Lila Nachtigall, M.D.

Safety and tolerability of testosterone patch therapy for up to 4 years in surgically menopausal women receiving oral or transdermal oestrogen
Nachtigall, Lila; Casson, Peter; Lucas, Johna; Schofield, Victoria; Melson, Chad; Simon, James A
2011 Jan;27(1):39-48, Gynecological endocrinology
Two clinical trials previously demonstrated the safety of 300 mug/day transdermal testosterone patch (TTP) treatment for up to 6 months in 1094 surgically menopausal women with hypoactive sexual desire disorder (HSDD). Adverse events (AE), clinical laboratory tests, vital signs, physical examinations and mammograms were evaluated in open-label extensions of these two trials for up to 4 years and are presented in this article. Nine hundred and sixty-seven patients received at least one application of the TTP resulting in 1092 patient-years of exposure. There was no increase over time in the rate of new occurrences or severity of AEs, serious AEs, or withdrawals due to AEs. The most common AEs associated with treatment were application site reactions and unwanted hair growth; however, most were mild and rarely resulted in study withdrawal. No clinically meaningful changes in serum chemistry, haematology, lipid profile, carbohydrate metabolism, renal and liver function or coagulation parameters were noted with up to 4 years of therapy. Consistent with age-appropriate expected rates, three cases of invasive breast cancer were observed. No important changes in the safety or tolerability profile of TTP were revealed with long-term use for up to 4 years in otherwise healthy oophorectomised women with HSDD on concomitant oestrogen
— id: 115428, year: 2011, vol: 27, page: 39, stat: Journal Article,

The selective estrogen receptor modulator DT56a (Femarelle) does not affect platelet reactivity in normal or thrombophilic postmenopausal women
Nachtigall, Margaret J; Jessel, Rebecca H; Flaumenhaft, Robert; Nachtigall, Richard; Yoles, Israel; Naftolin, Frederick; Nachtigall, Lila E
2011 Mar;18(3):285-288, Menopause
OBJECTIVE: The purpose of this study was to assess the effect of DT56a (Femarelle), a selective estrogen receptor modulator, on platelet function in normal and thrombophilic women being treated for severe menopausal symptoms. METHODS: The Platelet Function Analyzer-100 (PFA-100) was used to asses platelet reactivity at baseline and after 8 weeks of treatment with Femarelle (644 mg/d in divided doses) in 25 symptomatic postmenopausal women with normal clotting times and seven symptomatic women with shortened clotting times (<61 s). The PFA-100 measure of closure time is considered equal to clotting time in assessing clotting function and platelet adhesion, aggregation, and blood coagulation factors. Closure times were measured after 3 and 8 weeks in all participants and at 1 year in the women with shortened clotting times. The nonparametric Wilcoxon signed rank test was used to assess the changes between baseline and each of the three subsequent measurements. RESULTS: Pretreatment study of all seven women with shortened closure times confirmed abnormalities associated with thrombophilia: four women were heterozygous for the factor V Leiden gene mutation, one was heterozygous for the prothrombin gene mutation, one was found to have protein S deficiency, and one had increased anticardiolipin antibodies. All participants reported improved symptoms during the treatment period. No significant change in closure times was found in the normally clotting participants after 3 or 8 weeks of Femarelle therapy (P > 0.26). No significant change in closure time was seen in the seven thrombophilic women after 3 or 8 weeks or 1 year of Femarelle treatment (P > 0.26). The regression curve for measures over time was not significant (P = 0.26). CONCLUSIONS: Femarelle, whose active ingredient is DT56a, did not adversely affect platelet reactivity as measured by PFA closure times in symptomatic thrombophilic postmenopausal women or normal controls. Femarelle, a novel selective estrogen receptor modulator that inhibits menopausal symptoms without thrombogenicity, may offer a new clinical choice for therapy of symptomatic postmenopausal women
— id: 129318, year: 2011, vol: 18, page: 285, stat: Journal Article,

Therapy: nonhormonal treatment of hot flashes-a viable alternative?
Nachtigall, Lila E
2010 Feb;6(2):66-67, Nature reviews. Endocrinology
A new study published in the Journal of Clinical Oncology has ascertained the efficacy of selective serotonin-reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and gabapentin to decrease menopausal hot flashes. Are these nonhormonal treatment options a viable alternative to hormone replacement therapy?
— id: 106372, year: 2010, vol: 6, page: 66, stat: Journal Article,

Endometrial Safety and Clinical Pharmacokinetics of an Ultra-Low Dose Estradiol Vaginal Tablet for Treatment of Menopausal Women with Vaginal Atrophy
Simon, James; Gut, Robert; Goldstein, Jeffrey; Germak, John; Nachtigall, Lila
2010 JUN ;31(3):S40-S40, Endocrine reviews
— id: 128829, year: 2010, vol: 31, page: S40, stat: Journal Article,

Endometrial safety of ultra-low-dose estradiol vaginal tablets
Simon, James; Nachtigall, Lila; Ulrich, Lian G; Eugster-Hausmann, Michaela; Gut, Robert
2010 Oct;116(4):876-883, Obstetrics & gynecology
OBJECTIVE:: To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17beta-estradiol vaginal tablets in postmenopausal women with vaginal atrophy. METHODS:: Endometrial biopsy data from individuals using active treatment (n=205) in a randomized, double-blind, placebo-controlled trial were pooled with the data from an open-label endometrial safety trial (n=336). Patients received 10-microgram estradiol vaginal tablets for 52 weeks. All endometrial biopsy samples were histologically analyzed at baseline and at end of trial by the same laboratory in both trials. RESULTS:: A total of 541 women using estradiol were included in the combined analysis of endometrial safety. A total of 456 women completed the trials, and 443 women had a biopsy performed at week 52: 85.6% were categorized as 'atrophic endometrium,' 12.6% had nonevaluable biopsy samples, 1.1% had polyps, and 0.2% were categorized as 'weakly proliferative.' One case of complex hyperplasia without atypia was reported in an individual exposed to trial drug for only 9 days. One woman's biopsy sample demonstrated endometrioid adenocarcinoma, grade 2, but the lack of an evaluable screening biopsy sample makes it uncertain whether the carcinoma was preexisting. In total, two events of hyperplasia and carcinoma were reported in 386 evaluable biopsy samples (incidence rate 0.52% per year). CONCLUSION:: The reported background incidence rate of endometrial hyperplasia and carcinoma in postmenopausal women is 0% to 1%. The results of this pooled analysis therefore support the endometrial safety of unopposed ultra-low-dose vaginal estrogen. There was no increased risk of endometrial hyperplasia and carcinoma in postmenopausal women undergoing treatment with 10-microgram estradiol vaginal tablets for 1 year under study conditions. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00108849 (VAG-2195) and NCT00431132 (VAG 1748). LEVEL OF EVIDENCE:: II
— id: 112563, year: 2010, vol: 116, page: 876, stat: Journal Article,

Association of oral but not transdermal estrogen therapy with enhanced platelet reactivity in a subset of postmenopausal women
Flaumenhaft, Robert; Nachtigall, Margaret; Lowenstein, Joanna; Nachtigall, Lisa; Nachtigall, Richard; Nachtigall, Lila
2009 Mar-Apr;16(2):407-412, Menopause
OBJECTIVE: We sought to determine the effects of oral versus transdermal estrogen therapy on platelet function in postmenopausal women. METHODS: Blood obtained from 84 postmenopausal women was tested for closure times using the Platelet Function Analyzer-100 before and after administration of oral or transdermal estrogen for 8 weeks. RESULTS: Women with normal closure times at baseline (n = 71) demonstrated no significant change after receiving estrogen therapy with oral (n = 29) or transdermal (n = 42) estrogen. Women with borderline closure times of 61 to 66 seconds (n = 13) showed a significant acceleration of closure times (P = 0.0008) after oral estrogen therapy (-6.8 +/- 0.7 seconds, n = 5) but no significant change from baseline after transdermal estrogen therapy (1.1 +/- 0.5 seconds, n = 8). CONCLUSIONS: An acceleration of closure times as measured by the Platelet Function Analyzer-100 in women with borderline baseline closure times is associated with the use of oral, but not transdermal, estrogen therapy. These results suggest that oral estrogen therapy increases platelet reactivity in a subset of women
— id: 129000, year: 2009, vol: 16, page: 407, stat: Journal Article,

Screening the postmenopausal ovary
Nachtigall, LE
2009 NOV-DEC ;16(6):1092-1092, Menopause
— id: 105370, year: 2009, vol: 16, page: 1092, stat: Journal Article,

Does combined hormone replacement therapy improve the health-related quality of life of postmenopausal women?
Nachtigall, Lila
2009 Mar;5(3):136-137, Nature clinical practice. Endocrinology & metabolism
This Practice Point commentary discusses the findings and limitations of a study by Welton et al. that assessed the effect of combined hormone replacement therapy (HRT) on health-related quality of life (QOL) in postmenopausal women. Evidence of the effect of HRT on health-related QOL in this group of patients in prior literature has been lacking, in part because of the varied, nonvalidated instruments used for evaluation. Welton et al. overcame that issue by the use of multiple questionnaires, and included specific questions on sexual functioning. However, all studies on health-related QOL are limited by the subjective selection of the parameters included in the instruments. Within this limitation, these authors concluded that HRT (estrogen alone in women without a uterus, and estrogen plus progestin for women with a uterus) offers more benefit than risk for postmenopausal, symptomatic women
— id: 135227, year: 2009, vol: 5, page: 136, stat: Journal Article,

