Hormone replacement therapy in young women with karyotypically normal spontaneous premature ovarian failure [protocol]

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Hormone replacement therapy in young women with karyotypically normal spontaneous premature ovarian failure [protocol]"

Transcription

1 Página 1 de 7 Hormone replacement therapy in young women with karyotypically normal spontaneous premature ovarian failure [protocol] Kalantaridou SN, Calis KA, Nelson LM. This protocol should be cited as: Kalantaridou SN, Calis KA, Nelson LM.. Hormone replacement therapy in young women with karyotypically normal spontaneous premature ovarian failure (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 2, Oxford: Update Software. Background Present menopausal hormone replacement therapy regimens were designed for women who experience ovarian failure (normal menopause) around age 50. Postmenopausal women who take hormone replacement therapy prolong their exposure to estrogen beyond the average age of completion of their reproductive phase. At least 1% of women, however, experience premature ovarian failure before the age of 40, and optimal hormone replacement therapy regimens should be established for these younger women (Coulam 1986). For example, compared with normal postmenopausal women, women with premature ovarian failure need higher doses of estrogen to control menopausal symptoms. A prospective, randomised, controlled study showed that estrogen replacement therapy prevents bone loss in postmenopausal women (PEPI trial 1996). Furthermore, a prospective cohort study and a case-control study have shown that estrogen replacement decreases the risk for fractures in postmenopausal women (Cauley 1995; Michaelsson 1998). Nonetheless, in a small study, the recognized bone-sparing dose of mg of conjugated estrogen (Lindsay 1984) failed to prevent vertebral bone loss in premenopausal women made estrogen-deficient by gonadotropin-releasing hormone agonist therapy (Sugimoto 1993). Also, available evidence suggests that the usual menopausal hormone replacement therapy is not adequate to protect young women with premature ovarian failure from developing osteoporosis (Anasti 1998). Two-thirds of women with premature ovarian failure have femoral neck bone mineral density more than one standard deviation below the mean of similar age women with normal ovarian function, despite taking estrogen replacement therapy (Anasti 1998). Also, a prospective study has shown (Cummings 1993) that a femoral neck bone mineral density more than one standard deviation below the mean of age-matched controls predicts a 2.6-fold increased risk of hip fracture. The findings of these two studies suggest that two-thirds of women with premature ovarian failure may be at increased risk for hip fracture despite taking estrogen replacement. Premature ovarian failure is a condition that causes amenorrhea, elevated gonadotropins, hypoestrogenemia (Kalantaridou 1998) and hypoandrogenemia (Bermudez 1993). Young women can experience ovarian failure by several mechanisms, including karyotypic abnormalities, autoimmunity, radiation or chemotherapy, and surgical castration. In most cases the cause of premature ovarian failure is unknown (karyotypically normal spontaneous premature ovarian failure). Women with premature ovarian failure are at higher risk for cardiovascular disease compared to naturally menopausal women (Van der Schouw 1996; Jacobsen 1997). Also, women with premature ovarian failure have a nearly twofold agespecific increase in mortality rate compared to naturally menopausal women (Snowdon 1989; Cooper 1998). The aim of this review is to evaluate evidence from randomised controlled trials, if any, that hormone replacement (estrogen/progestin, estrogen/androgen/progestin or other types of hormone replacement strategies, such as for example tibolone) can maintain bone mass of women with spontaneous premature ovarian failure.

2 Página 2 de 7 Objectives To investigate whether the use of hormone replacement therapy can restore bone mass in young women with premature ovarian failure. We will test the hypothesis that "hormone replacement therapy (estrogen/progestin, estrogen/androgen/progestin or other types of hormone replacement strategies, such as for example tibolone) maintains bone of women with spontaneous premature ovarian failure. Secondary hypotheses will include: "hormone replacement therapy (estrogen/progestin, estrogen/androgen/progestin or other types of hormone replacement strategies, such as for example tibolone) can: 1) treat symptoms of sex steroid deficiency (such as hot flashes, night sweats, dyspareunia, e.t.c.), 2) decrease heart disease risk factors, 3) restore sexual function, and 4) restore cognitive function in women with premature ovarian failure". Criteria for considering studies for this review Types of studies Randomised controlled studies will be considered for inclusion in this review if they evaluate the effect of hormone replacement on bone mineral density and/or fractures of women with spontaneous premature ovarian failure. Only double blind randomised controlled studies will be considered suitable for inclusion. Randomised controlled studies evaluating the effect of hormone replacement on symptoms of sex steroid deficiency, heart disease risk factors, sexual or cognitive function in young women with premature ovarian failure will be considered as well. Types of participants Women with spontaneous premature ovarian failure and normal chromosomes receiving hormone replacement therapy. Criteria for karyotypically normal spontaneous premature ovarian failure: 1. Age > 18 and < 40 years 2. Two FSH levels > 40 miu/ml (at least one month apart) 3. Amenorrhea for at least four months 4. No evidence of genetic, metabolic, toxic, or iatrogenic cause of the ovarian failure Types of intervention Randomised controlled studies investigating the effect of hormone replacement (estrogen/progestin/androgen, or other types of hormone replacement strategies, such as for example tibolone; administered by all routes, i.e. orally and/or parenterally) on bone mineral density and/or fractures of women with premature ovarian failure will be considered suitable for inclusion in this review. All the randomised controlled studies with bone densitometry (measured by DEXA, DPA, etc) will be included. Studies investigating the effect of hormone replacement on symptoms of sex steroid deficiency, heart disease risk factors, cognitive or sexual function will be considered as well. One year should be the minimum length of the trials. Groups to be compared: 1. women with spontaneous premature ovarian failure receiving estrogen/progestin (or other types of hormone replacement strategies, such as for example tibolone)

