Faculty Bibliography

Menopause is characterised by a rapid and progressive reduction in oestradiol, the endogenous form of the steroid hormone oestrogen. This brings about many changes in a woman's body some of which, like hot flushes, are discomforting but not life-threatening. Others, like loss of bone density and decline in cardiovascular function, have serious life threatening consequences. Many of these changes can be eliminated or reduced with hormone replacement therapy (HRT). Despite its benefits, however, some women are not candidates for this treatment and many others choose not to take it. As a result, there is growing interest among patients about natural alternatives to conventional HRT. There are a number of herbal and nutritional alternatives proposed for management of symptoms and reduction of health risks among menopausal women, and the group of phytoestrogens called isoflavones are promising compounds. Red clover is a valuable source of the four important isoflavones (genistein, daidzein, biochanin and formononetin), and clinical data are now accumulating to indicate that standardised extracts may provide a range of health benefits in women. [References: 38] <97>

OBJECTIVE: To compare the effects of three commonly prescribed estrogen replacement therapies-oral conjugated equine estrogens (CEE; n = 37), oral micronized estradiol (ME; n = 25), and transdermal estradiol (TE; n = 24)-on the binding characteristics of plasma estradiol as related to the concentrations of blood sex hormone-binding globulin (SHBG), estradiol, and estrone. DESIGN: Menopausal volunteers, opting for estrogen replacement therapy, gave blood at 0, 2, and 4 months. SHBG was assayed by automated immunoabsorbent technology. Estradiol and estrone were determined by quantitative gas chromatography/mass spectrometry. After tritiated estradiol was added to serum, the percentage of estradiol not bound to protein was determined by ultrafiltration and the percentage of estradiol bound to SHBG was measured by a method exploiting that this protein, even when bound to estradiol, binds avidly to Concanavalin A-Agarose. RESULTS: In each study, 2- and 4-month data were similar. Increases in SHBG concentrations were 100% (p < 0.001), 45% (p < 0.001), and 12% (nonsignificant) for subjects who were receiving CEE, ME, and TE regimens, respectively. Decreases in the percentage of estradiol not bound to protein and increases in the percentage of estradiol bound to SHBG correlated with changes in the concentrations of this protein mediated by the therapies. The order for increases in estradiol was ME-TE >> CEE, whereas for estrone, the order was ME > CEE >> TE, divergent from the SHBG responses. CONCLUSIONS: The diverse responses observed can be explained by differences in the estrogen load delivered to target tissues as controlled by the intermediary circulation and metabolism of the hormones introduced in these regimens

Objective: To assess the effectiveness of a vaginal moisturizer in menopausal women with external vaginal dryness. We studied a nonhormonal topically applied external vaginal moisturizer in women with external vaginal (vulvar) dryness to see if we could approach the results of a topically applied hormonal product.Methods: The 4-week clinical study included 30 subjects who were randomly divided into two groups to use either one of two topically-applied products for treating vaginal dryness: Vagisil Intimate Moisturizer (VIM) a nonprescription, nonhormonal, water based lotion and Premarin Creme (PC), a prescription hormone cream. VIM was applied twice a day to the external vaginal area. PC was applied once every other day to the internal vaginal area in healthy menopausal patients with vaginal dryness not requiring systemic therapy. The parameters studied were external dryness (0-5), pH, and subject discomfort (0-5). Patients accepted into the study were evaluated for vaginal dryness at baseline determined on a scale of 0-5. An external pH was taken and the patient rated her own discomfort on a scale of 0-5. Patients were seen at 2 and 4 weeks at which time they repeated the discomfort scale and were rated by the investigator for external vaginal dryness and pH. Subjects reported any adverse events.Results: 100% of PC treated patients and 75% of VIM patients decreased their pH to below 5. However, significant improvement was reported by patient and physician evaluation in both treatment groups.Conclusion: The nonhormonal, topical lotion Vagisil Intimate Moisturizer is a viable alternative to hormone cream for treatment of external vaginal dryness