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Oestrogens for treatment or prevention of pelvic organ prolapse in women

Many women suffer from pelvic organ prolapse, which is a downward descent of the vagina (front passage) and/or uterus (womb). It is more common after childbirth and after the menopause.  Women may not have symptoms or they may feel bulge and/or pressure vaginally, as well as a range of urinary, bowel and sexual problems. These symptoms may affect quality of life. Prolapse is associated with weakness in muscles and supporting structures in the pelvis. Treatment can be conservative (pessaries or rings), pelvic floor muscle training or surgery.  Oestrogen (female hormone) treatment can be used to reduce thinning of the vaginal and pelvic tissues. This may help to reduce or prevent the symptoms of prolapse, or may be used to make other prolapse treatments work better. This review did not find any clear evidence to suggest whether oestrogens work. However, as they are often used, especially with pessaries or before and after prolapse surgery, research is needed to identify any benefits or risks.  

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Medical interventions for traumatic hyphema

We reviewed the evidence about the effect of medical interventions for treating people with traumatic hyphema.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Oestrogens for urinary incontinence in women

Urinary incontinence is the leakage of urine when coughing or exercising (stress urinary incontinence) or after a strong uncontrollable urge to urinate (urgency urinary incontinence). In women who have gone through the menopause, low oestrogen levels may contribute to urinary incontinence. The review found 34 trials including more than 19,000 women of whom over 9000 received oestrogen. The review found that significantly more women who received local (vaginal) oestrogen for incontinence reported that their symptoms improved compared to placebo. There was no evidence about whether the benefits of local oestrogen continue after stopping treatment but this seems unlikely as women would revert to having naturally low oestrogen levels. Trials investigating systemic (oral) administration, on the other hand, found that women reported worsening of their urinary symptoms. The evidence comes mainly from two very large trials including 17,642 incontinent women. These trials were investigating other effects of hormone replacement therapy as well as incontinence, such as prevention of heart attacks in women with coronary heart disease, bone fractures, breast and colorectal cancer. In addition, in one large trial women who did not have incontinence at first were more likely to develop incontinence. There may be risks from long‐term use of systemic oestrogen, such as heart disease, stroke and cancer of the breast and uterus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2015
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Commonly used types of postmenopausal estrogen for treatment of hot flashes: scientific review

This review compared the efficacy and safety of conjugated equine estrogen and 17-beta-estradiol for reducing menopausal hot flashes. The author concluded that they have consistent and comparable treatment effects and may have similar short-term adverse effects. Limitations in the methodology and reporting of the review process weaken the reliability of the conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Vaginal estrogen for genitourinary syndrome of menopause: a systematic review

OBJECTIVE: To comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Bioidentical hormones for vasomotor menopausal symptoms (hot flushes or night sweats)

This Cochrane review evaluates the effectiveness and safety of bioidentical hormone treatment (BHT) compared to no treatment or non‐bioidentical hormone treatment (HT) for vasomotor symptoms experienced during the menopausal transition period.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: Systematic Review to Update the 2002 and 2005 U.S. Preventive Services Task Force Recommendations

Menopausal hormone therapy to prevent chronic conditions, such as cardiovascular disease and cancer, is currently not recommended because of its adverse effects.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: May 2012
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Oral Progesterone for the Treatment of Menopausal Symptoms: A Review of the Clinical Evidence [Internet]

The purpose of this review is to examine the clinical efficacy of micronized progesterone (Prometrium), a natural, bio-identical hormone, and methoxyprogesterone acetate (MPA; Provera), a synthetic hormone, individually and comparatively, for the management of menopausal symptoms.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 29, 2014
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Drug Class Review: Hormone Therapy for Postmenopausal Women or Women in the Menopausal Transition Stage: Final Report Update # 3 [Internet]

Estrogen was approved as a hormone supplement in the 1940's to treat estrogen withdrawal symptoms in menopausal women. Estrogen production declines in women when ovarian function changes with aging or after surgical removal of the ovaries. This drop in estrogen levels can trigger a vasomotor response resulting in a sensation of flushing and sweating that interferes with function and sleep (hot flashes or flushes). Studies conducted in recent years have identified additional health benefits of postmenopausal estrogen besides symptom management (osteoporosis) as well as potential harms (cardiovascular disease, breast cancer, and cholecystitis). The purpose of this review was to compare the efficacy and adverse effects of different estrogens.

Drug Class Reviews - Oregon Health & Science University.