3 Página 3 de 7 replacement compared with women with spontaneous premature ovarian failure receiving estrogen/androgen/progestin replacement 2. women with premature ovarian failure receiving estrogen/progestin (or other types of hormone replacement strategies, such as for example tibolone) replacement compared with women premature ovarian failure receiving placebo (or no treatment) 3. women with premature ovarian failure receiving estrogen/androgen/progestin replacement compared with women with premature ovarian failure receiving placebo (or no treatment). Types of outcome measures Studies will be considered suitable for inclusion in this review if they evaluate any of the following outcome measures in women with spontaneous premature ovarian failure receiving hormone replacement: Spinal bone mineral density (L2-4) and/or hip bone mineral density (femoral neck, trochanter, Ward's triangle, total hip) Vertebral and/or hip fracture rates Symptoms of sex-steroid deficiency (such as hot flashes, night sweats, dyspareunia), Heart disease risk factors (i.e. total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, body composition) Sexual and cognitive function In addition, any other outcome assessed in the trials will be considered as well. Search strategy for identification of studies The literature search will be limited initially to those studies reported in English. Trials reported in a foreign language will be sought over time as resources permit. All publications which describe randomised, controlled trials investigating the effect of hormone replacement on bone mineral density, symptoms of sex-steroid deficiency, heart disease risk factors, sexual and cognitive function of women with premature ovarian failure will be obtained using the search strategy developed by the Menstrual Disorders and Subfertility Group for MEDLINE and handsearching of specialist journals and examination of review articles (see Review Group details for more information). The reviewers will also search the electronic database EMBASE. In addition, the following terms and variations of these terms will be included: premature ovarian failure premature menopause hormone replacement therapy estrogens progestogens androgens tibolone Reference lists of included and excluded studies will be inspected. Investigators conducting randomised controlled trials examining the safety and efficacy of hormone replacement therapy in women with premature ovarian failure will be contacted to obtain study data and details of subsequent journal publication. Methods of the review The selection of trials for inclusion in the review will be undertaken by two reviewers (SNK and KAC) employing the search strategy described above. A third reviewer (LMN) will assess any trials where there will be uncertainty regarding eligibility. All the reviewers are experienced in clinical issues.

4 Página 4 de 7 An assessment of the quality of trials and data extraction will be performed independently by the three reviewers (SNK, KAC, LMN) using forms designed according to the Cochrane guidelines. Any discrepancies will be resolved by discussion. When necessary, additional information on trial methodology or actual original data will be sought from the principal author of any trials that appear to meet the eligibility criteria. Included trials will be analysed for the following quality criteria and methodological details: a) Method of randomizations; blinding; number of patients randomised, excluded, or lost to follow up; reporting of the outcome of all the women enrolled and whether the trial was single or multicentered; the presence of power calculation; duration of the study; sources of any funding. b) Information on the trial participants included age, number of years since the development of ovarian failure, exclusion criteria. c) Interventions used: types of therapeutic agent used, dose, duration, and timing of administration of therapeutic agents used. d) Outcomes: 1. Outcomes relevant to this analysis (e.g. changes in bone mineral density, changes in total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, body composition, sexual and cognitive function). Bone mineral density is the principal outcome measure. 2. Primary outcomes of the trial, which may differ from the outcomes relevant to this analysis 3. Adverse effects due to hormone replacement therapy will be recorded (such as endometrial hyperplasia and breast cancer). Major quality criteria will be given a ranking to enable sensitivity analyses. Results from trials using estrogen/progestin, estrogen/androgen/progestin, tibolone will be analysed separately. Dosages will be broken down for analysis as well. Sensitivity analysis will be performed according to randomizations quality, control group comparison (either placebo or no treatment), equality at baseline, rate of withdrawal and losses to follow-up, intention to treat analysis, and length of treatment period. Statistical analysis will be performed in accordance with the guidelines for statistical analysis developed by the Menstrual Disorders and Subfertility Group as it applies to continuous outcomes. Heterogeneity between the results of different studies will be examined by inspecting the scatter in data points and the overlap in their confidence intervals and by checking the results of the chi-squared tests. If the randomised controlled studies have different length of therapy, subgroup analysis will be performed. We will combine placebo- and no-treatment studies. These studies will be analysed separately as subgroups. This review will include eligible trials that are retrievable as of April Subsequent eligible trials will be included in an update of this review. Acknowledgements Potential conflict of interest None known References Additional references

5 Página 5 de 7 Anasti 1998 Anasti JN, Kalantaridou SN, Kimzey LM, Defensor RA, Nelson LM. Bone loss in young women with karyotypically normal spontaneous premature ovarian failure. Obstetrics and Gynecology 1998;91:12-5. Bermudez 1993 Bermudez JA, Moran C, Herrera J, Barahona E, Perez MC, Zarate A. Determination of the steroidogenic capacity in premature ovarian failure. Fertility and Sterility 1993;60: Cauley 1995 Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings SR. Estrogen replacement therapy and fractures in older women. Study of osteoporotic fractures research group. Annals of Internal Medicine 1995;122:9-16. Cooper 1998 Cooper GS, Sandler DP. Age at natural menopause and mortality. Annals of Epidemiology 1998;8: Coulam 1986 Coulam CB, Adamson SC, Annegers JF. Incidence of premature ovarian failure. Obstetrics and Gynecology 1986;67: Cummings 1993 Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993;341:72-5. Jacobsen 1997 Jacobsen BK, Nilssen S, Heuch I, Kvale G. Does age at natural menopause affect mortality from ischemic heart disease?. Journal of Clinical Epidemiology 1997;50: Kalantaridou 1998 Kalantaridou SN, Davis SR, Nelson LM. Premature ovarian failure. Endocrinology and Metabolism Clinics of North America 1998;27: Lindsay 1984 Lindsay R, Hart DM, Clark DM. The minimum effective dose of estrogen for prevention of postmenopausal bone loss. Obstetrics and Gynecology 1984;63: Michaelsson 1998 Michaelsson K, Baron JA, Farahmand BY, Johnell O, Magnusson C, Persson PG, Persson I, Ljunghall S. Hormone replacement therapy and risk of hip fracture:

