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62 PLANT DERIVED ALTERNATIVES FOR HORMONE REPLACEMENT THERAPY (HRT)
S14
9th European Congress on Menopause and Andropause / Maturitas 71, Supplement 1 (2012) S1–S82
References: [1] Borrelli F, Ernst E. Maturitas. 2010; 66:333-43. [2] Ricci E, Cipriani S, Chiaffarino F, Malvezzi M, Parazzini F. J Womens Health. 2010;19:1609-17.
62 PLANT DERIVED ALTERNATIVES FOR HORMONE REPLACEMENT THERAPY (HRT) W. Wuttke, D. Seidlova-Wuttke. Department of Endocrinology, University Medical Center Goettingen, Goettingen, Germany
60 ACUPUNCTURE FOR HOT FLASHES E.K. Borud. Faculty of Medicine, University of Tromsø, Fetsund, Norway Hot flushes are common and distressing in postmenopausal women. Treatment with oestrogens carries health risks. Current hypotheses for hot flush mechanisms involve a narrowing of the thermoneutral zone, which may be counteracted by interventions that increase oestrogen, endorphin or serotonin levels, or decrease noradrenalin levels. Acupuncture is supposed to have several mechanisms with the potential to reduce hot flush frequency and severity. This talk includes a presentation of a review of the current clinical trial literature. Sixteen studies are included. Three studies comparing acupuncture with no specific therapy show that acupuncture treatment leads to a reduction of around 50% in hot flush frequency. There were seven comparisons between acupuncture and other therapy: three showed acupuncture to have a significantly smaller effect on frequency than oestrogen therapy, two found a similar effect to relaxation, one found a significantly greater effect than the food supplement oryzanol, and one was unclear. Out of seven studies that compared acupuncture with some other form of needle penetration, five showed no effect, one showed an effect on frequency, and another on severity but not frequency. Two studies compared acupuncture with non-penetrating, blunt needles: one was significantly positive for flush severity but not frequency, and the other showed no effect. In conclusion, the results from all studies are in agreement with the hypothesis that acupuncture relieves hot flushes. There are few data supporting the hypothesis that the effect of acupuncture is point specific. Future research should investigate whether there is a biological effect of the needling itself.
The sales of plant derived products for the treatment of climacteric/ postmenopausal complaints or diseases have increased since publication of the Women’s Health Initiative. Contradictory results published on effects of isoflavones on estrogen regulated organs point to both, beneficial as well as adverse effects. Psycho-vegetative climacteric complaints such as hot flushes are only slightly influenced by phytoestrogens (isoflavones). Soy products have cancer preventing properties in the mammary gland; however, they may only be exerted if the developing gland was under the influence of isoflavones during childhood and puberty. Another non-estrogenic alternative for the treatment of climacteric complaints are substances that influence neurotransmitters in hypothalamic thermo regulatory centers thereby ameliorating hot flushes. Serotoninergic and GABAergic compounds inhibit climacteric complaints, particularly hot flushes and plant derived extracts containing serotoninergic or GABA-ergic compounds may be profitable for climacteric women. The special extract of Cimicifuga racemosa (CR, Black cohosh) BNO 1055 was in a number of double-blind placebo-controlled studies similarly effective to alleviate hot flushes both, in animal as well as in clinical studies. Active compounds appear to be serotoninergic and GABA-ergic in nature and the serotonin analogue 5-methyl-serotonin was identified in BNO 1055. In ovariectomized rats both, the CR extract or 5-methyl-serotonin prevented the occurrence of hot flushes. Interestingly the Cimicifuga racemosa extract had also mild antiosteoporotic effects. Both, saponins and polar substances in BNO 1055 appear to cooperate positively in preventing osteoporosis. Therefore, CR BNO 1055 may be an ideal substitute to replace hormone therapy of climacteric/postmenopausal women.
