Insights from the Women's Health Initiative: individualizing risk assessment for hormone therapy decisions.

Abstract:

:Identifying appropriate candidates for menopausal hormone therapy (HT) is challenging given the complex profile of risks and benefits associated with treatment. Most professional societies agree that HT should not be used for chronic disease prevention. Recent findings from the Women's Health Initiative and other randomized trials suggest that a woman's age, proximity to menopause, underlying cardiovascular risk factor status, and various biological characteristics may modify health outcomes with HT. An emerging body of evidence suggests that it may be possible to assess individual risk and therefore better predict who is more likely to have favorable outcomes versus adverse effects when taking HT. Thus, once a woman is identified as a potential candidate for HT due to moderate-to-severe menopausal symptoms or other indications, risk stratification may be an important tool for minimizing patient risk. This individualized approach holds great promise for improving the safety of HT. We review here the evidence for this approach, focusing on vascular health because of limited data on other outcomes. The ultimate goal of this research is to develop a personalized risk/benefit prediction model to be used when a woman seeks therapy for symptom management. Patient centered outcomes including quality of life and sense of well-being should also be incorporated and will directly impact the benefit: risk ratio and compliance. Additional research on hormone dose, formulation, and route of delivery will be important for improving this model.

journal_name

Semin Reprod Med

authors

Wild RA,Manson JE

doi

10.1055/s-0034-1384626

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

433-7

issue

6

eissn

1526-8004

issn

1526-4564

journal_volume

32

pub_type

杂志文章,评审
  • Molecular mechanisms of treatment resistance in endometriosis: the role of progesterone-hox gene interactions.

    abstract::HOX genes, encoding homeodomain transcription factors, are dynamically expressed in endometrium, where they are necessary for endometrial growth, differentiation, and implantation. In human endometrium, the expression of HOXA10 and HOXA11 is driven by sex steroids, with peak expression occurring at time of implantatio...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0029-1242996

    authors: Cakmak H,Taylor HS

    更新日期:2010-01-01 00:00:00

  • The Role of a Mitochondrial Progesterone Receptor (PR-M) in Progesterone Action.

    abstract::Historically, progesterone functions to regulate gene expression via two nuclear progesterone receptors (PR-B and PR-A). Yet, actions of progesterone independent of gene regulation have been observed for decades. These are based on progesterone induced cellular events that occur too rapidly to involve gene transcripti...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0035-1552583

    authors: Price TM,Dai Q

    更新日期:2015-05-01 00:00:00

  • Fertility preservation: definition, history, and prospect.

    abstract::Exposure to gonadotoxic agents for treating cancer and other diseases or postponement of maternity jeopardize the prospects of genetic parenthood and are major factors driving the development of fertility preservation technologies. Although its mainstays, cryopreservation and vitrification, have been adopted from infe...

    journal_title:Seminars in reproductive medicine

    pub_type: 历史文章,杂志文章,评审

    doi:10.1055/s-0029-1241051

    authors: Gosden RG

    更新日期:2009-11-01 00:00:00

  • Does the European Union Tissues and Cells Directive improve quality in the in vitro fertilization laboratory? A case study in a tertiary referral center.

    abstract::Since 2004, assisted conception is encompassed by the European Directive on the Quality and Safety of Tissues and Cells (2004/23/EC). The aim of a standard for quality and safety is to minimize risks of errors, contamination, and accidents and to maximize efficiency of use. This article presents a case study of the im...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章

    doi:10.1055/s-0032-1311521

    authors: Willemen D,D'Hooghe T,Knoops I,De Neubourg D,Spiessens C

    更新日期:2012-06-01 00:00:00

  • Uterine receptivity and the ramifications of ovarian stimulation on endometrial function.

