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1
Björn, Inger. "Hormone replacement therapy and effects on mood." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94115.
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Background: During the past 5 decades, hormone replacement therapy (HRT) has been used, and appreciated for its beneficial effects, by millions of women in their menopause. As treatment for climacteric symptoms, estrogen is outstanding, and effects on hot flushes, vaginal dryness, and insomnia have been widely documented. The increased risks of venous thrombosis and breast cancer, however, restrict the use of estrogen. Estrogen treatment in women with a remaining uterus includes a progestin, added to protect the endometrium from hyperplasia and malignancies. The long-standing clinical impression, that progestin addition negatively influences mood, has been discussed in previous studies. Mood deterioration is, however, not mortal, although mood is important to the wellbeing and daily functioning of women treated with hormones. Studies of the mental side effects of HRT add to our understanding of steroid effects in the brain. Aims and methods: In our studies, we aimed to establish to what extent negative side effects cause women to discontinue HRT, and find out which drug compounds lead to mood deterioration. The questions asked were whether the type and dose of progestin and the estrogen dose during the progestin addition influence the mood and physical symptoms during sequential HRT. Compliance with HRT and reasons for discontinuing the therapy were evaluated in a retrospective longitudinal follow-up study. Treatment effects were studied in three randomized, double-blind, cross-over trials. During continuous estrogen treatment, effects of sequential addition of a progestin were studied by comparing two different progestins, medroxyprogesterone acetate (MPA) andnorethisterone acetate (NETA), comparing different doses of the same progestin, MPA, and comparing two doses of estrogen during addition of the same dose of MPA. The main outcome measure was the daily rating on mood and physical symptoms kept by the participants throughout the studies. The clinical trials were carried out at three gynecological centers in northern Sweden. Results and conclusions: Besides fear of cancer and a wish to determine whether climacteric symptoms had meanwhile disappeared, negative side effects was the most common reason or discontinuing HRT. Tension in the breasts, weight gain, a depressed mood, abdominal bloating, and irritability were the most important side effects seen both in women who continued HRT and in women who had discontinued the therapy. In our clinical trials, we showed that addition of a progestin to estrogen treatment induces cyclic mood swings characterized by tension, irritability, and depression, as well as increased breast tension, bloatedness, and hot flushes. Women with a history of premenstrual syndrome (PMS) appeared to be more sensitive to the progestin addition and responded with lower mood scores compared with women without previous PMS. In our studies, MPA provoked depressed mood to a lesser extent than did NETA. Surprisingly, the higher dose of MPA (20 mg) enhanced the mood, compared with 10 mg, when added to estrogen treatment. In women continuously treated with 3 mg estradiol, mood and physical symptoms worsened during the progestin addition, as compared with treatment with 2 mg estradiol. The negative side effects seen during sequential HRT have much in common with symptoms seen in the premenstrual dysphoric disorder (PMDD), which is a psychoneuroendocrine disorder with psychiatric expression. Explanations for treatment effects on mood are likely to be found in drug interactions with neurotransmitter systems of the brain.Diss. (sammanfattning) Umeå : Umeå universitet, 2003
digitalisering@umu
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Hillard, Timothy Charles. "The prevention of postmenopausal osteoporosis : effects of oral and transdermal hormone replacement therapy." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295875.
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Ödmark, Inga-Stina. "Hormone replacement therapy : benefits and adverse effects." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-243.
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Background: Numerous studies have shown that estrogen replacement therapy (ERT) is an effective treatment for vasomotor symptoms, insomnia and vaginal dryness. Beneficial effects have also been shown on lipid patterns and on the incidence of osteoporotic fractures. As ERT increases the risk of endometrial adenocarcinoma, combinations with various progestogens have been developed in order to protect the endometrium. However, the addition of progestogens tends to reduce the beneficial effects of estrogens on mood, cognition and lipid metabolism. The added progestogen often causes side effects such as irritability and depression. There is evidence that the effect on wellbeing varies between women and with the type of progestogen used. Women who prefer to avoid withdrawal bleedings can be given continuous combined hormone replacement therapy (HRT). Unfortunately, irregular bleedings are common at the beginning of treatment and reduces compliance. Recently, several studies have reported an increased risk of breast cancer and venous thrombosis, and therefore long-term treatment with HRT for women without climacteric symptoms is no longer recommended. The ongoing debate has, for the time being, resulted in a recommendation that improving quality of life (QoL) by treatment of climacteric symptoms should be the only indication for prescribing HRT. Aims and methods: The aims of the study were to investigate bleeding patterns, changes in wellbeing at onset and during long-term treatment, and lipid and lipoprotein profiles with two different types of continuous combined HRT. In addition, women starting, and women switching from mainly sequential HRT were compared. The design was a randomised, double-blind, one year, prospective, multicentre study including 249 healthy postmenopausal women who were given continuous daily oral treatment with either combined 0.625mg conjugated estrogen (CE) and 5mg medroxyprogesterone acetate (MPA) or combined 2mg 17β - estradiol (E2) and 1mg norethisterone acetate (NETA). Bleedings, if any, were recorded daily throughout the study. The main outcome measures (changes in wellbeing and climacteric symptoms) consisted of daily ratings of 12 items on a validated symptom scale. Serum concentrations of lipids and lipoproteins were measured at baseline and after one year of treatment. Results and conclusions: The majority of drop-outs were confined to the first three months, and the main reasons were bleedings and/or decreased wellbeing. Drop-outs were three times more common in the E2/NETA group. During the first month, 67% of the women reported irregular bleedings. The number of bleeding days decreased on both treatments during the first four months. Treatment with CE/MPA resulted in less irregular bleedings and a shorter time to amenorrhoea compared to E2/NETA. As expected, "starters" experienced more sweats than "switchers" at the onset of treatment, but both groups improved significantly. Side effects such as breast tenderness, swelling, depression and irritability appeared during the first treatment week in both groups. The side effects of HRT appeared much more quickly than the benefits and were more frequent in women with a history of premenstrual syndrome (PMS). Breast tenderness was more common in the E2/NETA group throughout the whole study period. Apart from that, there were no differences between the two treatment regimens as regards effects on well-being at the end of the study. Lipoprotein(a) levels, an important risk factor for cardiovascular disease, decreased in both treatment groups. Triglyceride levels increased in women treated with CE/MPA, and levels of total cholesterol, high density lipoprotein and low density lipoprotein fell in the E2/NETA group. In conclusion, treatment with E2/NETA caused more bleeding problems than treatment with CE/MPA. CE/MPA was better tolerated than E2/NETA at the beginning of the study, but among the women remaining in the study there was no difference in QoL between the two treatment groups. HRT counselling should take into account that a history of PMS increases the likelihood of side effects and that these may precede any beneficial effects. Both treatments produced beneficial effects on lipid and lipoprotein levels, and neither of the regimens was superior in this respect.
