat mass ( using dual-energy x-ray absorptiometry ) in 94 sedentary postmenopausal women , aged 40 - 65 years , after 12 months of resistance and weight-bearing aerobic exercise training . Women currently on oral HRT ( n = 39 ) and not on HRT ( n = 55 ) were r and omized within groups to exercise and no exercise , result ing in four groups : exercise + HRT ( n = 20 ) , HRT ( n = 22 ) , exercise ( n = 24 ) , and control ( n = 28 ) . Fasting blood sample s were measured for resting serum total levels of estrone , estradiol , cortisol , and rostenedione , growth hormone , and insulin-like growth factor 1 at baseline and 12 months . RESULTS We found significant effects of exercise on increases in total body , arm , and leg lean soft tissue mass , and decreases in leg fat mass and percentage of body fat . There were no interaction effects of exercise and HRT on the changes in muscle strength and body composition . No significant changes in total hormone levels were found after 12 months . CONCLUSIONS Exercise training result ed in significant beneficial changes in lean soft tissue and fat mass in early postmenopausal women . These changes in body composition were neither influenced by prolonged HRT use nor accompanied by changes in total levels of the hormones determined in this study Objective To assess the effect of  combined hormone replacement therapy ( HRT )  on health related quality of life . Design R and omised placebo controlled double blind trial . Setting General practice s in United Kingdom ( 384 ) , Australia ( 94 ) , and New Zeal and ( 24 ) . Participants Postmenopausal women aged 50 - 69 at r and omisation ; 3721 women with a uterus were r and omised to combined oestrogen and progestogen  ( n=1862 ) or placebo  ( n=1859 ) . Data on health related quality of life at one year were available from 1043 and 1087 women , respectively . Interventions Conjugated equine oestrogen 0.625 mg plus medroxyprogesterone acetate 2.5/5.0 mg or matched placebo orally daily for one year . Main outcome measures Health related quality of life and psychological wellbeing as measured by the women ’s health question naire . Changes in emotional and physical menopausal symptoms as measured by a symptoms question naire and depression by the Centre for Epidemiological Studies depression scale ( CES-D ) . Overall health related quality of life and overall quality of life as measured by the European quality of life instrument ( EuroQol ) and visual analogue scale , respectively . Results After one year small but significant improvements were observed in three of nine components of the women ’s health question naire for those taking combined HRT compared with those taking placebo :  vasomotor symptoms ( P<0.001 ) , sexual functioning ( P<0.001 ) , and sleep problems ( P<0.001 ) . Significantly fewer women in the combined HRT group reported hot flushes ( P<0.001 ) , night sweats ( P<0.001 ) , aching joints and muscles ( P=0.001 ) , insomnia ( P<0.001 ) , and vaginal dryness ( P<0.001 ) than in the placebo group , but greater proportions reported breast tenderness ( P<0.001 ) or vaginal discharge ( P<0.001 ) . Hot flushes were experienced in the combined HRT and placebo groups by 30 % and 29 % at trial entry and 9 % and 25 % at one year , respectively . No significant differences in other menopausal symptoms , depression , or overall quality of life were observed at one year . Conclusions Combined HRT started many years after the menopause can improve health related quality of life . Trial registration IS RCT N 63718836
This moderate to large effect size , showing lower ratings of depressed mood in treated patients compared with controls , implicated HRT as a potential treatment of or prophylactic for depression in menopausal women .
One can generalize from the studies review ed here only with great caution , but there is little evidence to support the use of estradiol to improve mood in nondepressed patients ( not surprisingly ) and some evidence to support the antidepressant efficacy of estradiol in perimenopausal but not postmenopausal women
BACKGROUND Controversy regarding the antidepressant efficacy of hormone replacement therapy ( HRT ) stems almost from its inception and reflects the same method ological inconsistencies that have compromised efforts to determine whether the perimenopause is accompanied by an increase in mood symptoms or depression .
Since this publication , multiple studies have aim ed to discern the relationship between HRT and menopausal mood .
METHODS The purpose of this systematic review is to examine the findings and quality of the evidence amassed since Zweifel and O'Brien 's meta- analysis .