Efficacy of low-dose estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial
Bachmann, Gloria; Lobo, Rogerio A; Gut, Robert; Nachtigall, Lila; Notelovitz, Morris
2008 Jan;111(1):67-76, Obstetrics & gynecology
OBJECTIVE: To evaluate the efficacy of two vaginal doses of estradiol (E2) compared with placebo in the treatment of atrophic vaginitis. METHODS: In a multi-center, randomized, double-blind, parallel-group study, 230 postmenopausal women received treatment with 25 mcg or 10 mcg E2 or placebo for 12 weeks. Efficacy was measured through composite score of three vaginal symptoms and grading of vaginal health. Additional analyses included maturation of vaginal and urethral mucosa. Safety assessments included endometrial biopsy, adverse events, changes in laboratory tests, and physical examinations. After 12 weeks of treatment, all patients were switched to the open-label extension and received treatment with 25 mcg E2 up to week 52. RESULTS: Vaginal tablets with 25 mcg and 10 mcg E2 showed significant (P<.001) improvement in composite score of vaginal health. Other results with 10 mcg E2 were not entirely consistent with those for 25 mcg E2. Over 12 weeks, both active treatments resulted in greater decreases in vaginal pH than placebo. There were no significant differences between the 25 mcg and 10 mcg E2 groups in terms of improvements in maturation value or composite score of three vaginal symptoms. The efficacy was maintained to week 52 with 25 mcg E2. CONCLUSION: Vaginal tablets with 25 mcg and 10 mcg E2 provided relief of vaginal symptoms, improved urogenital atrophy, decreased vaginal pH, and increased maturation of the vaginal and urethral epithelium. Those improvements were greater with 25 mcg than with 10 mcg E2. Both doses were effective in the treatment of atrophic vaginitis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00465192 and NCT00464971 LEVEL OF EVIDENCE: I
— id: 90910, year: 2008, vol: 111, page: 67, stat: Journal Article,

Health-related quality of life in the SWAN
Nachtigall, Lila
2008 May-Jun;15(3):407-407, Menopause
— id: 90907, year: 2008, vol: 15, page: 407, stat: Journal Article,

Femarelle (R), a Novel SERM for the Treatment of Menopause. Did Not Affect the Clotting Time of Either Normal or Thrombophilic Postmenopausal Women
Nachtigall, M; Nachtigall, L; Nachtigall, R; Yoles, I; Flaumenhaft, R
2008 NOV-DEC ;15(6):1220-1220, Menopause
— id: 90945, year: 2008, vol: 15, page: 1220, stat: Journal Article,

An Ultra-Low Dose (10mcg) Estradiol Vaginal Tablet Is Safe and Effective for the Treatment of Vaginal Atrophy in Post-Menopausal Women
Simon, J; Nachtigall, L; Archer, DF; Lang, E; Gut, R; Ijtian, W
2008 NOV-DEC ;15(6):1224-1224, Menopause
— id: 90946, year: 2008, vol: 15, page: 1224, stat: Journal Article,

Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet
Simon, James; Nachtigall, Lila; Gut, Robert; Lang, Eva; Archer, David F; Utian, Wulf
2008 Nov;112(5):1053-1060, Obstetrics & gynecology
OBJECTIVE: To evaluate the efficacy of ultra-low-dose 10-microgram 17beta-estradiol (E2) vaginal tablets for treatment of vaginal atrophy. METHODS: Postmenopausal women (N=309) were randomly assigned to 10-microgram E2 or placebo vaginal tablets for 52 weeks in a multicenter, double-blind study. Primary efficacy endpoints included change from baseline to week 12 in vaginal cytology, vaginal pH, and most bothersome urogenital symptoms score. Grading of vaginal health was a secondary efficacy assessment. Safety assessments included endometrial biopsy, physical and gynecologic examinations, and recording adverse events. RESULTS: At week 12, the change from baseline for 10 micrograms E2 compared with placebo demonstrated significant improvement in vaginal Maturation Index (proportion of parabasal cells: -37% compared with -9%; superficial cells: 13% compared with 4%; intermediate cells: 24% compared with 5%; P<.001 for each), Maturation Value (25.0 compared with 6.5, P<.001), grading of vaginal health (-0.91 compared with -0.51, P<.001), vaginal pH grade (-1.3 compared with -0.4, P<.001), and most bothersome symptoms score (-1.23 compared with -0.87, P=.003). For each component of vaginal Maturation Index, vaginal Maturation Value, grading of vaginal health, and vaginal pH, treatment effects were statistically different from placebo after 2 weeks of treatment. For most bothersome symptoms, treatment effect became apparent after 4 weeks and reached statistical significance at week 8 of therapy. All treatment effects were statistically significant at week 52. There were no major safety findings regarding physical, gynecologic, or laboratory assessments. CONCLUSION: After 12 weeks of treatment, an ultra-low-dose 10-microgram E2 vaginal tablet, compared with placebo, demonstrated significant improvement for the primary endpoints: vaginal cytology and pH and most bothersome urogenital symptoms score. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT00108849 LEVEL OF EVIDENCE: I
— id: 90906, year: 2008, vol: 112, page: 1053, stat: Journal Article,

Breast density as a clinical entity: is it a marker for breast cancer?
Nachtigall, Lila E
2007 May-Jun;14(3 Pt 1):345-346, Menopause
— id: 90904, year: 2007, vol: 14, page: 345, stat: Journal Article,

Wanted: A new look at the Women's Health Initiative and hormone therapy
Naftolin, F; Nachtigall, L
2007 ;23(2):101-101, Gynecological endocrinology
— id: 102963, year: 2007, vol: 23, page: 101, stat: Journal Article,

Complementary and hormonal therapy for vasomotor symptom relief: a conservative clinical approach
Nachtigall, Lila E; Baber, Rodney J; Barentsen, Ronald; Durand, Nancy; Panay, Nick; Pitkin, Joan; van de Weijer, Peter H M; Wysocki, Susan
2006 Apr;28(4):279-289, Journal of obstetrics & gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.
Vasomotor symptoms are the most common menopausal symptom experienced by women and the leading reason menopausal women seek health care advice. The recent shift towards a more conservative use of hormone therapy (HT) during menopause has prompted the need for treatment regimens to be individualized according to symptom severity. Our objective was to develop a new algorithm that enables practitioners to customize treatment regimens according to symptom severity. In order to develop a comprehensive treatment algorithm, we conducted a literature review and considered the findings from recently published treatment guidelines from around the world. We also evaluated the results of systematic reviews investigating the efficacy and safety of complementary and alternative medicines. We found a growing trend away from prescription HT in women with mild to moderate symptoms and an increasing trend toward lifestyle modification and the use of complementary and alternative medicines. On the basis of these findings, we have developed an algorithm that accounts for symptom severity. The algorithm presented here provides treatment options based on symptom severity and a comprehensive approach for integrating lifestyle modifications and complementary therapies with prescription treatment regimens
— id: 66464, year: 2006, vol: 28, page: 279, stat: Journal Article,

Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder
Simon, James; Braunstein, Glenn; Nachtigall, Lila; Utian, Wulf; Katz, Molly; Miller, Sam; Waldbaum, Arthur; Bouchard, Celine; Derzko, Christine; Buch, Akshay; Rodenberg, Cynthia; Lucas, Johna; Davis, Susan
2005 Sep;90(9):5226-5233, Journal of clinical endocrinology & metabolism
CONTEXT: Hypoactive sexual desire disorder (HSDD) is one of the most common sexual problems reported by women, but few studies have been conducted to evaluate treatments for this condition. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of a testosterone patch in surgically menopausal women with HSDD. DESIGN: The design was a randomized, double-blind, parallel-group, placebo-controlled, 24-wk study (the Intimate SM 1 study). SETTING: The study was performed at private or institutional practices. PATIENTS: The subjects studied were women, aged 26-70 yr, with HSDD after bilateral salpingo-oophorectomy who were receiving concomitant estrogen therapy. Placebo (n = 279) or testosterone 300 microg/d (n = 283) was administered. There were 19 patients who withdrew due to adverse events in the placebo group and 24 in the 300 mug/d testosterone group. INTERVENTION: Testosterone (300 microg/d) or placebo patches were applied twice weekly. MAIN OUTCOME MEASURE(s): The primary end point was the change in the frequency of total satisfying sexual activity at 24 wk. Secondary end points included other sexual functioning end points and safety assessments. RESULTS: At 24 wk, there was an increase from baseline in the frequency of total satisfying sexual activity of 2.10 episodes/4 wk in the testosterone group, which was significantly greater than the change of 0.98 episodes/4 wk in the placebo group (P = 0.0003). The testosterone group also experienced statistically significant improvements in sexual desire and a decrease in distress. The overall safety profile was similar in both treatment groups. CONCLUSION: In the Intimate SM 1 study, the testosterone patch improved sexual function and decreased distress in surgically menopausal women with HSDD and was well tolerated in this trial
— id: 90911, year: 2005, vol: 90, page: 5226, stat: Journal Article,

