title: The benefits of hormone replacement therapy in pre-menopausal women with oestrogen deficiency on haemodialysis.
abstract: BACKGROUND
  Impaired sexual function is an important cause of depression in uraemic females. Hyperprolactinaemia is frequent, and often associated with decreased serum oestradiol concentration, which can significantly contribute to accelerated bone loss. The aim of the study was to evaluate the effect of hormone replacement therapy (HRT) on sexual function, serum 17beta-oestradiol and prolactin, and bone mineral density (BMD) in pre-menopausal women undergoing haemodialysis.
  
  
  METHODS
  Among 63 women on haemodialysis, aged 18-45 years, 23 with secondary amenorrhoea and serum oestradiol < 30 pg/ml were enrolled into the 1 year study. They were divided into: group I (n = 13) treated with transdermal oestradiol with cyclic addition of noretisterone acetate, and control group II (n = 10). BMD was measured with dual energy X-ray absorptiometry (DEXA).
  
  
  RESULTS
  No important changes in sexual function and hormonal profile were observed in the control group, whereas in all women from group I the treatment induced regular menses and a marked improvement of libido and sexual activity. Serum 17beta-oestradiol increased after the first month from 20.5 +/- 11.7 to 46.8 +/- 13.6 pg/ml (P < 0.001) and remained at that level until the end of the study, accompanied by a decrease of serum prolactin (from 1457 +/- 1045 to 691 +/- 116 mIU/ml after 12 months; P < 0.001). In group I, the treatment induced an increase in BMD, although significant only in L2-L4 (P < 0.05), whereas in group II a mild insignificant decrease was observed. However, a comparison of BMD values after 12 months in both groups revealed marked (P < 0.01-P < 0.05) differences at all studied sites.
  
  
  CONCLUSIONS
  Transdermal HRT allows sustained physiological serum oestradiol concentrations in pre-menopausal women with oestrogen deficiency on haemodialysis, with the restoration of regular menses and a marked improvement in their sexual function. The treatment inhibits bone demineralization and can play an important role in the prevention of early osteoporosis in this group of patients.
authors.affiliation: Department of Internal Medicine and Nephrology, The Medical University of Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Matuszkiewicz-Rowiñska
authors.forename: K
authors.initials: K
authors.lastname: Skórzewska
authors.forename: S
authors.initials: S
authors.lastname: Radowicki
authors.forename: A
authors.initials: A
authors.lastname: Sokalski
authors.forename: J
authors.initials: J
authors.lastname: Przedlacki
authors.forename: S
authors.initials: S
authors.lastname: Niemczyk
authors.forename: D
authors.initials: D
authors.lastname: Włodarczyk
authors.forename: J
authors.initials: J
authors.lastname: Puka
authors.forename: M
authors.initials: M
authors.lastname: Switalski
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000187:drug effects; D004958:Estradiol / Q000097:blood; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000172:deficiency*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007989:Libido / Q000187:drug effects; D008598:Menstruation / Q000187:drug effects; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control; D011388:Prolactin / Q000097:blood; D006435:Renal Dialysis
chemical_list: D004967:Estrogens; D004958:Estradiol; D011388:Prolactin