Hormonal contraception and risk of breast cancer: a critical look.

Today health professionals are not only required to know medicine, but scientific reading, interpretation, and communication of new data. The new information about contraception and hormonal therapies must be analyzed by gynecologists to determine whether or not the new data are applicable to their patients and if it has an impact on their health. Recently a new study of hormonal contraceptives and the risk of breast cancer was published. In this study, the investigators found an elevation of the relative risk of breast cancers on the users versus the nonusers of hormonal contraception. After analyzing the publication and other data available, it is our opinion that it is a very low increase of the risk and its impact should be evaluated case by case, not forgetting to take into account the numerous beneficial effects that hormonal contraception have.

Quality of life in climacteric Chilean women treated with low-dose estrogen.

OBJECTIVES: To evaluate the impact of low-dose oral estrogen therapy on the health-related quality of life (HRQoL) in 45-64-year-old women from the East Metropolitan Health Service (SSMO) in Santiago, Chile. MATERIAL AND METHODS: We conducted an observational cross-sectional study. A random population sample of women between 45 and 64 years of age was obtained through an invitation to contact one of 15 primary health care centers of the SSMO of Santiago, Chile. Out of the 927 women who were originally contacted, 844 women were able to complete the Menopausal Rating Scale (MRS) questionnaire. Information about demographic parameters, health issues, and modality of hormonal therapy (HT) were registered. Three groups were compared: group 1 (n=647; non-users of HT), group 2 (n=82; users of low-dose oral estrogen HT), and group 3 (n=115; users of non low-dose estrogens HT). RESULTS: There were no differences among groups in terms of demographic and health issue parameters. The results of the MRS scores (total score and somatic, psychological and urogenital domain scores) showed significant differences across the 3 study groups, with more favorable results for HRQoL in groups 2 and 3 (p<0.01 for total, somatic, and psychological scores; p=0.05 for urogenital score). CONCLUSION: Climacteric women in the 45-64 age range using HT were shown to have a more favorable impact on HRQoL than non-HT users. Women using low-dose oral estrogen HT had a positive effect on HRQoL, similar to that obtained using non low-dose estrogen regimens.

[Differential effects on serum IGF-1 of tibolone (5 mg/day) vs combined continuous estrogen/progestagen in post menopausal women]. / Efecto diferencial sobre el IGF-1 sérico de tibolona (5 mg/día) vs combinado continuo de estrógeno/progestina en mujeres postmenopáusicas.

BACKGROUND: Tibolone has estrogenic, androgenic and progestational effects and is used in post menopausal women. It apparently has weaker effects on endometrial proliferation and mammary stimulation than conventional hormone replacement therapy. AIM: To compare the metabolic effects of tibolone (5 mg/day) and continuous combined conjugated estrogens/medroxyprogesterone acetate in postmenopausal women. PATIENTS AND METHODS: Postmenopausal women, aged 45 to 60 years old, receiving estradiol valerate and medroxyprogesterone were included in the study. After a two months wash out period, in a double blind fashion, they were randomly assigned to oral tibolone 5 mg/day or equine conjugated estrogens 0.625 mg + medroxiprogesterone acetate 2.5 mg/day (ECE/MPA). At baseline, 30 and 45 days of treatment, fasting serum osteocalcin, somatomedin C (IGF-1, insulin-like growth factor 1), growth hormone (GH), and follicle stimulating hormone and first morning urine calcium and creatinine were measured. RESULTS: Thirty women were studied. There was more than 50% fall in urine calcium with either tibolone or ECE/MPA, while fasting GH or osteocalcin did not show significant changes. Serum IGF-1 increased significantly with tibolone at basal, 30 (+109%) and 45 days of treatment and did not change in the ECE/MPA group. CONCLUSIONS: Tibolone (5 mg/day) and ECE/MPA induced a similar reduction in urinary calcium. Tibolone increased serum IGF-1 levels. This may be due to undetected increment of overall GH secretion or to a specific action or IGF-1 generation from the liver and appears to be a novel differential effect of tibolone.

Procesos expansivos intraselares secretores de prolactina y no secretores: experiencia clínica en 80 casos / Secretive and non secretive intrasellar expansive process of prolactin and non-secretive: clinical experience in 80 cases

Se estudian 80 mujeres con proceso expansivo intraselar secretor de prolactina o no secretor. 51,25% de ellas eran muy secretoras de prolactina (más de 75 ng/ml) y las otras eran no secretoras o poco secretoras (menos de 75 ng/ml). Las del primer grupo eran todas amenorreias, en cambio, en las otras existían inclusive eumenorreicas. Se identifican microadenomas (66,25%), macroadenomas o complicados (17,5% y aracnoideoceles (16,25%). El 45,3% de los microadenomas, el 92,9% de los adenomas complicados y el 30,8% de los aracnoideoceles demostraron ser muy secretores de prolactina. 13,6% del total fueron intervenidas por vía transesfenoidal, con indicación quirúrgica precisa. El estudio histológico demostró un adenoma cromófobo en 10 casos. En el 7,5% de las mujeres estudiadas hubo compromiso quiasmático según los campos visuales de Goldman. Se verificó un 52,9% de recidiva post-operatoria. 37 mujeres anovulantes que deseaban embarazo, lográndose gestación en el 86,5% de ellas