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61. Non-Epithelial Ovarian Cancer: ESMO Clinical Practice Guidelines

origin. SCSTs and steroid cell tumours constitute a heterogeneous group of tumours (Table 3) and vary in their capacity to produce clinically signi?cant amounts of steroid hormones. Granulosa cell tumours are typically oestrogenic and may be associated with various clinical syndromes, depending upon the age of the patient. SLCTs typically produce androgens, and clinical virilisa- tion is observed in 70%–85% of patients. Those with sex cord ele- ments may be malignant, with granulosa cell tumours (...) that the most used combination is the 5-day bleomycin/etoposide/cisplatin (BEP) regimen [III, A] [31]. Clinical Practice Guidelines Annals of Oncology iv4 | Ray-Coquard et al. Volume 29 | Supplement 4 | October 2018 Downloaded from https://academic.oup.com/annonc/article-abstract/29/Supplement_4/iv1/4983953 by guest on 16 April 2019When ChT is not offered, a close and active surveillance pro- gramme should be proposed [III, C]. Vazquez and Rustin postulate a surveillance schedule involving regular clinical

2018 European Society for Medical Oncology

62. Prevention of Cardiovascular Disease in Women

should form 50% of total grain intake. • Naturally occurring sugars are preferred. Avoid sweets and sucrose -sweetened beverages. • Reduce daily salt intake to approximately 1-1¼ teaspoon salt. • Replace saturated and trans-fats with monounsaturated and polyunsaturated fats. Nutrition Physical Activity • Exercise for at least 30 - 45 minutes, 5 times a week. Women who need to lose weight or sustain weight loss should exercise more. Weight maintenance /reduction • Ideal BMI for Asian women is 18.5 (...) hypertension appears to be related to the progesterogenic, not the estrogenic, potency of the preparation. 292 Hypertension due to COC is likely the most frequent cause of secondary hypertension in young women. 293 Women on COC should have their BP monitored periodically. In contrast, HRT as either oral or transdermal oestrogen alone or in combination with a progestin, has neutral effects or may lower the BP in normotensive and in hypertensive women. 290 Factors that predispose to pregnancy-induced

2016 Ministry of Health, Malaysia

63. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science

fraction is higher in women Physiology Women have reduced sympathetic and enhanced parasympathetic activity Women have lower plasma concentrations of norepinephrine Cardiovascular adaptations In response to stress, women experience an increased pulse rate, resulting in increased cardiac output; men have increased vascular resistance, resulting in increased BP Women are more sensitive to altitude or body positioning changes and experience more orthostatic hypotension and syncope Hematologic indexes (...) , older women, who are more at risk for IHD, tend to be more physically inactive than men. Many older women lack experience in team activities and group exercise, contributing to their PI. However, this is changing as more baby boomers age and participate in group activities such as water aerobics, yoga, and Pilates. The National Institute on Aging has excellent step-by-step instructional material to encourage safe activity in the older population, Your Everyday Guide from the National Institute

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2016 American Heart Association

64. Lymphangioleiomyomatosis Diagnosis and Management Part I: An Official ATS/JRS Clinical Practice Guideline

invasive management (conditional recommendation based on very low-quality evidence). d We suggest NOT using doxycycline as treatment for LAM (conditional recommendation based on low-quality evidence). d WesuggestNOTusinghormonal therapy as treatment for LAM (conditional recommendation based on very low- quality evidence). Hormonal therapies include progestins, gonadotrophin- releasing hormone agonists, selective estrogen receptor modulators like tamoxifen, and oophorectomy. ORCID ID: 0000-0001-7168 (...) for LAM. (“Hormonal therapy” includes the progestins, GnRH agonists, selective estrogen receptor modulators like tamoxifen, and oophorectomy.) Conditional Very low VEGF-D as a diagnostic test For patients whose CT scan shows cystic abnormalities characteristic of LAM but have no con?rmatory clinical or extrapulmonary radiologic features of LAM, we recommend VEGF-D testing before consideration of proceeding to diagnostic lung biopsy. (“Con?rmatory features of LAM” include tuberous sclerosis complex