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Talbi, Oussama. "Synthesis of Homo A-CD Estrogens for Potential Use in Hormone Replacement Therapy." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32082.
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Hormone replacement therapy (HRT) has been subject to much debate due to concerns that long term use of such treatment of menopause increases the risk of breast and uterine cancer. This is thought to be caused by estradiol (1) binding to the estrogen receptor α (ERα) resulting in increased cell proliferation. Another possible mechanism relates to toxicity of the estrodiol metabolites, which are thought to be genotoxic ortho-quinones. In a previous project, a series of A-CD estrogens (2) were synthesised as non-carcinogenic estradiol agonists where the cis CD ring junction was thought to be the cause of the desirable selectivity for ERβ. In this thesis, homo A-CDs were synthesised (3) with expansion of the D ring thought to increase the selecitivty for ERβ. Relative Binding Affinities (RBA) were determined with selectivity to ERα and ERβ. Most ligands showed decreased selectivity when compared to the original A-CD series. However, compounds carrying the CF3 moiety continued to show very high potency. In addition, novel synthetic routes were employed in the preparation of certain compounds.
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Duncan, Ann Carolyn. "Hormone replacement therapy and vascular protection : the influence of oestrogen on the endothelium." Thesis, University of Glasgow, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.482821.
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Williamson, Tanika. "Hormone Replacement Therapy (HRT) Modulates Peripheral and Central Auditory System Processing With Aging." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6604.
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After the findings were reported for the Women’s Health Initiative (WHI) study in the past decade, there has been a significant decline in the overall use of hormone replacement therapy (HRT) among women. However, there are still millions of middle-aged, menopausal women in the U.S. who are currently undergoing hormone therapy. Their reasons for continuing treatment include relief of severe menopausal symptoms, aid in the management of osteoporosis and reduction in the risk of colon cancer (Ness et al., 2005). The purpose of the following investigation was to evaluate the impact of HRT on the central and peripheral auditory systems both during and after treatment. Over the course of the study, hormone treatments were administered to female aging CBA/CaJ mice to observe what effects estrogen (E) and progestin (P) have on the peripheral and central auditory systems. Female CBA/CaJ middle age mice were ovariectomized and placed into 4 HRT groups (E, P, E+P and Placebo [Pb]). Hormone treatment lasted 6 months followed by a recovery/washout period of 1 month. During this time, electrophysiology tests such as auditory brainstem responses (ABR) and ABR gap in noise (GIN) were used to measure neural activity for the auditory nerve and brainstem. Distortion product otoacoustic emission (DPOAE) testing was also implemented to assess the functional status of the outer hair cells (OHC) and their ability to amplify sound in the cochlea. After 6 months of treatment, animals treated with E exhibited the least amount of changes in ABR thresholds and ABR GIN amplitudes than any other subject groups. Interestingly, P animals exhibited an abrupt increase in ABR thresholds only 3 months after treatment; however, for ABR GIN amplitude levels a progressive reduction observed throughout the study. E+P and Pb animals showed signs of accelerated age-related hearing loss (ARHL) with significantly elevated ABR thresholds and dwindling ABR GIN amplitude levels. No significant signs of recovery were observed for any of the hormone groups. Therefore, in the present murine investigation, the effects of HRT were long lasting.
To further expand on the results obtained for the electrophysiology tests, molecular biology experiments were performed to evaluate the expression of IGF-1R and FoxO3 in the cochlea during hormone therapy, from both in vitro and in vivo perspectives. Both genes play significant roles in the PI3K/AKT pathway and were specifically chosen because of their role in anti-apoptotic responses and cell survival. It was hypothesized that E attenuates the effects of ARHL via the PI3K/AKT pathway by up-regulating IGF-1R and FoxO3 to counteract the effects of oxidative stress in the aging mammalian cochlea. qPCR experiments were performed with stria vascularis (SV) lateral wall cells extracted from the cochlea of each animal in the hormone groups post-treatment (in vivo) and in SVK-1 cells treated with HRT over various lengths of time (in vitro) to evaluate the expression levels of IGF-1R and FoxO3. In-vivo experiments showed that the E-treated animals had significantly higher IG-1R levels compared to the other subject groups after treatment was discontinued. Similarly, IGF-1R levels steadily increased for E-treated SVK-1 cells over the course of hormone therapy, compared to P and E+P cells. FoxO3 expression, on the other hand, declined for all of the hormone-treated cells groups, relative to control SVK-1 cells (in vitro), and no statistical differences were detected for FoxO3 levels among the post-treatment animals (in vivo). These findings indicate that there is cross talk between E and IGF-1R involving the PI3K/AKT pathway, which contributes to the delayed onset of ARHL observed during HRT with E. Meanwhile, FoxO3 may not play a role in neuro-protective properties in the cochlea during HRT, as initially hypothesized.