Validation of the profile of female sexual function (PFSF) in surgically and naturally menopausal women
Derogatis, Leonard; Rust, John; Golombok, Susan; Bouchard, Celine; Nachtigall, Lila; Rodenberg, Cynthia; Kuznicki, James; McHorney, Colleen A
2004 Jan-Feb;30(1):25-36, Journal of sex & marital therapy
The Profile of Female Sexual Function (PFSF) is a patient-based instrument for the measuring of loss of sexual function in menopausal women with low libido (hypoactive female sexual desire disorder). The instrument, which contains 37 items in seven domains (sexual desire, arousal, orgasm, sexual pleasure, sexual concerns, sexual responsiveness, and sexual self-image) and a single-item measure of overall satisfaction with sexuality, has been extensively developed and initially validated in over 500 oophorectomized women with low libido in North America, Europe, and Australia. Initial validation results showed the PFSF is capable of discriminating these patients from age-matched controls and produced consistent responses and sensitivity across geographies. The objective of this nonrandomized, parallel-group study was to examine the psychometric properties of the final PFSF in an independent group of surgically menopausal women with low libido and to extend validation to naturally menopausal women with low libido. Participants from 16 study centers in North America included surgically (n = 59) and naturally (n = 88) menopausal women with low libido and their age-matched control subjects, both premenopausal (n = 57) and naturally menopausal (n = 47), who reported no problems with libido. Subjects completed the PFSF at baseline and again 4 weeks later. Adjusted mean scores for each of the seven domains were statistically significantly lower (P < 0.0001) in surgically menopausal women with low libido compared with age-matched control women, and in naturally menopausal women with low libido compared with naturally menopausal control women, demonstrating excellent discriminant validity. Test-retest reliability ranged from 0.57 to 0.91 for the seven domain scores, whereas internal-consistency reliability ranged from 0.74 to 0.95. Results of this research support the conclusion that the PFSF is a valid and reliable instrument for measurement of loss of sexual function in both naturally and surgically menopausal women with low libido
— id: 90912, year: 2004, vol: 30, page: 25, stat: Journal Article,

Menopausal changes, quality of life, and hormone therapy
Nachtigall, Lila E; Nachtigall, Margaret J
2004 Jul;47(2):485-488, Clinical obstetrics & gynecology
— id: 45982, year: 2004, vol: 47, page: 485, stat: Journal Article,

The Women's Health Initiative could not have detected cardioprotective effects of starting hormone therapy during the menopausal transition
Naftolin, Frederick; Taylor, Hugh S; Karas, Richard; Brinton, Eliot; Newman, Isadore; Clarkson, Thomas B; Mendelsohn, Michael; Lobo, Rogerio A; Judelson, Debra R; Nachtigall, Lila E; Heward, Christopher B; Hecht, Harvey; Jaff, Michael R; Harman, S Mitchell
2004 Jun;81(6):1498-1501, Fertility & sterility
The Women's Health Initiative (WHI) randomized controlled trial failed to show cardioprotection by estrogen plus progestin treatment of postmenopausal women. But by design, the WHI population was 10-fold underpowered to show cardioprotection of women starting hormone treatment during the menopausal transition. Thus, observational studies that showed cardioprotection in such women remain the only applicable clinical guide to this issue. Randomized controlled trials are urgently needed to test cardioprotection in women starting treatment during the menopausal transition
— id: 66014, year: 2004, vol: 81, page: 1498, stat: Journal Article,

Effect of raloxifene on sexual function in postmenopausal women
Kessel, B; Nachtigall, L; Plouffe, L; Siddhanti, S; Rosen, A; Parsons, A
2003 Sep;6(3):248-256, Climacteric : journal of the International Menopause Society
OBJECTIVE: To determine the effects of raloxifene on sexual function in postmenopausal women with pre-existing vaginal atrophy treated with vaginal estrogen cream. METHODS: A total of 187 naturally postmenopausal women, 42-80 years of age, with signs of genitourinary atrophy were enrolled in this 6-month, multicenter, parallel-group study. Subjects were randomized to oral raloxifene HCl 60 mg daily or matching placebo; the same subjects were also randomized to receive one application of either vaginal conjugated estrogen cream 0.5 g twice weekly for 6 months or non-hormonal vaginal moisturizer twice weekly for 3 months, followed by conjugated estrogen cream for 3 months. Both investigators and subjects were masked to the identity of the oral medication. The vaginal preparations were administered in an open-label fashion. The Sexual Activity Questionnaire (SAQ) was administered at baseline and at 3 and 6 months. Safety was assessed throughout the study. RESULTS: A total of 102 women were sexually active at baseline and, of these, 82 were also sexually active at the 6-month end-point. At 6 months, raloxifene and placebo, in the presence of vaginal conjugated estrogen cream, were both associated with improvement from baseline in vaginal dryness and reduced discomfort during sexual activity. There were no significant differences between raloxifene and placebo groups in any SAQ item. Enjoyment of sexual activity significantly increased from baseline with raloxifene but not with placebo. No difference in adverse events was observed between groups. CONCLUSION: Raloxifene had no negative effects on sexual function in postmenopausal women with vaginal atrophy who were treated concomitantly with vaginal estrogen cream
— id: 90913, year: 2003, vol: 6, page: 248, stat: Journal Article,

Kobieta po czterdziestce : obawy i nadzieje = What every woman should know
Nachtigall, Lila; Nachtigall, Robert; Heilman, Joan Rattner
Warszawa : Wydawn. Lekarskie PZWL, 2003,
— id: 1754, year: 2003, vol: , page: , stat: ,

Ostrogen : fur Jugendlichkeit und sexuelle Vitalitat, gegen Depression und Osteoporose = Estrogen
Nachtigall, Lila E; Heilman, Joan R
Munchen : Hugendubel, 2002,
— id: 1752, year: 2002, vol: , page: , stat: ,

Isoflavones in the management of menopause
Nachtigall LE
2001 Jul-Aug;23(4):26-28, Totalhealth magazine
— id: 26855, year: 2001, vol: 23, page: 26, stat: Journal Article,

Isoflavones in the management of menopause
Nachtigall LE
2001 ;7(SUPPL. 1):8-12, Journal of the British Menopause Society
Menopause is characterised by a rapid and progressive reduction in oestradiol, the endogenous form of the steroid hormone oestrogen. This brings about many changes in a woman's body some of which, like hot flushes, are discomforting but not life-threatening. Others, like loss of bone density and decline in cardiovascular function, have serious life threatening consequences. Many of these changes can be eliminated or reduced with hormone replacement therapy (HRT). Despite its benefits, however, some women are not candidates for this treatment and many others choose not to take it. As a result, there is growing interest among patients about natural alternatives to conventional HRT. There are a number of herbal and nutritional alternatives proposed for management of symptoms and reduction of health risks among menopausal women, and the group of phytoestrogens called isoflavones are promising compounds. Red clover is a valuable source of the four important isoflavones (genistein, daidzein, biochanin and formononetin), and clinical data are now accumulating to indicate that standardised extracts may provide a range of health benefits in women. [References: 38] <97>
— id: 26881, year: 2001, vol: 7, page: 8, stat: Journal Article,

Colorectal cancer
Nachtigall, Lila E
2001 Nov;26(11):45-?, Female Patient
In women, colorectal cancer is the third most common non-skin-related cancer and the third leading cause of cancer death, accounting for approximately 11% of all cancer-related mortality. Although colorectal cancer risk is not associated with menopause per se, it increases as women get older
— id: 90920, year: 2001, vol: 26, page: 45, stat: Journal Article,

Los estrogenos : terapia hormonal sustitutiva = Estrogen
Nachtigall, Lila; Heilman, Joan Rattner
Barcelona : Oniro, 2001,
— id: 1744, year: 2001, vol: , page: , stat: ,

Re: effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin
Archer DF; Bush T; Nachtigall LE
2000 Dec 6;92(23):1950-1952, Journal of the National Cancer Institute
— id: 18775, year: 2000, vol: 92, page: 1950, stat: Journal Article,

A clinical study to assess the effectiveness of a nonhormonal vaginal moisturizer in menopausal women
Nachtigall LE; Nachtigall MJ; Jacob E
2000 Apr 1;95(4 Suppl 1):S59-S59, Obstetrics & gynecology
Objective: To assess the effectiveness of a vaginal moisturizer in menopausal women with external vaginal dryness. We studied a nonhormonal topically applied external vaginal moisturizer in women with external vaginal (vulvar) dryness to see if we could approach the results of a topically applied hormonal product.Methods: The 4-week clinical study included 30 subjects who were randomly divided into two groups to use either one of two topically-applied products for treating vaginal dryness: Vagisil Intimate Moisturizer (VIM) a nonprescription, nonhormonal, water based lotion and Premarin Creme (PC), a prescription hormone cream. VIM was applied twice a day to the external vaginal area. PC was applied once every other day to the internal vaginal area in healthy menopausal patients with vaginal dryness not requiring systemic therapy. The parameters studied were external dryness (0-5), pH, and subject discomfort (0-5). Patients accepted into the study were evaluated for vaginal dryness at baseline determined on a scale of 0-5. An external pH was taken and the patient rated her own discomfort on a scale of 0-5. Patients were seen at 2 and 4 weeks at which time they repeated the discomfort scale and were rated by the investigator for external vaginal dryness and pH. Subjects reported any adverse events.Results: 100% of PC treated patients and 75% of VIM patients decreased their pH to below 5. However, significant improvement was reported by patient and physician evaluation in both treatment groups.Conclusion: The nonhormonal, topical lotion Vagisil Intimate Moisturizer is a viable alternative to hormone cream for treatment of external vaginal dryness
— id: 11791, year: 2000, vol: 95, page: S59, stat: Journal Article,

Serum estradiol-binding profiles in postmenopausal women undergoing three common estrogen replacement therapies: associations with sex hormone-binding globulin, estradiol, and estrone levels [In Process Citation]
Nachtigall LE; Raju U; Banerjee S; Wan L; Levitz M
2000 Jul-Aug;7(4):243-250, Menopause
OBJECTIVE: To compare the effects of three commonly prescribed estrogen replacement therapies-oral conjugated equine estrogens (CEE; n = 37), oral micronized estradiol (ME; n = 25), and transdermal estradiol (TE; n = 24)-on the binding characteristics of plasma estradiol as related to the concentrations of blood sex hormone-binding globulin (SHBG), estradiol, and estrone. DESIGN: Menopausal volunteers, opting for estrogen replacement therapy, gave blood at 0, 2, and 4 months. SHBG was assayed by automated immunoabsorbent technology. Estradiol and estrone were determined by quantitative gas chromatography/mass spectrometry. After tritiated estradiol was added to serum, the percentage of estradiol not bound to protein was determined by ultrafiltration and the percentage of estradiol bound to SHBG was measured by a method exploiting that this protein, even when bound to estradiol, binds avidly to Concanavalin A-Agarose. RESULTS: In each study, 2- and 4-month data were similar. Increases in SHBG concentrations were 100% (p < 0.001), 45% (p < 0.001), and 12% (nonsignificant) for subjects who were receiving CEE, ME, and TE regimens, respectively. Decreases in the percentage of estradiol not bound to protein and increases in the percentage of estradiol bound to SHBG correlated with changes in the concentrations of this protein mediated by the therapies. The order for increases in estradiol was ME-TE >> CEE, whereas for estrone, the order was ME > CEE >> TE, divergent from the SHBG responses. CONCLUSIONS: The diverse responses observed can be explained by differences in the estrogen load delivered to target tissues as controlled by the intermediary circulation and metabolism of the hormones introduced in these regimens
— id: 11577, year: 2000, vol: 7, page: 243, stat: Journal Article,

Hormone therapy and breast cancer: Update 2000
Nachtigall, Lila E
2000 Oct;25(10):77-?, Female Patient
— id: 90921, year: 2000, vol: 25, page: 77, stat: Journal Article,

Making the switch from OCs to HRT
Nachtigall, Lila E
2000 Aug;25(8):35-?, Female Patient
— id: 90922, year: 2000, vol: 25, page: 35, stat: Journal Article,

Lo que toda mujer debe saber = What every woman should know
Nachtigall, Lila; Nachtigall, Robert; Heilman, Joan Rattner
Barcelona : Granica, 2000,
— id: 1743, year: 2000, vol: , page: , stat: ,

Estrogen
Nachtigall, Lila; Neilman, Joan Rattner
New York : Harper Resource, 2000,
— id: 1740, year: 2000, vol: , page: , stat: ,

Menopause 2000
Nachtigall, Lila; Nachtigall, Lisa B
Secaucus, N.J. : Network for Continuing Medical Education, c1999,
As we approach the turn of the century, controversy still exists about how best to manage menopause and postmenopausal problems. Who needs to be treated? And who is better off without intervention? How can you individualize management to address not only the major issues surrounding menopause (e.g. osteoporosis and heart disease), but also those that mean a great deal in terms of quality-of-life (e.g. vaginal dryness, sexual function, and psychological effects)? Overall, do younger physicians rely on high-tech testing at the expense of the 'hands-on' clinical expertise demonstrated by their older colleagues? Find out how two generations of experts in obstetrics and gynecology strike the balance in managing this often divisive medical issue
— id: 614, year: 1999, vol: , page: , stat: ,

Menopause meets the Boomers
Nachtigall, Lila; Shephard, Cybill
North Ryde NSW : Novogen Laboratories, 1999,
— id: 1755, year: 1999, vol: , page: , stat: ,

Nonprescription alternatives to hormone replacement therapy
Nachtigall, Lisa B; Nachtigall, Margaret J; Nachtigall, Lila E
1999 Jun;24(6):59-?, Female Patient
— id: 90919, year: 1999, vol: 24, page: 59, stat: Journal Article,

Towards better recognition of urogenital aging. Proceedings of the 8th International Congress on the Menopause held on November 5, 1996, in Sydney, Australia. Chairman's introduction
Nachtigall L
1998 May;178(5):S243-S244, American journal of obstetrics & gynecology
— id: 12123, year: 1998, vol: 178, page: S243, stat: Journal Article,

The symptoms of perimenopause
Nachtigall LE
1998 Dec;41(4):921-927, Clinical obstetrics & gynecology
— id: 12045, year: 1998, vol: 41, page: 921, stat: Journal Article,

Zhenshchina posle 40 = What every woman should know
Nachtigall, Lila; Nachtigall, Robert; Heilman, Joan Rattner
Moskva : "Panorama", 1998,
— id: 1758, year: 1998, vol: , page: , stat: ,

Use of transvaginal ultrasonography to monitor the effects of tamoxifen on uterine leiomyoma size and ovarian cyst formation
Schwartz LB; Rutkowski N; Horan C; Nachtigall LE; Snyder J; Goldstein SR
1998 Nov;17(11):699-703, Journal of ultrasound in medicine
To evaluate the effects of tamoxifen on leiomyomas and ovarian cysts in postmenopausal breast cancer patients, uterine and leiomyoma volumes were monitored sonographically in 17 postmenopausal women receiving postoperative tamoxifen for breast cancer; patients were examined twice with a mean of 1.18 +/- 0.17 years between examinations. The mean increase in leiomyoma volume was 1.26 +/- 0.73 cm3. The mean myoma volume was significantly larger at follow-up evaluation than at initial ultrasonography (5.75 +/- 1.09 cm3 versus 4.36 +/- 0.817 cm3, respectively; Wilcoxon signed rank test, P = 0.0218). Six women developed new leiomyomas. Of the 21 leiomyomas initially detected, 13 increased, six decreased, and two were unchanged in volume. The mean increase in uterine volume was 17.45 +/- 8.49 cm3. Three patients had simple ovarian cysts at initial ultrasonographic examination, two of which remained unchanged in size, and the third resolved. Two patients had newly developed simple ovarian cysts. The increase in uterine and leiomyoma volumes with the development of new leiomyomas and the persistence or development of ovarian cysts in some patients support the existence of agonistic tamoxifen effects. Serial measurements of uterine and leiomyoma volumes and surveillance for ovarian cysts is recommended for tamoxifen users
— id: 12060, year: 1998, vol: 17, page: 699, stat: Journal Article,

The use of transvaginal ultrasound and saline infusion sonohysterography for the evaluation of asymptomatic postmenopausal breast cancer patients on tamoxifen
Schwartz LB; Snyder J; Horan C; Porges RF; Nachtigall LE; Goldstein SR
1998 Jan;11(1):48-53, Ultrasound in obstetrics & gynecology
Tamoxifen has been shown to decrease the recurrence rate of breast cancer. Evidence that tamoxifen use may be associated with an increased risk of endometrial cancer has caused investigators to recommend routine invasive sampling. We have assessed a minimally invasive alternative for endometrial surveillance of tamoxifen-treated patients utilizing transvaginal ultrasound and saline infusion sonohysterography. Asymptomatic women (n = 44) with breast cancer on postoperative tamoxifen treatment were referred to our gynecological ultrasound unit. Initially, the endometrial echo was measured with unenhanced transvaginal ultrasound. If a distinct echo measured < or = 5 mm, no further procedure was performed. For thickened or inadequately visualized echoes, sonohysterography was performed. If a thin echo was noted on sonohysterography, no further procedure was performed. If focal changes were detected, hysteroscopy/dilatation and curettage (D&C) was performed. For generalized symmetrically thickened echoes, a blind biopsy was done. If sonohysterography was unsuccessful, hysteroscopy/D&C was performed. Eleven (25%) patients had thin unenhanced echoes of < or = 5 mm. Twenty-five (57%) patients had thickened endometrial echoes. Three (7%) had naturally occurring endometrial fluid outlining a polyp. An endometrial echo could not be visualized in five (11%) patients. Sonohysterography was successfully performed in 21 out of 30 (70%) patients with either thickened or non-visualized unenhanced echoes. Of these, two patients had thin endometria with coexisting myomas; seven had thin endometria with typical tamoxifen-induced subendometrial changes: and seven had focal polypoid thickening confirmed by hysteroscopy/D&C. Histology revealed carcinoma associated with two, proliferation in one and four polyps. Five patients had thickened unenhanced echoes with symmetrically thickened single-layer measurements on sonohysterography. Histology revealed that three were proliferative, one was inactive and one was hyperplastic. In the nine patients with unsuccessful sonohysterography, hysteroscopy/D&C revealed inactive endometria in six, and three polyps. Our paradigm of evaluating the endometrial response to tamoxifen is concluded to overcome the shortcomings of either unenhanced transvaginal ultrasound or blind biopsy alone while it kept the number of invasive sampling procedures to 55% (24 out of 44)
— id: 7783, year: 1998, vol: 11, page: 48, stat: Journal Article,

