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Cimicifuga racemosa for treatment of vasomotor symptoms: Mode of action
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EMAS2017 / Maturitas 100 (2017) 93–202
symptoms resolution. At 5 years of follow-up, there were 2 unfavorable events (2.5%): 1 breast papillary tumor and 1 superficial thrombophlebitis. Conclusion: There were persistent symptoms in 70% of ♀ ≥ 60 years, and 73% of these needed HT maintenance. There were no significant differences between progressive reduction of the HT dose and expectant attitude. Tibolone also was a valid option in symptoms control. In this study group, HT use was safe. The recommendations should be respected and the accuracy of surveillance increased. http://dx.doi.org/10.1016/j.maturitas.2017.03.125 P026 Hormone replacement therapy and the impact of “gap time” in cardiovascular versus breast cancer risk Mihaela Nicoleta Plotogea 1 , Oana Maria Ionescu 2 , Elvira Bratila 1 , Diana Elena Comandasu 1,∗ , Costin Berceanu 3 , Claudia Mehedintu 1 1
‘Carol Davila’ University of Medicine and Pharmacy, Obstetrics Gynecology, Bucharest, Romania 2 ‘Filantropia’ Clinical Hospital, Obstetrics Gynecology, Bucharest, Romania 3 Craiova University of Medicine and Pharmacy, Obstetrics Gynecology, Craiova, Romania The gold standard for menopause symptoms, hormone replacement therapy (HRT) should be individualized for each patient, corresponding to her need, expectations, history and benefits should always outweigh the risks. Following WHI (Women Health Initiative) results, studies have tried to explain the heart paradox, as well as estrogen effects related to age or the moment of treatment initiation. ELITE (Early versus Late Interventional Trial with Estradiol) concludes that estrogen has a favorable effect on atherosclerosis and cardiovascular events when administrated in early menopause comparing to its neutral or even adverse effect in older women, when started later than 10 years after the menopausal onset. Knowing that estrogen has thickening effects on the blood, the therapy should be initiated before the development of advanced atherosclerotic plaques, because, when administrated later, together with the increase in the production of clothing factors, it makes the blood more likely to clot. Regarding breast cancer (BC), the time hypothesis is also supported by various studies. Starting therapy later than 5 years after the onset of menopause is associated with a significant reduction of BC risk, because the estrogen deprivation associated to menopause determines a sensitization of breast cancer cells to the proapoptotic effects of estrogen, whereas immediately initiation has no advantageous effects. Furthermore, hormone receptors-positive breast cancers in postmenopausal women respond to treatment with high dose estrogen therapy, while similar tumors in premenopausal women do not. This paradoxical response to addition or deprivation of estrogen can explain both decrease in BC after initiation of HRT and the decrease following cessation of treatment. Unfortunately, “gap time” cannot optimize both benefits and risks for cardiovascular diseases and breast cancer. http://dx.doi.org/10.1016/j.maturitas.2017.03.126
P027 Cimicifuga racemosa for treatment of vasomotor symptoms: Mode of action Petra Nicken ∗ , Jennifer-Christin Kuchernig, Stephanie Pickartz, Hans-Heinrich Henneicke-von Zepelin, Klaus-Ulrich Nolte Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany Worldwide, 50–85% of women experience disabling symptoms during menopausal transition; these significantly affect their wellbeing and quality of life. Cimicifuga racemosa (CR) has shown its efficacy against Vasomotor Symptoms (VMS). The pathophysiology of VMS is still unclear; the mode of action is still being debated. The role of circulating levels of estrogen in triggering VMS has been critically discussed. The most probable site of thermoregulatory dysfunction appears to be the hypothalamic thermoregulatory center. Estrogen fluctuations affect several neurotransmitter systems and cause imbalances in the serotonin- and noradrenalin-levels in the hypothalamic thermoregulatory center, which have been shown to result in VMS. The aim of this pharmacological overview is to discuss the relevant pharmacological properties of CR, which may contribute to the mechanism of action for the relief of VMS. Literature (e.g. MEDLINE, EMBASE, BIOSIS) was collected till 2016 and analyzed for CR extracts and its constituents interacting with brain receptors or modulating brain metabolism and activity. The current data suggest that alleviation of VMS by CR is not caused by estrogen-agonistic effects. Several publications verified that CR contains substances that bind to serotonin, dopamine, GABA and -opioid brain receptors leading to receptor-mediated functional activity. CR modulates the ratio of cerebral monoamines and metabolites as well as brain activity (EEG). Moreover, CR and its constituents exert anti-inflammatory, antioxidant and radical scavenger activities. These counteract inflammatory processes and oxidative stress caused by estrogen fluctuations whereby neurons recover their sensitivity to temperature changes. We hypothesize that CR restores imbalanced thermoregulation and mitigates VMS occurrence by a multifaceted mechanism. This includes direct action on serotonin, dopamine and -opioid receptors and anti-inflammatory, antioxidant and radical scavenger effects. http://dx.doi.org/10.1016/j.maturitas.2017.03.127 P028 Use of vaginal CO2 laser for the treatment of genitourinary syndrome of menopause. ˜ Experience at the Hospital General de Cataluna – Quironsalud group Sonia Sanchez ∗ , Milagros Martínez, Sandra Gómez, Laura Rodellar, Eugenia Gil, Joan Manel Xiberta Hospital Universitari General Catalunya, Ginecología y Obstetricia, Sant Cugat del Valles, Spain GUSM affects more than half of all menopausal women. Moisturizers and lubricants along with local estrogen therapy are the treatments of choice for these patients. However, not all patients feel comfortable with this type of treatment and others cannot use estrogens because they have a contraindication (i.e.: an active cancer).