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Banks, Emily. "Hormone replacement therapy : the epidemiology of use and effect on breast cancer screening in the UK." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312139.
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Ballard, Karen Dawn. "Women on the verge of HRT : factors influencing women's decisions about taking hormone replacement therapy." Thesis, Royal Holloway, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396150.
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Sinchugova, Nataliya. "Vilken betydelse har val av progestagen-typ respektive behandlingsregim för bröstcancerrisk vid hormonersättningsterapi (HRT)?" Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-43495.
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Hormonersättningsterapi (HRT) används för att lindra vasomotoriska och urogenitala symtom associerade med klimakteriet. Eftersom behandling med enbart östrogen förknippats med endometriell hyperplasi och livmodercancer, tillsätts progestagener till östrogen-beredningar i HRT hos kvinnor med intakt livmoder för att motverka den proliferativa effekten av östrogen och förebygga cancerutveckling i livmodern. Sådan kombinerad HRT har emellertid associerats med ökad risk för bröstcancer. Vid kombinerad HRT används olika typer av progestagener och olika behandlingsregimer (kontinuerlig eller sekventiell tillförsel). Syftet med detta arbete var att undersöka vad som ökar risken för bröstcancer vid kombinerad HRT: valet av progestagen-typ eller vilken behandlingsregim (kontinuerlig/sekventiell) som används. Metoden som användes var en litteraturstudie som omfattade sju studier om HRT och bröstcancerrisk, vilka hämtades från databasen PubMed. Utifrån undersökta studier kan man dra slutsats att ökad risk för bröstcancer associeras med kombinerad östrogen-progestagen HRT jämfört med HRT med enbart östrogen och framför allt om man jämför kontinuerlig kombinerad HRT med sekventiell kombinerad HRT med ett dos-responsförhållande som bakomliggande grund. Progestagen-typ kan ha effekt på risken för bröstcancer men detta behöver undersökas ytterligare.
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Jackson, Barbara Ann, and n/a. "A study of baby boomer women and their expectations of menopause." University of Canberra. Professional & Community Education, 1996. http://erl.canberra.edu.au./public/adt-AUC20060801.142823.
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This is a study of a generation of women who are about to enter the
climacteric period of their life, the menopause. Born between the years
1946 and 1956 they have been the object of continuous scrutiny by various
interest groups. Because they are seen to be unique, many acronyms and
titles, the most noted being the 'Baby Boomers' have been attached to
them. The women of this generation have been classed as a Very active'
generation, leaving a clear mark on society and the re-emerging women's
movement. As they near menopause they are approaching a stage that
could be seen as their last reproductive transition. For many women
there is no cultural ritual, nor a single story to guide them through this
period They are however not without advice. The 'big voices' of the
drug companies, the medical system and the media, all tender their
guidance as the dominant voice. These women have been told what to
do by experts throughout their whole lives. It seems 'expert advice' on
their reproductive phases have been penned mostly by men in the
interests of treating, controlling and saving them. Control of their body
remains a key struggle, both physically and linguistically.
The purpose of the research was to study the expectations of this
post-war, Baby Boom generation of menopause. The study shows that
some women have made decisions to embrace non-medical help and
accept menopause as an inevitable transition, while others are willing to
consider medical help to enhance their 'quality of life '. Believing it is
time to look after themselves, it seems many women will take a
pragmatic view and accept medical opinion that the menopause is a
deficiency disease, even if this requires them to become part of the
consumer driven/drug company push for a 'symptom free' menopause.
They wish to remain untroubled and express a willingness to do
whatever they need to fulfil this. Their fervent hope is that the
menopause will not upset their career, family or 'life'. Consequently a
large majority of these women will think about or actively pursue
hormone replacement therapy.
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Van, Wyk de Vries Anel. "South African consumers' opinion of the potential health benefits of soy and soy products as hormone replacement therapy (HRT) / Anel Van Wyk de Vries." Thesis, North-West University, 2003. http://hdl.handle.net/10394/338.
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There is an increasing awareness in the food industry about the role that
proper nutrition plays in maintaining health and preventing disease. Women
especially have always been interested in nutrition and its impact on their
well-being. This awareness has placed more pressure on the food industry to
provide a greater variety of nutritious and wholesome products which has led
to the development of a new field in the food industry, called functional foods.
These are food products that apart from the micro- and macronutrients that it
already provides have additional important physiologically active functions
that enhance health. These active components, called phytochemicals (from
plant sources) and zoochemicals (from animal sources) have changed the role
of diet in health. Functional foods can, by nature or design, bridge the
traditional gap between food and medicine and thereby provide consumers
with the opportunity to become involved in their own health care. One of these
functional foods that have been receiving increased attention and research is
soy. Apart from other health benefits of soy, such as cholesterol reduction and
bone strengthening, scientific evidence has shown that soy can be used as an
alternative for hormone replacement therapy (HRT). The increased interest in
the latter can be ascribed to the changed attitude of women, as well as
evidence of the side effects of conventional hormone replacement therapies.