Sex hormone-binding globulin in estrogen-dependent cancer and estrogen replacement therapy
Levitz M; Banerjee S; Raju U; Toniolo PG; Shore RE; Nachtigall LE
1997 Sep 26;828:358-365, Annals of the New York Academy of Sciences
— id: 12252, year: 1997, vol: 828, page: 358, stat: Journal Article,

Sexual function in menopause and postmenopause
Nachtigall LE
1997 ;6:632-636, Current therapy in endocrinology & metabolism
— id: 12408, year: 1997, vol: 6, page: 632, stat: Journal Article,

Ostrogen : fur Jugendlichkeit, Ausgeglichenheit und sexuelle Vitalitat, gegen Hitzewallungen, Depression und Osteoporose = Estrogen
Nachtigall, Lila E; Heilman, Joan R
Munchen : Ariston-Verlag, 1997,
— id: 1751, year: 1997, vol: , page: , stat: ,

Kobieta po czterdziestce : obawy i nadzieje = What every woman should know
Nachtigall, Lila; Nachtigall, Robert; Heilman, Joan Rattner
Warszawa : Wydawn. Lekarskie PZWL, 1997,
— id: 1747, year: 1997, vol: , page: , stat: ,

Depois dos 40 : as mais novas tecnologias sobre a saude da mulher = What every woman should know
Nachtigall, Robert D; Heilman, Joan Rattner; Duarte, Claudia Gerpe; Nachtigall, Lila
Rio de Janeiro : Editora Rosa dos Tempos, 1997,
— id: 2268, year: 1997, vol: , page: , stat: ,

Alterations in steroid hormone receptors in the tamoxifen-treated endometrium
Schwartz LB; Krey L; Demopoulos R; Goldstein SR; Nachtigall LE; Mittal K
1997 Jan;176(1 Pt 1):129-137, American journal of obstetrics & gynecology
OBJECTIVE: Our purpose was to evaluate whether tamoxifen has estrogenic endometrial effects as defined by histologic study or alterations in steroid hormone receptor expression. STUDY DESIGN: Nineteen postmenopausal tamoxifen-treated breast cancer patients who also had endometrial sampling were identified from files in the Department of Obstetrics and Gynecology. To examine the subgroup of 15 polyps, age-matched, non-hormonally treated patients with polyps (n = 8) or atrophic endometria (n = 5) served as comparison groups. Proliferative (n = 3) and secretory (n = 5) endometria served as procedural controls. Immunohistochemical studies for steroid receptors (estrogen, progesterone) were performed. RESULTS: Glandular cell progesterone receptor was significantly increased and stromal cell estrogen receptor was significantly decreased in tamoxifen-treated versus atrophic endometria. Progesterone receptor staining was not significantly different in tamoxifen-treated versus control polyps, although staining was high in both groups. Stromal cell estrogen receptor staining was significantly reduced in tamoxifen-treated versus control polyps, although there were no histologic differences. Reduced stromal cell estrogen receptor and increased glandular cell progesterone receptor staining was found in all tamoxifen-treated endometria regardless of the diagnosis. CONCLUSION: The tamoxifen-associated changes in endometrial steroid receptors support an estrogenic effect that is independent of histologic diagnosis and duration of use. This may contribute to the pathogenesis of tamoxifen-associated polyps and carcinomas
— id: 7784, year: 1997, vol: 176, page: 129, stat: Journal Article,

Menopause in perspective
Bunyan, Maureen; Utian, Wulf H; Gass, Margery L; Nachtigall, Lila E
[Cleveland OH] : North American Menopause Society, 1996,
— id: 1757, year: 1996, vol: , page: , stat: ,

Adrenal hypoplasia congenita with hypogonadotropic hypogonadism: evidence that DAX-1 mutations lead to combined hypothalmic and pituitary defects in gonadotropin production
Habiby, R L; Boepple, P; Nachtigall, L; Sluss, P M; Crowley, W F Jr; Jameson, J L
1996 Aug 15;98(4):1055-1062, Journal of clinical investigation
Adrenal hypoplasia congenita (AHC) is an X-linked disorder that typically presents with adrenal insufficiency during infancy. Hypogonadotropic hypogonadism (HHG) has been identified as a component of this disorder in affected individuals who survive into childhood. Recently, AHC was shown to be caused by mutations in DAX-1, a protein that is structurally similar in its carboxyterminal region to orphan nuclear receptors. We studied two kindreds with clinical features of AHC and HHG. DAX-1 mutations were identified in both families. In the JW kindred, a single base deletion at nucleotide 1219 was accompanied by an additional base substitution that resulted in a frameshift mutation at codon 329 followed by premature termination. In the MH kindred, a GGAT duplication at codon 418 caused a frameshift that also resulted in truncation of DAX-1. Baseline luteinizing hormone (LIT), follicle-stimulating hormone (FSH), and free-alpha-subunit (FAS) levels were determined during 24 h of frequent (q10 min) venous sampling. In patient MH, baseline LH levels were low, but FAS levels were within the normal range. In contrast, in patient JW, the mean LH and FSH were within the normal range during baseline sampling, but LH secretion was erratic rather than showing typical pulses. FAS was apulsatile for much of the day, but a surge was seen over a 3-4-h period. Pulsatile gonadotropin releasing hormone (GnRH) (25 ng/kg) was administered every 2 h for 7 d to assess pituitary responsiveness to exogenous GnRH. MH did not exhibit a gonadotropin response to pulsatile GnRH. JW exhibited a normal response to the first pulse of GnRH, but there was no increase in FAS. In contrast to the priming effect of GnRH in GnRH-deficient patients with Kallmann syndrome, GnRH pulses caused minimal secretory responses of LH and no FAS responses in patient JW. The initial LH response in patient JW implies a deficiency in hypothalamic GnRH. On the other hand, the failure to respond to pulsatile GnRH is consistent with a pituitary defect in gonadotropin production. These two cases exemplify the phenotypic heterogeneity of AHC/HHG, and suggest that DAX-1 mutations impair gonadotropin production by acting at both the hypothalamic and pituitary levels
— id: 90914, year: 1996, vol: 98, page: 1055, stat: Journal Article,

Estrogen replacement. The evolving role of transdermal delivery
Lobo RA; Ettinger B; Hutchinson KA; Knopp RH; Lindsay R; Nachtigall LE; Santoro N; Studd J
1996 Oct;41(10 Suppl):781-796, Journal of reproductive medicine
— id: 18776, year: 1996, vol: 41, page: 781, stat: Journal Article,

Menopause & good health
Nachtigall, Lila E
[Washington DC] : International Information Resources, 1996,
— id: 1749, year: 1996, vol: , page: , stat: ,

Too young for hot flashes?
Nachtigall, Lila E
1996 Jul;113(7):110-?, Ladies' Home Journal
Perimenopause, which occurs when a woman's body begins producing less estrogen and progesterone, can begin at different ages for different women, with some women developing symptoms as early as their mid-thirties. Low-dose oral contraceptives help most women relieve perimenopausal symptoms, such as hot flashes
— id: 90923, year: 1996, vol: 113, page: 110, stat: Journal Article,

Does the use of postmenopausal hormone replacement therapy influence the size of uterine leiomyomata? A preliminary report
Schwartz, LB; Lazer, S; Mark, M; Nachtigall, LE; Horan, C; Goldstein, SR
1996 ;3(1):38-43 SPR, Menopause
To determine if the use of hormone replacement therapy (HRT) in postmenopausal women influences the size of uterine leiomyomas, we report a series of 14 cases of postmenopausal women with uterine leiomyomas that were monitored with transvaginal pelvic ultrasound before and then at a mean of 19.7 +/- 6.3 months after initiating HRT. A small group of seven postmenopausal women with uterine leiomyomas not treated with HRT were also evaluated at two time points (9.6 +/- 1.7 months apart). There were no significant changes in mean uterine or myoma volumes from the time of the initial to follow-up ultrasound in the postmenopausal women treated with HRT. Neither the type of estrogen or progestin preparation nor the HRT regimen (sequential versus continuous combined) affected the mean uterine or myoma volume. There were also no significant changes in the mean myoma volume in the small group of postmenopausal women not on HRT during this interval of time; however, the mean uterine volume decreased. The use of HRT in postmenopausal women with uterine leiomyomas does not seem to significantly increase uterine or myoma size, but may prevent the overall uterine size from shrinking postmenopausally, although larger prospectively designed studies are needed to confirm these findings. Therefore, perhaps following the less time-consuming sonographic measurement of the overall uterine volume is adequate, and may be even preferable, for monitoring these patients rather than using the more labor-intensive serial measurement of the volume of each individual myoma
— id: 53012, year: 1996, vol: 3, page: 38, stat: Journal Article,