    abstract::Controlled ovarian stimulation (COS) is widely used in assisted reproduction techniques (ART). However, hormonal treatment induces endometrial alterations that may alter implantation rates compared with natural cycles. Endometrial alterations have been observed by histological and biochemical techniques. The recent de...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2007-991043

    authors: Horcajadas JA,Díaz-Gimeno P,Pellicer A,Simón C

    更新日期:2007-11-01 00:00:00

  • Medical therapy of endometriosis.

    abstract::The medical treatment of endometriosis is a critical aspect of the therapeutic approach to this disease. Past methods have been based upon systemic hormonal alterations, resulting in suppression of this estrogen-responsive disorder. Treatments such as danazol, progestogens, oral contraceptives, GnRH-agonists, and gest...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2003-41327

    authors: Olive DL

    更新日期:2003-05-01 00:00:00

  • Neuropeptide Control of Puberty: Beyond Kisspeptins.

    abstract::Puberty is a fundamental developmental event in the lifespan of any individual, when sexual and somatic maturation is completed, and reproductive capacity is achieved. While the tempo of puberty is under strong genetic determination, it is also modulated by a wide array of internal and environmental cues, including, p...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0039-3400967

    authors: Barroso A,Roa J,Tena-Sempere M

    更新日期:2019-07-01 00:00:00

  • Epigenetic transgenerational effects of endocrine disruptors on male reproduction.

    abstract::Endocrine-disrupting chemicals generally function as steroid receptor signaling antagonists or agonists that influence development to promote adult-onset disease. Exposure to the endocrine disruptors during the initiation of male reproductive tract development interferes with the normal hormonal signaling and formatio...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0029-1237428

    authors: Guerrero-Bosagna CM,Skinner MK

    更新日期:2009-09-01 00:00:00

  • Trophoblast Development in the Murine Preimplantation Embryo.

    abstract::Trophoblast cells of the murine placenta are derived from the trophectoderm (TE) cells of the preimplantation embryo. Establishment of the TE cell lineage is the result of a cell segregation event early in blastomere division. Models of cell lineage segregation suggest it is driven by the internalization of spatial in...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0035-1570025

    authors: Underhill LA,Robins JC

    更新日期:2016-01-01 00:00:00

  • Pharmacologic treatment of polycystic ovary syndrome.

    abstract::Women with polycystic ovary syndrome (PCOS) most often seek treatment for reduction of hair growth and/or acne, restoration of menstrual cyclicity, and infertility. In addition, these patients are increasingly seeking advise and treatment for the metabolic abnormalities related to PCOS (e.g., insulin resistance and ty...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2003-43305

    authors: Ehrmann DA,Rychlik D

    更新日期:2003-08-01 00:00:00

  • Endoscopic management of leiomyomata.

    abstract::Prior to the advent of modern minimally invasive surgery techniques, the primary surgical management of symptomatic leiomyomata for women desiring future fertility or uterine conservation was through laparotomy. Today, many cases of intramural and subserous leiomyomata are managed with laparoscopic myomectomy and sele...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2004-828621

    authors: Advincula AP,Song A

    更新日期:2004-05-01 00:00:00

  • Big enough for an aromatase inhibitor? How adiposity affects male fertility.

    abstract::Obesity is a pandemic and is associated with multiple medical problems including subfertility. Male obesity has been associated with altered semen parameters and reproductive hormonal levels, including a reduced testosterone:estradiol (T:E₂) ratio. Treatment methods employed for obesity-related male subfertility inclu...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0033-1345272

    authors: Stephens SM,Polotsky AJ

    更新日期:2013-07-01 00:00:00

  • Pelvic pain, adnexal masses, and ultrasound.

    abstract::Pelvic pain, acute or chronic, accounts for more than 10% of referrals to gynecologists. Pain accounts for more than 40% of gynecologic diagnostic laparoscopies. Predicting operative findings is critical in planning surgical interventions, as well as preoperative and postoperative medical therapy. Ultrasound is useful...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2008-1076144

    authors: Shwayder JM

    更新日期:2008-05-01 00:00:00

  • In vitro maturation of oocytes.