2016 American Thoracic Society

65. Combined hormonal contraception and the risk of VTE: a guideline

norethindrone and its derivatives, including levonorgestrel (4). Third-generation combined oral contraceptive pills con- tainingtheprogestinsdesogestrelandgestodenewereformu- lated to be less androgenic than the second-generation progestins (5). Norgestimate is technically a third- generation progestin; however, its bioactivity is mediated mainly through levonorgestrel, which distinguishes it from other third-generation progestins (6). Finally, fourth- generationcontraceptivepillsinclude,amongothers,thepro (...) - gestin drospirenone, which is derived from spironolactone and has anti-androgenic activity (7). In addition, CHCs are available in several routes of administration including pills, transdermal patches, and vaginal ring. For the purpose of this document, only preparations available in the United States will be discussed. SCIENTIFICQUESTIONS DoestheDoseofEstrogenAffectVTERates? Modern combined oral contraception may contain 10, 15, 20, 30, or 35 mg of EE administered continuously for 21 or 24 out of 28

2016 Society for Assisted Reproductive Technology

66. Aromatase Inhibitors in Gynecologic Practice

rate compared with clomiphene citrate. Lifestyle changes that result in weight loss should be strongly encouraged. Aromatase inhibitors are a promising therapeutic option that may be helpful for the management of endometriosis-associated pain in combination therapy with progestins. Conclusions and Recommendations The American College of Obstetricians and Gynecologists supports the following recommendations and conclusions: For women with breast cancer, bone mineral density screening is recommended (...) with letrozole compared with clomiphene citrate. 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 cancer, ovulation induction, and endometriosis, and long-term follow-up data from relevant studies. Aromatase is a microsomal cytochrome P450 hemoprotein-containing enzyme (P450arom, the product of the CYP19

2016 American College of Obstetricians and Gynecologists

67. Endocrine Therapy for Hormone Receptor-Positive Metastatic Breast Cancer

: endocrine therapies, including selective ER modulators (tamoxifen or toremifene), ER downregulators (fulvestrant), progestins (megestrol acetate or medroxyprogesterone), luteinizing hormone–releasing hormone analogs (goserelin, leuprorelin, or buserelin), nonsteroidal third-generation AIs (anastrozole or letrozole), and steroidal third-generation AIs (exemestane); mTOR inhibitors (everolimus or temsirolimus); CDK 4/6 inhibitors (palbociclib); estrogens; and chemotherapy. Selected articles made any

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2016 American Society of Clinical Oncology Guidelines

68. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

of lifestyle therapy are associated with efficacy? 91 Q6.1. Meal plan and macronutrient composition 92 Q6.2. Physical activity 93 Q6.3. Behavior interventions 96 Q7. Is pharmacotherapy effective to treat overweight and obesity? 102 Q7.1. Should pharmacotherapy be used as an adjunct to lifestyle therapy? 102 Q7.2. Does the addition of pharmacotherapy produce greater weight loss and weight-loss maintenance than lifestyle therapy alone? 102 Q7.3. Should pharmacotherapy only be used in the short term to help (...) of Clinical Endocrinologists; ACE = American College of Endocrinology; ACSM = American College of Sports Medicine; ADA = American Diabetes Association; ADAPT = Arthritis, Diet, and Activity Promotion Trial; ADHD = attention-deficit hyperactivity disorder; AHA = American Heart Association; AHEAD = Action for Health in Diabetes; AHI = apnea-hypopnea index; ALT = alanine aminotransferase; AMA = American Medical Association; ARB = angiotensin receptor blocker; ART = assisted reproductive technology; AUC