6 Página 6 de 7 population based case control study. The Swedish Hip Fracture Study Group. British Medical Journal 1998;316: PEPI trial 1996 The Writing Group for the PEPI trial. Effects of hormone therapy on bone mineral density. Results from the postmenopausal estrogen/progestin interventions (PEPI) Trial. The Journal of the American Medical Association 1996;276: Snowdon 1989 Snowdon DA, Kane RL, Beeson WL, Burke GL, Sprafka JM, Potter J, Iso H, Jacobs DR Jr, Phillips RL. Is natural menopause a biologic marker of health and aging?. American Journal of Public Health 1989;79: Sugimoto 1993 Sugimoto AK, Hodsman AB, Nisker JA. Long-term gonadotropin-releasing hormone agonist with standard postmenopausal estrogen replacement failed to prevent vertebral bone loss in premenopausal women. Fertility and Sterility 1993;60: Van der Schouw 1996 Van der Schouw YT, Van der Graaf Y, Steyerberg EW, Eijkemans MJC, Banga JD. Age at menopause as a risk for cardiovascular mortality. Lancet 1996;347: Cover sheet Hormone replacement therapy in young women with karyotypically normal spontaneous premature ovarian failure Reviewer(s) Contribution of Reviewer(s) Kalantaridou SN, Calis KA, Nelson LM. Sophia N. Kalantaridou: Took the lead in writing the protocol, developed objectives, selection criteria, methods and background. Karim A. Calis: Contributed to background section. Developed and performed search strategy. Lawrence M. Nelson: Conceptualised and edited the protocol. Issue protocol first published Date of last minor amendment Date of last substantive amendment Most recent changes 2001 issue 4 Information not supplied by reviewer 05 August 2001 Information not supplied by reviewer

7 Página 7 de 7 Review expected to be published in: Contact address Cochrane Library number Editorial group Editorial group code Issue 4, 2003 Ms Sophia Kalantaridou Kosti Palama 3 Ioannini GREECE 5042 Telephone: Facsimile: CD Cochrane Menstrual Disorders and Subfertility Group MENSTR

Menopause and HRT. John Smiddy and Alistair Ledsam

Menopause and HRT. John Smiddy and Alistair Ledsam Menopause and HRT John Smiddy and Alistair Ledsam Menopause The cessation of menstruation Diagnosed retrospectively after 1 year of amenorrhoea Average age 51 in the UK Normal physiology - Menstruation

More information

CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology

CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology A 49-year-old woman complains of irregular menses over the past 6 months, feelings of inadequacy, vaginal dryness, difficulty sleeping, and episodes

More information

06-Mar-17. Premature menopause. Menopause. Premature menopause. Menstrual cycle oestradiol. Premature menopause. Prevalence ~1% Higher incidence:

06-Mar-17. Premature menopause. Menopause. Premature menopause. Menstrual cycle oestradiol. Premature menopause. Prevalence ~1% Higher incidence: Menopause Dr Sonia Davison MBBS FRACP PhD Endocrinologist and Clinical Fellow, Jean Hailes for Women s Health Women s Health Research Program, Monash University = the last natural menstrual period depletion

More information

Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals

Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals Hormones and Healthy Bones Joint Project of National Osteoporosis Foundation and Association of Reproductive Health Professionals Literature Review (January 2009) Hormone Therapy for Women Women's Health

More information

Premature Ovarian Failure: Is there a role for steroids? A randomized, double-blind, placebo-controlled trial.

Premature Ovarian Failure: Is there a role for steroids? A randomized, double-blind, placebo-controlled trial. Premature Ovarian Failure: Is there a role for steroids? A randomized, double-blind, placebo-controlled trial. Rebecca Fenichel A. Study Purpose and Rationale Premature ovarian failure is a condition causing

More information

Pharmacy Management Drug Policy

Pharmacy Management Drug Policy SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 9/29/2017 If the member s subscriber contract excludes coverage

More information

Integrated care: guidance on fracture prevention in cancer-associated bone disease; treatment options

Integrated care: guidance on fracture prevention in cancer-associated bone disease; treatment options Paris, November 1st 2016 Integrated care: guidance on fracture prevention in cancer-associated bone disease; treatment options René Rizzoli MD International Osteoporosis Foundation and Division of Bone

More information

Hormone Treatments and the Risk of Breast Cancer

Hormone Treatments and the Risk of Breast Cancer Cornell University Program on Breast Cancer and Environmental Risk Factors in New York State (BCERF) Updated July 2002 Hormone Treatments and the Risk of Breast Cancer 1) Hormone Treatment After Menopause

More information

The British Menopause Society and Women s Health Concern recommendations on the management of women with premature ovarian insufficiency

The British Menopause Society and Women s Health Concern recommendations on the management of women with premature ovarian insufficiency Review The British Menopause Society and Women s Health Concern recommendations on the management of women with premature ovarian insufficiency Post Reproductive Health 2017, Vol. 23(1) 22 35! The Author(s)

More information

This includes bone loss, endometrial cancer, and vasomotor symptoms.