    abstract::In vitro maturation of oocytes is a safe and effective treatment offered in some fertility centers for assisted reproduction, where immature oocytes are retrieved from unstimulated ovaries. Therefore, the procedure avoids ovarian stimulation with expensive gonadotropins, side effects of the medications, and risks such...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2005-872452

    authors: Rao GD,Tan SL

    更新日期:2005-08-01 00:00:00

  • Anejaculation: an electrifying approach.

    abstract::Anejaculation within the context of a male infertility evaluation can be a distressing condition for patients. A variety of causes for anejaculation have been identified, and although the condition cannot be reversed, in many cases a minimally invasive treatment is feasible, allowing the patient to pursue his desire f...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0029-1202307

    authors: Ohl DA,Quallich SA,Sønksen J,Brackett NL,Lynne CM

    更新日期:2009-03-01 00:00:00

  • The impact of bariatric surgery on obesity-related infertility and in vitro fertilization outcomes.

    abstract::Obesity-related infertility is one of the most common problems of reproductive-age obese women who desire childbearing. The various types of bariatric surgeries have proved effective in controlling excessive weight gain, improving fertility, and preventing certain maternal and fetal complications in these women. This ...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0032-1328880

    authors: Tan O,Carr BR

    更新日期:2012-12-01 00:00:00

  • Contraceptive vaginal rings.

    abstract::Contraceptive vaginal rings (CVRs) contain sex steroids that diffuse through a plastic polymer ring at a constant rate and are absorbed directly through the vaginal epithelium into the systemic circulation. This delivery system provides many advantages over oral contraceptives (OCs), including avoidance of the first-p...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2001-18646

    authors: Harwood B,Mishell DR Jr

    更新日期:2001-12-01 00:00:00

  • Microbiota and pelvic inflammatory disease.

    abstract::Female genital tract microbiota play a crucial role in maintaining health. Disequilibrium of the microbiota has been associated with increased risk of pelvic infections. In recent years, culture-independent molecular techniques have expanded understanding of the composition of genital microbiota and the dynamic nature...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0033-1361822

    authors: Sharma H,Tal R,Clark NA,Segars JH

    更新日期:2014-01-01 00:00:00

  • Mixed signals: development of the testis.

    abstract::Induction and patterning of the testis occurs over a brief window of time. Before male-specific morphogenesis, the gonad primordium is bipotential and capable of developing into either an ovary or testis. However, expression of the transcription factor SRY initiates male development and induces patterning, proliferati...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0028-1108005

    authors: Cool J,Capel B

    更新日期:2009-01-01 00:00:00

  • Lesbian Pregnancy: Care and Considerations.

    abstract::The constructs and the provision of preconception and obstetrical care have historically been based on the assumption of heterosexuality, and have often excluded lesbian women. However, due to significant strides in lesbian, gay, bisexual, transgender, and queer (LGBTQ) civil rights, more lesbian women desire to creat...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0037-1606385

    authors: Bushe S,Romero IL

    更新日期:2017-09-01 00:00:00

  • The history and principles of cryopreservation.

    abstract::The ability of glycerol to protect cells from freezing injury was discovered accidentally. The subsequent development of cryopreservation techniques has had a huge impact in many fields, most notably in reproductive medicine. Freezing injury has been shown to have two components, direct damage from the ice crystals an...

    journal_title:Seminars in reproductive medicine

    pub_type: 历史文章,杂志文章,评审

    doi:10.1055/s-2002-23515

    authors: Pegg DE

    更新日期:2002-02-01 00:00:00

  • The impact of type 1 and type 2 diabetes mellitus on the oocyte and the preimplantation embryo.

    abstract::Whereas the importance of close monitoring and tight glycemic control in diabetic pregnancies cannot be ignored, the growing body of knowledge surrounding the different effects of diabetes mellitus on the earliest stages of reproduction underscores the need for aggressive screening among reproductive-aged women at ris...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2008-1042957

    authors: Jungheim ES,Moley KH

    更新日期:2008-03-01 00:00:00

  • Intrauterine environment and polycystic ovary syndrome.

