Faculty Bibliography

Three regimens of hormone replacement therapy were administered to 62 postmenopausal women for a period of 12 weeks and evaluated for their effect on blood lipids. Each group was given a continuous dose of 0.625 mg of conjugated estrogens combined with either a continuous dose of 2.5 mg of medroxyprogesterone acetate or 5.0 mg of medroxyprogesterone acetate, or a cyclic dose of 5.0 mg of medroxyprogesterone acetate on days 17-28 of the cycle. After treatment there was a significant decrease in the total cholesterol (P less than .0007) and low density lipoprotein cholesterol (P less than .0001) together with a significant increase in high density lipoprotein cholesterol (P less than .0029). There was no significant difference in the response of the blood lipids to the three hormone groups. Therefore, preference would depend on the combination that caused the least bleeding or amenorrhea

Physicians who prescribe hormone replacement therapy for menopausal women should explain the purpose, risks, and side effects of the treatment. This enhances compliance and discourages patients from discontinuing therapy because of fears of cancer or misconceptions about hormone replacement therapy. The physician should explain that the risk of endometrial cancer is virtually eliminated (reduced to that of a normal woman or a woman not receiving therapy) by the addition of progestogen to estrogen regimens, and that when this cancer does occur, it is usually diagnosed and treated early. Recent studies have not conclusively shown a significant effect of progestogen on lipid profiles relevant to cardiovascular disease. Hormone replacement therapy does not appear to be associated with an increased risk of breast cancer. Nuisance side effects (such as edema and breast tenderness) can be better tolerated if the physician prepares the patient, offers a solution, and helps to put the problem in perspective. Other measures, such as providing written information and avoiding unnecessary biopsies, also enhance compliance

Ham's F-10 medium (Gibco, Grand Island, NY) and medium T6 with and without 15% fetal calf serum (FCS) were compared for their ability to support development of murine blastocysts with the capacity to implant and produce normal fetuses when transferred to pseudopregnant females. All media supported equal rates of blastocyst development from 2-cell embryos. In addition, there were no differences in the rates of blastocyst implantation. However, once implanted, blastocysts grown in T6 produced a significantly higher proportion of normal fetuses (58.5% to 65.9%) than blastocysts grown in either Ham's F-10 (2.4%) or T6 with FCS (27.6%). These results demonstrate that the rate of murine blastocyst development from 2-cell embryos in vitro is not a good criterion of healthy embryos. Murine blastocysts transferred in medium with 0% versus 50% FCS implanted and developed into normal fetuses at equal rates

Cardiovascular disease is extremely rare in premenopausal women except for those who have diabetes or hypertension. It can be surmised, but is not yet proved, that protection from atherosclerotic coronary artery disease is an action related to the production of estrogen. In the consideration of hypertension, true systemic hypertension must be differentiated from blood pressure that is elevated spuriously from excessive sclerosis of the large arteries, which is more common in elderly patients. Both types of hypertension tend to increase with advancing age, and women have a greater incidence overall. All hypertensives should be actively treated