This includes bone loss, endometrial cancer, and vasomotor symptoms. Hello and welcome. My name is Chad Barnett. I m a Clinical Pharmacy Specialist in the Division of Pharmacy at the University of Texas, MD Anderson Cancer Center and I m very pleased today to be able to

More information

Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis

Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis Oral Alendronate Vs. Three-Monthly Iv Ibandronate In The Treatment Of Postmenopausal Osteoporosis Miriam Silverberg A. Study Purpose and Rationale More than 70% of fractures in people after the age of

More information

Use of Low Potency Estrogens Does Not Reduce the Risk of Hip Fracture

Use of Low Potency Estrogens Does Not Reduce the Risk of Hip Fracture Bone Vol. 30, No. 4 April 2002:613 618 Use of Low Potency Estrogens Does Not Reduce the Risk of Hip Fracture K. MICHAËLSSON, 1 J. A. BARON, 2 B. Y. FARAHMAND 3 and S. LJUNGHALL 4 1 Department of Orthopaedics,

More information

Hormonal Control of Human Reproduction

Hormonal Control of Human Reproduction Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with

More information

Serum estrogen level after hormone replacement therapy and body mass index in postmenopausal and bilaterally ovariectomized women

Serum estrogen level after hormone replacement therapy and body mass index in postmenopausal and bilaterally ovariectomized women Maturitas 50 (2005) 19 29 Serum estrogen level after hormone replacement therapy and body mass index in postmenopausal and bilaterally ovariectomized women Toshiyuki Yasui a,, Hirokazu Uemura a, Yuka Umino

More information

Outline. Estrogens and SERMS The forgotten few! How Does Estrogen Work in Bone? Its Complex!!! 6/14/2013

Outline. Estrogens and SERMS The forgotten few! How Does Estrogen Work in Bone? Its Complex!!! 6/14/2013 Outline Estrogens and SERMS The forgotten few! Clifford J Rosen MD rosenc@mmc.org Physiology of Estrogen and estrogen receptors Actions of estrogen on bone BMD, fracture, other off target effects Cohort

More information

Research. Breast cancer represents a major

Research. Breast cancer represents a major Research GENERAL GYNECOLOGY Gynecologic conditions in participants in the NSABP breast cancer prevention study of tamoxifen and raloxifene (STAR) Carolyn D. Runowicz, MD; Joseph P. Costantino, DrPH; D.

More information

THE RISE AND FALL OF MENOPAUSAL HORMONE THERAPY

THE RISE AND FALL OF MENOPAUSAL HORMONE THERAPY Annu. Rev. Public Health 2005. 26:115 40 doi: 10.1146/annurev.publhealth.26.021304.144637 Copyright c 2005 by Annual Reviews. All rights reserved THE RISE AND FALL OF MENOPAUSAL HORMONE THERAPY Elizabeth

More information

Appendix: Reference Table of HT Brand Names

Appendix: Reference Table of HT Brand Names Appendix: Reference Table of HT Brand Names This is a full reference table in alphabetical order, of Brand Name drugs used in HT. It is the basis for prescription advice throughout this handbook. Drug

More information

ORIGINAL INVESTIGATION

ORIGINAL INVESTIGATION Parathyroid Hormone for Treatment of Osteoporosis Carolyn Crandall, MD ORIGINAL INVESTIGATION Background: Osteoporosis is a common condition associated with multiple deleterious consequences. No therapy

More information

PROSPECTIVE STUDIES HAVE

PROSPECTIVE STUDIES HAVE ORIGINAL CONTRIBUTION Serum Estradiol Level and Risk of Breast Cancer During Treatment With Steven R. Cummings, MD Tu Duong, MA Emily Kenyon, PhD Jane A. Cauley, DrPH Malcolm Whitehead, MB,BS, FRCOG Kathryn

More information

2. The effectiveness of combined androgen blockade versus monotherapy.

2. The effectiveness of combined androgen blockade versus monotherapy. Relative effectiveness and cost-effectiveness of methods of androgen suppression in the treatment of advanced prostate cancer Blue Cross and Blue Shield Association, Aronson N, Seidenfeld J Authors' objectives

More information

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist

Use of DXA / Bone Density in the Care of Your Patients. Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Use of DXA / Bone Density in the Care of Your Patients Brenda Lee Holbert, M.D. Associate Professor Senior Staff Radiologist Important Websites Resources for Clinicians and Patients www.nof.org www.iofbonehealth.org

More information

Setting The setting was secondary care. The economic study was carried out in Sweden.

Setting The setting was secondary care. The economic study was carried out in Sweden. Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study Borgstrom F, Johnell O, Kanis J A, Oden A, Sykes D, Jonsson B Record Status This

More information

Asmall number of studies have examined

Asmall number of studies have examined Appendix B: Evidence on Hormone Replacement Therapy and Fractures B Asmall number of studies have examined directly the relationship between use of hormonal replacement therapy and risk of hip fracture

More information

Clinical Practice. Presented by: Internist, Endocrinologist

Clinical Practice. Presented by: Internist, Endocrinologist Clinical Practice Management of Osteoporosis Presented by: SaeedBehradmanesh, h MD Internist, Endocrinologist Iran, Isfahan, Feb. 2017 Definition: A disease characterized by low bone mass and microarchitectural

More information

Medical Director Update

Medical Director Update Medical Director Update Articles: Bone Density Test Can Predict Fractures Over Twenty-Five Years Community Awareness Bone Density Testing Program: 18 Months Experience More Attention Should Be Paid To

More information

Year: Issue 1 Obs/Gyne The silent epidemic: Postmenopausal vaginal atrophy

Year: Issue 1 Obs/Gyne The silent epidemic: Postmenopausal vaginal atrophy Year: 2013 - Issue 1 Obs/Gyne The silent epidemic: Postmenopausal vaginal atrophy By: Dr David W Sturdee, Immediate past President International Menopause Society and Hon Consultant Gynaecologist, Solihull

More information

International Journal of Advanced Research in Biological Sciences ISSN : Research Article

