phytoestrogens and Thrombosis

EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1.. the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause. 2.. the use of transdermal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease. 3.. when the use of progesterone is necessary, micronized progesterone is considered the safer alternative. 4.. in symptomatic menopausal women who are at significant risk from the use of hormone replacement therapy, the use of selective serotonin re-uptake inhibitors and possibly other nonhormonal agents may offer significant symptom relief. 5.. AACE does not recommend use of bioidentical hormone therapy. 6.. AACE fully supports the recommendations of the Comité de l'Évolution des Pratiques en Oncologie regarding the management of menopause in women with breast cancer. 7.. HRT is not recommended for the prevention of diabetes. 8.. In women with previously diagnosed diabetes, the use of HRT should be individualized, taking in to account age, metabolic, and cardiovascular risk factors.. AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CAC = coronary artery calcification; CEE = conjugated equine estrogen; CEPO = Comité de l'Évolution des Pratiques en Oncologie; CAD = coronary artery disease; CIMT = carotid intima media thickness; CVD = cardiovascular disease; FDA = Food and Drug Administration; HDL = high-density lipoprotein; HRT = hormone replacement therapy; HT = hypertension; KEEPS = Kronos Early Estrogen Prevention Study; LDL = low-density lipoprotein; MBS = metabolic syndrome; MPA = medroxyprogesterone acetate; RR = relative risk; SERM = selective estrogen-receptor modulator; SSRI = selective serotonin re-uptake inhibitor; VTE = venous thrombo-embolism; WHI = Women's Health Initiative.

Topics: Administration, Cutaneous; Administration, Oral; Aged; Amines; Breast Neoplasms; Cardiovascular Diseases; Cimicifuga; Cognition; Cyclohexanecarboxylic Acids; Diabetes Mellitus; Endocrinology; Estradiol; Estrogen Replacement Therapy; Estrogens; Excitatory Amino Acid Antagonists; Female; Gabapentin; gamma-Aminobutyric Acid; Hot Flashes; Humans; Menopause; Middle Aged; Osteoporosis; Phytoestrogens; Phytotherapy; Progesterone; Progestins; Risk Assessment; Selective Serotonin Reuptake Inhibitors; Societies, Medical; Thrombosis; Vasomotor System

Topics: Breast Neoplasms; Climacteric; Complementary Therapies; Coronary Artery Disease; Female; Hormone Replacement Therapy; Hot Flashes; Humans; Life Style; Osteoporosis, Postmenopausal; Phytoestrogens; Risk Factors; Thrombosis

Soybean isoflavones of genistein and biochanin A, its analogue, promote the activity for generating tissue-plasminogen activator (tPA) from human cervical cancer cells (HeLa S3) and human umbilical vein endothelial cells (HUVEC). At a concentration of 50 microM, each of 14 types of isoflavones were added to HeLa culture solution and incubated. After 24 h, the culture solution was replaced, and then incubated for another 24 h. When fibrinolytic activity was checked in the resulting culture solution using the fibrin plate method, substantial fibrinolytic activity was confirmed for two types of isoflavones. Genistein showed the highest level of fibrinolytic activity at 12.4 times the control, and for biochanin A, an analogue of genistein, the level was 3.5 times the control. Checking fibrinolytic activity and molecular weight of the protein bands separated by zymography, a rise in the protein band concentration in proportion to the concentration of the reagents added was confirmed for the protein band with activity in the same position as the standard reference tPA, which has a molecular weight of about 68 kDa. ELISA also demonstrated that the concentration of tPA in the culture solution was higher than that of plasminogen activator-1. Fibrinolytic activity of HUVEC incubated with 25 microM of biochanin A was much higher than that of the control, which suggests that these soybean isoflavones could have beneficial effects on blood circulation in vivo.

Topics: Enzyme Activation; Fibrinolysis; Genistein; Glycine max; HeLa Cells; Humans; Isoflavones; Phytoestrogens; Plant Preparations; Thrombosis; Tissue Plasminogen Activator; Umbilical Veins

This study tested the effect of Epimedium-derived phytoestrogen (PE) on preventing steroid-associated osteonecrosis (ON) in rabbit model.. Thirty 28-week-old male New-Zealand white rabbits were divided into control group (CON; n=14) and PE group (PE; n=16; 5 mg/kg body weight/day) after receiving an established inductive protocol for inducing steroid-associated ON. Before and after inductive protocol, Dynamic-MRI was employed on bilateral femora for local intra-osseous perfusion, blood samples were examined for coagulation, fibrinolysis and lipid-transportation, and marrow samples were quantified for adipogenesis-gene mRNA expression. Six weeks later, bilateral femora were dissected for Micro-CT-based micro-angiography, and then ON lesion, intravascular thrombosis and extravascular fat-cell-size were examined histopathologically.. The incidence of ON in the PE group (31%) was significantly lower than that in the CON group (93%). Compared to the CON group, local intra-osseous perfusion was maintained in the PE group. Blocked trunk vessels were seldom found in micro-angiography of the PE-treated rabbits. Thrombosis incidence and fat-cell-size were both significantly lower in the PE group than those in the CON group. During the early period after induction, indicator of coagulation, fibrinolysis, lipid-transportation and adipogenesis-gene expression were found with significantly changing pattern in the PE group compared to the CON group.. PE was able to exert beneficial effect on preventing steroid-associated ON in rabbits with inhibition of both thrombosis and lipid deposition.

Topics: Adrenal Cortex Hormones; Animals; Epimedium; Femur; Lipid Metabolism; Magnetic Resonance Imaging; Male; Osteonecrosis; Phytoestrogens; Phytotherapy; Plant Preparations; Rabbits; Reverse Transcriptase Polymerase Chain Reaction; Thrombosis