2016 American Association of Clinical Endocrinologists

69. Acne clinical guideline

, A. Hormonal profiles and prevalence of polycystic ovary syndrome in women with acne. J Dermatol . 1997 ; 24 : 223–229 | | , x 53 Lucky, A.W. Endocrine aspects of acne. Pediatr Clin North Am . 1983 ; 30 : 495–499 | , x 54 Lucky, A.W., McGuire, J., Rosenfield, R.L., Lucky, P.A., and Rich, B.H. Plasma androgens in women with acne vulgaris. J Invest Dermatol . 1983 ; 81 : 70–74 | | | , x 55 Abulnaja, K.O. Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris. Braz J Med (...) : 25–33 | | | | | Spironolactone B II, III x 102 Shaw, J.C. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol . 2000 ; 43 : 498–502 | | | | , x 103 Sato, K., Matsumoto, D., Iizuka, F. et al. Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians. Aesthetic Plast Surg . 2006 ; 30 : 689–694 | | | Flutamide C III x 104 Wang, H.S., Wang, T.H., and Soong, Y.K. Low dose flutamide

2016 American Academy of Dermatology

70. Oestrogen deficiency symptoms in postmenopausal women: conjugated oestrogens and bazedoxifene acetate

smokers (more than 15 cigarettes per day) were excluded. Transvaginal ultrasound was completed at screening. Women in whom endometrial thickness could not be measured, or those with endometrial thickness of greater than 4 mm, focal endometrial abnormality, or complex or simple ovarian cysts (depending on the size) were excluded. Participants could not have used oral oestrogen, progestin, androgen or selective oestrogen receptor modulator-containing drugs, transdermal hormone products, intrauterine (...) significant improvements compared with placebo in some but not all primary outcomes in the conjugated oestrogens and bazedoxifene 0.45 mg/20 mg group. Statistically significant improvements in certain elements of quality of life compared with placebo were seen in both RCTs. However, no active comparator was included, making it difficult to establish the effectiveness of conjugated oestrogens and bazedoxifene 0.45 mg/20 mg compared with existing treatments. Because of the small number of women exposed

2017 National Institute for Health and Clinical Excellence - Advice

71. Guideline on the management of premature ovarian insufficiency

with POI and endometriosis 123 12.5.d Women with POI and other medical issues 123 12.6. Treatment with androgens 127 12.6.a Indications 128 12.6.b Risks of androgen therapy 129 12.6.c Routes of administration, dose, duration, monitoring 129 13. Puberty induction 138 14. Complementary treatments in POI 144 Appendix 1: Abbreviations 148 Appendix 2: Glossary 150 Appendix 3: Guideline group 152 Appendix 4: Research recommendations 154 Appendix 5: Methodology 156 Appendix 6: Reviewers of the guideline draft (...) this condition be called? The term “premature ovarian insufficiency” should be used to describe this condition in research and clinical practice. GPP How should POI be defined? Premature ovarian insufficiency is a clinical syndrome defined by loss of ovarian activity before the age of 40. POI is characterised by menstrual disturbance (amenorrhea or oligomenorrhea) with raised gonadotropins and low estradiol. What is the prevalence of POI in the general population? The prevalence of POI is approximately 1

2015 European Society of Human Reproduction and Embryology

72. Breast Cancer Prevention (PDQ®): Health Professional Version

, compared with women who have the lowest breast density.[ ] Study Design : Cohort, case-control studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Modifiable Factors With Adequate Evidence of Increased Risk of Breast Cancer Combination hormone therapy Based on solid evidence, combination hormone therapy (HT) (estrogen-progestin) is associated with an increased risk of developing breast cancer. Magnitude of Effect : Approximately a 26% increase in incidence of invasive (...) studies. Internal Validity : Good. Consistency : Good. External Validity : Poor. Interventions With Adequate Evidence of Decreased Risk of Breast Cancer Selective estrogen receptor modulators (SERMs): benefits Based on solid evidence, tamoxifen and raloxifene reduce the incidence of breast cancer in postmenopausal women, and tamoxifen reduces the risk of breast cancer in high-risk premenopausal women. The effects observed for tamoxifen and raloxifene show persistence several years after active