    abstract::The maternal-fetal environment plays an important role in developmental programming of adult disease. Metabolic and hormonal dysfunction during human fetal development accompanies gestational diabetes as a common occurrence in mothers with polycystic ovary syndrome (PCOS), while human fetal androgen excess from congen...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0034-1371087

    authors: Dumesic DA,Goodarzi MO,Chazenbalk GD,Abbott DH

    更新日期:2014-05-01 00:00:00

  • Neuroendocrine changes with reproductive aging in women.

    abstract::Aging has dramatic effects on the reproductive system in women. Undoubtedly, the most notable changes in the neuroendocrine axis arise from the loss of ovarian function, and thus, the loss of negative feedback on the hypothalamus and pituitary. Progressive decreases in inhibin B and inhibin A result in an early increa...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2007-984740

    authors: Hall JE

    更新日期:2007-09-01 00:00:00

  • Genetic disorders related to male factor infertility and their adverse consequences.

    abstract::Assisted reproductive techniques have revolutionized the treatment of male reproductive failure, allowing biological fatherhood to be achieved by many men that nature would have never permitted. As we are able to help more and more couples with our therapies, the genetic basis of the man's spermatogenic, anatomical, o...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0032-1307418

    authors: Harnisch B,Oates R

    更新日期:2012-04-01 00:00:00

  • MicroRNA signature and regulatory functions in the endometrium during normal and disease states.

    abstract::During the menstrual cycle, human endometrium undergoes extensive cyclic morphologic and biochemical modifications in preparation for embryo implantation. These processes are highly regulated by ovarian steroids and various locally expressed gene products and involve inflammatory reaction, apoptosis, cell proliferatio...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-0028-1096128

    authors: Pan Q,Chegini N

    更新日期:2008-11-01 00:00:00

  • Evaluation of a Center of Research Excellence in Polycystic Ovary Syndrome as a Large-Scale Collaborative Research Translation Initiative, Including Evaluating Translation of Guideline Impact.

    abstract::Research translation and evaluation are often underconsidered in research design and implementation thus limiting research benefit to the end user. In this article, we first describe a best practice approach to evaluation, for a center of research excellence in polycystic ovary syndrome. Within this, we outline a comp...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章

    doi:10.1055/s-0038-1667308

    authors: Garad R,Kozica-Olenski S,Teede HJ

    更新日期:2018-01-01 00:00:00

  • In vitro maturation for patients with polycystic ovary syndrome.

    abstract::In vitro fertilization (IVF) with ovarian stimulation is an effective treatment for couples needing treatment with assisted reproductive technologies (ART) where polycystic ovary syndrome (PCOS) is coexisting. However, it is also associated with an increased risk of ovarian hyperstimulation syndrome. In vitro maturati...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2007-992932

    authors: Reinblatt SL,Buckett W

    更新日期:2008-01-01 00:00:00

  • Müllerian anomalies.

    abstract::The reproductive organs in both males and females consist of gonads, internal ductal structures, and external genitalia. Normal sexual differentiation is dependent on the genetic sex determined by the presence or absence of the Y chromosome at fertilization. Testes develop under the influence of the Y chromosome and o...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2004-815593

    authors: Gell JS

    更新日期:2003-11-01 00:00:00

  • Androgen physiology.

    abstract::Androgen receptors are present in numerous tissues throughout the female body, and knowledge of the specific actions of androgens at different sites is increasing, along with the understanding of their contribution to various pathophysiological states. This article reviews the physiology of androgens (testosterone and...

    journal_title:Seminars in reproductive medicine

    pub_type: 杂志文章,评审

    doi:10.1055/s-2006-939565

    authors: Davison SL,Bell R

    更新日期:2006-04-01 00:00:00