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Biomedical subjects

L Speroff

Publications and source records attributed to L Speroff.

At least 55 records · Page 3Linked to original sources
PubMed1993

Menopause and hormone replacement therapy.

The beneficial impact of hormone replacement therapy on postmenopausal women is substantial. The size of the positive impact has probably been underestimated owing to compliance issues. Patients and physicians need to learn about the important contribution to preventive health care that occurs with estrogen. Negative beliefs about menopause by both patients and physicians may contribute to poor compliance with hormone replacement therapy. It is time to emphasize the positive aspects: the prospect for long life made healthy by a good preventive care program.

Breast Neoplasms↗
PubMed1993

Evaluation of a new generation of oral contraceptives. The Advisory Board for the New Progestins.

OBJECTIVE: To assess the differences and similarities in efficacy, safety, and metabolic effects of oral contraceptives (OCs) containing the new progestins desogestrel, gestodene, and norgestimate. All formulations reviewed contained no more than 35 micrograms ethinyl estradiol. DATA SOURCES: Data were reported from approximately 100 published reports, dating from 1980, of comparative and noncomparative clinical studies on phasic and fixed-dose preparations culled from computer searches of several sources, including MEDLINE and Excerpta Medica. METHODS OF STUDY SELECTION: An attempt was made to select the most meaningful studies in terms of length, size, methodology, and quality of description. All clinical studies were considered; in general, review articles were not. Some preclinical studies were also included. No abstracts were used. DATA EXTRACTION AND SYNTHESIS: The indices chosen for examination were contraceptive efficacy, cycle control, coagulation, carbohydrate and lipid metabolism, and androgenicity. CONCLUSIONS: The new formulations were found to be comparable in efficacy to each other and to established agents. They also appeared to be less androgenic than current OCs and to have less impact on carbohydrate and lipoprotein metabolism. Cycle control was similar to that of older products. Changes in coagulation-promoting and antithrombotic factors were minor. Clinical relevance of the results could not be determined because of small sample size and methodologic differences between studies.

Androgens↗
PubMed1991

Adrenal and ovarian steroid hormone responses to gonadotropin-releasing hormone agonist treatment in polycystic ovary syndrome.

It has been postulated that in polycystic ovary syndrome ovarian steroids can influence adrenal steroidogenesis. To test this hypothesis, basal and dexamethasone-suppressed-corticotropin-stimulated steroid hormone responses were compared among three groups of women before, during, and after gonadotropin-releasing hormone agonist treatment for 3 months. The groups were characterized as follows: (1) women with polycystic ovary syndrome with high dehydroepiandrosterone sulfate levels (greater than 400 micrograms/dl), (2) women with polycystic ovary syndrome with normal dehydroepiandrosterone sulfate levels (less than 300 micrograms/dl), and (3) normal ovulatory women. In response to gonadotropin-releasing hormone agonist, basal serum luteinizing hormone, follicle-stimulating hormone, estradiol, estrone, 17-hydroxyprogesterone, androstenedione, and testosterone in all three groups were suppressed to similar levels. Basal serum dehydroepiandrosterone sulfate levels in the group with high levels declined, but they did not reach the normal, unaltered concentrations in the other two groups. Two subjects with polycystic ovary syndrome in this group with high levels, who showed the greatest declines in basal serum dehydroepiandrosterone sulfate levels (34%, 40%), also had evidence of 3 beta-hydroxysteroid dehydrogenase deficiency before treatment, which was resolved by the end of treatment. In both groups with polycystic ovary syndrome, the increase in maximum incremental rise of dehydroepiandrosterone and dehydroepiandrosterone sulfate levels in response to a pharmacologic dose of corticotropin from a dexamethasone-suppressed baseline (adrenal androgen capacity) remained unaltered during gonadotropin-releasing hormone agonist administration. We conclude that ovarian steroids may promote excessive adrenal androgen secretion in women with polycystic ovary syndrome, may induce 3 beta-hydroxysteroid dehydrogenase deficiency as a mechanism for adrenal involvement in some women with polycystic ovary syndrome, and do not influence adrenal androgen capacity.

3-Hydroxysteroid Dehydrogenases↗
PubMed1991

A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome.

A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporotic fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed.

Adult↗
PubMed1990

A study of combined continuous ethinyl estradiol and norethindrone acetate for postmenopausal hormone replacement.

In a blinded, prospective, dose-response pilot study of continuous estrogen-progestin replacement therapy, 77 thin, nonsmoking, white women, who were 12 to 60 months postmenopausal and had normal medical histories, were randomly assigned to receive one of five dose combinations of daily ethinyl estradiol and norethindrone acetate (20 micrograms and 1.0 mg, 10 micrograms and 1.0 mg, 10 micrograms and 0.5 mg, 5 micrograms and 1.0 mg, and 5 micrograms and 0.5 mg) or conjugated estrogens 0.625 mg on days 1 to 25 and medroxyprogesterone acetate 10 mg on days 16 to 25. An additional 10 women meeting the same criteria served as a comparison group by taking calcium only. During 12 months of therapy, continuous users had significantly less vaginal bleeding and spotting than did sequential users. As compared with baseline values, bone metabolism and computerized tomographic measurements of vertebral trabecular bone density at month 12 indicated reduced bone turnover and increased density in hormone users. Endometrial biopsy specimens were negative for hyperplasia and neoplasia. The continuous ethinyl estradiol-norethindrone acetate tablet, even at the lowest doses studied, provided the same salutary effects on bone, endometrium, and postmenopausal symptoms as sequential therapy while minimizing annoying vaginal bleeding and spotting.

Adult↗
PubMed1989

The effects of oral contraceptives on reproduction.

Early reports linking the use of contraceptive steroids to congenital malformations have not been substantiated. There is a delay in the return of fertility after cessation of oral contraceptive use, but this may be concentrated in childless women aged 30 to 34. Oral contraception does not influence the rate of infertility. After the cessation of oral contraceptive use, there is no increase in the incidence of spontaneous abortion in subsequent pregnancies, nor is there an increased risk of pregnancy complications. Women who use oral contraceptives do not breast-feed as long as nonusers, but no differences can be detected between the growth and development of the children of oral contraceptive users and nonusers. There is no relationship between oral contraceptive use and pituitary adenomas, or between oral contraceptive use and subsequent amenorrhea.

Adult↗
PubMed1988

Does exposure of preovulatory oocytes to ultrasonic radiation affect reproductive performance?

Ultrasonography of preovulatory oocytes has been reported to lead to reduced litter size in rats. Because of the growing popularity of ultrasound-guided follicular aspiration in human in vitro fertilization programs, further study of ultrasonic radiation's effect on the preovulatory oocyte is warranted. We used 106 virgin Sprague-Dawley rats which, on the evening of proestrus, received ultrasonic radiation of sham treatment after the onset of the luteinizing hormone (LH) surge. No differences were found between control (C) and experimental (US) animals in pregnancy rate, number of corpora lutea, implantations, pups, and mean pup and placental weights at autopsy on day 22 of pregnancy. Ultrasonic radiation applied to meiotically active, preovulatory oocytes did not affect the reproductive performance of these rats.

Animals↗
PubMed1988

Dose-dependent effects of postmenopausal estrogen and progestin on antithrombin III and factor XII.

