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Compliance consideration with estrogen replacement: Withdrawal bleeding and other factors
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Citations from the Literature
Estrogen favorably alters lipid metabolism and should therefore diminish the risk for coronary heart disease in estrogen users. Epidemiologic data from case-control and prospective cohort studies have suggested that estrogen use may confer protection from cardiovascular disease and decrease all-cause mortality rates in postmenopausal women. Because the ageadjusted mortality rate due to heart disease among American women is approximately four times the combined mortality rate due to endometrial and breast cancers, even modest changes in the risk of fatal heart disease after estrogen use would dramatically impact the overall risk-benefit.
Compliance consideration with estrogen replacement: Withdrawal bleeding and other factors Hahn RG Department of Family Medicine, University of Tennessee, 1121 Union Ave., Memphis, TN38104, USA AM J OBSTET GYNBCOL 1989, 161/6 II SUPPL (18541858) Withdrawal bleeding and other side effects such as edema, bloating, premenstrual irritability, lower abdominal cramps, dysmenorrhea, and breast tenderness limit compliance with hormonal replacement therapy. Although many of these troublesome side effects can be managed by adjusting the dose or changing the source of the estrogen or progestin components, postmenopausal women view withdrawal bleeding as the most negative factor influencing their decision to use hormonal replacement therapy. Additionally, the potential link between postmenopausal estrogen use and subsequent endometrial hyperplasia and cancer concerns potential users. Cyclic progestins protect the endometrium from hyperplastic changes but may not prevent withdrawal bleeding. Both patient and physician education, including the nature of menopause and the protective role of estrogens in osteoporosis and cardiovascular disease, are critical to improving compliance with hormonal replacement.
Estrogen replacement therapy: What the future holds Hammond CB Department of Obstetrics and Gynecology, Duke University Medical Center, Box 3853, Durham, NC 27710, USA AM J OBSTET GYNECOL 1989, 161/6 II SUPPL (18641868) Although hormonal replacement therapy has proved beneficial for many postmenopausal women, several issues remain to be resolved through future research. Improved combination therapy, better delivery systems, and optimal dosing may enhance compliance, which is essential for maximum benefit from therapy. Epidemiologic studies are necessary to clarify the role of estrogen in osteoporosis and cardiovascular disease. Additionally, the contribution of hormonal replacement therapy to the development of breast and endometrial cancers needs to be clarified. Int J Gynecol Obstet 32
PREGNANCY, DELIVERY Effect of placental IateraIity on uterine artery resistance and development of preeciampsia and intrauterine growth retardation Kofinas AD; Penry M; Swain M; Hatjis CG Section on Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake Forest University, 300 South Hawthorne Road, WinstonSalem, NC 27103, USA AM J OBSTET GYNECOL 1989,161/6 1(1536-1539) We studied 153 pregnant women with normal pregnancies and 147 women with complicated pregnancies (diabetes, hypertensive disorders, and intrauterine growth retardation) to evaluate the association of placental location and the development of preeclampsia, intrauterine growth retardation, and uterine artery resistance. The placental location was determined by real-time ultrasonography, and the uterine artery resistance was determined by continuous-wave Doppler flow velocity waveform analysis. In the presence of preeclampsia or intrauterine retardation, up to 75% of the patients had unilaterally located placentas and 25% central placentas, whereas in the absence of these two conditions only 51% of the patients had unilateral and 49% central placentas (P < 0.02). In patients with unilateral placentas, the incidence of preeclampsia and intrauterine growth retardation was 2.8-fold and 2.7-fold greater than in patients with central placentas (P < 0.03 and P < 0.01). Among all patients unilateral placental location was more likely to be associated with abnormal uterine artery flow velocity waveforms than central placental location (P < 0.001). We conclude that unilateral placental location may predispose to the development of preeclampsia and intrauterine growth retardation by its effect on uterine artery resistance.
The centrai hemodynamics of severe preeciampsia Mabie WC; Ratts TE; Sibai BM Department of Obstetrics and Gynecology, University of Tennessee, 853 Jefferson Ave., Memphis, TN38103, USA AM J OBSTET GYNECOL 1989,161/6 1(1443-1448) Swan-Ganz hemodynamic monitoring in 49 antepartum patients with severe preeclampsia revealed a variable hemodynamic profile. The majority of patients had normal left ventricular filling pressure (8.4 + 0.2 mmHg), normal to high cardiac index (4.4 -C 0.1 L.min-‘.m*), and upper normal to moderately elevated systemic vascular resistance (1226 f 37 dynes.sec.cm+). Eight patients had pulmonary edema and their findings included high wedge pressure (18 + 1 mmHg), upper normal to high cardiac index (4.9 f 0.5 L.min-‘.mit?), and normal systemic vascular resistance (964 + 50 dynes.sec.cm-5). Left ventricular function was hyperdynamic in 73% of the 49 patients. Patients with chronic hypertension and superimposed preeclampsia were hemodynamically indistinguishable from patients with preeclampsia alone. We conclude that, in general, preeclampsia is a high cardiac output state associated with an inappropriately high peripheral resistance. The normal wedge
Citations from the Literature
Estrogen favorably alters lipid metabolism and should therefore diminish the risk for coronary heart disease in estrogen users. Epidemiologic data from case-control and prospective cohort studies have suggested that estrogen use may confer protection from cardiovascular disease and decrease all-cause mortality rates in postmenopausal women. Because the ageadjusted mortality rate due to heart disease among American women is approximately four times the combined mortality rate due to endometrial and breast cancers, even modest changes in the risk of fatal heart disease after estrogen use would dramatically impact the overall risk-benefit.