Version: October 2007
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Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]

We conducted this systematic review to support the U.S. Preventive Services Task Force (USPSTF) in updating its recommendation on screening for cognitive impairment in older adults. Our review addresses five questions: 1) Does screening for cognitive impairment in community-dwelling older adults improve decisionmaking, patient, family/caregiver, or societal outcomes?; 2) What is the test performance of screening instruments to detect dementia or mild cognitive impairment (MCI) in community-dwelling older adult primary care patients?; 3) What are the harms of screening for cognitive impairment?; 4) Do interventions for early dementia or MCI in older adults improve decisionmaking, patient, family/caregiver, or societal outcomes?; and 5) What are the harms of interventions for cognitive impairment?

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: November 2013
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The effects of postmenopausal hormone therapies on female sexual functioning: a review of double-blind, randomized controlled trials

This review assessed the effects of hormone therapies on female sexual function in postmenopausal women. The authors concluded that some oestrogen therapies and some testosterone therapies (combined with oestrogen) improved measures of sexual function, but the individual response was uncertain. It is difficult to assess the reliability of the authors' conclusions given the limited search and the lack of reporting of review methods.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-Acting Reversible Contraception

Contraception can be divided into two broad categories: hormonal and nonhormonal. There are two categories of hormonal contraception: combined oestrogen and progestogen and progestogen-only. Long-acting reversible contraception (LARC) is defined in this guideline as methods that require administering less than once per cycle or month.

NICE Clinical Guidelines - National Collaborating Centre for Women’s and Children’s Health (UK).

Version: October 2005
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Menopause: Full Guideline

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 12, 2015
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Urinary Incontinence in Women: The Management of Urinary Incontinence in Women

This guidance is a partial update of National Institute for Health and Care Excellence (NICE) clinical guideline 40 (published October 2006) and will replace it.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: September 2013
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Combined treatment with GnRH analogues and add‐back therapy for women with uterine fibroids

Uterine fibroids may be shrunk with gonadotropin‐releasing hormone (GnRH) analogues but commonly cause hot flushes. Combining GnRHa with other drugs may decrease hot flushes (a strategy known as add‐back therapy) but cause other problems such as low bone mineral density. The efficacy and safety of this approach is controversial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions in the management of serum lipids for preventing stroke recurrence

There is evidence of a reduction in subsequent serious vascular events from statin therapy in patients with a history of ischaemic stroke or transient ischaemic attack (TIA). Studies have shown that interventions for reducing either total serum cholesterol or low density lipoprotein cholesterol levels reduce the risk of coronary heart disease (CHD) and stroke events in people with a history of CHD. However, for stroke patients the relation between the level of serum cholesterol and cholesterol subfractions with the risk of future stroke or cardiovascular events is unclear. This review, which includes eight studies involving approximately 10,000 participants, shows statin therapy, but not other lipid‐lowering measures, reduces the risk of subsequent major vascular events and a marginal benefit in decreasing stroke events, but not all‐cause mortality in those with a history of ischaemic cerebrovascular disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Screening for Osteoporosis: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]

Osteoporosis and related fractures are common in older individuals and lead to premature mortality, loss of function and independence, reduced quality of life, and high costs. Despite its importance, osteoporosis is under detected in the United States. This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: July 2010
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Systematic Review of Women Veterans Health Research 2004–2008 [Internet]

Women are playing an ever increasing role in the US military, representing about 15% of active military personnel, 17% of reserve and National Guard forces, and 20% of new military recruits. Concurrently, women are one of the fastest growing groups of new users in the Department of Veterans Affairs (VA) Healthcare System, with particularly high rates of utilization among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Of the more than 100,000 OEF/OIF women veterans, over 44% have enrolled in the VA system for health care. Thus, women veterans represent an integral part of the veteran community.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: October 2010
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Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease

This guideline updates for primary prevention, the NICE technology appraisal, ‘Statins for the prevention of cardiovascular events’ (TA94, 2007) and reviews and updates the recommendations made in the NICE guideline Lipid Modification (CG67, 2008) for primary and secondary prevention of cardiovascular disease (CVD). The scope for this guideline was limited to the identification and assessment of CVD risk and to the assessment and modification of lipids in people at risk of CVD, or people with known CVD. The guideline development group wishes to make clear that lipid modification should take place as part of a programme of risk reduction which also include attention to the management of all other known CVD risk factors.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2014
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