Parallel Session: Ovarian Cancer 61 ANDROGENS INHIBIT THE ACTION OF 17β-ESTRADIOL IN HUMAN BREAST TISSUE: AN IN VITRO STUDY R. Erkkola 1 , N. Eigeliene 2 , P. Härkönen 2,3 . 1 Dept. Ob-Gyn, University Central Hospital of Turku; 2 Dept. Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland; 3 Dept. Laboratory Medicine, Lund University, Tumor Biology, Malmö University Hospital, Malmö, Sweden Backgroud: Hormone replacement therapy (HRT) produces a proliferative response in normal breast epithelium, which may have breast cancer (BC) promoting effects. Androgens may counteract the effects of estrogen and progestagens, yet the effect of androgens on normal human breast tissues (HBTs) needs to be researched more extensively. Methods: HBTs were obtained from reduction mammoplasties of postmenopausal women. The explants were cultured with or without testosterone (T) and 5α-dihydrotestosterone (DHT) or 17β-estradiol (E2 ) alone and in combinations (E2 /T and E2 /DHT) for 7 and 14 days. Endpoints included histomorphologic, immunohistochemical, western blot, and mRNA assessment of biomarkers of proliferation, and apoptosis and steroid hormone receptor expression in cultured HBTs. Results: T and DHT resulted in significantly reduced proliferation in breast epithelial cells, while E2 had an opposite effect. The combinations E2 /T and E2 /DHT significantly attenuated the E2 stimulated increase of proliferation and increased the relative number of apoptotic cells. T and DHT increased the relative numbers of androgen receptor (AR) positive cells and strongly decreased ERα positive cells. E2 increased the number of ERα positive cells, but AR and ERβ positive cells were decreased. The level of ERβ was not affected significantly by androgen treatment. The combination of T or DHT with E2 mainly opposed the E2 effect on hormone receptor expression by decreasing the levels of ERα and reversing AR and ERβ to control levels. Conclusions: In normal HBT, T and DHT oppose the effect of E2 resulting in a more physiological hormone environment.
63 FIRST GREEK PILOT STUDY ON LAPAROSCOPIC TREATMENT OF ENDOMETRIAL CANCER BY GYNAECOLOGICAL ONCOLOGISTS T. Panoskaltsis 1,2 , Z. Voulgaris 2 , D. Hasiakos 1 , G. Pistofidis 3 , K. Pavlakis 4,5 . 1 Gynaecological Oncology, 2nd Academic Dept. OB/GYN, Aretaieion Hospital; 2 Gynaecological Oncology, IASO Women’s Hospital; 3 Endoscopic Surgery, Athens Centre of Endoscopic Training (ACET); 4 Laboratory of Histopathology, Athens University Medical School; 5 Laboratory of Histopathology, IASO Women’s Hospital, Athens, Greece Aim: Establishing the role of laparoscopic surgery for endometrial cancer by gynaecological oncologists in Greece. Material & Methods: We describe the characteristics-outcome of first 17 cases of an on-going study. Inclusion criteria are: preoperative histology G1-endometrioid carcinoma and, on imaging, no evidence of extrauterine disease. Advanced age, high BMI or previous surgery do not constitute exclusion criteria for laparoscopic surgery. The patients undergo total laparoscopic hysterectomy, bilateral salpingoophorectomy and complete laparoscopic pelvic lymphadenectomy (one had only laparoscopic hysterectomy with ovarian conservation). One patient underwent a type-II radical hysterectomy (cervical involvement on MRI, confirmed on histology - endometrial clear cell adenocarcinoma with cervical extension). Results: No case was converted to laparotomy. Mean age was 58.2 years and mean BMI 28.5. There were no anaesthetic-intraoperative complications. All patients were discharged after a mean of 2,11 days. The mean number of lymph nodes retrieved was 19. One ureterovaginal fistula occurred, treated conservatively with pigtail insertion for 30 days. One bladder perforation was sutured laparoscopically the following day. There was accordance with imaging findings and final histology, except for the case described above. Surgical stage was Ia in all cases, except three (2 Ib and II). Brachytherapy was administered in three patients (two with LVSI and another with clear cell carcinoma, who also had chemotherapy). All patients are well after a mean follow-up of 11,4 months (4-29).
