Skip to main content
SpringerLink
Log in

Postmenopause and Ageing: The Concept of Personalized Therapy

  • Chapter
Book cover Frontiers in Gynecological Endocrinology

Part of the book series: ISGE Series ((ISGE))

  • 1340 Accesses

Abstract

The climacteric syndrome is a complex condition characterized by a set of symptoms and degenerative changes that ensue due to the decline in production of sex steroids by the ovaries. This set of changes identifies women at additional risk of degenerative changes during ageing and calls for personalized interventions. Hence, there is a need for safe methods for the short- and long-term management of postmenopausal women. Hormone replacement therapy (HRT) is widely used for the relief of menopausal symptoms and for the prevention of diseases linked to long-term hormonal deprivation. The use of HRT has increased rapidly in the past decade but is currently a subject of debate because of the possible negative effects on the breast. Other molecules have been studied as alternatives to standard hormonal replacement therapy to relief the symptoms also in women with contraindications to hormones or who refuse sex steroids for personal reasons. The aim of this chapter is to discuss the results of the principal studies performed in these last few years on the safety of HRT and of other climacteric therapies and to suggest how to personalize therapies in climacteric women.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Manson JE, Chlebowski RT, Stefanick ML et al (2013) Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA 310:1353–1368

    Article  CAS  PubMed  Google Scholar 

  2. Simoncini T, Genazzani AR (2007) Timing is everything. Gynecol Endocrinol 23:1–4

    Article  PubMed  Google Scholar 

  3. Herrington DM, Reboussin DM, Brosnihan KB et al (2000) Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 343:522–529

    Article  CAS  PubMed  Google Scholar 

  4. Ettinger B, Pressman A, Sklarin P, Bauer DC, Cauley JA, Cummings SR (1998) Associations between low levels of serum estradiol, bone density, and fractures among elderly women: the study of osteoporotic fractures. J Clin Endocrinol Metab 83:2239–2243

    CAS  PubMed  Google Scholar 

  5. Lindsay R, Gallagher JC, Kleerekoper M, Pickar JH (2002) Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 287:2668–2676

    Article  CAS  PubMed  Google Scholar 

  6. Pike CJ (1999) Estrogen modulates neuronal Bcl-xL expression and beta-amyloid-induced apoptosis: relevance to Alzheimer’s disease. J Neurochem 72:1552–1563

    Article  CAS  PubMed  Google Scholar 

  7. Henderson VW, Benke KS, Green RC, Cupples LA, Farrer LA (2005) Postmenopausal hormone therapy and Alzheimer’s disease risk: interaction with age. J Neurol Neurosurg Psychiatry 76:103–105

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Shumaker SA, Legault C, Kuller L et al (2004) Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study. JAMA 291:2947–2958

    Article  CAS  PubMed  Google Scholar 

  9. Resnick SM, Henderson VW (2002) Hormone therapy and risk of Alzheimer disease: a critical time. JAMA 288:2170–2172

    Article  PubMed  Google Scholar 

  10. Prest SJ, May FE, Westley BR (2002) The estrogen-regulated protein, TFF1, stimulates migration of human breast cancer cells. FASEB J 16:592–594

    CAS  PubMed  Google Scholar 

  11. Collaborative Group on Hormonal Factors in Breast Cancer (1997) Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet 350:1047–1059

    Article  Google Scholar 

  12. Chen WY, Manson JE, Hankinson SE et al (2006) Unopposed estrogen therapy and the risk of invasive breast cancer. Arch Intern Med 166:1027–1032

    Article  CAS  PubMed  Google Scholar 

  13. Fournier A, Berrino F, Riboli E, Avenel V, Clavel-Chapelon F (2005) Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer 114:448–454

    Article  CAS  PubMed  Google Scholar 

  14. Gambacciani M, Monteleone P, Sacco A, Genazzani AR (2003) Hormone replacement therapy and endometrial, ovarian and colorectal cancer. Best Pract Res Clin Endocrinol Metab 17:139–147

    Article  CAS  PubMed  Google Scholar 

  15. Weiderpass E, Adami HO, Baron JA et al (1999) Risk of endometrial cancer following estrogen replacement with and without progestins. J Natl Cancer Inst 91:1131–1137

    Article  CAS  PubMed  Google Scholar 

  16. Towler BP, Irwig L, Glasziou P, Weller D, Kewenter J (2000) Screening for colorectal cancer using the faecal occult blood test, hemoccult. Cochrane Database Syst Rev (2):CD001216

    Google Scholar 

  17. Grodstein F, Newcomb PA, Stampfer MJ (1999) Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. Am J Med 106:574–582

    Article  CAS  PubMed  Google Scholar 

  18. Smith CL, O’Malley BW (2004) Coregulator function: a key to understanding tissue specificity of selective receptor modulators. Endocr Rev 25:45–71

    Article  CAS  PubMed  Google Scholar 

  19. Huber J, Palacios S, Berglund L et al (2002) Effects of tibolone and continuous combined hormone replacement therapy on bleeding rates, quality of life and tolerability in postmenopausal women. BJOG 109:886–893

    Article  CAS  PubMed  Google Scholar 

  20. Godsland IF (2001) Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974-2000. Fertil Steril 75:898–915

    Article  CAS  PubMed  Google Scholar 

  21. Rymer J, Robinson J, Fogelman I (2002) Ten years of treatment with tibolone 2.5 mg daily: effects on bone loss in postmenopausal women. Climacteric 5:390–398