Consumer research in the nutraceutical area is, however, still in its infancy
stage.
Objective:
The main objective of this study was thus to assess South African consumers'
opinion of the potential health benefits of soy and soy products as an
alternative for HRT. To attain this main objective, the following specific
objectives were stated:
To determine, by means of a consumer questionnaire, the percentage of
South African consumers who are aware of soy.
To determine, by means of an attitude scale, the attitudinal disposition
of South African consumers towards the potential health benefits of
soy and soy products as an alternative for HRT.
To determine South African consumers' opinions regarding the
menopausal related health benefits of soy.
To determine whether there is a relation between respondents who
Eat/drink soy and their opinion of the potential health benefits of soy.
To determine whether there is a relation between respondents who
never use soy and their opinion of the bone strengthening benefit of
soy.
To determine whether there is a relation between respondents' opinion
of the health benefits of soy and their opinions of soy as an alternative
for HRT and reliever of menopausal symptoms, respectively.
Methods:
In this study, consumers' opinion regarding the health benefits of soy was
evaluated using a questionnaire. Respondents were randomly selected from
nine metropolitan, as well as rural areas in South Africa, representing the four
main race groups, namely whites, blacks, coloureds and Indians. The total
sample size of the metropolitan and rural subjects was 3001. A sub-dataset
was created which included female respondents that have heard of soy before
and were premenopausal (35-44 years) and post-menopausal (50-59 years) of
age. Thus, the total number of respondents used for further statistical analyses
was 825. The respondents expressed their opinions of the health benefits of
soy on a five-point hedonic (Likert) scale which was adapted to a three-point
scale for easier interpretation of the tables.
Results:
1. Of the 3 001 respondents, 2 437 (80%) were aware of soy.
2. A mean attitudinal disposition score of 2.47 on a three-point scale
indicated a neutral to positive attitudinal disposition of the South
African consumer population towards the potential health benefits of
soy and soy products as alternative for HRT. No practically significant
differences were found between the mean values of each statement,
which indicated that no specifically strong opinions were expressed
between different races or between different age groups.
3. Of all the consumers surveyed and those who did express a specific
opinion, 72% agreed that soy has many health benefits compared to
only 7% who disagreed. Although 34% of South Africans expressed a
positive opinion when asked if soy can be used as alternative for HRT,
the majority (46%) of the population had a neutral opinion. Forty-two
percent of the consumers who held an opinion regarding soy as reliever
of menopausal symptoms were positive, 35% had a neutral opinion and
23% of South Africans did not agree that soy can relieve menopausal
symptoms.
4. A relation, although not of practical significance, was found between
respondents who eat/drink soy and their opinion of the health benefits
of soy. Of the respondents who indicated that they eat/drink soy, the
majority agreed that soy has many health benefits. The respondents
who disagreed when asked if they eat/drink soy, still expressed an
overall positive opinion when asked whether soy has many health
benefits.
5. A relation, although not of practical significance, was found between
respondents who never use soy and their opinion of the bone
strengthening benefit of soy. Of those who indicated that they use soy,
the majority agreed that soy has a bone strengthening benefit. On the
contrary, only 43% of those who agreed that they never use soy were
positive about the bone strengthening benefit of soy, whereas 37% held
a neutral opinion and 20% expressed a negative opinion.
6. The relation between respondents' opinion of the overall health
benefits of soy and their opinion of soy as alternative for HRT and
reliever of menopausal symptoms was of practical significance. Of the
respondents who did not agree that soy has many health benefits, the
majority expressed a negative opinion of soy as an alternative for HRT.
Of those who agreed that soy has many health benefits, 45% expressed
a neutral opinion and 44% a positive opinion of soy as alternative for
HRT. Almost half (47%) of the respondents who agreed that soy does
have many health benefits, expressed a neutral opinion when asked if
soy can relieve menopausal symptoms, whereas only 30% had a
positive opinion in this regard. The majority (86%) of the respondents
who disagreed that soy has many health benefits, also expressed a
negative opinion of soy as reliever for menopausal symptoms
Conclusion:
The results of this study indicate that 80% of the South African consumer
population are aware of soy and that South African consumers have a neutral
to positive attitudinal disposition towards the potential health benefits of soy.
Respondents did not express a particularly strong opinion regarding several
health benefits of soy. It may be hypothesized that they are not informed well
enough on the health benefits of soy as to take a stand and to form a definite
opinion. Neither different race groups, nor pre- or post-menopausal women
differ significantly in the frequency of their opinions, indicating that in this
study, race and age did not have a practical significant influence on opinion of
the health benefits of soy.
Of all those surveyed and who did express a specific opinion, 72% agreed that
soy has many health benefits, which is almost the same percentage (74%) as
American consumers who perceive soy products as healthy as according to the
United Soybean Board (USB) National Report (2003-2004:4). A survey by
Adams (2001:433) reported that 71% of American consumers believed that
plant-derived HRT have fewer risks and can thus be used as a safe alterative
for conventional HRT. According to the results of the present study only 34%
of South African consumers expressed a positive opinion when asked if soy
can be used as an alternative for HRT. Insufficient evidence on the safety and
efficacy of the potential health benefits of soy, as well as a lack of consumer
education in South Africa, could be the reason for this uncertainty among
XIV
South African consumers. While only 26% of American consumers are aware
that soy might relieve menopausal symptoms (USB National Report, 2003-
2004:4), results of the current study found that 42% of South Africans were of
opinion that soy can relieve menopausal symptoms.