The frequent use of estrogen and progestin replacement for treatment in postmenopausal women makes assessment of its effect on the coagulation system of interest. Although the amount of estrogen used to achieve the desired therapeutic effect is lower than the lowest doses in oral contraception, the age and medical condition of this population may amplify any hormone-induced risk. The common impression is that postmenopausal replacement therapy does not increase risk for thromboembolic disease, but no large epidemiologic studies of estrogen replacement have addressed that question. In this randomized prospective study, we examined the effects of varying low doses of an estrogen-progestin preparation on the titers of clotting factors in postmenopausal women. The coagulation factors selected for investigation were among those that have been reported to be significantly altered in the plasma samples of high-dose estrogen users. There were no changes in prothrombin time, factor X, fibrinogen, factor VII, or fibrinopeptide A in any of the hormone-treated groups. Mild but significant shortening of the partial thromboplastin time and elevation of factor XII titer were noted in all treatment groups. The titer of antithrombin III was reduced in the group given 20 micrograms ethinyl estradiol, but not in the groups given 5 or 10 micrograms. The clinical significance of these changes is difficult to determine in postmenopausal women receiving sex hormone replacement. However, we have not noted any thromboembolic episodes in our volunteers after a 1-year follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Estradiol and hemodynamics during ovulation induction.

Left ventricular size and stroke volume increase in human pregnancy and during estrogen administration in laboratory animals. In order to determine if elevated levels of endogenous estrogens in humans produce hemodynamic changes similar to those that occur during pregnancy, 14 patients were studied during ovulation induction at day 8 +/- 2 (SD) (proliferative phase) and at day 14 +/- 4 (midcycle) of their cycles. M-mode echocardiography was carried out with the patient in the left lateral decubitus, head down and head up positions. The mean serum estradiol level was 294 +/- 234 (SD) pg ml-1 at day 8 +/- 2 (treatment day) and it increased to 1503 +/- 531 pg ml-1 at day 14 +/- 4 (cycle day) of the same cycle. This change in serum estradiol was significant (P less than 0.001), associated with an increase in left ventricle diastolic dimension of 2.3 +/- 1.1 mm (P less than 0.001). During the same time period stroke volume and cardiac index correspondingly increased. Heart rate, fractional shortening, and blood pressure did not change and systemic vascular resistance decreased. Many of the cardiovascular adaptations of pregnancy are duplicated by high levels of endogenous estrogens and these changes are evident in as few as 6 days. Thus, we conclude that changes in endogenous estrogen correlate with certain cardiovascular parameters, the most striking of which is the left ventricular size. This may be one of the adaptive mechanisms by which the maternal circulation adapts to pregnancy.

Adult↗
PubMed1985

The effect of exercise on uterine activity in the last eight weeks of pregnancy.

In order to determine if moderate maternal exercise increased uterine activity, a prospective study was done during the last 8 weeks of pregnancy in 17 women. Two forms of exercise were chosen, weight-bearing (running) and non-weight-bearing (stationary bicycle), to study this hypothesis. The results show that with these types of exercise no increase in uterine activity was noted. This is useful information to convey to pregnant patients ready to engage in a physical fitness program.

Adult↗
PubMed1985

Estrogen replacement therapy: current thinking and practice.

Radiographic evaluation of the skeleton is not needed to assess need for hormone replacement. No available method (including CT and dual photon absorptiometry) can predict osteoporosis. Because patients prone to osteoporosis cannot be preselected, all women should be considered probable victims. To avoid excess bone mineral loss, estrogens should begin soon after the diagnosis of menopause in women who do not have contraindications, regardless of symptoms.

Adult↗
PubMed1983

Current concepts of the endocrine characteristics of normal menstrual function: the key to diagnosis and management of menstrual disorders.

Obviously, the endocrine mechanisms involved in producing the normal, cyclic pattern of menstrual bleeding are exceedingly complex. A review of even our current, far from complete, knowledge of the regulation of follicular growth, cyclic selection of a single dominant follicle, ovulation, and the neuroendocrine control of all three mechanisms only serves to emphasize the myriad of endogenous and exogenous factors that may adversely affect such a delicate balance and be manifest in menstrual disturbance. Indeed, one may wonder that the menstrual cycle is cyclic and predictable at all. Nevertheless, the efficiency with which the system normally operates is striking. Its very complexity often makes disorders of menstrual function a not infrequent symptom of disease outside the reproductive tract, a fact that should stress the need for prompt and thorough evaluation.

Corpus Luteum Maintenance↗