    Article  CAS  PubMed  Google Scholar 

  22. Beral V (2003) Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 362:419–427

    Article  CAS  PubMed  Google Scholar 

  23. Valdivia I, Campodonico I, Tapia A, Capetillo M, Espinoza A, Lavin P (2004) Effects of tibolone and continuous combined hormone therapy on mammographic breast density and breast histochemical markers in postmenopausal women. Fertil Steril 81:617–623

    Article  CAS  PubMed  Google Scholar 

  24. Kenemans P, Bundred NJ, Foidart JM et al (2009) Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: a double-blind, randomised, non-inferiority trial. Lancet Oncol 10:135–146

    Article  CAS  PubMed  Google Scholar 

  25. Kenemans P, Speroff L (2005) Tibolone: clinical recommendations and practical guidelines. A report of the International Tibolone Consensus Group. Maturitas 51:21–28

    Article  CAS  PubMed  Google Scholar 

  26. Axelson M, Sjovall J, Gustafsson BE, Setchell KD (1984) Soya–a dietary source of the non-steroidal oestrogen equol in man and animals. J Endocrinol 102:49–56

    Article  CAS  PubMed  Google Scholar 

  27. Tice JA, Ettinger B, Ensrud K, Wallace R, Blackwell T, Cummings SR (2003) Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized controlled trial. JAMA 290:207–214

    Article  CAS  PubMed  Google Scholar 

  28. Simoncini T, Fornari L, Mannella P et al (2005) Activation of nitric oxide synthesis in human endothelial cells by red clover extracts. Menopause 12:69–77

    Article  PubMed  Google Scholar 

  29. Anderson JW, Johnstone BM, Cook-Newell ME (1995) Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 333:276–282

    Article  CAS  PubMed  Google Scholar 

  30. de Kleijn MJ, van der Schouw YT, Wilson PW, Grobbee DE, Jacques PF (2002) Dietary intake of phytoestrogens is associated with a favorable metabolic cardiovascular risk profile in postmenopausal U.S.women: the Framingham study. J Nutr 132:276–282

    PubMed  Google Scholar 

  31. Mei J, Yeung SS, Kung AW (2001) High dietary phytoestrogen intake is associated with higher bone mineral density in postmenopausal but not premenopausal women. J Clin Endocrinol Metab 86:5217–5221

    Article  CAS  PubMed  Google Scholar 

  32. Atkinson C, Compston JE, Day NE, Dowsett M, Bingham SA (2004) The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 79:326–333

    CAS  PubMed  Google Scholar 

  33. Atkinson C, Warren RM, Sala E et al (2004) Red clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial. Breast Cancer Res 6:R170–R179

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Goodman MT, Wilkens LR, Hankin JH, Lyu LC, Wu AH, Kolonel LN (1997) Association of soy and fiber consumption with the risk of endometrial cancer. Am J Epidemiol 146:294–306

    Article  CAS  PubMed  Google Scholar 

  35. Usui T (2006) Pharmaceutical prospects of phytoestrogens. Endocr J 53:7–20

    Article  CAS  PubMed  Google Scholar 

  36. Barrett-Connor E, Grady D, Sashegyi A et al (2002) Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 287:847–857

    Article  CAS  PubMed  Google Scholar 

  37. Barrett-Connor E, Mosca L, Collins P et al (2006) Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 355:125–137

    Article  CAS  PubMed  Google Scholar 

  38. Simoncini T, Genazzani AR (2000) Raloxifene acutely stimulates nitric oxide release from human endothelial cells via an activation of endothelial nitric oxide synthase. J Clin Endocrinol Metab 85:2966–2969

    Article  CAS  PubMed  Google Scholar 

  39. Simoncini T, Genazzani AR, Liao JK (2002) Nongenomic mechanisms of endothelial nitric oxide synthase activation by the selective estrogen receptor modulator raloxifene. Circulation 105:1368–1373

    Article  CAS  PubMed  Google Scholar 

  40. Delmas PD, Bjarnason NH, Mitlak BH et al (1997) Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 337:1641–1647

    Article  CAS  PubMed  Google Scholar 

  41. Vogel VG, Costantino JP, Wickerham DL et al (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 295:2727–2741

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, Pisa, 56126, Italy

    Tommaso Simoncini, Silvia Pisaneschi, Stefania Spina, Guja Bernacchi, Silvia Di Bello, Elena Cecchi, Paolo Mannella & Andrea R. Genazzani

Authors
  1. Tommaso Simoncini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvia Pisaneschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefania Spina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guja Bernacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvia Di Bello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elena Cecchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Mannella
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea R. Genazzani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea R. Genazzani .

Editor information

Editors and Affiliations

  1. International Society of Gynecological Endocrinology, Pisa, Italy

    Andrea R. Genazzani

  2. Department of Obstetrics and Gynaecology, Mater Dei Hospital, Birkirkara, Malta

    Mark Brincat

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Simoncini, T. et al. (2014). Postmenopause and Ageing: The Concept of Personalized Therapy. In: Genazzani, A.R., Brincat, M. (eds) Frontiers in Gynecological Endocrinology. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-03494-2_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-03494-2_25

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03493-5

  • Online ISBN: 978-3-319-03494-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation