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Measuring both corticotropin-releasing hormone and a form of estrogen called estriol in the blood of pregnant women cannot accurately predict the women who will deliver prematurely. This was the conclusion of a study of 297 pregnant women.

Saliva is an acceptable body fluid for measuring estriol levels. Estriol is a form of estrogen produced by the fetal adrenal glands. It crosses the placenta and appears in the mother's blood, urine, and saliva. Estriol levels begin to rise as a woman approaches delivery, which means estriol measurements can predict a woman's risk of premature delivery. An enzyme-linked immunosorbent assay (ELISA) has been developed to measure estriol in saliva samples. This will make it easy to test pregnant women who may be at risk of premature delivery.

Measuring estriol in a pregnant woman's saliva appears to be more accurate than the Creasy score. The Creasy score is used to determine whether a woman will deliver prematurely. Researchers compared this method with salivary estriol measurements in 601 pregnant women. Estriol is produced by the fetus, but crosses the placenta and can be found in the mother's blood, urine, and saliva. The level of estriol increases substantially three to five weeks before birth. If it happens before then, it is a potential sign of premature birth. Salivary estriol levels were more accurate in predicting premature birth than the Creasy score in this study.

Background: A positive relationship has generally been observed between plasma estrogen levels and breast cancer risk in postmenopausal women, but most of these studies have been small and few have evaluated specific estrogen fractions (such as percent bioavailable estradiol). In addition, few studies have evaluated plasma androgen levels in relation to breast cancer risk, and their results have been inconsistent. We prospectively evaluated relationships between sex steroid hormone levels in plasma and risk of breast cancer in postmenopausal women by use of a case-control study nested within the Nurses' Health Study. Methods: Blood samples were collected during the period from 1989 through 1990. Among postmenopausal women not using hormone replacement therapy at blood collection (n = 11169 women), 156 women were diagnosed with breast cancer after blood collection but before June 1, 1994. Two control subjects were selected per case subject and matched with respect to age, menopausal status, month and time of day of blood collection, and fasting status at the time of blood collection. Results: From comparisons of highest and lowest (reference) quartiles, we observed statistically significant positive associations with risk of breast cancer for circulating levels of estradiol (multivariate relative risk [RR] = 1.91; 95% confidence interval [CI] = 1.06-3.46), estrone (multivariate RR = 1.96; 95% CI = 1.05-3.65), estrone sulfate (multivariate RR = 2.25; 95% CI = 1.23-4.12), and dehydroepiandrosterone sulfate (multivariate RR = 2.15; 95% CI = 1.11-4.17). We found no substantial associations with percent free or percent bioavailable estradiol, androstenedione, testosterone, or dehydroepiandrosterone. The positive relationships were substantially stronger among women with no previous hormone replacement therapy. Conclusion: Our data, in conjunction with past epidemiologic and animal studies, provide strong evidence for a causal relationship between postmenopausal estrogen levels and the risk of breast cancer. [J Natl Cancer Inst 1998;90: 1292-9]

Byline: Thomas R. Holbert Keywords: Transvaginal ultrasonography; endometrium; cancer Abstract: OBJECTIVE: This study was undertaken to evaluate endometrial thickness by transvaginal ultrasonography in asymptomatic postmenopausal women receiving estrogen replacement therapy. The endometrial thickness in this study group was compared with endometrial thickness measurements in a group of women who had abnormal postmenopausal bleeding. The recent literature was reviewed. STUDY DESIGN: Asymptomatic postmenopausal women receiving estrogen replacement, seen for routine examination during the 1-year period from Jan. 1, 1994, to Dec. 31, 1995, had the endometrium evaluated by transvaginal ultrasonography. Women with abnormal postmenopausal bleeding were likewise evaluated and their measurements compared with those of the study group. RESULTS: Twenty-seven different estrogen and estrogen-progestin combinations in 327 asymptomatic women were studied. Additionally, 24 women who were bleeding, not receiving estrogen, and 46 women with abnormal bleeding on estrogen therapy underwent ultrasonography of the endometrium. Endometrial thickness ranged from 1 to 15 mm in women on a regimen of combined estrogen-progestin therapy, 1 to 14 mm in women using sequential estrogen-progestin, and 3 to 15 mm for women receiving unopposed estrogen in the study group. For women with abnormal bleeding not using estrogen, the endometrium measured an average of 12.3 mm (range 2 to 29 mm), with unopposed estrogen 8.3 mm (range 4 to 13 mm), and for estrogen with progestin 6.5 mm (range 2 to 15 mm). Significant pathologic features were found in those women who had bleeding and endometrial measurements between 5.0 and 29 mm. CONCLUSION: There was no significant difference between endometrial thickness measurements in women receiving various combinations of estrogen replacement. In general, expected endometrial measurements can range from 1 to 15 mm. In women with postmenopausal bleeding, however, significant pathologic features may exist with an endometrium measuring as little as 5 mm. (Am J Obstet Gynecol 1997;176:1334-9.) Author Affiliation: Medford, Oregon Article Note: (footnote) [star] From private practice., [star][star] Reprint requests: Thomas R. Holbert, MD, 853 Spring St., Medford, OR 97504., a 0002-9378/97 $ 5.00 + 0 6/6/80912

A blood screening test for the levels of three hormones in the second trimester of pregnancy may be more accurate than a modified test in detecting Down syndrome in fetuses. The triple-marker blood screening test measures the levels of alpha-fetoprotein (AFP), unconjugated estriol, and human chorionic gonadotropin (hCG). The modified test measured AFP and free beta-hCG on the speculation that free beta-hCG may be a better indicator of Down syndrome. Researchers compared the accuracy of the blood tests in 2349 nonblack women, taking maternal age into account. The test using AFP and free beta-hCG was found to detect fewer fetuses with Down syndrome while testing more women as being positive for the risk. hCG level may be the best predictor of Down syndrome of all the markers.

Pregnant women who experience a low blood level of unconjugated estriol in the second trimester may be at risk for the death of fetuses before birth and for placental sulfatase deficiency. Unconjugated estriol levels are tested, along with the levels of two other substances, in the blood of pregnant women to detect fetuses with birth defects. Researchers found that 62 women out of 44,146 women tested had very low unconjugated estriol levels. Fetal death occurred in 23 (37.1%) of the patients, including six deaths that followed normal prenatal visits. Of 18 women with very low unconjugated estriol levels for which there was no explanation, 16 gave birth to boys. Male infants are predisposed to X chromosome-linked abnormalities.

Background: Alcohol use, height, and postmenopausal adiposity have each been positively associated with postmenopausal breast cancer risk in most epidemiologic studies. The mechanism underlying these associations is unclear, although an effect of these factors on hormone levels has been hypothesized. Few previous studies have evaluated the relationship of either alcohol consumption or height with plasma hormone levels. A positive association between adiposity and plasma estrogen levels in postmenopausal women has been reported consistently. Purpose: Using archived frozen plasma samples and corresponding data from participants in the Nurses' Health Study, we determined plasma hormone levels and assessed these levels in relation to alcohol consumption, height, and adiposity among postmenopausal women. Methods: Blood samples were collected from a subset of participants in the Nurses' Health Study in 1989 and 1990, then stored in liquid nitrogen. Hormone concentrations in 217 archived plasma samples (from healthy postmenopausal women) were analyzed in 1993. Spearman correlation coefficients were calculated to assess the linear association between alcohol consumption during the previous year (mean daily intake in grams per day ascertained from semiquantitative food-frequency questionnaires completed in 1990 or 1991), height, and adiposity (as measured by body mass index [BMI] in kg/[m.sup.2] with weight reported at time of blood collection), and plasma hormone levels. Two-sided P values were also calculated. Results: After controlling for age, height, smoking status, and BMI, alcohol consumption was positively associated with estrone sulfate concentrations (r = .17; P = .02); no statistically significant association was noted for the other plasma hormones measured. Mean plasma estrone sulfate levels were 159 pg/mL in women who reported no alcohol use versus 211 pg/mL in women consuming 30 g or more of alcohol per day. After adjusting for the other covariates, we observed a strong positive correlation between BMI and plasma estrogens (r ranging from .37 for estrone and estrone sulfate to .63 for bioavailable estradiol, with all P values