EMAS2017 / Maturitas 100 (2017) 93–202
symptoms resolution. At 5 years of follow-up, there were 2 unfavorable events (2.5%): 1 breast papillary tumor and 1 superficial thrombophlebitis. Conclusion: There were persistent symptoms in 70% of ♀ ≥ 60 years, and 73% of these needed HT maintenance. There were no significant differences between progressive reduction of the HT dose and expectant attitude. Tibolone also was a valid option in symptoms control. In this study group, HT use was safe. The recommendations should be respected and the accuracy of surveillance increased. http://dx.doi.org/10.1016/j.maturitas.2017.03.125 P026 Hormone replacement therapy and the impact of “gap time” in cardiovascular versus breast cancer risk Mihaela Nicoleta Plotogea 1 , Oana Maria Ionescu 2 , Elvira Bratila 1 , Diana Elena Comandasu 1,∗ , Costin Berceanu 3 , Claudia Mehedintu 1 1
‘Carol Davila’ University of Medicine and Pharmacy, Obstetrics Gynecology, Bucharest, Romania 2 ‘Filantropia’ Clinical Hospital, Obstetrics Gynecology, Bucharest, Romania 3 Craiova University of Medicine and Pharmacy, Obstetrics Gynecology, Craiova, Romania The gold standard for menopause symptoms, hormone replacement therapy (HRT) should be individualized for each patient, corresponding to her need, expectations, history and benefits should always outweigh the risks. Following WHI (Women Health Initiative) results, studies have tried to explain the heart paradox, as well as estrogen effects related to age or the moment of treatment initiation. ELITE (Early versus Late Interventional Trial with Estradiol) concludes that estrogen has a favorable effect on atherosclerosis and cardiovascular events when administrated in early menopause comparing to its neutral or even adverse effect in older women, when started later than 10 years after the menopausal onset. Knowing that estrogen has thickening effects on the blood, the therapy should be initiated before the development of advanced atherosclerotic plaques, because, when administrated later, together with the increase in the production of clothing factors, it makes the blood more likely to clot. Regarding breast cancer (BC), the time hypothesis is also supported by various studies. Starting therapy later than 5 years after the onset of menopause is associated with a significant reduction of BC risk, because the estrogen deprivation associated to menopause determines a sensitization of breast cancer cells to the proapoptotic effects of estrogen, whereas immediately initiation has no advantageous effects. Furthermore, hormone receptors-positive breast cancers in postmenopausal women respond to treatment with high dose estrogen therapy, while similar tumors in premenopausal women do not. This paradoxical response to addition or deprivation of estrogen can explain both decrease in BC after initiation of HRT and the decrease following cessation of treatment. Unfortunately, “gap time” cannot optimize both benefits and risks for cardiovascular diseases and breast cancer. http://dx.doi.org/10.1016/j.maturitas.2017.03.126
P027 Cimicifuga racemosa for treatment of vasomotor symptoms: Mode of action Petra Nicken ∗ , Jennifer-Christin Kuchernig, Stephanie Pickartz, Hans-Heinrich Henneicke-von Zepelin, Klaus-Ulrich Nolte Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany Worldwide, 50–85% of women experience disabling symptoms during menopausal transition; these significantly affect their wellbeing and quality of life. Cimicifuga racemosa (CR) has shown its efficacy against Vasomotor Symptoms (VMS). The pathophysiology of VMS is still unclear; the mode of action is still being debated. The role of circulating levels of estrogen in triggering VMS has been critically discussed. The most probable site of thermoregulatory dysfunction appears to be the hypothalamic thermoregulatory center. Estrogen fluctuations affect several neurotransmitter systems and cause imbalances in the serotonin- and noradrenalin-levels in the hypothalamic thermoregulatory center, which have been shown to result in VMS. The aim of this pharmacological overview is to discuss the relevant pharmacological properties of CR, which may contribute to the mechanism of action for the relief of VMS. Literature (e.g. MEDLINE, EMBASE, BIOSIS) was collected till 2016 and analyzed for CR extracts and its constituents interacting with brain receptors or modulating brain metabolism and activity. The current data suggest that alleviation of VMS by CR is not caused by estrogen-agonistic effects. Several publications verified that CR contains substances that bind to serotonin, dopamine, GABA and -opioid brain receptors leading to receptor-mediated functional activity. CR modulates the ratio of cerebral monoamines and metabolites as well as brain activity (EEG). Moreover, CR and its constituents exert anti-inflammatory, antioxidant and radical scavenger activities. These counteract inflammatory processes and oxidative stress caused by estrogen fluctuations whereby neurons recover their sensitivity to temperature changes. We hypothesize that CR restores imbalanced thermoregulation and mitigates VMS occurrence by a multifaceted mechanism. This includes direct action on serotonin, dopamine and -opioid receptors and anti-inflammatory, antioxidant and radical scavenger effects. http://dx.doi.org/10.1016/j.maturitas.2017.03.127 P028 Use of vaginal CO2 laser for the treatment of genitourinary syndrome of menopause. ˜ Experience at the Hospital General de Cataluna – Quironsalud group Sonia Sanchez ∗ , Milagros Martínez, Sandra Gómez, Laura Rodellar, Eugenia Gil, Joan Manel Xiberta Hospital Universitari General Catalunya, Ginecología y Obstetricia, Sant Cugat del Valles, Spain GUSM affects more than half of all menopausal women. Moisturizers and lubricants along with local estrogen therapy are the treatments of choice for these patients. However, not all patients feel comfortable with this type of treatment and others cannot use estrogens because they have a contraindication (i.e.: an active cancer).