International Journal of Advanced Research in Biological Sciences ISSN : Research Article Int. J. Adv. Res. Biol.Sci. 1(7): (2014): 167 172 International Journal of Advanced Research in Biological Sciences ISSN : 2348-8069 www.ijarbs.com Research Article Beneficial effect of Strontium Ranelate

More information

The Better Health News2

The Better Health News2 October, 2016 Volume11, Issue 10 The Better Health News2 Special Interest Articles: Menopause and Bioflavonoids Osteoporosis and Exercise Bone Health: More than Calcium & Vitamin D Flax Seeds and Menopause

More information

TAS-108: A Novel Steroidal Anti-Estrogen for Treatment of Breast Cancer

TAS-108: A Novel Steroidal Anti-Estrogen for Treatment of Breast Cancer SRI Biosciences TAS-108: A Novel Steroidal Anti-Estrogen for Treatment of Breast Cancer Potential Indications Neo-adjuvant therapy for ER + primary breast cancers in premenopausal women Adjuvant therapy

More information

North American Menopause Society (NAMS)

North American Menopause Society (NAMS) North American Menopause Society (NAMS) 2012 Hormone Therapy Position Statement Cynthia B. Evans, MD Assistant Professor-Clinical Department of Obstetrics and Gynecology The Ohio State University College

More information

POSITION PAPER FOR HEALTH CARE PROVIDERS Use of Pharmacologic Intervention for Breast Cancer Risk Reduction

POSITION PAPER FOR HEALTH CARE PROVIDERS Use of Pharmacologic Intervention for Breast Cancer Risk Reduction P.O. Box 30195 Lansing, MI 48909 Phone: 877-588-6224 FAX: 517-335-9397 www.michigancancer.org Introduction POSITION PAPER FOR HEALTH CARE PROVIDERS Use of Pharmacologic Intervention for Breast Cancer Risk

More information

American Journal of Internal Medicine

American Journal of Internal Medicine American Journal of Internal Medicine 2016; 4(3): 49-59 http://www.sciencepublishinggroup.com/j/ajim doi: 10.11648/j.ajim.20160403.12 ISSN: 2330-4316 (Print); ISSN: 2330-4324 (Online) The Effect of Dose-Reduced

More information

RALOXIFENE Generic Brand HICL GCN Exception/Other RALOXIFENE EVISTA Is the request for the prevention (risk reduction) of breast cancer?

RALOXIFENE Generic Brand HICL GCN Exception/Other RALOXIFENE EVISTA Is the request for the prevention (risk reduction) of breast cancer? Generic Brand HICL GCN Exception/Other RALOXIFENE EVISTA 16917 GUIDELINES FOR USE 1. Is the request for the prevention (risk reduction) of breast cancer? If yes, continue to #2. If no, approve by HICL

More information

25 mg oestradiol implants--the dosage of first choice for subcutaneous oestrogen replacement therapy?

25 mg oestradiol implants--the dosage of first choice for subcutaneous oestrogen replacement therapy? Research Subcutaneous estrogen replacement therapy. Jones SC. Journal of Reproductive Medicine March, 2004; 49(3):139-142. Department of Obstetrics and Gynecology, Keesler Medical Center, Keesler Air Force

More information

Reproductive Health and Pituitary Disease

Reproductive Health and Pituitary Disease Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives

More information

Menopause: diagnosis and management NICE guideline NG23. Published November 2015

Menopause: diagnosis and management NICE guideline NG23. Published November 2015 Menopause: diagnosis and management NICE guideline NG23 Published November 2015 1 Full title: Menopause : diagnosis and management Available at: http://www.nice.org.uk/guidance/ng23 Guideline published

More information

This house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against

This house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against This house believes that HRT should be the first-line prevention for postmenopausal osteoporosis: the case against Juliet Compston Professor of Bone Medicine University of Cambridge School of Clinical

More information

What s New in Menopause Management. Objectives

What s New in Menopause Management. Objectives What s New in Menopause Management Leslee L. Subak, MD Professor of Obstetrics, Gynecology & Reproductive Science University of California, San Francisco Objectives Define the menopause transition Review

More information

Name of Policy: Boniva (Ibandronate Sodium) Infusion

Name of Policy: Boniva (Ibandronate Sodium) Infusion Name of Policy: Boniva (Ibandronate Sodium) Infusion Policy #: 266 Latest Review Date: April 2010 Category: Pharmacology Policy Grade: Active Policy but no longer scheduled for regular literature reviews

More information

5. Summary of Data Reported and Evaluation

5. Summary of Data Reported and Evaluation 326 5. Summary of Data Reported and Evaluation 5.1 Exposure data Combined estrogen progestogen menopausal therapy involves the co-administration of an estrogen and a progestogen to peri- or postmenopausal

More information

lactotrophs 120 min- FSH 60 min- LH Hypothalamus GnRH pituitary Estradiol +/- Progesterone _ FSH L H Ovary Uterus Ovulation Antral follicle >2mm

lactotrophs 120 min- FSH 60 min- LH Hypothalamus GnRH pituitary Estradiol +/- Progesterone _ FSH L H Ovary Uterus Ovulation Antral follicle >2mm lactotrophs Hypothalamus GnRH 120 min- 60 min- LH Progesterone _ pituitary L H + Ovary + Estradiol +/- Uterus Antral follicle >2mm Ovulation Preovulatory follicles atresia Follicular phase Luteal phase

More information

Study Of Letrozole Extension. Coordinating Group IBCSG IBCSG BIG 1-07

Study Of Letrozole Extension. Coordinating Group IBCSG IBCSG BIG 1-07 tudy Of Letrozole Extension Coordinating Group IBCSG IBCSG 35-07 BIG 1-07 A phase III trial evaluating the role of continuous letrozole versus intermittent letrozole following 4 to 6 years of prior adjuvant

