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41. Risk factors for breast cancer: A review of the evidence 2018

4.7.12 Diet—foods high in carotenoids 108 4.7.13 Diet—Mediterranean diet 110 4.7.14 Diet—phytoestrogens 112 Breast cancer risk factors: A review of the evidence iv 4.7.15 Diet—glycaemic index 114 4.7.16 Diet—total energy 115 4.7.17 Diet—sugar 117 4.7.18 Diet—fat 118 4.7.19 Diet—processed meat 119 4.7.20 Diet—red meat 121 4.7.21 Environmental tobacco smoke 123 4.7.22 Tobacco smoking 125 4.7.23 Physical activity 127 4.7.24 Shift work disrupting circadian rhythm 130 4.8 Medical factors 133 4.8.1 Aspirin (...) and risk of breast cancer 393 Table D.53 Diet—processed meat and risk of breast cancer 395 Table D.54 Diet—red meat and risk of breast cancer 398 Table D.55 Environmental tobacco smoke and risk of breast cancer 401 Table D.56 Tobacco smoking and risk of breast cancer 405 Table D.57 Physical activity and risk of breast cancer 409 Table D.58 Shift work disrupting circadian rhythm and risk of breast cancer 415 Table D.59 Aspirin and risk of breast cancer 420 Table D.60 Cardiac glycosides and risk

2018 Cancer Australia

42. Aromatase Inhibitors in Gynecologic Practice

of thrombosis, endometrial cancer, andvaginalbleeding.Forwomenwithpolycysticovarysyndrome,andabodymassindexgreaterthan30,letrozole should be considered first-line therapy for ovulation induction because of the increased live birth rate compared with clomiphene citrate. Lifestyle changes that result in weight loss should be strongly encouraged. Aromatase inhibitorsareapromisingtherapeuticoptionthatmaybehelpfulforthemanagementofendometriosis-associated pain in combination therapy with progestins (...) that ovulationinductionwithletrozoleresulted inlowerlive birth rates and multiple gestation rates compared with gonadotropins; however, live birth and multiple gestation rates did not differ significantly between ovulation induction with letrozole compared with clo- miphene citrate. c Aromatase inhibitors are a promising therapeutic option that may help manage endometriosis-associated pain in combination therapy with progestins. This Committee Opinion revision provides updated information on the use of aromatase inhibitors in breast

2018 American College of Obstetricians and Gynecologists

43. Testosterone Therapy in Men with Hypogonadism

deficiency who have or are recovering from an acute illness or are engaged in short-term use of medications (e.g., opioids) that suppress testosterone concentrations. Table 2. Conditions in Which Measurement of FT Concentration Is Recommended 1. Conditions that are associated with decreased SHBG concentrations Obesity Diabetes mellitus Use of glucocorticoids, some progestins, and androgenic steroids Nephrotic syndrome Hypothyroidism Acromegaly Polymorphisms in the SHBG gene 1. Conditions (...) that are associated with decreased SHBG concentrations Obesity Diabetes mellitus Use of glucocorticoids, some progestins, and androgenic steroids Nephrotic syndrome Hypothyroidism Acromegaly Polymorphisms in the SHBG gene 2. Conditions associated with increased SHBG concentrations Aging HIV disease Cirrhosis and hepatitis Hyperthyroidism Use of some anticonvulsants Use of estrogens Polymorphisms in the SHBG gene 2. Conditions associated with increased SHBG concentrations Aging HIV disease Cirrhosis and hepatitis

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2018 The Endocrine Society

44. Evaluation and Treatment of Hirsutism in Premenopausal Women

on hirsutism of OCs containing antiandrogens [cyproterone acetate (CPA) and drospirenone (DSP)] vs other OCs, and OCs containing levonorgestrel (the most androgenic progestin) vs other OCs. The results of the network analysis were consistent with the previous meta-analyses, showing that OCs, antiandrogens, and the combination of OCs plus antiandrogens were all more effective than placebo and led to reduction in hirsutism scores. The addition of antiandrogens to OCs was slightly more effective than OCs (...) . The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We

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2018 The Endocrine Society

45. Evaluation and Treatment of Hirsutism in Premenopausal Women

on hirsutism of OCs containing antiandrogens [cyproterone acetate (CPA) and drospirenone (DSP)] vs other OCs, and OCs containing levonorgestrel (the most androgenic progestin) vs other OCs. The results of the network analysis were consistent with the previous meta-analyses, showing that OCs, antiandrogens, and the combination of OCs plus antiandrogens were all more effective than placebo and led to reduction in hirsutism scores. The addition of antiandrogens to OCs was slightly more effective than OCs (...) . The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We

