Menopause International > Volume 14, Number 4 > Pp. 178-179

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Literature review

Notes from the journals

John McGarry

STAR PAPER Endometrial effects of tibolone in elderly, osteoporotic women Ettinger B, Kenemans P, Johnson SR, Mol-Arts M, Van Os S, Seifert W, Verweij PJ, Cummings SR Obstet Gynecol 2008;112:653–9 Objective. To investigate endometrial effects of tibolone administered to postmenopausal women for three years. Methods. A total of 3500 postmenopausal women aged 60–85 years with a uterus and with osteoporosis were randomly given 1.25 mg tibolone orally daily, or placebo. Endometrial thickness in all women was measured, and 635 women with vaginal bleeding or endometrial thickness more than 4 mm had biopsies. Results. In the first year endometrial thickness increased by 1 mm in the tibolone group, with no further increases during the next two years. Biopsies showed endometrial hyperplasia in <1%. In 15% of women with an endometrial polyp, the tibolone patients were more than twice as likely to show hyperplasia within the polyp. A slight increase in grade 1 endometrioid adenocarcinoma was found among women receiving tibolone. Vaginal bleeding was 11% in the tibolone group and 3% in the placebo group. Conclusion. Tibolone treatment during three years minimally increased endometrial thickness, hyperplastic polyps, endometrial carcinoma and vaginal bleeding.

 

Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis

Politi MC, Schleinitz MD, Col NF

J Gen Intern Med 2008;23:1507–13

Background. Treatment of menopause symptoms are predicated on a transient duration of vasomotor symptoms, but there is little published evidence of the duration of such symptoms.

Objective. An extensive search of the literature looked at the duration of menopausal symptoms using meta-analytical techniques.

Methods. Vasomotor symptom prevalence among women in menopausal transition in time intervals based on years to or from final menstrual period were assessed.

Results. Totally 35,500 women were included. The numbers of women experiencing symptoms increased sharply in the two years before final menstrual period, and peaked one year after final menstrual period. Nearly 50% of all women reported vasomotor symptoms four years after final menstrual period, and 10% of all women reported symptoms up to 12 years after.

Conclusion. Our findings suggest for a median symptom duration of about four years among symptomatic women. A longer symptom duration may affect treatment decisions and clinical guidelines. Further prospective, longitudinal studies of menopausal symptoms should be conducted to confirm these results.

Significance of risk factors for osteoporosis is dependent on gender and menopause in rheumatoid arthritis

Oelzner P, Schwabe A, Lehmann G, Eidner T, Franke S, Wolf G, Hein G

Rheumatol Int 2008;28:1143–50

Background. What are the risk factors for osteoporosis in patients with rheumatoid arthritis (RA)?

Methods. Looked at in 343 postmenopausal women, were bone mineral density, lifetime use of glucocorticoid steroids, age, disease duration, body mass index (BMI), disease activity and bone turnover.

Results and conclusions. Osteoporosis was found in a significantly higher percentage in postmenopausal women and in men in comparison with premenopausal women. Risk factors for osteoporosis were older age, low BMI and high steroid use. There is a high prevalence of osteoporosis in both postmenopausal women and in men with RA.

Fragile X-associated primary ovarian insufficiency: evidence for additional genetic contributions to severity

Hunter JE, Epstein MP, Tinker SW, Charen KH, Sherman SL

Genet Epidemiol 2008;32:553–9

Objective. The fragile X mental retardation gene (FMR1) contains a CGG repeat sequence in its 5' untranslated region that can become unstable and expand in length between generations. Expanded repeats are associated with an increased risk for fragile-X- associated primary ovarian insufficiency (FXPOI). However, not all women who carry the premutation develop FXPOI.

Methods. To see if 225 families with the fragile X gene have an additional genetic effect that impinges on the age of menopause after adjustment for race, smoking and body mass index.

Results and conclusions. These extra genes seem to have an effect on age at menopause, and point to an increased need to take into consideration this additional gene effect when counselling women who carry FMR1 about the expected age of menopause, and for guidance of future studies to identify additional genes that influence ovarian insufficiency.

Oral health in perimenopausal and early postmenopausal women from baseline to two years of follow-up with reference to hormone replacement therapy

Tarkkila L, Furuholm J, Tiitinen A, Meurman JH

Clin Oral Invest 2008;12:271–7

Objective. Female sex hormones affect the mouth but there are little data on oral health of menopausal women. This is a two-year study. Because hormone replacement therapy (HRT) users have been reported to be more health conscious than non-users, differences were expected between these two groups.

Method. Oral health and saliva flow were looked at in these two groups. Tomography of the jaws was measured.