A relation, although not of practical significance, was found between
respondents who eat/drink soy and their opinion of the health benefits of soy.
This can be an indication that whether or not the South African consumer
population consume soy doesn't have an influence on their opinion of soy's
health benefits in practice. The relation found between respondents who never
use soy and their opinion of the bone strengthening benefit of soy were not of
practical significance. This can be an indication that whether or not South
Africans use soy does not influence their opinion of the bone strengthening
benefit of soy in practice. Furthermore, a practically significant relation was
found between respondents' opinion of the overall health benefits of soy and
their opinion of soy as alternative for HRT and reliever of menopausal
symptoms, respectively. Interestingly, respondents who expressed a positive
opinion regarding the health benefits of soy did not have a convincingly
positive opinion of soy as alternative for HRT and as reliever of menopausal
symptoms. They expressed a more neutral opinion. As expected, consumers
that were not of opinion that soy has certain health benefits, also disagreed
when asked if soy can be used as an alternative for HRT or as reliever of
menopausal symptoms.
Although the causes for the respondents' opinion or uncertainty were not
determined in this study, it can be hypothesised that it may be due to lack of
standardisation of evidence on the safety and efficacy of alternative hormone
replacement therapies. Further studies are still needed to determine the
contributing factors which influence consumers' opinion or lack of opinion on
soy. If consumers are not educated about the benefits and disadvantages of
soy as alternative for HRT, they cannot make intelligent decisions and
choices as to whether or not to use soy as alternative for HRT.Thesis (M. Consumer Science)--North-West University, Potchefstroom Campus, 2004.
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Wihlbäck, Anna-Carin. "Ovarian hormones and effects in the brain : studies of neurosteroid sensitivity, serotonin transporter and serotonin2A receptor binding in reproductive and postmenopausal women." Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-365.
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Background: Estrogen has been reported to enhance well-being and quality of life during the climacteric phase. In women with an intact uterus estrogen treatment is always combined with progestins in order to protect the endometrium from hyperplasia and malignancies. However, in certain women the addition of progestins causes cyclicity in negative mood symptoms and physical symptoms similar to those encountered during ovulatory cycles in women with premenstrual dysphoric disorder (PMDD). The ovarian hormones estradiol and progesterone have profound effects on a number of neurotransmitter systems in the brain, such as the gamma aminobutyric acid (GABA) system and the serotonergic system. Progesterone metabolites, such as allopregnanolone and pregnanolone (also referred to as neurosteroids) modify the GABAA receptor in the central nervous system (CNS) and enhance GABAergic inhibitory transmission. Neurosteroid sensitivity in human studies can be studied by saccadic eye movement measurements using pharmacodynamic challenges with pregnanolone. Altered neurosteroid sensitivity has been suggested as a possible contributory factor to the progesterone/progestin-induced adverse mood effects of hormone replacement therapy (HRT). There is also evidence of estrogen treatment affecting the serotonergic system in postmenopausal women, although progestin addition has been less well studied. Aims and method: The aim was to investigate whether the negative mood symptoms experienced during the progestin or progesterone phase of HRT were associated with changes in neurosteroid sensitivity, or changes in platelet serotonin uptake site (transporter) and serotonin2A (5-HT2A) receptor binding. The intention was also to investigate whether hormonal changes during the normal menstrual cycle affect these peripheral serotonergic parameters. Postmenopausal women with climacteric symptoms were given HRT in two randomized, double-blinded, placebo-controlled crossover studies. The women received 2 mg estradiol (E2) continuously during 28- day cycles. Synthetic progestins or natural progesterone were added sequentially during the last 14 days, and compared to a placebo addition. Before treatment, as well as during the last week of each treatment cycle the pharmacodynamic response to pregnanolone was assessed using saccadic eye movement measurements. Throughout the studies daily symptom ratings were made. In the study regarding synthetic progestins, platelet serotonin transporter and 5-HT2A receptor binding were assayed before entering the study, as well as during the last week of each treatment cycle. In the study on reproductive women, blood samples were collected for analysis of platelet serotonin transporter and 5-HT2A receptor binding at six different points in time during the menstrual cycle. Results and conclusion: The addition of synthetic progestins to estrogen treatment increased negative mood symptoms and physical symptoms, whereas positive symptoms decreased. The addition of progestins also increased the sensitivity to pregnanolone. The addition of natural progesterone to estrogen treatment increased the sensitivity to pregnanolone. However, in this study the pregnanolone sensitivity was enhanced also during estrogen treatment. Women expressing cyclicity in negative mood symptoms were more sensitive to pregnanolone than women without symptom cyclicity. Thus, it is evident that mood deterioration during HRT is associated with altered neurosteroid sensitivity. Platelet serotonin transporter and 5-HT2A receptor binding did not change during the different treatment conditions in HRT. Thus, we were unable to explain the negative mood changes of HRT by use of these peripheral serotonergic parameters. In the study on reproductive women however, it was clear that the serotonergic variables did change during the menstrual cycle. Binding to the serotonin transporter was higher in the late follicular phase than in the ovulatory, early luteal or mid-luteal phases. Binding to the 5-HT2A receptor was higher in the early follicular phase and the early luteal phase than in the mid-luteal phase. These findings may provide a link between the ovarian steroids, and the GABAergic and serotonergic neurotransmitter systems, which in turn, could explain part of the specific vulnerability that women have for the development of adverse mood effects during HRT, mood and anxiety disorders and for the deterioration of mood so frequently seen during the luteal phase.