2018 PDQ - NCI's Comprehensive Cancer Database

73. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

replacement therapy Data exist from both observational and randomized clinical trials regarding the association between postmenopausal HRT and breast cancer. A meta-analysis of data from 51 observational studies indicated a RR of breast cancer of 1.35 (95% CI, 1.21–1.49) for women who had used HRT for 5 or more years after menopause.[ ] The ( ), a randomized controlled trial of about 160,000 postmenopausal women, investigated the risks and benefits of HRT. The estrogen-plus-progestin arm of the study (...) , in which more than 16,000 women were randomly assigned to receive combined HRT or placebo, was halted early because health risks exceeded benefits.[ , ] Adverse outcomes prompting closure included significant increase in both total (245 vs. 185 cases) and invasive (199 vs. 150 cases) breast cancers (RR, 1.24; 95% CI, 1.02–1.5, P < . 001) and increased risks of coronary heart disease, stroke, and pulmonary embolism. Similar findings were seen in the estrogen-progestin arm of the prospective

2018 PDQ - NCI's Comprehensive Cancer Database

74. Breast Cancer Treatment (PDQ®): Health Professional Version

cancer include the following: Family health history.[ ] Major inheritance susceptibility.[ , ] - Germline mutation of the BRCA1 and BRCA2 genes and other breast cancer susceptibility genes.[ , ] Alcohol intake. Breast tissue density (mammographic).[ ] Estrogen (endogenous).[ - ] - Menstrual history (early menarche/late menopause).[ , ] - Nulliparity. - Older age at first birth. Hormone therapy history. - Combination estrogen plus progestin hormone replacement therapy. Obesity (postmenopausal (...) al.: Postmenopausal serum androgens, oestrogens and breast cancer risk: the European prospective investigation into cancer and nutrition. Endocr Relat Cancer 12 (4): 1071-82, 2005. [ ] Kaaks R, Berrino F, Key T, et al.: Serum sex steroids in premenopausal women and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 97 (10): 755-65, 2005. [ ] Collaborative Group on Hormonal Factors in Breast Cancer: Menarche, menopause, and breast

2018 PDQ - NCI's Comprehensive Cancer Database

75. Breast Cancer Prevention (PDQ®): Health Professional Version

, compared with women who have the lowest breast density.[ ] Study Design : Cohort, case-control studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Modifiable Factors With Adequate Evidence of Increased Risk of Breast Cancer Combination hormone therapy Based on solid evidence, combination hormone therapy (HT) (estrogen-progestin) is associated with an increased risk of developing breast cancer. Magnitude of Effect : Approximately a 26% increase in incidence of invasive (...) studies. Internal Validity : Good. Consistency : Good. External Validity : Poor. Interventions With Adequate Evidence of Decreased Risk of Breast Cancer Selective estrogen receptor modulators (SERMs): benefits Based on solid evidence, tamoxifen and raloxifene reduce the incidence of breast cancer in postmenopausal women, and tamoxifen reduces the risk of breast cancer in high-risk premenopausal women. The effects observed for tamoxifen and raloxifene show persistence several years after active

2018 PDQ - NCI's Comprehensive Cancer Database

76. Long-term Consequences Polycystic Ovary Syndrome

activity, cigarette smoking, family history of type II diabetes, dyslipidaemia, hypertension, impaired glucose tolerance, type II diabetes) at the time of initial diagnosis. In clinical practice, hypertension should be treated; however, lipid-lowering treatment is not recommended routinely and should only be prescribed by a specialist. P D D C P B B P B© Royal College of Obstetricians and Gynaecologists 3of 15 RCOG Green-top Guideline No. 33 What is the risk of having reduced health-related quality (...) of PCOS, the recommended baseline biochemical test for hyperandrogenism is free androgen index (total testosterone divided by sex hormone binding globulin [SHBG] x 100). 19 If there are signs of virilisation (e.g. deep voice, reduced breast size, increased muscle bulk, clitoral hypertrophy), rapidly progressing hirsutism (less than 1 year between hirsutism being noticed and seeking medical advice) or high total testosterone levels (greater than 5 nmol/l or more than twice the upper limit of normal