Results. No difference in oral health was observed between the groups. However, during the follow-up, women in HRT group had received more dental restorations.

Conclusion. Although no difference in oral health status or salivary flow rates between women using or not using HRT was found, the observation on dental restorations may indicate a more health-conscious attitude in the HRT group.

Two-year outcomes after surgery for stress urinary incontinence in older compared with younger women

Richter HE, Goode PS, Brubaker L, Zyczynski H, Stoddard AM, Dandreo KJ, Norton PA

Obstet Gynecol 2008;112:621–9

Objective. To see whether perioperative and postoperative outcomes after colposuspension operations for stress urinary incontinence (SUI) differed with age.

Methods. A prospective of adverse events, and two-year outcomes of women aged under and over 65 years old.

Results. Mean age was 70 years in the older group and 50 in the younger group. Older women had slightly longer time to normal activities but there was no difference in time to unaided normal voiding. Older women were more likely to still suffer stress test at follow-up, less subjective improvement in stress and residual urge incontinence. They were more likely to need repeat surgery.

Conclusion. Older women after surgery for SUI experience worse outcomes after two years.

Physical activity is negatively associated with the metabolic syndrome in the elderly

Bianchi G, Rossi V, Muscari A, Magalotti D, Zoli M; Pianoro Study Group

Quart J Med 2008;101:713–21

Background. An inverse association between physical activity and metabolic syndrome has been reported, but there are few studies in the elderly.

Methods. The relationships between physical activity, insulin resistance and metabolic syndrome were assessed in 1144 subjects aged 65–91 years. Activity was assessed by a self-administered questionnaire. Fasting insulin was measured.

Results. Waist circumference, triglycerides, blood glucose and HDL cholesterol were all more adversely affected among sedentary subjects than in the active population.

Conclusion. Physical activity is inversely associated with insulin resistance and the metabolic syndrome even in the elderly.

Osteoporosis in orthopaedic trauma patients: a diagnosis and treatment protocol

Collinge C, Lebus G, Gardner MJ, Gehrig L

J Orthop Trauma 2008;22:541–7

Objective. What is the risk of osteoporosis and fracture in orthopaedic trauma patients? Does evaluation, education and treatment help these patients?

Methods. Two hundred and sixty consecutive patients treated by an orthopaedic trauma surgeon for injury. Quantitative ultrasound (QUS) of the heel was carried out. Also a history of medical, osteoporotic, ovarian, nutritional, family and current injury was recorded.

Treatment. Intervention included (1) direct patient education, (2) twice-daily calcium and vitamin D therapy in hospital and after discharge, (3) referral to the patient's primary care physician (PCP) with a copy of the QUS results for discussion of further treatments and (4) A telephone interview at 12 months enquiring about osteoporosis treatment.

Results. Data on 92% with an average age of 51 years. Thirty percent had a high risk for osteoporosis, and 21% were at moderate risk. Intervention with education and therapy was achieved in 96% of high-risk patients. At the 12-month follow-up, 57% of patients in the high-risk osteoporosis group had consulted their PCP regarding the osteoporosis, and 47% had continued medical treatment, including bisphosphonates in 29% of the high-risk patients.

Conclusions. Orthopaedic trauma surgeons can play a significant role in helping to reduce the incidence of secondary fragility fractures.

Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study

Demichele A, Troxel AB, Berlin JA, Weber AL, Bunin GR, Turzo E, Schinnar R, Burgh D, Berlin M, Rubin SC, Rebbeck TR, Strom BL

J Clin Oncol 2008;26:4151–9

Objective. Raloxifene reduces the risk of breast cancer in women with osteoporosis, and both tamoxifen and raloxifene prevent breast cancer in high-risk women. What is the risk of endometrial cancer in patients taking raloxifene, tamoxifen and non-users in the general population? Also what kinds of endometrial tumours occur in these groups?

Methods. Women aged 50–79 years diagnosed with endometrial cancer were compared with controls.

Results. The study included 547 cases and 1410 controls. Among cases, 3.3% had taken raloxifene; 6.2% had taken tamoxifen. Among controls, 6.6% had taken raloxifene; 2.4% had taken tamoxifen. The risk of cancer in raloxifene users was half that of non-users, whereas tamoxifen users had three times the odds of developing endometrial cancer compared with raloxifene users (OR = 3.0; 95% CI 1.3–6.9). Also endometrial tumours in raloxifene users had a more favourable histological profile and were mainly stage I and low grade.

Conclusion. Raloxifene users had a lower risk of endometrial cancer compared with both tamoxifen users and non-users, suggesting that raloxifene is useful in endometrial cancer prevention.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by McGarry, J. Search for Related Content Social Bookmarking                      What's this?