Clinical management of the menopause
Wren, Barry G.; Nachtigall, Lila
New York : McGraw-Hill, c1996,
— id: 529, year: 1996, vol: , page: , stat: ,

Clinical trial of the estradiol vaginal ring in the U.S
Nachtigall LE
1995 Dec;22 Suppl:S43-S47, Maturitas
Vaginal atrophy can be reversed for most women through systemic hormones. Those women who cannot take systemic hormones can get relief of symptoms with local estrogen therapy, which ideally should be locally effective without significant systemic absorption and without endometrial stimulation. An estradiol-releasing vaginal ring was therefore tested for efficacy, safety and patient acceptability in a 15-week open-label, randomized parallel group trial with blinded evaluations of the cytological response data. Conjugated estrogen vaginal cream was used as a reference control. The primary objectives of the study were to evaluate whether the two treatments were equivalent regarding improvement in urogenital atrophy, improvement in physicians's overall evaluation of product performance on urinary and/or vaginal changes, and improvement in patient's assessment of urinary and/or vaginal symptoms. A secondary objective was to assess frequency of endometrial overstimulation during estrogen replacement therapy, to be measured by a progestogen challenge test. The ring and cream treatment produced an equivalent effect on the vaginal mucosa, and equivalence was also found in physician's and patient's assessments of both vaginal and urinary symptomatology. Both treatments were equally effective in improving the vaginal pH toward levels normally seen in fertile women (< 5.0). With regard to endometrial stimulation, significantly more patients had bleedings at progestogen challenge test after 3 months of treatment with cream than with the ring. The ring, however, was given significantly better overall product acceptability ratings by the patients. It can therefore be seen as an equally effective, but significantly more acceptable, new administration form for treatment of urogenital disorders due to estrogen deficiency, with a more favourable safety profile than vaginal cream
— id: 6942, year: 1995, vol: 22 Suppl, page: S43, stat: Journal Article,

Emerging delivery systems for estrogen replacement: aspects of transdermal and oral delivery
Nachtigall LE
1995 Sep;173(3 Pt 2):993-997, American journal of obstetrics & gynecology
The ideal preparation for estrogen replacement therapy has been the object of intensive research for decades, and the search continues. More than 40 new products are in development in the United States, the United Kingdom, and Europe. Most are transdermal, which reflects the growing acceptance of patch technology at a time when the overwhelming majority of women who use estrogen replacement take oral formulations. Most of the new oral formulations are a combination of estrogen and progestin. Aspects of transdermal and oral estrogen are discussed, including the advantages and disadvantages for use in women with concomitant medical conditions
— id: 6848, year: 1995, vol: 173, page: 993, stat: Journal Article,

Estrogen issues in relation to cardiovascular disease
Nachtigall LE; Nachtigall LB
1995 Jan-Feb;50(1):7-10, Journal of the American Medical Womens Association (1972)
— id: 56689, year: 1995, vol: 50, page: 7, stat: Journal Article,

Is hormone replacement therapy the right thing to do?
Nachtigall, Lila E
1995 Oct 16;:6-?, Des Moines Register
— id: 90924, year: 1995, vol: , page: 6, stat: Journal Article,

Estrogen
Nachtigall, Lila; Heilman, Joan Rattner
New York : HarperPerennial, 1995,
— id: 587, year: 1995, vol: , page: , stat: ,

What every woman should know : staying healthy after 40
Nachtigall, Lila; Nachtigall, Robert; Heilman, Joan Rattner
New York, NY : Warner Books, c1995,
— id: 583, year: 1995, vol: , page: , stat: ,

Younger all over: Great sex
Nachtigall, Lila; Whitehead, E. Douglas; Zussman, Shirley
1995 Jun;47(6):78-?, Prevention
Advice for maintaining a good sex life as one grows older is offered. Women should expect to remain sexually active and orgasmic as they age
— id: 90925, year: 1995, vol: 47, page: 78, stat: Journal Article,

A user-friendly, time-efficient form for eliciting pertinent information from perimenopausal and menopausal women
Schwartz LB; Mark M; DeCresce M; Porges R; Nachtigall LE
1995 ;2(3):104-106, Primary care update for ob/gyns
— id: 8108, year: 1995, vol: 2, page: 104, stat: Journal Article,

Increased expression of transforming growth factor beta isoforms and basic fibroblast growth factor in complex hyperplasia and adenocarcinoma of the endometrium: evidence for paracrine and autocrine action
Gold LI; Saxena B; Mittal KR; Marmor M; Goswami S; Nachtigall L; Korc M; Demopoulos RI
1994 May 1;54(9):2347-2358, Cancer research
Endometrial carcinoma is associated with antecedent simple and complex hyperplasia, and the endometrium is a target tissue for the action of cytokines and growth factors. Transforming growth factor (TGF)-beta s are potent cellular growth and differentiation regulatory factors. Therefore, we investigated the potential role for TGF-beta s in the normal proliferative endometrium and its possible involvement in the transition to complex hyperplasia and progression to endometrial carcinoma. The angiogenic and mitogenic growth factor, basic fibroblast growth factor, was used for comparison. Differential TGF-beta isoform-specific immunoreactivity was observed in the normal endometrium, which is composed of glandular and stromal cells. There was an increase in TGF-beta 3 but not TGF-beta 1 or TGF-beta 2 in the glandular epithelium from the proliferative to the secretory phase of the menstrual cycle. Immunostaining for TGF-beta 2 was more intense in the stroma than the glands. In contrast, TGF-beta 1 and TGF-beta 3 were near equal intensity in these two endometrial compartments, TGF-beta 3 being the most intense. The glandular epithelium demonstrated a statistically significant stepwise increase in the expression of all three TGF-beta s progressing from the normal proliferative endometrium to simple hyperplasia and on to complex hyperplasia. However, the stromal cells maintained approximately the same level of immunoreactivity for TGF-beta in all these samples. In comparing proliferative endometrium with complex hyperplasia, there was a 5.1-, 3.4-, and 2.6-fold increase in immunostaining in the glands for TGF-beta 1, TGF-beta 2, and TGF-beta 3, respectively (P < or = 0.001). There was no further increase in immunoreactivity with progression from preneoplastic complex hyperplasia to carcinoma. Immunoreactive basic fibroblast growth factor was slight in normal endometrium and simple hyperplasia. There was a 4.6- and 4.2-fold increase in immunostaining observed in complex hyperplasia compared with proliferative endometrium in the glandular (P < or = 0.0054) and stromal (P < or = 0.0053) cells, respectively, with no further increase in carcinoma. By in situ hybridization, an increase in mRNA for all TGF-beta isoforms paralleled TGF-beta immunoreactivity. However, in contrast to the increased immunostaining in the glands in complex hyperplasia, there was remarkably more mRNA in the stromal cell compartment. The discordant expression of mRNA and protein was only observed in the pathological endometrium since both were more highly expressed in the stromal cells in normal proliferative endometrium.(ABSTRACT TRUNCATED AT 400 WORDS)
— id: 6386, year: 1994, vol: 54, page: 2347, stat: Journal Article,

Comparative study: Replens versus local estrogen in menopausal women
Nachtigall LE
1994 Jan;61(1):178-180, Fertility & sterility
This was an open-label study comparing effects of a nonhormonal drug-free bioadhesive vaginal moisturizer to a local estrogen therapy in the treatment of vaginal dryness symptoms. There were 15 women evaluated in each treatment group during a 12-week period. Results indicated that the bioadhesive vaginal moisturizer was a safe and effective alternative to estrogen vaginal cream, with both therapies exhibiting statistically significant increases in vaginal moisture, vaginal fluid volume, and vaginal elasticity with a return of the premenopausal pH state
— id: 13006, year: 1994, vol: 61, page: 178, stat: Journal Article,

Ostrogen : was heutige sichere Therapie zu bewirken vermag = Estrogen
Nachtigall, Lila E; Heilman, Joan R
Munchen : Ariston-Verlag, 1994,
— id: 1750, year: 1994, vol: , page: , stat: ,

First Report of the Joint Task Force on Women's Issues
Nachtigall, Lila
[New York, NY] : The School, 1993,
— id: 466, year: 1993, vol: , page: , stat: ,

Estrogen may protect women against heart attack
Nachtigall, Lila E
1993 Jul 26;:13-?, State Journal Register (Springfield, IL)
In the past, oral contraceptives contained much higher dosages of estrogen than those used in post-menopausal hormone replacement therapy. And it's true that the higher doses of estrogen can decrease the anti-clotting factors in the blood -- and contribute to the formation of clots. A few decades ago, when many women over 35 who were using these higher-dose oral contraceptives developed serious blood clots, researchers found that it was due to two things: higher doses of estrogen and aging. Since that discovery in the 1970s, the U.S. Food and Drug Administration has required that only low-dose oral contraceptives be prescribed to women over 35. After reducing the dosage of estrogen for this group of women, the incidence of blood clots decreased dramatically. It turns out that aging is as important a factor as dosage in regard to clotting
— id: 90926, year: 1993, vol: , page: 13, stat: Journal Article,

