Effects of Transdermal Estrogen Therapy on Expressions of Estrogen Receptors and T-lymphocyte Apoptosis in Surgically Menopausal Women

Studies have demonstrated estrogen replacement therapy can improve the life quality of surgically menopausal women. However, the mechanisms in this process remain poorly defined. Here we show the effect of transdermal estrogen therapy on expressions of estrogen receptors and T-lymphocyte apoptosis in surgically postmenopausal women. Fifteen surgically menopausal women, 15 naturally menopausal women and 15 young women were chosen in our studies. Peripheral vein blood was collected and serum E2 and FSH levels were assessed using ACCESS. T-lymphocyte apoptosis and the expressions of Fas, FasL and ER subtypes α and β were determined. The serum E2 levels of surgically menopausal woman were significantly higher, and the ＂Improved Kupperman Index＂ and the scores of ＂Menopause Specific Quality of Life Questionnaire＂ in surgically menopausal women were significantly low after ERT. The rates of T-lymphocyte apoptosis and FasL expression in surgically menopausal women were decreased after ERT, but the difference was not significant. The expressions of ERa and ERβ in two menopausal groups were significantly lower than those of the young group. They were both significantly up-regulated after 3 months of ERT. Transdermal ERT could significantly upregulate the serum E2 level, could improve menopausal symptoms and life quality of surgically menopausal women and upregulate ERa and ERβ expressions on T lymphocytes, especially ERp. Thus, the low dose of transdermal ERT may have a protective effect on menopausal women＇s immune function and aging.

Clinical Effects of Bushen Culuan Prescription on Infertility Due to Decreased Ovarian Reserve of Kidney Deficiency and Liver Depression Pattern

Objective The objective of this study was to explore the clinical effects of Bushen Culuan prescription on infertility due to decreased ovarian reserve of kidney deficiency and liver depression pattern.Methods Totally 100 infertile patients with ovarian hypofunction treated from October 2019 to January 2022 were selected and divided into the observation group and the control group by a random number table.The control group was treated with estrogen sequential therapy,and the observation group was treated with Bushen Culuan prescription.The clinical efficacy,sex hormone levels including(follicle-stimulating hormone[FSH],luteinizing hormone[LH],and estradiol[E_(2)]),ovarian function,ovarian blood flow status(peak systolic velocity[PSV],antral follicle count[AFC],arterial pulse index[PI],and resistance index[RI]),and pregnancy outcome in the two groups were compared and analyzed.Results The total effective rate of the observation group(96.00%)was significantly higher than that of the control group(80.00%).The difference was statistically significant(p<0.05).Before treatment,there was no significant difference in sex hormone levels(FSH,LH,E_(2),and FSH/LH),ovarian function(number of primary follicles,number of dominant follicles,ovulation number,and endometrial thickness),and ovarian blood flow(PSV,RI,PI,and AFC)between the two groups(p>0.05).After treatment,the levels of serum hormones FSH,LH,E_(2),and FSH/LH decreased significantly in both groups.The number of primary follicles,dominant follicles,and ovulation increased significantly,and the thickness of endometrium decreased significantly;the indexes of PSV,RI,and AFC of ovarian blood flow increased significantly,and the PI index decreased significantly.The levels of each index in the observation group were better than those in the control group(p<0.05).In the control group,32 cases were pregnant within 1 year after treatment,and the pregnancy rate was 64.00%;21 cases in the observation group were pregnant within 1 year after treatment,and the pregnancy rate was 42.00%;the pregnancy rate in the observation group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.014,p=0.045<0.05).Conclusion Bushen Culuan prescription has a definite effect on infertility due to ovarian hypofunction.The action mechanism may involve multicomponent and multitarget stimulation to improve patients'ovarian function,regulate the level of sex hormones,and improve the pregnancy outcome.