More information

Low Back Pain Accompanying Osteoporosis

Low Back Pain Accompanying Osteoporosis Low Back Pains Low Back Pain Accompanying Osteoporosis JMAJ 46(10): 445 451, 2003 Toshitaka NAKAMURA Professor, Department of Orthopedic Surgery, University of Occupational and Environmental Health Abstract:

More information

Hot Topics in Bone Disease in 2017: Building Better Bones Breaking News in Osteoporosis

Hot Topics in Bone Disease in 2017: Building Better Bones Breaking News in Osteoporosis Hot Topics in Bone Disease in 2017: Building Better Bones Breaking News in Osteoporosis Aromatase Inhibitor-Induced Bone Loss in Early Breast Cancer Rachel Pessah-Pollack, M.D., F.A.C.E. Mount Sinai School

More information

Hormone therapy. Dr. med. Frank Luzuy

Hormone therapy. Dr. med. Frank Luzuy Hormone therapy Dr. med. Frank Luzuy Reasons for Initiating/Continuing HT* Menopause-Related Symptoms Osteoporosis, Bone Loss, Fracture Prevention Doctor Prescribed It, Told Me to Take It Cardiovascular

More information

Overview of Reproductive Endocrinology

Overview of Reproductive Endocrinology Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,

More information

Based on review of available data, the Company may consider the use of denosumab (Prolia) for the

Based on review of available data, the Company may consider the use of denosumab (Prolia) for the Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

denosumab (Prolia ) Policy # Original Effective Date: 07/21/2011 Current Effective Date: 04/19/2017

denosumab (Prolia ) Policy # Original Effective Date: 07/21/2011 Current Effective Date: 04/19/2017 Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium anastrozole 1mg tablets (Arimidex ) No. (198/05) AstraZeneca UK Ltd New indication: for adjuvant treatment of postmenopausal women with hormone receptorpositive early invasive

More information

Diagnosis of Vertebral Fractures by Vertebral Fracture Assessment

Diagnosis of Vertebral Fractures by Vertebral Fracture Assessment Journal of Clinical Densitometry, vol. 9, no. 1, 66 71, 2006 Ó Copyright 2006 by The International Society for Clinical Densitometry 1094-6950/06/9:66 71/$32.00 DOI: 10.1016/j.jocd.2005.11.002 Original

More information

Update from the 25th Annual San Antonio Breast Cancer Symposium December 11 14, 2002

Update from the 25th Annual San Antonio Breast Cancer Symposium December 11 14, 2002 Update from the 25th Annual San Antonio Breast Cancer Symposium December 11 14, 2002 Nearly 5,000 physicians, oncologists, radiologists, epidemiologists, basic scientists, and breast cancer advocates from

More information

HRT & Menopause Where Do We Stand Now?

HRT & Menopause Where Do We Stand Now? HRT & Menopause Where Do We Stand Now? Mrs. SY Hussain Consultant Gynaecologist The Holly Private Hospital Spire Roding Hospital The Wellington Hospital Discussion Points Discuss Recommendations made by

More information

SCIENTOMETRIC ANALYSIS OF ARTICLES CONTRIBUTIONS TO WEB OF SCIENCE ON UTERUS CANCER

SCIENTOMETRIC ANALYSIS OF ARTICLES CONTRIBUTIONS TO WEB OF SCIENCE ON UTERUS CANCER International Journal of Library & Information Science (IJLIS) Volume 5, Issue 2, May Aug 2016, pp. 57 70, Article ID: IJLIS_05_02_007 Available online at http://www.iaeme.com/ijlis/issues.asp?jtype=ijlis&vtype=5&itype=2

More information

Management of Perimenopausal symptoms

Management of Perimenopausal symptoms Management of Perimenopausal symptoms Serge Rozenberg CHU St Pierre Université libre de Bruxelles Belgium serge_rozenberg@stpierre-bru.be serge.rozenberg@skynet.be Conflict of interest & Disclosure Conflicts

More information

Growth Hormone plus Childhood Low- Dose Estrogen in Turner s Syndrome. N Engl J Med 2011;364: Present by R5 郭恬妮

Growth Hormone plus Childhood Low- Dose Estrogen in Turner s Syndrome. N Engl J Med 2011;364: Present by R5 郭恬妮 Growth Hormone plus Childhood Low- Dose Estrogen in Turner s Syndrome N Engl J Med 2011;364:1230-42. Present by R5 郭恬妮 Introduction Turner s syndrome : partial or complete X-chromosome monosomy, 1 in 2000

More information

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster DOI 10.1007/s00296-012-2460-y ORIGINAL ARTICLE Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security

More information

Does Black Cohosh Improve Anxiety/Depression Symptoms in Women Who Are Postmenopausal?

Does Black Cohosh Improve Anxiety/Depression Symptoms in Women Who Are Postmenopausal? Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 Does Black Cohosh Improve Anxiety/Depression

More information

NON-ADHERENCE TO ADJUVANT HORMONAL TREATMENT IN EARLY BREAST CANCER

NON-ADHERENCE TO ADJUVANT HORMONAL TREATMENT IN EARLY BREAST CANCER NON-ADHERENCE TO ADJUVANT HORMONAL TREATMENT IN EARLY BREAST CANCER C. Volovat 1, C. Lupascu 2, Simona-Ruxandra Volovat 1, E. Zbranca 3 1. Center of Medical Oncology Iasi 2. I. Tanasescu Vl. Butureanu

More information

How long should we treat primary osteoporosis?

