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There are many options available to address the quality of life and health concerns of menopausal women. The principal indication for hormone therapy (HT) is the treatment of vasomotor symptoms, and benefits generally outweigh risks for healthy women with bothersome symptoms who elect HT at the time of menopause. Although HT increases the risk of coronary heart disease, recent analyses confirm that this increased risk occurs principally in older women and those a number of years beyond menopause. These findings do not support a role for HT in the prevention of heart disease but provide reassurance regarding the safety of use for hot flushes and night sweats in otherwise healthy women at the menopausal transition. An increased risk of breast cancer with extended use is another reason short-term treatment is advised. Hormone therapy prevents and treats osteoporosis but is rarely used solely for this indication. If only vaginal symptoms are present, low-dose local estrogen therapy is preferred. Contraindications to HT use include breast or endometrial cancer, cardiovascular disease, thromboembolic disorders, and active liver disease. Alternatives to HT should be advised for women with or at increased risk for these disorders. The lowest effective estrogen dose should be provided for the shortest duration necessary because risks increase with increasing age, time since menopause, and duration of use. Women must be informed of the potential benefits and risks of all therapeutic options, and care should be individualized, based on a woman's medical history, needs, and preferences. [ABSTRACT FROM AUTHOR]

Presents the results of two studies on the effects of oral estrogen in low doses on plasma lipoproteins. Measurement of the metabolism of very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) by endogenously labeling their protein content, lipoprotein B; Methods; Results; Conclusions; More.

The prevalence of menstrual dysfunction is greater among athletes than in the general population. Many factors undergo change during the course of an athletic training program and any or all of these may contribute to disturbances in menstrual cyclicity. All athletes with oligomenorrhea, amenorrhea, or menarcheal delay require thorough evaluation to rule out serious pathological conditions, since the diagnosis of exercise-associated menstrual dysfunction can be made only by excluding other etiologic factors. Most athletes who have these problems should be treated to prevent undesirable sequelae. [ABSTRACT FROM AUTHOR]

Study Objective: To assess combined hormone therapy (CHT) prescribing patterns, possible impediments to CHT prescribing, and use of endometrial biopsy to monitor therapy.Design: Mailed questionnaire survey.Subjects: Gynecologists and general internists at two Boston teaching hospitals.Measurements and Main Results: Based on a 71% response rate, 72% of internists and 100% of gynecologists reported ever having prescribed CHT. Almost 60% of internists, compared with 8% of gynecologists, reported that over half of their female patients were older than 50 years of age. By logistic regression analysis of the internists' data, female gender of physician (odds ratio 11.0), belief that CHT decreases myocardial infarction risk (odds ratio 3.4), and knowledge of CHT's benefits and risks (odds ratio 2.8) were associated with prescribing. Endometrial biopsy was performed by a majority of physicians only when unexpected vaginal bleeding occurred and in cases of unclear menopausal transition. Physicians who were concerned about litigation were seven times more likely to perform baseline endometrial biopsy.Conclusions: In the authors' sample, as well as nationally, internists are more likely to provide care for menopausal women. Among internists, gender and knowledge are strongly associated with CHT prescribing. These findings have important educational implications if internists are to routinely provide information and counseling to women about osteoporosis and CHT. [ABSTRACT FROM AUTHOR]

Many postmenopausal women can't take estrogen, fear its link with breast cancer, or simply prefer a different approach. Be aware of the value of nonhormonal options so that you can respond to patients' concerns knowledgeably and realistically. [ABSTRACT FROM AUTHOR]

During reproductive life, ovarian steroid biosynthesis is gonadotropin dependent and occurs in theca and granulosa cells. In the menopausal ovary, there is atresia of ovarian follicles, with sparing of the androgen-producing theca-interstitial cell component. The aging ovary, therefore, produces significantly reduced amounts of estrogen, with continued, though decreased, androgen production. After menopause, ovarian estradiol biosynthesis is minimal, with circulating estrogen being derived principally from peripheral aromatization of ovarian and adrenal androgens. Androgen biosynthesis from the adrenal gland, in addition to that from the ovary, decreases with age. Although ovarian androgen production declines with age, there is not an abrupt decrease as is seen with ovarian estrogen levels at the time of menopause. The biological activity of these steroids, either before or after menopause, depends on the amount of steroid available in the unbound fraction. To this end, sex hormone-binding globulin (SHBG) levels are an important determinant of hormone action. Not only does the concentration of SHBG influence the biological effect of testosterone and estradiol, but these steroids also regulate SHBG concentrations. [ABSTRACT FROM AUTHOR]

Competing Interests: Financial disclosure/conflicts of interest: None reported.

