Menopause Int
· 2010 Mar · PMID 20424283
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The current evaluation of the benefit/risk ratio associated with menopausal hormone therapy (MHT) use is largely based on clinical trials which investigated the effects of oral treatments. Would MHT with transdermal estr...The current evaluation of the benefit/risk ratio associated with menopausal hormone therapy (MHT) use is largely based on clinical trials which investigated the effects of oral treatments. Would MHT with transdermal estrogens be associated with a more favourable benefit/risk ratio? We reviewed the available epidemiologic evidence on that question. Epidemiologic studies were considered if they provided risk estimates of conditions which carry an important weight among menopausal women, and for which epidemiologic evidence of a possible link with MHT use is convincing: cardiovascular diseases, breast cancer, diabetes, colorectal cancer and hip fracture. We did not include studies with only surrogate measures. We found that the available information on the potential impact of the route of administration of MHT on the risk of our selected outcomes is limited. To date, epidemiologic data suggest that it has no impact on the risk of breast cancer and hip fracture. Results on the risk of coronary heart disease and colorectal cancer are inconsistent. Studies on stroke and diabetes risk are too few to allow meaningful conclusions. There is a suggestion that transdermal MHT may be less deleterious than oral MHT regarding venous thromboembolism which needs to be confirmed. The issue of the route of administration of MHT should remain an active area of research as part of an attempt to identify treatment modalities that would have the least potential for exerting adverse effects.
Menopause Int
· 2010 Mar · PMID 20424282
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Premature ovarian failure is a relatively common clinical condition, and carries important long-term health consequences. Estrogen replacement is recommended to alleviate unpleasant hypo-estrogenic symptoms and reduce lo...Premature ovarian failure is a relatively common clinical condition, and carries important long-term health consequences. Estrogen replacement is recommended to alleviate unpleasant hypo-estrogenic symptoms and reduce long-term health risks. However, the most suitable form of estrogen replacement, and the exact effects of no treatment, is unknown. Surprisingly, little research has been carried out in this area. We describe the design of an ongoing clinical trial that will address these issues so that we can begin to provide evidence-based care for affected women.
Navarro MC, Sosa M, Saavedra P
… +5 more, Gil-Antullano SP, Castro R, Bonet M, Travesí I, de Miguel E
Menopause Int
· 2010 Mar · PMID 20424281
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BACKGROUND: Less advantaged social classes usually have unhealthier lifestyles and have more difficult access to health resources. In this work we study the possible association between poverty and the prevalence of obes...BACKGROUND: Less advantaged social classes usually have unhealthier lifestyles and have more difficult access to health resources. In this work we study the possible association between poverty and the prevalence of obesity and oophorectomy in a population of postmenopausal women. DESIGN: Cross-sectional observational study. OBJECTIVE: To study in a population of postmenopausal women in poverty the possible differences in the prevalence of obesity and oophorectomy, and to compare some other gynaecological data: age at menarche, age at menopause, fertile years, number of pregnancies, breastfeeding and the use of hormonal replacement therapy (HRT). METHOD: All patients were interviewed personally. A questionnaire was used to find out about their lifestyles and the medication they were taking. Their medical records were reviewed to confirm the existence of some diseases. A complete physical examination was performed with every patient. Weight and height were measured with the patient dressed in light clothes. Blood was obtained in a fasting state in order to carry out some analyses. Poverty was defined according to the Spanish National Institute of Statistics criteria. RESULTS: We enrolled 1225 postmenopausal women; 449 (36.6%) were under the threshold of poverty, defined by the Spanish National Institute of Statistics. Postmenopausal women in poverty had higher body mass index (29.2 +/- 4.8 versus 27.0 +/- 4.7 kg/m(2) P < 0.001), and a higher prevalence of obesity than postmenopausal women not in poverty (44.2% versus 24.3%, P = 0.001). The prevalence of oophorectomy was also higher in women in poverty (32.7% versus 27.2%, P < 0.04). Women in poverty had had a greater number of pregnancies (3 versus 2, P = 0.001). They also showed a higher rate of breastfeeding than women in medium and high social classes (65% versus 59%, P = 0.037). There were no statistically significant differences between the groups in either the age of menopause or fertile years, nor in the use of HRT. CONCLUSIONS: Postmenopausal women in poverty have higher levels of obesity, and also a greater prevalence of oophorectomy than women of medium and high social classes. They also presented a higher rate of breastfeeding and a greater number of pregnancies than those women not in poverty.
