However some uterine cancers are decreased by very

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Unformatted text preview: ne suggestion: low estrogen (0.3 µg) and dietary calcium. (Other alternatives discussed on next page.) • Inhibition of some cancer in postmenopausal women (i.e.ovarian) but may increase chances of other cancers – increased cervical or perhaps breast cancer – Also used for advanced prostatic cancer in men. Side or Toxic Effects • Postmenopausal bleeding – try to give minimal effective dose • May be associated with cancer – Endometrial - depending on report, increases 5-15x depending on dose and duration. – However, some uterine cancers are decreased by very small doses. – Vaginal in young women whose mothers were treated with diethylsilbesterol (DES) early in pregnancy • Increased headaches – associated with hypertension, fluid retention, and edema • Thromboembolism – works in several ways, especially on platelets, to decrease clot time – recommend suspension of estrogens prior to bed rest or surgery • Nausea, vomiting, diarrhea Postmenopausal Estrogen + Progesterone Use 16,608 Subjects, 50-79 yrs Study stopped after 5yrs – Reported July ‘02 • • • • • • Absolute numbers for Percentage Difference 10,000 patients for 1yr Test vs. Control Group +8 Breast Cancer + 26% +8 Strokes + 41% +18 Blood Clots + 100% +7 Heart Attacks + 29% Not Reported Colorectal Cancer –37% Not Reported Bone Fractures – 24% There was no difference in deaths between groups Bone Density • Problems to be addressed: – postmenopausal osteoporosis – hypercalcemia of malignancy – Paget’s disease. Alternatives to treat bone density • Selective Estrogen Receptor Modulators (SERMs) - raloxifene (Evista®) – Postmenopausal use only for bone density preservation. Stimulates some estrogen receptors and inhibits others. • • • • • • Affects lipid profile (lowers LDL but doesn’t raise HDL), Prevents bone loss. Does not control hot flashes. Does contribute to thromboembolism. Does not seem to stimulate breast or uterine tissue. Biphosphonates - alendronate (Fosamax®), etidronate (Didronal®), risedronate (Actonel®) – Mechanism: inhibit bone reabsorption, both normal and abnormal. – Greatest benefits in patients with most severe disease. • Annual 2-3% increase in bone mass is similar to estrogen and calcitonin therapy • But does not seem to plateau after 1 to 2 years as does that therapy. – New agent zoledronate (Zometa®) must be infused • Approved only for Paget’s disease and bone wasting caused by cancer. • However, one study on 351 women showed that a si...
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This document was uploaded on 02/07/2014.

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