Background: Adult- and adolescent-onset neuroblastomas are rare, with no established therapy. In addition, rare pheochromocytomas may harbor neuroblastic components. This study was designed to collect epidemiological, diagnostic and therapeutic data in order to better define the characteristics of malignant peripheral neuroblastic tumors (MPNT) and composite pheochromocytomas (CP) with MPNT., Procedure: Fifty-nine adults and adolescents (aged over 15 years) diagnosed with a peripheral or composite neuroblastic tumor, who were treated in one of 17 institutions between 2000 and 2020, were retrospectively studied., Results: Eighteen patients with neuroblastoma (NB) or ganglioneuroblastoma (GNB) had locoregional disease, and 28 patients had metastatic stage 4 NB. Among the 13 patients with CP, 12 had locoregional disease. Fifty-eight percent of the population were adolescents and young adults under 24 years of age. The probability of 5-year event-free survival (EFS) was 40% (confidence interval: 27%-53%)., Conclusions: Outcomes were better for patients with localized tumor than for patients with metastases. For patients with localized tumor, in terms of survival, surgical treatment was the best therapeutic option. Multimodal treatment with chemotherapy, surgery, radiotherapy, and immunotherapy-based maintenance allowed long-term survival for some patients. Adolescent- and adult-onset neuroblastoma appeared to have specific characteristics associated with poorer outcomes compared to pediatric neuroblastoma. Nevertheless, complete disease control improved survival. The presence of a neuroblastic component in pheochromocytoma should be considered when making therapeutic management decisions. The development of specific tools/resources (Tumor Referral Board, Registry, biology, and trials with new agents or strategies) may help to improve outcomes for patients., (© 2024 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Feticide is the practice of inducing fetal demise before the termination of pregnancy. In England and Wales, it is recommended for terminations of pregnancy beyond 21+6 weeks of gestation. This project analyses the trends in feticide in singleton pregnancy in England and Wales between 2012 and 2020. This project was a retrospective study that analysed data extracted from the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC). The data extracted by the DHSC included the prevalence of feticide, methods of feticide and termination, statutory grounds, gestation, service provider, maternal age, ethnicity and obstetric history. In addition, data analysis was carried out to identify trends. Between 2012 and 2020, there were 9310 feticides in England and Wales, undertaken in 0.5% of all abortions. The prevalence of feticide fluctuated; however, there was an overall decrease from 1084 cases in 2012 to 1000 cases in 2020. Intracardiac injection of potassium chloride was the most frequent method of achieving feticide (67.2%). Just over half (55.8%) of feticides took place under Ground E of the Abortion Act 1967, with the main indication being congenital malformations of the nervous system. Two-fifths (40.2%) of feticides took place at 23 weeks, 22.8% at 22 weeks and 13.5% between 20 and 21 weeks. The remainder occurred at later gestations: 17.5% at 24-29 weeks and 5.9% beyond 29 weeks. During our study period, it was more common for feticides to be carried out as part of a medical termination than a surgical termination and 60.3% occurred in NHS hospitals. Women undergoing feticide were mostly aged 30-34 years (38.3%) and of White ethnicity (78.6%). Feticide is an essential component of comprehensive abortion care for women undergoing late second and third-trimester abortions. This study provides insight into how feticide is carried out in England and Wales and demonstrates the effect of the COVID-19 pandemic on reducing feticide prevalence. Future research should analyse in more detail the use of the different methods of feticide., (© 2023. The Author(s).)