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2018 The Endocrine Society

46. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

and if anovulation needs to be con?rmed serum progesterone levels can be measured. _ Biochemicalhyperandrogenism EBR Calculated free testosterone, free androgen index, or calculated bioavailable testosterone should be used to assess biochemical hyperandrogenism in the diagnosis of PCOS. **** 44BB EBR High quality assays such as liquid chromatography–mass spectrometry (LCMS) and extraction/ chromatographyimmunoassays,shouldbeusedforthemostaccurateassessmentoftotalorfree testosterone in PCOS. *** 44BB EBR (...) on hormonal contraception, due to effects on sex hormone-binding globulin and altered gonadotrophin- dependent androgen production. _ CPP Where assessment of biochemical hyperandrogenism is important in women on hormonal contraception,drugwithdrawalisrecommendedforthreemonthsorlongerbeforemeasurement, and contraception management with a non-hormonal alternative is needed during this time. _ CPP Assessment of biochemical hyperandrogenism is most useful in establishing the diagnosis of PCOS

2018 Society for Assisted Reproductive Technology

47. Evaluation and Management of Testosterone Deficiency

Education and Research, Inc.® 9 testosterone differ. Given these inconsistences, prevalence of low testosterone has varied dramatically among studies, with statistics reporting 2 – 50%. 5-8 A summary of findings from four large-scale contemporary prevalence studies can be found in Table 3. Testosterone Measurement Testosterone is the predominant androgen in males and is involved in a multitude of physiological and biochemical processes throughout the body. It is bound to albumin (50%, loosely-bound (...) on age, varicocele grade, baseline testosterone level) has not been defined. 75 Gynecomastia is a benign enlargement of the male breast tissue that can occur at times of male androgen/ estrogen change (alteration in testosterone/estradiol [E2] ratio), infancy, adolescence, or old age, and may be a sign of low serum testosterone. Male breast growth can be classified as pharmacological (associated with risperidone, cimetidine, anti-androgens, digoxin, clomiphene, methadone, marijuana, chlorpromazine

2018 American Urological Association

48. Utian Translational Science Symposium report: New Ttherapies for Leiomyomas: When Surgery May Not Be the Best Option

leiomyomas include uncontrollable fac- tors such as increasing age, early menarche, late menopause, black ethnicity, and genetics. Lifestyle factors include obe- sity, dietary habits, and reduced physical activity, as well as early use of oral contraceptives (OCs). Increased parity and injectable progestins reduce the incidence. 4 Thediagnosisofuterineleiomyomasismadeafteracareful and thorough history and physical examination. Unusual complaints may include pain from ureteric obstruction, acute pain (...) . Womenwithsymptomaticuterineleiomyomasexperienceheavyuterinebleeding,bulksymptoms,miscarriages, and pregnancy complications. Surgical therapies such as myomectomy or hysterectomy are highly effective; however, medical therapy with progestin-predominant contraceptives or gonadotropin-releasing hormone (GnRH) agonists are in many ways inadequate to address the unmet need for better, noninvasive, and cost-effective treatments. Recent advances in medical treatment, such as selective progesterone receptor modulators, new oral GnRH analogs

2018 The North American Menopause Society

49. Hormonal Contraceptives

. Consider referral if the patient has more than one of the following: Age over 40 years Overweight, obesity (BMI >30 kg/m 2 ) Smoker (any amount) under 35 years if age Diabetes (controlled) Dyslipidemia Migraine without aura under 35 years of age Blood pressure >140/90 3. Contraindications to progestin-only contraceptives Active liver disease or history of/or actual benign or malignant liver tumours Breast cancer Undiagnosed abnormal vaginal bleeding Progestin-only preparations for contraception (...) Edema Oily skin and scalp Acne Hirsutism High androgen Lower androgenic activity (eg. 3 rd and 4 th generation COCs – see product chart) Adapted from RxFiles, 10th edition, Hormonal Contraception Chart B) Transdermal or intra-vaginal estrogen Same efficacy as oral contraceptives Main advantage of transdermal or intra-vaginal estrogen over oral contraceptives: daily action not required, may enhance compliance in some patients leading to better efficacy (however, real-world failure rates are similar

2018 medSask

50. Acne - Guidelines for Prescribing Topical Treatment

at their lesions. A hallmark sign of this are scars in the absence of cysts or nodules, or hyperpigmentation of an area that can last years. Mechanical acne is the result of physical irritation to an area leading to the acne lesions, such as a sweat band rubbing against the forehead. Drug-induced acne. Medications that can cause/worsen acne: glucocorticoids (oral, inhaled, and topical), androgens, oral contraceptives containing progestins with more potent androgenic actiivity (norethindrone, levonorgestrel (...) for acne and/or recommended by reputable and reliable guidelines are considered for these guidelines. Only the active ingredients in the "products" section are approved for pharmacist prescribing. e-therapeutics+ - Acne. Available at (Free access, registration required) Emedicine - . (Free access, registration required). Merck Manual Professional: (Free access) RxFiles. Acne Pharmacotherapy Comparison Chart. Available at Uptodate: Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris

