Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma

Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive loss of visual function and retinal ganglion cells (RGC). Current epidemiological, clinical, and basic science evidence suggest that estrogen plays a role in the aging of the optic nerve. Menopause, a major biological life event affecting all women, coincides with a decrease in circulating sex hormones, such as estrogen. While 59% of the glaucomatous population are females, sex is not considered a risk factor for developing glaucoma. In this review, we explore whether menopause is a sex-specific risk factor for glaucoma. First, we investigate how menopause is defined as a sex-specific risk factor for other pathologies, including cardiovascular disease, osteoarthritis, and bone health. Next, we discuss clinical evidence that highlights the potential role of menopause in glaucoma. We also highlight preclinical studies that demonstrate larger vision and RGC loss following surgical menopause and how estrogen is protective in models of RGC injury. Lastly, we explore how surgical menopause and estrogen signaling are related to risk factors associated with developing glaucoma (e.g., intraocular pressure, aqueous outflow resistance, and ocular biomechanics). We hypothesize that menopause potentially sets the stage to develop glaucoma and therefore is a sex-specific risk factor for this disease. Graphical Abstract

Markers of bone remodeling in patients with surgical menopause undergoing hormone replacement therapy with Divigel

Twenty women with surgical menopause, 40-50 years of age, received hormonal replacement therapy with transdermic preparation Divigel during 24 months. On the background of therapy with Divigel we witnessed normalization of indeces of osteal remodelingconsiderable decrease pyridinoline and deoxypyridinoline, and elevation of alkaline phosphatase. Mineral density of bone tissue in the group of patients with surgical menopause waslowerin comparison with control (p0,01). Divigeltumedto exertprotective influence on the bone tissue inpatients with osteoporosis irrespective о f duration о f surgical menopause by the beginning of therapy.

Hormonal rehabilitation of patients with cervical cancer after radical surgical treatment

Radical surgical treatment with and without radiation often induces symptoms of premature menopause in cervical cancer (CC) patients. Few retrospective studies seem to suggest that hormonal replacement therapy (HRT) is not detrimental for patients with CC and can improve life quality in this group of women. To investigate the effect of HRT on menopausal symptoms inpatients with С C history, 85 patients after CC treatment, 22-51 years old, were included into this research. In 59 patients HRT was carried out to overcomepostovariectomic syndrome (POES). Severity of menopausal symptoms, serum estradiol, FSH and lipid profiles were evaluated. The research showed high therapeutic effect as to reducing the frequency of postovariectomic frustration in HRT application. No recurrences of CC were observed in this group of patients. HRT side effects were extremely rare. HRT can effectively cure climacteric symptoms in women with surgical menopause induced by CC treatment.

The state of estrogen-dependent organs of women with surgical menopause and hormone replacement therapy

The research aims at studying the dynamics and character o f disorders in the target-organs and appraisingthe quality оf life in women with surgical menopause (SM ) on the background o f hormonal replacement therapy (HRT).Application o f Femoston as the preferable preparation was determined by functional state оf estrogen-dependent organs (cardiovascular system, bone tissue, and mamma) and accompanying extragenital diseases.Hormonal replacement therapy effectively reduces early climacterics disorders connected with menopause and promotes prophylaxis o f late complications o f menopause development (cardiovascular disease and osteoporosis). Femoston is the preparation o f choice fo r women with surgical menopause as it exerts minimum influence on the metabolism and doesnt have anabolic or glucocorticoid effects.

The effectiveness of the drug Divigel in patients with surgical menopause

Twenty women with surgical menopause aged40-50years received parenteral hormonal replacement therapy with estradiol (preparation Divigel) for the period of 12 months. Twenty healthy women formed the control group. The following indeces were estimated during the study: menopausal Kuppermans index, and the leveloffollicle-stimulatinghormone and estradiol in blood serum. Kuppermans index remarkably decreased in the course of treatment (p0,05). Decrease of FSH level was associated with stable growth of estradiol level (p0,05). The absence of manifested side effects and considerable change of body build index, the possibility of choosingthe minimal effective doze individually allow to apply HRT with Divigel more widely.

Surgical menopause: A toolkit for healthcare professionals

Surgical menopause (bilateral oophorectomy) is commonly undertaken during a hysterectomy to treat various medical conditions. Menopausal symptoms can be particularly severe due to the sudden loss of ovarian function. This clinical toolkit is intended to guide healthcare professionals caring for women undergoing surgical menopause. Women commonly experience vasomotor symptoms, sexual dysfunction and an increased risk of cardiovascular and osteoporotic disease. Compared with a natural menopause, loss of libido can be more pronounced following a surgical menopause. Hormone Replacement Therapy (HRT) plays a significant role in managing surgical menopause, especially in women aged under 45 years old. All women undergoing surgical menopause should have adequate counselling regarding the hormonal consequences of surgery and the role of HRT with a view to provide individualised, patient-centred care.