Hormone replacement therapy
Nachtigall LE; Nachtigall MJ
1992 Dec;4(6):907-913, Current opinion in obstetrics & gynecology
Although hormone replacement therapy (HRT) has been available for almost 100 years, conflicting opinions still exist about its efficacy and safety. There is uniform agreement that vasomotor instability and vaginal atrophy are totally reversible with HRT. Effective treatment of bone loss with HRT depends on the number of years of estrogen deprivation, peak bone mass, and rapidity of bone loss. Oral, transdermal, and pellet estrogens are equality effective. Mortality from coronary heart disease decreased 20% to 40% in women on HRT, yet the mechanism has not yet been ascertained. The increased risk of endometrial cancer has been confirmed, but better diagnostic techniques for detection in the precancerous state have been developed. The relationship of breast cancer to estrogen use has not been conclusive. Meta-analysis of 13 studies results in a relative risk of 1.06, whereas a large case-control study reveals a relative risk of 0.9. However, it is clear that in the average, healthy woman, low-dose estrogen replacement for less than 10 years does not increase the risk of breast cancer. Physicians are encouraged to help patients weigh the risks and benefits of HRT
— id: 13352, year: 1992, vol: 4, page: 907, stat: Journal Article,

Incidence of breast cancer in a 22-year study of women receiving estrogen-progestin replacement therapy
Nachtigall MJ; Smilen SW; Nachtigall RD; Nachtigall RH; Nachtigall LE
1992 Nov;80(5):827-830, Obstetrics & gynecology
OBJECTIVE: To review the incidence of breast cancer in a continuous 22-year study of conjugated estrogen-medroxyprogesterone acetate hormone replacement therapy. METHODS: Eighty-four pairs of continuously hospitalized postmenopausal women who were matched for age, smoking history, and medical diagnosis were treated with estrogen-progestin hormone replacement therapy or placebo in a prospective and double-blind manner for 10 years. In the subsequent 12 years, the women were offered the choice of starting, stopping, or continuing hormone replacement therapy. RESULTS: After the initial 10 years, the incidence of breast cancer in the placebo group was 4.8%, whereas no cancers were found in the hormone replacement therapy group (P = .12). After an additional 12 years of follow-up, the overall incidence of breast cancer in the women who had never taken hormone replacement therapy was 11.5%, whereas no breast cancers had developed in the women who had ever taken hormone replacement therapy (P < .01). CONCLUSIONS: These data suggest that the 22-year administration of estrogen-progestin hormone replacement therapy did not increase the incidence of breast cancer in a small group of continuously hospitalized postmenopausal women
— id: 57462, year: 1992, vol: 80, page: 827, stat: Journal Article,

Postmenopausal osteoporosis : prevention is the answer
Nachtigall, Lila; Chesnut, Charles
[Ardsley NY] : Ciba-Geigy, 1992,
— id: 1756, year: 1992, vol: , page: , stat: ,

Estrogen
Nachtigall, Lila; Heilman, Joan Rattner
New York : Harper Prerennial, 1991,
— id: 1741, year: 1991, vol: , page: , stat: ,

Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding
Goldstein, S R; Nachtigall, M; Snyder, J R; Nachtigall, L
1990 Jul;163(1 Pt 1):119-123, American journal of obstetrics & gynecology
Endometrial sampling is the mainstay of management of the postmenopausal patient with uterine bleeding. Thirty women with postmenopausal bleeding were studied prospectively. Before endometrial sampling, a vaginal probe ultrasonographic examination was performed. Eleven patients demonstrated a thin 'pencil line' endometrial echo in which the maximum anteroposterior thickness on the long axis view was less than or equal to 5 mm. All eleven patients had minimal tissue obtained on biopsy and a pathology report of 'tissue insufficient for diagnosis.' Seventeen patients had an echogenic endometrium greater than or equal to 6 mm. Pathology reports of their samples revealed tissue insufficient for diagnosis (two cases), proliferative endometrium (six), secretory endometrium (three), hyperplastic endometrium (three), polyp (two), and endometrial cancer (one case). Two additional patients had no endometrial echo visualized because of associated myomas. These findings suggest (1) that the absence of significant endometrial tissue (echo less than or equal to 5 mm) on vaginal ultrasonography in cases with postmenopausal bleeding is uniformly associated with tissue insufficient for diagnosis, and (2) when endometrial thickness is greater than or equal to 6 mm the histologic diagnosis should be determined in the pathology laboratory
— id: 90915, year: 1990, vol: 163, page: 119, stat: Journal Article,

Lipid changes after hormone replacement therapy for menopause
Kable, W T; Gallagher, J C; Nachtigall, L; Goldgar, D
1990 May;35(5):512-518, Journal of reproductive medicine
Three regimens of hormone replacement therapy were administered to 62 postmenopausal women for a period of 12 weeks and evaluated for their effect on blood lipids. Each group was given a continuous dose of 0.625 mg of conjugated estrogens combined with either a continuous dose of 2.5 mg of medroxyprogesterone acetate or 5.0 mg of medroxyprogesterone acetate, or a cyclic dose of 5.0 mg of medroxyprogesterone acetate on days 17-28 of the cycle. After treatment there was a significant decrease in the total cholesterol (P less than .0007) and low density lipoprotein cholesterol (P less than .0001) together with a significant increase in high density lipoprotein cholesterol (P less than .0029). There was no significant difference in the response of the blood lipids to the three hormone groups. Therefore, preference would depend on the combination that caused the least bleeding or amenorrhea
— id: 90916, year: 1990, vol: 35, page: 512, stat: Journal Article,

Enhancing patient compliance with hormone replacement therapy at menopause
Nachtigall LE
1990 Apr;75(4 Suppl):77S-80S, Obstetrics & gynecology
Physicians who prescribe hormone replacement therapy for menopausal women should explain the purpose, risks, and side effects of the treatment. This enhances compliance and discourages patients from discontinuing therapy because of fears of cancer or misconceptions about hormone replacement therapy. The physician should explain that the risk of endometrial cancer is virtually eliminated (reduced to that of a normal woman or a woman not receiving therapy) by the addition of progestogen to estrogen regimens, and that when this cancer does occur, it is usually diagnosed and treated early. Recent studies have not conclusively shown a significant effect of progestogen on lipid profiles relevant to cardiovascular disease. Hormone replacement therapy does not appear to be associated with an increased risk of breast cancer. Nuisance side effects (such as edema and breast tenderness) can be better tolerated if the physician prepares the patient, offers a solution, and helps to put the problem in perspective. Other measures, such as providing written information and avoiding unnecessary biopsies, also enhance compliance
— id: 18778, year: 1990, vol: 75, page: 77S, stat: Journal Article,

The medicalization of the menopause
Nachtigall LE
1990 ;592(4 Suppl):179-179, Annals of the New York Academy of Sciences
— id: 18779, year: 1990, vol: 592, page: 179, stat: Journal Article,

Protecting older women from their growing risk of cardiac disease
Nachtigall LE; Nachtigall LB
1990 May;45(5):24-9, 33, Geriatrics
Heart disease is the leading cause of mortality and a major cause of morbidity in women in the United States. Premenopausal and postmenopausal risk factors for cardiac disease must be reduced to protect women from this major health hazard. The main coronary risk factors for premenopausal women are hypertension, smoking, hyperlipidemia, obesity, and diabetes. Postmenopausal women have these risk factors in addition to a lack of estrogen. Most studies have shown that replacing estrogen in the menopausal woman reduces cardiovascular disease, probably by increasing HDL and decreasing LDL
— id: 18777, year: 1990, vol: 45, page: 24, stat: Journal Article,

Ostrogen : was heutige sichere Therapie zu bewirken vermag = Estrogen
Nachtigall, Lila E; Heilman, Joan R
Munchen : Ariston-Verlag, 1989,
— id: 1753, year: 1989, vol: , page: , stat: ,

Estrogen : ha-'uvdot she-yeshanu et kayayikh : ... tipul tahalifi be-estrogen = Estrogen
Nachtigall, Lila; Heilman, Joan Rattner; Lesing, Yosi
[Tel Aviv] : Danielah Di-Nur, 1988,
— id: 2266, year: 1988, vol: , page: , stat: ,

The effect of preimplantation culture conditions on murine embryo implantation and fetal development
Arny M; Nachtigall L; Quagliarello J
1987 Nov;48(5):861-865, Fertility & sterility
Ham's F-10 medium (Gibco, Grand Island, NY) and medium T6 with and without 15% fetal calf serum (FCS) were compared for their ability to support development of murine blastocysts with the capacity to implant and produce normal fetuses when transferred to pseudopregnant females. All media supported equal rates of blastocyst development from 2-cell embryos. In addition, there were no differences in the rates of blastocyst implantation. However, once implanted, blastocysts grown in T6 produced a significantly higher proportion of normal fetuses (58.5% to 65.9%) than blastocysts grown in either Ham's F-10 (2.4%) or T6 with FCS (27.6%). These results demonstrate that the rate of murine blastocyst development from 2-cell embryos in vitro is not a good criterion of healthy embryos. Murine blastocysts transferred in medium with 0% versus 50% FCS implanted and developed into normal fetuses at equal rates
— id: 11326, year: 1987, vol: 48, page: 861, stat: Journal Article,