2014 Royal College of Obstetricians and Gynaecologists

77. Acne vulgaris

(if not contraindicated) in combination with topical agents can be considered as an alternative to systemic antibiotics in women. Oral progesterone only contraceptives or progestin implants with androgenic activity may exacerbate acne, second and third generation combined oral contraceptives are generally preferred. Co-cyprindiol (Dianette®) or other ethinylestradiol/cyproterone acetate containing products may be considered in moderate to severe acne where other treatments have failed but require careful discussion (...) on the trunk and upper limbs. Acne fulminans is a sudden severe inflammatory reaction that precipitates deep ulcerations and erosions, sometimes with systemic effects (such as fever and arthralgia). [ ; ; ; ; ; ; ] Causes What causes it? The pathogenesis of acne is not completely understood but is thought to involve several processes including: Altered follicular keratinocyte proliferation leading to formation of follicular plugs (comedones). Androgen induced seborrhoea (increased sebum production) within

2018 NICE Clinical Knowledge Summaries

78. Bone health in estrogen-free contraception. (PubMed)

estrogen-free contraceptives. All progestins exert activity through binding to specific progesterone receptors; hereby, three different groups of progestins exist: pregnanes, gonanes, and estranges. Progestins also comprise specific glucocorticoid, androgen, or mineralocorticoid receptor interactions. Anabolic action of a progestogen may be affected via androgenic, anti-androgenic, or synadrogenic activity. The C 19 nortestosterone class of progestogens is known to bind with more affinity to androgen (...) Bone health in estrogen-free contraception. Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas progestogens exert activity through binding to specific progesterone receptors. New estrogen-free contraceptive and its possible implication on bone turnover are discussed in this review. Insufficient bone acquisition during development and/or accelerated bone loss after attainment of peak bone mass (PBM) are 2

2019 Osteoporosis International

79. Hot Flashes and Night Sweats (PDQ®): Health Professional Version

of hot flashes.[ ][ ] Risk associated with progestin use is unknown.[ ] Other Pharmacologic Interventions Numerous nonestrogenic, pharmacologic treatment interventions for hot flash management in women with a history of breast cancer and in some men who have undergone androgen deprivation therapy have been evaluated. Options with reported efficacy include androgens, progestational agents, gabapentin, SSRIs, selective serotonin norepinephrine inhibitors, alpha adrenergic agonists (e.g., methyldopa (...) , radiation therapy, or androgen treatment. Causes of “male menopause” include orchiectomy, gonadotropin-releasing hormone use, or estrogen use. Drug-associated causes of hot flashes and night sweats in men and women include tamoxifen, aromatase inhibitors, opioids, tricyclic antidepressants, and steroids. Women who are extensive metabolizers of tamoxifen related to CYP2D6 may have more severe hot flashes than women who are poor metabolizers.[ ] References Lynn Henry N, Rae JM, Li L, et al.: Association

2017 PDQ - NCI's Comprehensive Cancer Database

80. Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

mortality/major cardiovascular events) Observational studies suggest that women with DM may require greater frequency/intensity of physical activity than men to reduce cardiovascular events Fitness: Look AHEAD showed greater improvements in cardiorespiratory fitness in men compared with women Diabetes Aerobic and Resistance Exercise trial and a meta-analysis showed similar improvements in fitness in response to exercise training Glycemic control/DM prevention: Women with T1DM may have greater (...) , it does by race. Almost 50% of NHBs compared with one third of NHWs and Hispanics have hypertension. Therefore, hypertension has the potential to magnify the severity of diabetic heart disease in NHB women. High-Density Lipoprotein Cholesterol Women have higher high-density lipoprotein cholesterol (HDL-C) than men, and nondiabetic NHBs have higher HDL-C levels than NHWs. In addition to being active in reverse cholesterol transport, HDL-C has antithrombotic, anti-inflammatory, and antioxidant activity

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2015 American Heart Association

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