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Birzniece, Vita. "Neuroactive steroids and rat CNS." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-296.
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Habiba, Marwan A. "Endometrial responses to hormone replacement therapy." Thesis, University of Leicester, 1998. http://hdl.handle.net/2381/30471.
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Ödmark, Inga-Stina. "Hormone replacement therapy : benefits and adverse effects /." Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-243.
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Brooks, Alan Arnold. "Investigation of endometrial response to hormone therapy in oocyte recipients." Thesis, University College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362369.
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Homer, Natalie. "Erythocyte oxidative stress : focus on hormone replacement therapy." Thesis, University of Strathclyde, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273852.
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Daly, Edel. "Balancing the benefits and risks of hormone replacement therapy." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393609.
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Griffiths, Frances Ellen. "Hormone replacement therapy : perspectives from women, medicine and sociology." Thesis, Durham University, 1997. http://etheses.dur.ac.uk/5084/.
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Developed on the boundary between medicine and sociology, this thesis develops a critique of the perspectives of these disciplines through analysis of a study of women's perspectives on hormone replacement therapy. Women's perspectives are explored through a postal questionnaire survey and a study using individual interviews and focus groups. The survey results provide a measure of women’s attitudes towards, and knowledge of, hormone replacement therapy. The individual interviews detail the way women move towards a decision about the therapy and identifies common themes, particularly women's fears and what influences their fears. The focus groups explore contrasting themes including women's control and choice in decisions about therapy, contrary themes in women’s attitudes and the different ways of thinking used by the women. The results of the studies are assessed for their implications for clinical general practice. The thesis also takes a sociological perspective on women and HRT and on the research process, in particular exploring two themes. Firstly, the interaction between the social context, the research subject and the research process. This includes the social factors influencing the development of the research and choice of research methods, and the influence of the research methods on the results obtained. The second theme is the perspectives and levels of analysis used by the main disciplines contributing to the thesis; biomedicine, biostatistics, general practice and sociology. The thesis explores how the different perspectives and levels of analysis influence research and how they are used to manage the social context. These explorations are used to suggest future directions for research on hormone replacement therapy and for general practice.
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Armstrong, Alison L. "Hormone replacement therapy - effects on strength, balance and bone density." Thesis, University of Nottingham, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284686.
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Towne, Cheryl Luann Rush. "Older women's beliefs about hormone replacement therapy : a qualitative study /." View online, 2000. http://repository.eiu.edu/theses/docs/32211130976791.pdf.
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Pace, Diane Todd. "Effect of postmenopausal hormone replacement on heart rate variability." View the abstract Download the full-text PDF version, 1998. http://etd.utmem.edu/ABSTRACTS/1998-003-pace-index.html.
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Thesis (Ph.D)--University of Tennessee Health Science Center, 1998.Title from title page screen (viewed on October 17 2008). Research advisor: Kay F. Engelhardt. Document formatted into pages (xi, 162 p. : ill.). Vita. Abstract. Includes bibliographical references (p.162).
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Elinson, Lynn. "Implementation of practice guidelines, a case study of hormone replacement therapy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/NQ27640.pdf.
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Cheffins, Tracy. "Hormone replacement therapy and breast cancer in a mammographic screening program /." Title page, table of contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmc515.pdf.
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Wood, Elizabeth. "Women's decisions and decisional conflict regarding long term hormone replacement therapy." Thesis, University of Ottawa (Canada), 1995. http://hdl.handle.net/10393/9800.
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Long term preventive hormone replacement therapy (LTP-HRT) is attracting considerable attention for its potential in reducing the incidence of coronary heart disease and osteoporosis associated fractures in post-menopausal women. The study objectives were: (1) to describe women's decisions and decisional conflict regarding LTP-HRT after being presented with the evidence of benefits and risks and clarifying values; (2) to describe the difference between those who accept or decline LTP-HRT in terms of: (a) expectations of LTP-HRT benefits and risks, and (b) the importance women attach to the benefits and the risks; and (3) to describe the factors women identify as contributing to their decision to take or not take LTP-HRT or being unsure about taking LTP-HRT. The typical woman who participated in the study was 57 years of age; had some post secondary education; and was currently using HRT. Over half the women had at least one CHD risk factor and had a hysterectomy. Less than 15% of the respondents reported having osteoporosis or a first degree relative with breast cancer. Women's decisions to take LTP-HRT were distributed as follows: 56% yes; 26% no; and 18% unsure. Women who accepted or declined LTP-HRT did not have statistically significant differences in expectations of risk of CHD, osteoporosis, and breast cancer with and without hormone therapy. In contrast, women's importance ratings of LTP-HRT benefits and side effects did differ significantly between those accepting and declining LTP-HRT. The reasons most often identified by women who chose LTP-HRT were prevention of CHD and osteoporosis (61%) and relief of hot flashes (54%). Those who chose not to take LTP-HRT gave reasons such as dislike of taking pills (47%), and risk of cancer (11%). (Abstract shortened by UMI.)
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Fischer, Mary A. "Women’s Experiences of Discontinuing Hormone Therapy: A Dissertation." eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsn_diss/23.