Follow-up on triple marker testing may identify chromosomal abnormalities other than Down syndrome. Triple testing measures maternal blood levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. Triple testing was carried out on 11,434 pregnant women between 15 and 22 weeks pregnant. Follow-up information was available on 74% of the women. Fourteen (5%) Down syndrome fetuses had positive triple tests. Calculations show the expected number to be 20, therefore 70% were detected. Twelve cases of other chromosomal abnormalities were found among the 468 patients who had genetic analysis. Only one was diagnosed during ultrasound imaging. Except for two cases of one type of sex chromosome abnormality, whose occurrence is known to correlate with abnormal triple testing results, the rest are believed to be serendipitous discoveries.

Background. Besides the well-known association between endometrial carcinoma (EC) and unopposed estrogen, androgens also may play a role in this respect; however, previous studies on endogenous estrogens and androgens in patients with EC and control subjects have yielded mostly divergent results, probably because of the use of poorly defined control groups. Methods. Circulating steroid and pituitary hormones and sex hormone-binding globulin were measured in patients with EC and matched control groups of either patients with nonmalignant postmenopausal bleeding (hospital control subjects) and healthy, symptom-free women (nonhospital control subjects). Results. Patients with EC had higher serum levels of adrenal [C.sub.21] and [C.sub.19] steroids, estrogens, and biologically active testosterone than nonhospital control subjects, whereas the hospital control subjects constituted an intermediate group in this respect. Conclusions. The results clearly indicate an altered steroid homeostasis, probably reflecting an increased 'adrenal drive' in patients with EC. The results also stress the necessity of using strictly defined, healthy, symptom free control subjects instead of the frequently used hospital control subjects when studying more subtile endocrine aberrations.

Previous studies have reported that specific nutrients in the diet can alter the levels of sex steroids in the blood. Since a proper hormonal balance is required for normal menstrual cycles, there may be a relationship between diet and menstrual irregularity. One study reported that menstrual irregularity is five times more common among women who are vegetarians than among those who are nonvegetarians, and that increasing the amount of protein in the diet increases the probability of having regular menstruation. Also, it has been reported that dietary habits and menstrual status affect bone density in women athletes. This article describes the results of a study performed to examine the relationship between diet, menstrual regularity and bone density in premenopausal women. The study included 27 vegetarian and 37 nonvegetarian women. Both groups were of similar height, weight, age, and menarche, and had similar medical histories and level of education. Both groups consumed diets that contained less than 30 percent of the total calories as fat. Menstrual irregularity was more common among the vegetarian than the nonvegetarian women. Also, the vegetarians had lower levels of estrogen in their urine. Spinal bone density was similar in both groups of women. Drinking caffeinated beverages increased the amount of calcium in the urine but did not appear to alter bone density. As the amount of fat consumed in the diet increased the amount of luteinizing hormone (a hormone that stimulates the release of sex steroids from the ovaries) also increased. This observation was true only for the vegetarians. The results of this study indicate that vegetarian diets may be associated with irregular menstruation. Differences in dietary practices between vegetarian and nonvegetarian women did not appear to alter bone density. (Consumer Summary produced by Reliance Medical Information, Inc.)