How long should we treat primary osteoporosis? Earn 3 CPD Points online Current Osteoporosis management With a FOCUS on ideal length of treatment and considerations in the use of menopausal hormone therapy for fracture prevention Dr Tobie De Villiers

More information

22/09/2014. Menopause Management. Menopause. Menopause symptoms

22/09/2014. Menopause Management. Menopause. Menopause symptoms Menopause Management Dr Sonia Davison Jean Hailes for Women s Health Menopause Time of last menstrual period - average age 51 Premature Menopause: occurs before age 40 Perimenopause (menopause transition):

More information

Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India

Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India International Journal of Public Health Science (IJPHS) Vol.3, No.4, December 2014, pp. 276 ~ 280 ISSN: 2252-8806 276 Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India

More information

Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence

Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence 2.1 BMI and Breast Cancer Risk BMI is routinely used to qualify an individual s adiposity, yet it is simply a measure

More information

Hysterectomy with Preservation of both Ovaries does not Result in Premature Ovarian Failure

Hysterectomy with Preservation of both Ovaries does not Result in Premature Ovarian Failure The Journal of International Medical Research 2007; 35: 416 421 Hysterectomy with Preservation of both Ovaries does not Result in Premature Ovarian Failure V ATAY 1, T CEYHAN 2, İ BASER 2, S GUNGOR 2,

More information

HORMONES AND YOUR HEALTH Charlie Tucker Pharm. D

HORMONES AND YOUR HEALTH Charlie Tucker Pharm. D HORMONES AND YOUR HEALTH Charlie Tucker Pharm. D All of the hormones in your body are designed to work together. This is God s plan. Therefore, if one is altered, or deficient, it will affect the actions

More information

Review Future possibilities in the prevention of breast cancer Breast cancer prevention trials Jack Cuzick

Review Future possibilities in the prevention of breast cancer Breast cancer prevention trials Jack Cuzick Review Future possibilities in the prevention of breast cancer Breast cancer prevention trials Jack Cuzick Imperial Cancer Research Fund, London, UK Received: 17 December 1999 Accepted: 30 March 2000 Published:

More information

The Significance of Vertebral Fractures

The Significance of Vertebral Fractures Special Report The Significance of Vertebral Fractures Both the prevalence and the clinical significance of vertebral fractures has been greatly underestimated by physicians. Vertebral fractures are much

More information

Evaluation Of The Efficacy And Tolerability Of Micronutrient Supplementation In Treatment Of Post Menopausal Symptoms

Evaluation Of The Efficacy And Tolerability Of Micronutrient Supplementation In Treatment Of Post Menopausal Symptoms 1 of 6 4/24/2012 10:58 AM The Internet Journal of Gynecology and Obstetrics ISSN: 1528-8439 Evaluation Of The Efficacy And Tolerability Of Micronutrient Supplementation In Treatment Of Post Menopausal

More information

Hormone therapy for menopausal vasomotor symptoms

Hormone therapy for menopausal vasomotor symptoms Hormone therapy for menopausal vasomotor symptoms Given our available (better) options for treating hot flashes, can we reduce our use of medroxyprogesterone acetate? OBG Manag. 2014;26(7):10,13 15. Robert

More information

PROSPERO International prospective register of systematic reviews

PROSPERO International prospective register of systematic reviews PROSPERO International prospective register of systematic reviews The effect of probiotics on functional constipation: a systematic review of randomised controlled trials EIRINI DIMIDI, STEPHANOS CHRISTODOULIDES,

More information

Lab Tests Made Simple

Lab Tests Made Simple Body Fluids Commonly Used for Testing Steroid Hormones Blood Serum (venipuncture) Plasma (venipuncture) Capillary Blood (finger/heel stick) Urine Saliva Limitations of Hormone Testing in Different Body

More information

Bioidentical Hormones

Bioidentical Hormones 2014 Bioidentical Hormones Bioidentical Hormones for Menopause-related Vasomotor Symptoms What are menopause-related vasomotor symptoms? Menopause is defined as not menstruating (having your period) for

More information

OSTEOPOROSIS: PREVENTION AND MANAGEMENT

OSTEOPOROSIS: PREVENTION AND MANAGEMENT OSTEOPOROSIS: OVERVIEW OSTEOPOROSIS: PREVENTION AND MANAGEMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Key Risk factors Screening and Monitoring

More information

2017 Position Statement of Hormone Therapy of NAMS: overview SHELAGH LARSON, MS, RNC WHNP, NCMP ACCLAIM, JPS HEALTH NETWORK

2017 Position Statement of Hormone Therapy of NAMS: overview SHELAGH LARSON, MS, RNC WHNP, NCMP ACCLAIM, JPS HEALTH NETWORK 2017 Position Statement of Hormone Therapy of NAMS: overview SHELAGH LARSON, MS, RNC WHNP, NCMP ACCLAIM, JPS HEALTH NETWORK WHI the only large, long-term RCT of HT in women aged 50 to 79 years, Drug trail

More information

Page 1

Page 1 Osteoporosis Osteoporosis is a condition characterised by weakened bones that fracture easily. After menopause many women are at risk of developing osteoporosis. Peak bone mass is usually reached during

More information

Guideline for the investigation and management of osteoporosis. for hospitals and General Practice

Guideline for the investigation and management of osteoporosis. for hospitals and General Practice Guideline for the investigation and management of osteoporosis for hospitals and General Practice Background Low bone density is an important risk factor for fracture. The aim of assessing bone density

More information

Labrix Clinical Services, Inc.

Labrix Clinical Services, Inc. Labrix Clinical Services, Inc. Advantages of Labrix Clinical Services, Inc. We Cater to the Healthcare Practitioner Labrix sample collection tubes are small; only 1 ml of saliva is required from the patient.