Compliance consideration with estrogen replacement: Withdrawal bleeding and other factors Hahn RG Department of Family Medicine, University of Tennessee, 1121 Union Ave., Memphis, TN38104, USA AM J OBSTET GYNBCOL 1989, 161/6 II SUPPL (18541858) Withdrawal bleeding and other side effects such as edema, bloating, premenstrual irritability, lower abdominal cramps, dysmenorrhea, and breast tenderness limit compliance with hormonal replacement therapy. Although many of these troublesome side effects can be managed by adjusting the dose or changing the source of the estrogen or progestin components, postmenopausal women view withdrawal bleeding as the most negative factor influencing their decision to use hormonal replacement therapy. Additionally, the potential link between postmenopausal estrogen use and subsequent endometrial hyperplasia and cancer concerns potential users. Cyclic progestins protect the endometrium from hyperplastic changes but may not prevent withdrawal bleeding. Both patient and physician education, including the nature of menopause and the protective role of estrogens in osteoporosis and cardiovascular disease, are critical to improving compliance with hormonal replacement.
Estrogen replacement therapy: What the future holds Hammond CB Department of Obstetrics and Gynecology, Duke University Medical Center, Box 3853, Durham, NC 27710, USA AM J OBSTET GYNECOL 1989, 161/6 II SUPPL (18641868) Although hormonal replacement therapy has proved beneficial for many postmenopausal women, several issues remain to be resolved through future research. Improved combination therapy, better delivery systems, and optimal dosing may enhance compliance, which is essential for maximum benefit from therapy. Epidemiologic studies are necessary to clarify the role of estrogen in osteoporosis and cardiovascular disease. Additionally, the contribution of hormonal replacement therapy to the development of breast and endometrial cancers needs to be clarified. Int J Gynecol Obstet 32
PREGNANCY, DELIVERY Effect of placental IateraIity on uterine artery resistance and development of preeciampsia and intrauterine growth retardation Kofinas AD; Penry M; Swain M; Hatjis CG Section on Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake Forest University, 300 South Hawthorne Road, WinstonSalem, NC 27103, USA AM J OBSTET GYNECOL 1989,161/6 1(1536-1539) We studied 153 pregnant women with normal pregnancies and 147 women with complicated pregnancies (diabetes, hypertensive disorders, and intrauterine growth retardation) to evaluate the association of placental location and the development of preeclampsia, intrauterine growth retardation, and uterine artery resistance. The placental location was determined by real-time ultrasonography, and the uterine artery resistance was determined by continuous-wave Doppler flow velocity waveform analysis. In the presence of preeclampsia or intrauterine retardation, up to 75% of the patients had unilaterally located placentas and 25% central placentas, whereas in the absence of these two conditions only 51% of the patients had unilateral and 49% central placentas (P < 0.02). In patients with unilateral placentas, the incidence of preeclampsia and intrauterine growth retardation was 2.8-fold and 2.7-fold greater than in patients with central placentas (P < 0.03 and P < 0.01). Among all patients unilateral placental location was more likely to be associated with abnormal uterine artery flow velocity waveforms than central placental location (P < 0.001). We conclude that unilateral placental location may predispose to the development of preeclampsia and intrauterine growth retardation by its effect on uterine artery resistance.
The centrai hemodynamics of severe preeciampsia Mabie WC; Ratts TE; Sibai BM Department of Obstetrics and Gynecology, University of Tennessee, 853 Jefferson Ave., Memphis, TN38103, USA AM J OBSTET GYNECOL 1989,161/6 1(1443-1448) Swan-Ganz hemodynamic monitoring in 49 antepartum patients with severe preeclampsia revealed a variable hemodynamic profile. The majority of patients had normal left ventricular filling pressure (8.4 + 0.2 mmHg), normal to high cardiac index (4.4 -C 0.1 L.min-‘.m*), and upper normal to moderately elevated systemic vascular resistance (1226 f 37 dynes.sec.cm+). Eight patients had pulmonary edema and their findings included high wedge pressure (18 + 1 mmHg), upper normal to high cardiac index (4.9 f 0.5 L.min-‘.mit?), and normal systemic vascular resistance (964 + 50 dynes.sec.cm-5). Left ventricular function was hyperdynamic in 73% of the 49 patients. Patients with chronic hypertension and superimposed preeclampsia were hemodynamically indistinguishable from patients with preeclampsia alone. We conclude that, in general, preeclampsia is a high cardiac output state associated with an inappropriately high peripheral resistance. The normal wedge