Cardiovascular disease and hypertension in older women
Nachtigall LE
1987 Mar;14(1):89-105, Obstetrics & gynecology clinics of North America
Cardiovascular disease is extremely rare in premenopausal women except for those who have diabetes or hypertension. It can be surmised, but is not yet proved, that protection from atherosclerotic coronary artery disease is an action related to the production of estrogen. In the consideration of hypertension, true systemic hypertension must be differentiated from blood pressure that is elevated spuriously from excessive sclerosis of the large arteries, which is more common in elderly patients. Both types of hypertension tend to increase with advancing age, and women have a greater incidence overall. All hypertensives should be actively treated
— id: 18780, year: 1987, vol: 14, page: 89, stat: Journal Article,

Oestrogen : the new women's dynamic : how it can change your life
Nachtigall, Lila; Heilman, Joan Rattner
London : Arlington, 1987,
— id: 1742, year: 1987, vol: , page: , stat: ,

Estrogen : the facts can change your life
Nachtigall, Lila; Heilman, Joan Rattner
Los Angeles : Body Press, 1986,
— id: 1748, year: 1986, vol: , page: , stat: ,

Estrogen : the facts can change your life : the latest word on what the new, safe estrogen therapy can do for great sex, strong bones, good looks, longer life, preventing hot flashes
Nachtigall, Lila; Heilman, Joan Rattner
New York : Harper & Row, c1986,
— id: 242, year: 1986, vol: , page: , stat: ,

Is estrogen replacement therapy necessary?
Hammond CB; Nachtigall LE
1985 Oct;30(10 Suppl):797-801, Journal of reproductive medicine
Estrogen replacement therapy (ERT) is the most effective treatment for vasomotor hot flushes and urethrovaginal atrophy in postmenopausal women. Evidence also suggests that ERT delays osteoporosis and may even reduce the risk of atherosclerosis. Despite continuing controversy, the risks of ERT are now considered minimal. With individualized therapy and appropriate monitoring, ERT with progestin supplements appears to be safe and effective for the great majority of postmenopausal women
— id: 18782, year: 1985, vol: 30, page: 797, stat: Journal Article,

Management of the postmenopausal woman with hypertension. Case presentation and panel discussion
Kaplan NM; Mishell DR; Hammond CB; Henderson BE; LaRosa JC; Lobo RA; Mashchak CA; Nachtigall LE; Perry HM; Ross R
1985 Oct;30(10 Suppl):821-826, Journal of reproductive medicine
— id: 18781, year: 1985, vol: 30, page: 821, stat: Journal Article,

Evaluating the infertile couple
Nachtigall, Lila; Quagliarello, John
New York : Network for Continuing Medical Education, 1984,
— id: 1994, year: 1984, vol: , page: , stat: ,

ESTROGEN REPLACEMENT THERAPY - REPLY
NACHTIGALL, LE
1983 ;61(3):398-399, Obstetrics & gynecology
— id: 40710, year: 1983, vol: 61, page: 398, stat: Journal Article,

Menopause : the current view
King, Theodore M; Nachtigall, Lila E
New York : Network for Continuing Medical Education, 1982,
— id: 1745, year: 1982, vol: , page: , stat: ,

Anorexia nervosa : psychic puzzle
Nachtigall, Lila E
New York : Network for Continuing Medical Education, 1982,
— id: 1746, year: 1982, vol: , page: , stat: ,

Estrogen replacement therapy I: a 10-year prospective study in the relationship to osteoporosis
Nachtigall LE; Nachtigall RH; Nachtigall RD; Beckman EM
1979 Mar;53(3):277-281, Obstetrics & gynecology
A 10-year, double-blind prospective study was undertaken to evaluate the effects of estrogen replacement therapy. The sample population consisted of 84 pairs of randomly chosen postmenopausal patients who were matched for age and diagnosis. One half of the patients received conjugated estrogens and cyclic progesterone, while the other half received placebo. Estrogen-treated patients whose therapy started within 3 years of menopause showed improvement or no increase in osteoporosis. Control patients demonstrate an increase in their osteoporosis
— id: 18785, year: 1979, vol: 53, page: 277, stat: Journal Article,

Estrogen replacement therapy II: a prospective study in the relationship to carcinoma and cardiovascular and metabolic problems
Nachtigall LE; Nachtigall RH; Nachtigall RD; Beckman EM
1979 Jul;54(1):74-79, Obstetrics & gynecology
A 10-year double-blind prospective study was undertaken to evaluate the effects of estrogen replacement therapy (ERT). The sample population consisted of 84 pairs of randomly chosen postmenopausal in-patients, matched for age and diagnosis. The treatment group received high-dose conjugated estrogens, cyclically with progesterone. The controls recieved placebos. Results revealed no statistically significant difference in that incidence of thrombophlebitis, myocardial infarction (MI), or uterine cancer. There was a lower incidence of breast cancer in the treated group. Estrogen-treated patients showed a higher incidence of cholelithiasis. Those in the treated group who began the study with elevated beta/alpha lipoprotein ratios showed a reduction in that ratio over the course of the study, while the controls either maintained or increased their ratios. The low number of cases precludes drawing any real significance from the data on diseases of low frequency. The study excludes only a high incidence of complications from estrogens
— id: 18784, year: 1979, vol: 54, page: 74, stat: Journal Article,

Premature menopause: a reversible entity?
Szlachter BN; Nachtigall LE; Epstein J; Young BK; Weiss G
1979 Sep;54(3):396-398, Obstetrics & gynecology
Secondary hypergonadotropic, hypoestrogenic amenorrhea, or premature menopause, is usually considered an irreversible process. Four patients with this entity were observed to have evidence of ovulation. Three of these patients became pregnant while they were treated with estrogen replacement therapy (ERT) for their hypoestrogenic symptoms. Estrogen replacement may be effective in reversal of this process
— id: 18783, year: 1979, vol: 54, page: 396, stat: Journal Article,

The Lila Nachtigall report
Nachtigall, Lila; Heilman, Joan Rattner
New York : Putnum, c1977,
— id: 208, year: 1977, vol: , page: , stat: ,

ESTROGENS AND ENDOMETRIAL CARCINOMA - REPLY
Nachtigall, LE; Nachtigall, RH; Nachtigall, RB; Beckman, EM
1976 ;294(15):848-848, New England journal of medicine
— id: 29486, year: 1976, vol: 294, page: 848, stat: Journal Article,

Induction of an LH surge with estradiol benzoate. A clinical test of pituitary-hypothalamic axis competence
Weiss G; Nachtigall LE; Ganguly M
1976 Apr;47(4):415-418, Obstetrics & gynecology
Intramuscular injection of 6.6 mg of estradiol benzoate (EB) in oil was used in 34 women as a test of the ability of the pituitary-hypothalamic axis to produce a gonadotropin surge (positive-feedback response). These responses were compared to Clomid responses. All of the normal cycling women, two-thirds of oligo-ovulatory but menstruating women, and one-third of amenorrheic women had LH surges to EB challenge. Estradiol benzoate is a more specific test of positive feedback response than Clomid. It also may be effective in inducing ovulation in some amenorrheic patients refractory to Clomid treatment
— id: 18786, year: 1976, vol: 47, page: 415, stat: Journal Article,

INDUCTION OF AN LH SURGE WITH ESTRADIOL BENZOATE - CLINICAL TEST OF PITUITARY HYPOTHALAMIC AXIS COMPETENCE
Weiss, G; Nachtigall, L; Ganguly, M
1976 ;7(1-2):17-18, Gynecologic & obstetric investigation
— id: 29487, year: 1976, vol: 7, page: 17, stat: Journal Article,

Coagulation studies of menopausal women taking estrogen replacement
Beller, F K; Nachtigall, L; Rosenberg, M
1972 May;39(5):775-778, Obstetrics & gynecology
— id: 90917, year: 1972, vol: 39, page: 775, stat: Journal Article,

Amenorrhea following use of oral contraceptives
Rifkin I; Nachtigall LE; Beckman EM
1972 Jun 1;113(3):420-432, American journal of obstetrics & gynecology
— id: 18787, year: 1972, vol: 113, page: 420, stat: Journal Article,

Pseudo-pseudohypoparathyroidism and pregnancy. A case report
Jewelewicz, R; Nachtigall, L E
1971 Mar;37(3):396-401, Obstetrics & gynecology
— id: 18788, year: 1971, vol: 37, page: 396, stat: Journal Article,

A rapid method for the assay of plasma estriol in pregnancy
Nachtigall, L; Bassett, M; Hogsander, U; Slagle, S; Levitz, M
1966 Sep;26(9):941-948, Journal of clinical endocrinology & metabolism
— id: 90918, year: 1966, vol: 26, page: 941, stat: Journal Article,

IMMUNOLOGIC TEST FOR PREGNANCY
KUPPERMAN, H S; NACHTIGALL, L E; RACHLIN, J; SABIN, C
1964 Jul;36:55-61, Postgraduate medicine
— id: 90905, year: 1964, vol: 36, page: 55, stat: Journal Article,