More information

Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche. Tecniche di sincronizzazione ovocitaria. La sincronizzazione follicolare

Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche. Tecniche di sincronizzazione ovocitaria. La sincronizzazione follicolare Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche Tecniche di sincronizzazione ovocitaria. La sincronizzazione follicolare Carlo Alviggi The rational of Follicular synchronization

More information

Contractor Number 03201

Contractor Number 03201 Local Coverage Article for Bone Mass Measurements Coverage - 2012 CPT Updates (A51577) Contractor Information Contractor Name Noridian Administrative Services, LLC opens in new window Contractor Number

More information

Cardiovascular Disease Risk: Pre-, Peri-, andpost-menopausal

Cardiovascular Disease Risk: Pre-, Peri-, andpost-menopausal Cardiovascular Disease Risk: Pre-, Peri-, andpost-menopausal JoAnn E. Manson, MD, DrPH, FAHA Chief, Division of Preventive Medicine Brigham and Women's Hospital Professor of Medicine i and dthe Michael

More information

CLINICIAN INTERVIEW CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN

CLINICIAN INTERVIEW CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN Nanette K. Wenger, MD, is a recognized authority on women and coronary heart disease. She chaired the US National Heart, Lung, and Blood Institute conference

More information

The Clinical Case for Smoking Cessation for ORTHOPAEDIC PATIENTS

The Clinical Case for Smoking Cessation for ORTHOPAEDIC PATIENTS The Clinical Case for Smoking Cessation for ORTHOPAEDIC PATIENTS What is this initiative aiming to achieve? The aim of this initiative is to provide clinical support for temporary abstinence with a view

More information

Challenging the Current Osteoporosis Guidelines. Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA

Challenging the Current Osteoporosis Guidelines. Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Challenging the Current Osteoporosis Guidelines Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Whom to screen Which test How to diagnose Whom to treat Benefits

More information

How HRT Hurts the Heart

How HRT Hurts the Heart How HRT Hurts the Heart Coronary artery disease (CAD) is a killer and recent studies have come up with evidence that HRT might have a role in increasing CAD among women. Why? Zaheer Lakhani, MD, FRCP For

More information

John J. Wolf, DO Family Medicine

John J. Wolf, DO Family Medicine John J. Wolf, DO Family Medicine Objectives: 1. Review incidence & Risk of Osteoporosis 2.Review indications for testing 3.Review current pharmacologic & Non pharmacologic Tx options 4.Understand & Utilize

More information

Osteoporosis: fragility fracture risk. Costing report. Implementing NICE guidance

Osteoporosis: fragility fracture risk. Costing report. Implementing NICE guidance Osteoporosis: fragility fracture risk Costing report Implementing NICE guidance August 2012 NICE clinical guideline 146 1 of 15 This costing report accompanies the clinical guideline: Osteoporosis: assessing

More information

Menopause & HRT. Rosie & Alex. Image:

Menopause & HRT. Rosie & Alex. Image: Menopause & HRT Rosie & Alex Image: http://www.keepcalm-o-matic.co.uk/ Menopause The permanent cessation of menstruation for 12 months When does it happen? Average age 51 Image: Nature Medicine - 12, 612-613

More information

Hormone replacement therapy and risk of hip fracture: population based case-control study

Hormone replacement therapy and risk of hip fracture: population based case-control study 21 Rolfe S, Harper NJN. Ability of hospital doctors to calculate drug doses. BMJ 1995;310:1173-4. 22 Stoneham M, Saville GM, Wilson IH. Knowledge about pulse oximetry among medical and nursing staff. Lancet

More information

Osteoporosis is a disease that is

Osteoporosis is a disease that is Pharmacologic Prevention of Osteoporotic Fractures THOMAS M. ZIZIC, M.D., Johns Hopkins University School of Medicine, Baltimore, Maryland Osteoporosis is characterized by low bone mineral density and

More information

Bone Mineral Density and Risk of Breast Cancer

Bone Mineral Density and Risk of Breast Cancer American Journal of Epidemiology Copyright 1998 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol. 148, No. 1 Printed in U.S.A. Bone Mineral Density and Risk of

More information

Featured Topic: Estrogen and DIM (6 slides)

Featured Topic: Estrogen and DIM (6 slides) Featured Topic: Estrogen and DIM (6 slides) Estrogen: Key hormone for women s health Estrogen is best known for its role in controlling the menstrual cycle Estrogen is also important for bones, skin and

More information

HORMONE REPLACEMENT THERAPY

HORMONE REPLACEMENT THERAPY TRIALS OF HR RUTH (Barrett- Connor et al 29 ) JULY 2006 (Country) mean ± sd, range International trial 67.5 an Placebo component in 67.5 ± 6.7 women with Raloxifene or multiple 67.5 ± 6.6 risk factors

More information

Osteoporosis/Fracture Prevention

Osteoporosis/Fracture Prevention Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team

More information

NCCP Chemotherapy Protocol

NCCP Chemotherapy Protocol Letrozole Monotherapy INDICATIONS FOR USE: INDICATION Adjuvant treatment of postmenopausal women with hormone receptor positive invasive early breast cancer. Extended adjuvant treatment of hormone-dependentinvasive

More information

Correlation between Thyroid Function and Bone Mineral Density in Elderly People

Correlation between Thyroid Function and Bone Mineral Density in Elderly People IBBJ Spring 2016, Vol 2, No 2 Original Article Correlation between Thyroid Function and Bone Mineral Density in Elderly People Ali Mirzapour 1, Fatemeh Shahnavazi 2, Ahmad Karkhah 3, Seyed Reza Hosseini

More information

METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 /

METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 / METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 / 2 0 1 8 Prostate Cancer- Statistics Most common cancer in men after a skin

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 21 July 2010

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 21 July 2010 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 21 July 2010 Review of the dossier of the medicinal product included on the list of reimbursable medicines for a period

More information

Female sex steroids and contraceptives agents

Female sex steroids and contraceptives agents Female sex steroids and contraceptives agents Female Sex Hormones Sex hormones produced by the gonads are necessary for conception, embryonic maturation, and development of primary and secondary sexual

More information