2018 medSask

51. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association

exposure to estrogen and androgens, insulin-related factors, adipokines, and inflammation. , A meta-analysis of 29 observational studies found a significant reduction in breast cancer risk among the most physically active compared with the least active women. A more recent meta-analysis of 22 studies involving 123 574 participants found an inverse relationship between physical activity and breast cancer events and deaths. Compared with those who reported low or no lifetime recreational prediagnosis (...) factors ( ). Cardiovascular clinical care and research have focused on risk factors for >60 years, because it is believed that ≈80% of CVD can be prevented through risk factor modifications such as promoting a healthy diet, physical activity, and a healthy weight; abstinence from tobacco; blood pressure control; diabetes mellitus management; and a good lipid profile. Adherence to a larger number of ideal cardiovascular health behaviors or factors from the American Heart Association’s Life’s Simple 7

2018 American Heart Association

52. Male Infertility

Obstet Gynecol, 2009. 21: 223. 57. Baccetti, B., et al. Ultrastructural studies of spermatozoa from infertile males with Robertsonian translocations and 18, X, Y aneuploidies. Hum Reprod, 2005. 20: 2295. 58. Miyagawa, Y., et al. Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study. J Urol, 2005. 173: 2072. 59. Ferlin, A., et al. Male infertility and androgen receptor gene mutations: clinical features (...) and identification of seven novel mutations. Clin Endocrinol (Oxf), 2006. 65: 606. 60. Gottlieb, B., et al. Molecular pathology of the androgen receptor in male (in)fertility. Reprod Biomed Online, 2005. 10: 42. 61. Rajender, S., et al. Phenotypic heterogeneity of mutations in androgen receptor gene. Asian J Androl, 2007. 9: 147. 62. Tincello, D.G., et al. Preliminary investigations on androgen receptor gene mutations in infertile men. Mol Hum Reprod, 1997. 3: 941. 63. Giwercman, A., et al. Preserved male

2018 European Association of Urology

53. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

and then annually with (free) T4 and TSH measurements beginning in early childhood and throughout the lifespan (⨁⨁◯◯). R 6.4. We suggest counseling on healthy nutrition and physical activity starting in early childhood (⨁⨁◯◯). R 6.5. We recommend lifelong annual measurement of HbA1c with or without fasting plasma glucose starting at age of 10 years (⨁⨁◯◯). R 6.6. We recommend that a lipid profile be performed in individuals who have at least one risk factor for cardiovascular disease starting at age 18 years (...) a separate systematic literature search was performed, and for which available evidence was synthesized. For each question, the eligibility criteria, endpoint definition, search strategy and main findings are described below. What is the effect of growth-promoting treatment in TS? (GRADE question 1) Short stature, present in most individuals with TS, is treated with GH, with/without oxandrolone (a non-aromatizable androgen), with the goals of increasing adult height. We systematically searched

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2016 European Society of Human Reproduction and Embryology

54. Endometrial Hyperplasia, Management of

of Obstetricians and Gynaecologists A D P P Phyperplas* or premalignant endometr* or precancer* endometr* or endometrial neoplasms or endometr* cancer) AND (intrauterine devices or mirena or progest* or LNG-IU* or gestag* or fertility- sparing therapy or conservative therapy or hormon* therapy or estrogen replacement therapy or hormone replacement therapy or tamoxifen or progestins or hysterectomy or ultrasound or magnetic resonance imaging or computed tomography or endometr* biopsy or hysteroscopy (...) for endometrial hyperplasia reflect this aetiology: increased body mass index (BMI) with excessive peripheral conversion of androgens in adipose tissue to estrogen; anovulation associated with the perimenopause or polycystic ovary syndrome (PCOS); estrogen-secreting ovarian tumours, e.g. granulosa cell tumours (with up to 40% prevalence of endometrial hyperplasia); and drug-induced endometrial stimulation, e.g. the use of systemic estrogen replacement therapy or long-term tamoxifen. 5–10 A Cochrane meta

2016 Royal College of Obstetricians and Gynaecologists

55. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

: measures, modification; office visits; patient outcome; performance measures; physical activity; potassium intake; protein intake; renin inhibitor; risk reduction: behavior, counseling; screening; sphygmomanometers; spironolactone; therapy; treatment: adherence, compliance, efficacy, outcome, protocol, regimen; weight. Additional relevant studies published through June 2016, during the guideline writing process, were also considered by the writing committee and added to the evidence tables when (...) disease and hypertension ACC/AHA/AMA-PCPI 2011 Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults AHA 2010 Resistant hypertension: diagnosis, evaluation, and treatment AHA 2008 * The full-text SIHD guideline is from 2012. A focused update was published in 2014. AATS indicates American Association for Thoracic Surgery; ACC, American College of Cardiology; ACOG, American College of Obstetricians and Gynecologists; ACR, American