9th European Congress on Menopause and Andropause / Maturitas 71, Supplement 1 (2012) S1–S82
References: [1] Borrelli F, Ernst E. Maturitas. 2010; 66:333-43. [2] Ricci E, Cipriani S, Chiaffarino F, Malvezzi M, Parazzini F. J Womens Health. 2010;19:1609-17.
62 PLANT DERIVED ALTERNATIVES FOR HORMONE REPLACEMENT THERAPY (HRT) W. Wuttke, D. Seidlova-Wuttke. Department of Endocrinology, University Medical Center Goettingen, Goettingen, Germany
60 ACUPUNCTURE FOR HOT FLASHES E.K. Borud. Faculty of Medicine, University of Tromsø, Fetsund, Norway Hot flushes are common and distressing in postmenopausal women. Treatment with oestrogens carries health risks. Current hypotheses for hot flush mechanisms involve a narrowing of the thermoneutral zone, which may be counteracted by interventions that increase oestrogen, endorphin or serotonin levels, or decrease noradrenalin levels. Acupuncture is supposed to have several mechanisms with the potential to reduce hot flush frequency and severity. This talk includes a presentation of a review of the current clinical trial literature. Sixteen studies are included. Three studies comparing acupuncture with no specific therapy show that acupuncture treatment leads to a reduction of around 50% in hot flush frequency. There were seven comparisons between acupuncture and other therapy: three showed acupuncture to have a significantly smaller effect on frequency than oestrogen therapy, two found a similar effect to relaxation, one found a significantly greater effect than the food supplement oryzanol, and one was unclear. Out of seven studies that compared acupuncture with some other form of needle penetration, five showed no effect, one showed an effect on frequency, and another on severity but not frequency. Two studies compared acupuncture with non-penetrating, blunt needles: one was significantly positive for flush severity but not frequency, and the other showed no effect. In conclusion, the results from all studies are in agreement with the hypothesis that acupuncture relieves hot flushes. There are few data supporting the hypothesis that the effect of acupuncture is point specific. Future research should investigate whether there is a biological effect of the needling itself.
The sales of plant derived products for the treatment of climacteric/ postmenopausal complaints or diseases have increased since publication of the Women’s Health Initiative. Contradictory results published on effects of isoflavones on estrogen regulated organs point to both, beneficial as well as adverse effects. Psycho-vegetative climacteric complaints such as hot flushes are only slightly influenced by phytoestrogens (isoflavones). Soy products have cancer preventing properties in the mammary gland; however, they may only be exerted if the developing gland was under the influence of isoflavones during childhood and puberty. Another non-estrogenic alternative for the treatment of climacteric complaints are substances that influence neurotransmitters in hypothalamic thermo regulatory centers thereby ameliorating hot flushes. Serotoninergic and GABAergic compounds inhibit climacteric complaints, particularly hot flushes and plant derived extracts containing serotoninergic or GABA-ergic compounds may be profitable for climacteric women. The special extract of Cimicifuga racemosa (CR, Black cohosh) BNO 1055 was in a number of double-blind placebo-controlled studies similarly effective to alleviate hot flushes both, in animal as well as in clinical studies. Active compounds appear to be serotoninergic and GABA-ergic in nature and the serotonin analogue 5-methyl-serotonin was identified in BNO 1055. In ovariectomized rats both, the CR extract or 5-methyl-serotonin prevented the occurrence of hot flushes. Interestingly the Cimicifuga racemosa extract had also mild antiosteoporotic effects. Both, saponins and polar substances in BNO 1055 appear to cooperate positively in preventing osteoporosis. Therefore, CR BNO 1055 may be an ideal substitute to replace hormone therapy of climacteric/postmenopausal women.