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Although many women find relief from menopause through hormone therapy (HT), current guidelines recommend that HT be used only for short-term relief of symptoms. Women who attempt to stop HT often encounter troublesome recurrent symptoms leading to a diminished quality of life (QoL); 25% of women who discontinue eventually resume HT. Unfortunately, there is little information for women and their health care providers as to the best way to discontinue HT or how to prepare and guide women through this process. An in-depth description of women‘s experiences during HT discontinuation and the factors influencing recurrent symptoms, QoL and discontinuation outcome would provide knowledge to develop much needed counseling and support interventions. The purpose of this study was to explore women‘s experiences discontinuing hormone therapy for menopause.
This Internet-based mixed-methods study used a dominant Qualitative Descriptive design with embedded quantitative QoL measurements. Participants completed the quantitative questionnaires online while open-ended questions were completed either online or by telephone. Interview data were analyzed through Qualitative Content Analysis; descriptive statistics were used to explore the quantitative measures. Participants were stratified by discontinuation status for comparison of variations in discontinuation experiences, QoL and influencing factors.
Thirty-four women (20 stopped, 9 resumed, 4 tapering) were enrolled. One overarching theme--'a solitary journey'--emerged: although all women embarked on this journey, each woman traveled her own path. Two subthemes--'burden and interference' and 'appraising risk'--encompassed the symptom factors (severity, interference and sensitivity) that influenced women's experiences and the manner in which women evaluated their options. Other influencing factors included: readiness viii and reasons for stopping HT, beliefs about menopause and roles. QoL was strongly connected to symptoms for many but not all women. Information from health care providers was inconsistent; women desired more support from providers and other women.
The rich description of women's experiences stopping HT highlights the need for providers to assess women's sensitivity to symptoms and readiness to discontinue to determine which women might benefit from more support. Greater health literacy would enhance women's understanding of HT risks. More research is needed on symptom clusters and interference and strategies for minimizing their impact.
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Howe, Kathleen S. "Exercise therapy as treatment for postmenopausal osteoporosis in women not currently taking hormone replacement therapy." [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0004600.
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Gooding, Kim Mary. "Sex hormones and the microcirculation." Thesis, University of Exeter, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248164.
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Jackson, Simon. "Oestrogen supplementation in postmenopausal urinary stress incontinence : effect secondary to altered collagen pathophysiology?" Thesis, University of Bristol, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390374.
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Rhoads, Misty Lynn. "Hormone replacement therapy : attitudes, knowledge, and usage by perimenopausal and postmenopausal women /." View online, 2005. http://repository.eiu.edu/theses/docs/32211131275302.pdf.
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Kirsh, Victoria Amy. "Hormone replacement therapy and the risk of breast cancer in postmenopausal women." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0004/MQ45912.pdf.
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Hosain, Yasmin A. "Class inequalities in prescription drug use, the case of hormone replacement therapy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ62756.pdf.
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Alam, Farhana, Peter D. Semonche, and Dana Reed-Kane. "Patient Satisfaction with Pharmacist Intern Intervention and Consultation in Hormone Replacement Therapy." The University of Arizona, 2016. http://hdl.handle.net/10150/614016.
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Class of 2016 AbstractObjectives: Specific Aim #1: Assess no difference in patient satisfaction. Our working hypothesis is that there is no difference in satisfaction with follow-up calls in women receiving HRT from pharmacists or pharmacy intern students at Reed’s Compounding Pharmacy. Specific Aim #2: Assess patient satisfaction with follow-up calls from pharmacy student interns. Our working hypothesis is that women receiving HRT are satisfied with follow-up calls for their therapy when it is conducted by pharmacy student interns, which enhances proper treatment guidance and adherence. Methods: This study will be a descriptive, direct comparison study that will use data obtained through an online questionnaire consisting of the following: four questions determining the patient’s demographics and eighteen questions on patient satisfaction with follow-up calls from Reed’s Compounding Pharmacy with pharmacy student interns. Results: Of the estimated 60 patients sample size, only 31 questionnaires were completed. The largest proportion of patients was between the ages of 51 and 60 (58%). The length of therapy in participating women varied quite significantly with one-fourth of patients on HRT for 4-5 years or more (26%). The patient satisfaction of follow-up calls conducted by pharmacy intern students survey results indicated, in general, that patients agreed that they were satisfied with the service that they were receiving from the pharmacy interns. There was no disagreement with the items, the intern provides education that will help me understand how to take my medications, being pleased that the intern is following-up, having input on hormone therapy, and with the items regarding intern professionalism and intern knowledge. The greatest disagreement was with three items asking about comfort talking with either a female or male intern, and the item about paying extra to ensure follow-up calls. Results from this study were compared with results from five questions adapted using a questionnaire from DiMaggio et al. Note that this study used 7 response fields: strongly disagreed, somewhat disagreed, disagreed, no opinion, agreed, somewhat agreed, strongly agreed. Data from DiMaggio et al used 5 response fields: strongly disagreed, disagreed, no opinion, agreed, strongly agreed. Responses were grouped by strongly disagreed, somewhat disagreed, disagreed, and no opinion in one and strongly agreed, somewhat agreed, and agreed in the second. The data from both studies were compared by considering proportion of patients who agreed at some level with each item. There was no statistical difference between the two groups (p > 0.08); both groups showed a high level of agreement on the five satisfaction items. Conclusions: The women receiving hormone replacement therapy in this study were satisfied with follow-up calls from pharmacy student interns at Reed’s Compounding Pharmacy. There is no difference in satisfaction with follow-up calls in women receiving HRT from pharmacists or pharmacy student interns. In addition to satisfaction, women are satisfied with follow-up calls for their therapy when it is conducted by pharmacy student interns, which enhances proper treatment guidance and adherence.