Several studies have reported that girls are reaching puberty and menarche (onset of menstruation) at a much younger age than they were several decades ago. This has been attributed to changes in dietary habits. Studies have reported that the amount and distribution of body fat may play an important role in determining menarche. Female sex steroids such as estrogen are required for sexual development and they are influenced by the distribution of body fat. Also, it has been reported that dietary fiber may reduce the amount of estrogen in the body by increasing the amount of estrogen that is lost from the body in feces. To investigate the relationship between diet, hormone levels and menarche, 63 pubertal girls were studied. The effects of dietary fiber and vegetable protein on menarche and breast development were determined. The girls who consumed less dietary fiber had higher blood levels of estrogen, had earlier breast development and reached menarche earlier than those who consumed more fiber in their diet. The results of this study suggest that a low-fiber diet may increase the rate of breast development and cause menarche to occur at an earlier age. These findings are significant because it has been reported that girls who mature earlier may have a greater risk of developing breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hormones are thought to be involved in the development of breast cancer. Studies have reported that early menarche (beginning of menstruation), late menopause, not having children, and a delayed first pregnancy are associated with an increased risk for breast cancer. Almost one-third of all breast tumors regress following treatments that reduce estrogen levels in the body. Studies that have tried to link breast cancer with diet have focused on dietary fat. Some of these studies found a positive relationship between the amount of fat consumed in the diet and the risk of developing breast cancer, while other studies did not. Also, it has been reported that reducing the amount of fat in the diet lowers blood estrogen levels. A study using laboratory rats reported that the development of breast tumors following exposure to chemical carcinogens was reduced in rats fed a diet high in fiber and low in fat. To further investigate the relationship between diet and breast cancer, a study was performed to determine the effect of dietary fiber on blood hormone levels. During the two-month study period, 62 premenopausal women increased their dietary intake of fiber from 15 to 30 grams per day. The fiber was supplied as wheat bran, oat bran, or corn bran. Blood levels of estrogen, progesterone, and sex-hormone binding globulin were measured before and after the diet period. The wheat bran diet lowered blood levels of estrogen. The other two diets had no effect on blood hormone levels. It is suggested that wheat bran may reduce the risk of breast cancer by lowering blood estrogen levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Doctors who measure estriol in a pregnant woman's saliva to determine whether she will deliver prematurely should do so during the day. Estriol is produced by the fetus and crosses the placenta into the mother's blood, urine and saliva. Estriol levels rise as delivery approaches. Researchers measured estriol in saliva samples that 14 pregnant women collected at various times during the day and night. Estiol levels began to increase at 10 p.m., reaching a peak at 4 a.m., and returning to day levels by 7 a.m. The levels did not vary substantially during the day.

The adverse effects of smoking during pregnancy are well established. Studies have shown that smoking during pregnancy lowers maternal blood levels of estrogen and human chorionic gonadotropin (hCG), the hormone produced by the developing embryo. In this study, the effects of smoking on alpha-fetoprotein (AFP, a marker of fetal abnormalities), progesterone (a hormone produced by the placenta) and dehydroepiandrosterone (DHEAS, a virilizing hormone) were studied. Blood samples from 462 pregnant women (77 with Down's syndrome fetuses and 385 without) were analyzed for cotinine, a by-product of nicotine metabolism, to determine smoking status. Then the hormone levels were related to the amount of cotinine found in the blood. In both the pregnancies complicated by Down's syndrome and the normal pregnancies, higher AFP and DHEAS were found in smokers than nonsmokers, while the levels of unconjugated estrogen, hCG and progesterone were lower among the smokers than nonsmokers. The differences between smokers and nonsmokers were statistically significant for all measurements except unconjugated estrogen. Since AFP is a routine screening tool used for predicting risk of fetal abnormalities, to avoid false-positive results appropriate adjustments should be made when assessing AFP in smokers. Therefore, there it is advantageous to consider a pregnant woman's smoking habits when evaluating the likelihood of having a Down's syndrome fetus based on her AFP level. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gynecomastia, or breast enlargement in men, may be caused by cirrhosis of the liver, a chronic disease characterized by accumulation of fatty substances, structural changes, and degeneration of liver tissue. The prevalence of gynecomastia was shown to be associated with body mass and age. The body mass and prevalence of gynecomastia were similar in patients with cirrhosis without edema or fluid accumulation and normal subjects. However, patients with severe cirrhosis and edema within the abdomen or other body sites, are generally thin or have low body mass. The prevalence of gynecomastia and levels of the sex hormones testosterone, estrogen, and estradiol, were assessed in 18 patients with severe cirrhosis and 18 nonobese subjects. Gynecomastia was detected in 50 percent of normal subjects and correlated with body mass, and in 44 percent of patients with severe cirrhosis, but was not associated with body mass. Patients with cirrhosis had lower levels of testosterone, but higher estrogen to testosterone and estradiol to testosterone ratios, compared with normal subjects. However, these ratios were similar among cirrhotic patients with or without gynecomastia. The results suggest that factors other than the estrogen to testosterone ratio are involved in the development of gynecomastia in cirrhotic patients and normal subjects. It is also possible that the sensitivity of the breast tissue to the increased estrogen-testosterone ratio may vary widely. (Consumer Summary produced by Reliance Medical Information, Inc.)