Parallel Session: Ovarian Cancer 61 ANDROGENS INHIBIT THE ACTION OF 17β-ESTRADIOL IN HUMAN BREAST TISSUE: AN IN VITRO STUDY R. Erkkola 1 , N. Eigeliene 2 , P. Härkönen 2,3 . 1 Dept. Ob-Gyn, University Central Hospital of Turku; 2 Dept. Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland; 3 Dept. Laboratory Medicine, Lund University, Tumor Biology, Malmö University Hospital, Malmö, Sweden Backgroud: Hormone replacement therapy (HRT) produces a proliferative response in normal breast epithelium, which may have breast cancer (BC) promoting effects. Androgens may counteract the effects of estrogen and progestagens, yet the effect of androgens on normal human breast tissues (HBTs) needs to be researched more extensively. Methods: HBTs were obtained from reduction mammoplasties of postmenopausal women. The explants were cultured with or without testosterone (T) and 5α-dihydrotestosterone (DHT) or 17β-estradiol (E2 ) alone and in combinations (E2 /T and E2 /DHT) for 7 and 14 days. Endpoints included histomorphologic, immunohistochemical, western blot, and mRNA assessment of biomarkers of proliferation, and apoptosis and steroid hormone receptor expression in cultured HBTs. Results: T and DHT resulted in significantly reduced proliferation in breast epithelial cells, while E2 had an opposite effect. The combinations E2 /T and E2 /DHT significantly attenuated the E2 stimulated increase of proliferation and increased the relative number of apoptotic cells. T and DHT increased the relative numbers of androgen receptor (AR) positive cells and strongly decreased ERα positive cells. E2 increased the number of ERα positive cells, but AR and ERβ positive cells were decreased. The level of ERβ was not affected significantly by androgen treatment. The combination of T or DHT with E2 mainly opposed the E2 effect on hormone receptor expression by decreasing the levels of ERα and reversing AR and ERβ to control levels. Conclusions: In normal HBT, T and DHT oppose the effect of E2 resulting in a more physiological hormone environment.
63 FIRST GREEK PILOT STUDY ON LAPAROSCOPIC TREATMENT OF ENDOMETRIAL CANCER BY GYNAECOLOGICAL ONCOLOGISTS T. Panoskaltsis 1,2 , Z. Voulgaris 2 , D. Hasiakos 1 , G. Pistofidis 3 , K. Pavlakis 4,5 . 1 Gynaecological Oncology, 2nd Academic Dept. OB/GYN, Aretaieion Hospital; 2 Gynaecological Oncology, IASO Women’s Hospital; 3 Endoscopic Surgery, Athens Centre of Endoscopic Training (ACET); 4 Laboratory of Histopathology, Athens University Medical School; 5 Laboratory of Histopathology, IASO Women’s Hospital, Athens, Greece Aim: Establishing the role of laparoscopic surgery for endometrial cancer by gynaecological oncologists in Greece. Material & Methods: We describe the characteristics-outcome of first 17 cases of an on-going study. Inclusion criteria are: preoperative histology G1-endometrioid carcinoma and, on imaging, no evidence of extrauterine disease. Advanced age, high BMI or previous surgery do not constitute exclusion criteria for laparoscopic surgery. The patients undergo total laparoscopic hysterectomy, bilateral salpingoophorectomy and complete laparoscopic pelvic lymphadenectomy (one had only laparoscopic hysterectomy with ovarian conservation). One patient underwent a type-II radical hysterectomy (cervical involvement on MRI, confirmed on histology - endometrial clear cell adenocarcinoma with cervical extension). Results: No case was converted to laparotomy. Mean age was 58.2 years and mean BMI 28.5. There were no anaesthetic-intraoperative complications. All patients were discharged after a mean of 2,11 days. The mean number of lymph nodes retrieved was 19. One ureterovaginal fistula occurred, treated conservatively with pigtail insertion for 30 days. One bladder perforation was sutured laparoscopically the following day. There was accordance with imaging findings and final histology, except for the case described above. Surgical stage was Ia in all cases, except three (2 Ib and II). Brachytherapy was administered in three patients (two with LVSI and another with clear cell carcinoma, who also had chemotherapy). All patients are well after a mean follow-up of 11,4 months (4-29).