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Lundström, Eva. "Mammographic breast density and postmenopausal hormone therapy /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-581-X/.
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Yeung, Wing-kwan Rosa. "Adjunctive effect on hormone replacement therapy on periodontal treatment responses in postmenopausal women." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B3765195X.
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Riman, Tomas. "An epidemiologic study of epithelial ovarian malignancies : with a focus on hormone-related factors /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-362-7/.
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Jacobs, Eric J. "Hormone replacement therapy and colon cancer among members of a health maintenance organization /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/10886.
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Diarsvitri, Wienta. "Association of high mammographic density with hormone replacement therapy and other risk factors." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ63294.pdf.
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Yeung, Wing-kwan Rosa, and 楊穎筠. "Adjunctive effect on hormone replacement therapy on periodontal treatment responses in postmenopausal women." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B3765195X.
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O'Meara, Ellen Siobhan. "The influence of hormone replacement therapy after breast cancer on recurrence and death /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/10925.
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Greenblum, Catherine Margaret. "Women Who Continue Hormone Replacement Therapy Despite Findings from the Women's Health Initiative." UNF Digital Commons, 2006. http://digitalcommons.unf.edu/etd/340.
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Since the results of the Women's Health Initiative (WHI) study were published in 2002, millions of women and their healthcare practitioners have had to re-examine decisions about the use of hormone replacement therapy. This level one descriptive study explored the characteristics of menopausal women who could not tolerate estrogen withdrawal and continued taking hormone replacement therapy despite findings of risk published in the Women's Health Initiative. The sample included the medical records of 1,195 patients in a single-physician OB-GYN practice in northeast Florida. All records of women with a birth date in 1954 or prior and a visit to the practice for gynecological care between July 2002 and March 1, 2004 were reviewed to collect data about demographics, past medical history, and hormone replacement therapy (HRT) use.
A significant portion of women (77.2%) had discontinued HRT. Of the women remaining on HRT, 54.7% changed either the dose or type of hormones taken. Only 59.5% of these women remained on the same estrogen dose both before and after the WHI results were published in 2002. Interestingly, there were 29 women (4%) who initiated HR T use after July 2002. The women who remained on HR T after WHI were more likely to be younger, Caucasian (72. 7% ), non-smokers (82.3% ), and taking medication for other conditions (68.5%). The older the woman, the less likely she was to have continued HRT. Younger women were more likely to have changed HRT drug and/or dose post-WHI.
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Sue, Caron Anne. "HEALTH BENEFITS AND QUALITY OF LIFE IN POSTMENOPAUSAL WOMEN ON HORMONE REPLACEMENT THERAPY." University of Cincinnati / OhioLINK, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=ucin976028221.
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Hu, Fei-Shu. "Update of Patient Satisfaction with Pharmacist Intervention and Consultation in Hormone Replacement Therapy." The University of Arizona, 2005. http://hdl.handle.net/10150/624753.
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Class of 2005 AbstractObjectives: To assess whether the satisfaction of women with the pharmacist administered bio-identical hormone replacement therapy consultation service has improved since the implementation of a follow up call program at Reed’s Compounding Pharmacy. Methods: A questionnaire was mailed to 200 randomly selected women who had completed their HRT consultation and received all three follow-up calls provided by Reed’s Compounding Pharmacy within the time frame from July 22, 2003 to April 22, 2004. The returned surveys were then organized and analyzed using Microsoft Excel. Additionally, independent t-tests were used to compare data collected in 2001 vs. 2004 on relevant questionnaire items of interest. Main results: Of the 200 surveys sent out to patients, 125 replied (a response rate of 62.5%). Over 50% heard about it through referral from their provider, and almost 35.2% from a friend or a relative. Regarding the follow-up call service, 95.9% of the patients either agreed or strongly agreed that it was helpful; however, only 73.8% feel comfortable discussing their concerns with student interns, who are responsible for the follow-up calls. In the assessment of new health conditions developed after natural hormone therapy initiation, 94.3% of the respondents reported with no new health conditions. T-tests revealed an improvement in patient satisfaction items between 2001 and 2004 with p-values < 0.05. Principal Conclusions: The results of the study showed that there was an improvement in patient satisfaction with the consultation service since 2001, and most of the differences found were statistically significant. The survey result also showed that participants were happy about the follow-up calls, which in terms, perhaps contributed to the increase in satisfaction.
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McKenzie, Joyce. "Effects of hormone replacement therapy on postmenopausal women with type 2 diabetes mellitus." Thesis, University of Glasgow, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433922.
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Bowler, Wayne Bowler. "Purinergic receptors in bone : expression and functional significance." Thesis, University of Liverpool, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243259.
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Hill, Deirdre A. "Hormone use patterns, intrauterine device use, and endometrial cancer /." Thesis, Connect to this title online; UW restricted, 1997. http://hdl.handle.net/1773/10899.
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Conner, Peter. "Hormone therapy and the breast : aspects on proliferation, apoptosis and mammographic density /." Stockholm : Karolinska institutet, 2004. http://diss.kib.ki.se/2004/91-7349-918-8/.
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Schumaker, Carl David. "The risk of breast cancer from hormone replacement therapy combined with mammographic radiation exposure." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0001/MQ40106.pdf.
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Manassiev, Nikolai. "The effects of hormone replacement therapy on insulin and carbohydrate metabolism in postmenopausal women." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.520935.
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Marsden, Joanne. "The therapeutic consequences of hormone replacement therapy for menopausal health in breast cancer survivors." Thesis, Institute of Cancer Research (University Of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.397993.
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