2001 NOV 5 - (NewsRx.com & NewsRx.net) -- Children are born with the ability to make antibodies, proteins that fight infection. However, they do not respond to immunization in the [...]

Adoption of a low-fat diet does not lower estrogen levels in postmenopausal women, reported Dr. Michelle Holmes of Harvard Medical School, Boston, and her associates. Findings from previous smaller studies [...]

2000 DEC 9 - (NewsRx.com) -- Prolonged elevation in estrogen levels can put women with endometriosis at increased risk of cancer, researchers at the Mayo Clinic in Rochester, Minnesota, suggest. [...]

Women can now collect and mail their saliva from home, to be tested for estradiol, progesterone, testosterone, and other hormones. The Aeron Saliva Specimen Collection kit includes a mailing tube, [...]

The presence of receptors for estrogen (estrogen receptor, ER) or progesterone (PR), two female sex hormones, in the tumors or lymph nodes of patients with breast cancer is known to have implications for treatment and prognosis. In general, tumors that are ER-positive (possess ERs) have a better prognosis, since they respond to hormone therapy. Twenty percent of the patients with both ER- and PR-positive tumors, however, do not respond to such treatment. It is possible that the hormone receptor status of tissue other than the primary tumor also needs to be considered in planning treatment. To address this issue, researchers studied 38 women (median age, 54) with breast cancer whose hormone receptor status was known. Thirty-seven had ER and PR assays performed on both the primary tumor and one lymph node; one patient had only PR assays performed. Correlations between results for the tumor and the lymph node were then calculated. Results showed that there was no difference in the overall frequency of receptor-positive tissue in nodes and in tumors. There was 82 percent agreement between results for tumors and for nodes; however, six patients with ER-positive tumors had ER-negative nodes. One patient with an ER-negative tumor had an ER-positive nodal metastasis. For progesterone, the overall concordance between results from the two specimens was 84 percent. Four patients with PR-positive tumors had PR-negative nodes, and two patients with PR-negative tumors had PR-positive nodes. Twenty-five of these 38 women would have undergone hormonal therapy based on results from the tumor assay. However, based on results from the lymph node assays, only six of these 25 would be labeled as having hormonally insensitive tumors. Only one patient judged as having an unresponsive tumor according to the tumor assay would have been re-assigned to receive treatment, based on the nodal assay. In evaluating the hormone receptor character of tumors for the development of appropriate treatments, accuracy is critical. It appears that evaluation of the receptor content of nodal metastases may be more important than that of the primary tumor, since these may lack hormone receptors even when the tumor is receptor-positive. (Consumer Summary produced by Reliance Medical Information, Inc.)