Percutaneous estrogen in prevention of early postmenopausal bone loss in Chinese women

OBJECTIVE: To identify the optimal dosage of 17beta-estradiol gel + oral progestin for preventing bone loss in postmenopausal Chinese women. METHODS: A 3-year open label, randomized, prospective clinical trial was conducted. Sixty healthy women who had been postmenopausal for 1 to 5 years were recruited and divided into following 4 groups: group 1, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus micronized progesterone (MP) 100 mg/d; group 2, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d; group 3, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus micronized progesterone (MP) 100 mg/d; and group 4, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d. Estrogen and progestin were given continuously for 25 days per month. Bone mineral density (BMD) was measured using quantitative computed tomography (QCT) for trabecular bone of L2-5 and dual energy X-ray absorptiometry (DEXA) for L2-4 and hip 5 times during the trial at baseline and at the 6-, 12-, 18-, 24- and 36-month visits. RESULTS: Fifty-nine patients (98.3%, 59/60) stayed in the study for 1 year, 56 patients (93.3%, 56/60) for 2 years, and 51 (85%, 51/50) for 3 years. On average, menopausal symptoms were relieved by 80% after 6 months of treatment. By the 24th month, the mean increase in BMD ranged from 4.3% to 7.5% in trabecular bone; and by the 36th month, it ranged from 4.2% to 6.2% in L2-4 and 1.61% to 3.77% in the neck. There were significant difference after treatment (P 0.05) was found in improvement of symptoms, levels of bone markers or BMD. CONCLUSION: A daily dose of estradiol gel, either 0.75 mg or 1.5 mg, is effective in preventing early postmenopausal bone loss and relieving menopausal symptoms. After 3-year treatment, spinal BMD could increase steadily, so does hip BMD, especially in the first 2 years.

How to judge the association of postmenopausal hormone therapy and the risk of breast cancer

The relevance of postmenopausal hormone therapy(HT)for breast cancer risk has been long debated,although it is one of the most important barriers for women to accept HT.Various opinions have been reported from recent randomized clinical trials and epidemiological studies.These unanswered questions include:whether HT has a positive impact on breast cancer;whether risks of therapy with unopposed estrogen and combined estrogenprogestin are different;and whether different types and routes of estrogen and progestogens,as well as the duration and cessation of HT use,have different impacts on this disorder.Recently,there has been some good news such as the following:the currently available data do not provide sufficient evidence to prove a causal relationship between postmenopausal HT and breast cancer;breast cancer in postmenopausal women using HT usually has better prognosis than that of nonusers.In conclusion,HT is still the most effective method of relieving climacteric symptoms for many postmenopausal women.However,a possible risk of breast cancer associated with long-term HT usage should not be ignored.With respect to prevention of breast cancer,regular evaluation of individual breast cancer susceptibility and close follow-up through mammography and/or breast sonography are necessary strategies for the safety of HT use.

Menopausal depression:comparison of hormone replacement therapy and hormone replacement therapy plus fluoxetine

BACKGROUND: To compare the efficacy and safety of hormone replacement therapy (HRT) combined with fluoxetine, with HRT alone, in post-menopausal women suffering from depression. METHODS: A randomized, open-label, parallel trial was applied. HRT was administered to all patients for 2 cycles, with 14 days of estrogen therapy and 14 days of estrogen plus progesterone. Patients who were randomly assigned to the HRT plus fluoxetine group were given fluoxetine in combination with HRT. Hamilton Depression Rating Scale (HAMD), Kupperman Menopausal Index (KMI), and Clinical Global Impressions scale were used to measure the efficacy. RESULTS: One hundred and twenty-three post-menopausal patients with depression were enrolled in the study. Among them, 120 had at least one post-treatment visit and entered into the statistical analysis. The mean total HAMD scores were significantly lower, and the percentages of HAMD score reductions were higher in the HRT plus fluoxetine Group compared with the HRT Group, after at least 3 weeks of treatment, with an average difference of 5 points at the endpoint. The Clinical Global Impression-Severity and Clinical Global Impression-Improvement scores were significantly different in the 2 groups, in favor of the combination therapy. The mean total KMI was significantly lower in the Combination Group compared with the HRT Group, after at least 6 weeks of treatment, with an average 4.5-point difference between the groups. No statistically significant differences were found in most of the adverse events reported in the Combination Group compared with the HRT group, with the exception of 3 symptoms, i.e., dry mouth, loss of appetite, and abdominal distention. They were mild to moderate in severity. Two patients in the HRT group, but none in the combination group, dropped out due to adverse events. CONCLUSION: HRT plus fluoxetine therapy was effective in the treatment of menopausal depression with a satisfactory safety profile.