 About Menopause
Maintaining Health
Glossary
FAQ
Helpful Examinations
Helpful Therapies
 Hormones
Non Hormones
Alternative
Updates
Links
Contact Us
|
The issue of HRT use in patient with breast cancer creates many concerns and seems that so far have been lacking sufficient proofs to formulate basing on evidence data (EBM) "gold standards" procedures. Standard procedures should include annual mammography and introducing alternative therapy with the intention of estrogen deficiency prevention.
Alternative to estrogens agents use should in women surviving breast cancer should be based on individual risk assessment .
Agents reducing cholesterol level, called HMG-CoA reductase inhibitors or statins allow to achieve the basic aim- primary prevention of heart disease. In comparison to estrogens statins more potently reduce cholesterol level and have endothelium protective activity .
In prospective randomized studies they decrease the number of new cardiovascular incidents in about 30% . It is necessary to notic that cardioprotective estrogens vascular effect is result of both lowering lipid levels and direct vascular action.
Taking into consideration risk factors of osteopenia it is necessary to carry out densitometry enabling quantitative assessment of bone mass. Bone mass value (T-score) lower than -2.5 SD allow to diagnose osteoporosis and patients should be treated with standard methods. Bisphosphonians are believed to have the same antiresorptive potential as estrogens . Raloxifen is effective in prevention and therapy of osteoporosis in women with reduced bone mass should be considered as therapy of choice. In the event of troublesome estrogen deficiency symptoms tibolon use should be considered.
In about half of postmenopausal women serious inflammatory and atrophic transformation in genitourinary system. Helpful can be agents moisturizing vagina nad prepartion directly delivering hormones to vagina with not large systemic effect, like cream containing estriol or vaginal globulka.
Placebo application reduces the number and intensity of hot flushes in about 25%. Clonidine and in less scale vitamin E causes significant ailments reduction than placebo, but is less effective than estrogens. In the other hand megestrol acetate in dose of 40 mg per day seems to be equally effective as estrogens. Longterm effects of megestrol acetate therapy are not know.
In last period attention is paid to the anitidepressant use in fighting against vasomotor symptoms. Preparations venlafaxine, mitrazepin and fluoxetine proved its usefulness in therapy of this pathology .
According to several studies phyoestrogens in form of soybean capsules containing 20 mg/d isoflavones significantly reduce hot flush incidence.
In subgroup of women after breast cancer therapy that have still severe problems resulting from estrogen deficiency introducing hormone replacement therapy can be considered. Recommendation of the consensus from Boar's Head Inn conference on the treatment of estrogen deficiency symptoms in women surviving breast cancer are following: "In women who have had an established diagnosis of breast cancer, we should seek other established symptomatic or health promoting interventions before considering the use of estrogens. When estrogen is used as a last resort, it should be used in the lowest dose for the shortest duration of time only after full discussion of concerns regarding potential risks with respect to breast cancer outcomes. When estrogen is being considered, the role of the informed woman as the final decision maker should be accepted by the health care practitioner."
|