2017 American Heart Association

56. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary

coat, masked, ambulatory, isolated ambulatory, isolated clinic, diagnosis, reverse white coat, prevention, therapy, treatment, control; intervention; lifestyle: measures, modification; office visits; patient outcome; performance measures; physical activity; potassium intake; protein intake; renin inhibitor; risk reduction: behavior, counseling; screening; sphygmomanometers; spironolactone; therapy; treatment: adherence, compliance, efficacy, outcome, protocol, regimen; weight. Additional relevant (...) 2014 An effective approach to high blood pressure control AHA/ACC/CDC 2014 Ambulatory blood pressure monitoring ESH 2013 Performance measures for adults with coronary artery disease and hypertension ACC/AHA/AMA-PCPI 2011 Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults AHA 2010 Resistant hypertension: diagnosis, evaluation, and treatment AHA 2008 * The full-text SIHD guideline is from 2012. A focused update was published

2017 American Heart Association

57. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update from the American College of Physicians

participated in the discussion for this guideline but was recused from voting on the recommendations because of active indirect financial and intellectual conflicts. A record of disclosures and management of conflicts of interest is kept for each CGC meeting and conference call and can be viewed at . Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he (...) no difference between calcium alone and placebo for reduced vertebral and nonvertebral fracture risk ( ), although adherence was low. Data on the efficacy of vitamin D alone for reducing fracture risk are mixed, and the overall effect is uncertain ( , , , , , , , , - ). Physical Activity Evidence is insufficient to conclusively show the effect of physical activity on fracture risk ( ). There are no studies that evaluated the comparative effectiveness of physical activity with that of other interventions

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2017 American College of Physicians

58. Obesity in Adolescents

in preventing short-term and long-term morbidity. The obstetrician–gynecologist who is knowledgeable about the behavioral and environmental factors that influence obesity may be better able to educate parents, guardians, and adolescents and advocate for programs that increase physical activity and improve nutrition. The obstetrician–gynecologist should be able to identify obese adolescents, particularly those at risk of comorbid conditions. They may have the opportunity to initiate behavioral counseling (...) should be knowledgeable about the behavioral and environmental factors that influence obesity and should educate adolescents and their parents about an active lifestyle and healthy caloric intake. The obstetrician–gynecologist should be able to identify obese adolescents, particularly those at risk of comorbid conditions. Obstetrician–gynecologists may have the opportunity to initiate behavioral counseling, participate in multidisciplinary teams that care for overweight and obese adolescents

2017 American College of Obstetricians and Gynecologists

59. The 2017 hormone therapy position statement of The North American Menopause Society

of Medical Sciences (CIOMS). 3. NAMS POSITION STATEMENT Menopause, Vol. 24, No. 7, 2017 729Copyright @ 2017 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. ethinyl estradiol. Conjugated equine estrogen, used in the WHI, is isolated from the urine of pregnant mares and comprised of estrone sulfate (weaker than estradiol) and mixtures of more than 10 minor components of different active forms of estrogens (weak estrogen agonists). Conju- gated equine estrogens (...) in cognitive outcomes between types of estrogen and the brain serotonergic system, with estradiol providing more robust anxiolytic and antidepressant effects. 6,7 Progestogen indication: need for endometrial protection Chronic unopposed endometrial exposure to estrogen increases the risk for endometrial hyperplasia or cancer. 8,9 The primary menopause-related indication for progestogen use is to prevent endometrial overgrowth and the increased risk of endometrial cancer during ET use. Progestins com- monly

2017 The North American Menopause Society

60. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline

hormone levels; (3) the requirement for and the effects of progestins and other agents used to suppress endogenous sex steroids during treatment; and (4) the risks and benefits of gender-affirming hormone treatment in older transgender people. To successfully establish and enact these protocols, a commitment of mental health and endocrine investigators is required to collaborate in long-term, large-scale studies across countries that use the same diagnostic and inclusion criteria, medications, assay (...) identity, the prevalence of GD/gender incongruence was much greater in this group than in the general population without a DSD. This supports the concept that there is a role for prenatal/postnatal androgens in gender development ( – ), although some studies indicate that prenatal androgens are more likely to affect gender behavior and sexual orientation rather than gender identity per se ( , ). Researchers have made similar observations regarding the potential role of androgens in the development

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2017 Pediatric Endocrine Society

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