Menopause Int
· 2010 Mar · PMID 20424280
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OBJECTIVES: We aimed to determine the prevalence of endometrial cancer in patients presenting with recurrent postmenopausal bleeding (PMB) after initial negative investigations. STUDY DESIGN: This was a retrospective stu...OBJECTIVES: We aimed to determine the prevalence of endometrial cancer in patients presenting with recurrent postmenopausal bleeding (PMB) after initial negative investigations. STUDY DESIGN: This was a retrospective study carried out in a dedicated PMB clinic. All patients presenting with recurrent PMB between 1 January 2003 and 31 May 2009 were studied. All patients had transvaginal ultrasound, speculum examination and endometrial sampling attempted. Main outcome measure The prevalence of endometrial cancer in patients presenting with recurrent PMB after initial negative investigations. RESULTS: A total of 1536 women with PMB were seen over a period of 56 months. Sixty-six required definitive treatment after their first visit. One hundred and twenty-six re-presented with recurrent bleeding. The prevalence of endometrial cancer in women presenting for the first time with PMB was 3.04% whereas that in women presenting with recurrent PMB after initial negative investigations was 4%. One of these women re-presented within six months of initial visit and another within one year. All the other cancers were diagnosed more than one year after initial negative investigations (range 19.6-57.1 months). One woman had an endometrial cancer even though the endometrial thickness was less than 3 mm. CONCLUSIONS: Women with recurrent PMB after initial negative investigations are no more likely to have endometrial cancer than those presenting for the first time but re-investigation is indicated if six months has elapsed.
Burbos N, Musonda P, Giarenis I
… +4 more, Shiner AM, Giamougiannis P, Morris E, Nieto JJ
Menopause Int
· 2010 Mar · PMID 20424279
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OBJECTIVE: The aim of this study is to identify the causes of vaginal bleeding in different age groups of postmenopausal women. Also, we attempt to estimate the incidence of postmenopausal vaginal bleeding and endometria...OBJECTIVE: The aim of this study is to identify the causes of vaginal bleeding in different age groups of postmenopausal women. Also, we attempt to estimate the incidence of postmenopausal vaginal bleeding and endometrial cancer in a defined geographical area. STUDY DESIGN: The study was conducted at a gynaecological oncology centre in the United Kingdom, between February 2006 and May 2009. Patients were investigated according to established evidence-based departmental guidelines. RESULTS: During the study period 3047 women were referred with postmenopausal vaginal bleeding. In 1356 women (44.5%) the endometrial thickness measured less than 5 mm on transvaginal ultrasound scan. Benign histology was found in 1144 women (37.5%). Benign endometrial polyps were the cause of bleeding in 10.1% of the cases. The incidence of endometrial cancer in our study population was 5%. The rate of postmenopausal vaginal bleeding during the study period peaks at the age of 55-59 years (25.9/1000 postmenopausal women/year) and declines thereafter. The peak incidence of endometrial cancer during the study period (12.6/10,000 postmenopausal women/year) was seen between the ages of 60 and 64 years and similarly declines with increasing age. CONCLUSION: To our knowledge, this is the first population-based estimation of the incidence of genital tract bleeding and endometrial cancer among postmenopausal women in the United Kingdom. The results of this study showing the age-related differential diagnosis can be used to inform clinical practice when counselling postmenopausal women with vaginal bleeding.
Menopause Int
· 2009 Dec · PMID 19933471
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The menopause is an isolated event in a much wider process that was probably an evolutionary adaptation essential for survival in the Pliocene. As a reproductive strategy, it is largely vestigial in the 21st century, par...The menopause is an isolated event in a much wider process that was probably an evolutionary adaptation essential for survival in the Pliocene. As a reproductive strategy, it is largely vestigial in the 21st century, part of an era that has seen a doubling of the average human longevity compared with that of the past. This process commences as an accelerated decline in female fertility, usually from the fourth decade of life, culminating in a total cessation of reproductive capacity for those surviving. The 20th and 21st century sees a huge increase in the numbers surviving and the duration of that postreproductive life phase extending for decades. This extended period of what is essentially a hormone deficiency state is a recent phenomenon and by no means part of the natural history of the human individual. It is therefore not surprising to see a postmenopausal increase in the incidence of so many disorders above that expected by age alone. Recent reproductive patterns have seen increases in the birth rate and requests for fertility treatments among women in their late 30s and 40s. Many try for pregnancy but are unsuccessful. The genes that permit later reproduction and hence later menopause are therefore being preferentially selected. Slowly over generations we will expect to see the fertility of future 40 year olds increase and the age of menopause to extend much later into our, now, longer lives.
Menopause Int
· 2009 Dec · PMID 19933470
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Endometriosis is an estrogen-dependent condition and is characterized by the presence of ectopic endometrial tissue. The pathogenesis of this condition remains an enigma. Endometriosis has well known associations with me...Endometriosis is an estrogen-dependent condition and is characterized by the presence of ectopic endometrial tissue. The pathogenesis of this condition remains an enigma. Endometriosis has well known associations with menopause both in terms of secondary outcomes from medical and surgical therapy in premenopausal women, as well as a natural occurrence/recurrence of the disease in women going through menopause naturally. This review article aims to discuss the current day modalities of management of endometriosis with their pros and cons especially in the context of menopause and cancer.
Menopause Int
· 2009 Dec · PMID 19933469
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Pregnancy in peri- and postmenopausal women is associated with an increased risk of complications and represents several challenges in terms of clinical management. Women in these age groups typically fall into one of tw...Pregnancy in peri- and postmenopausal women is associated with an increased risk of complications and represents several challenges in terms of clinical management. Women in these age groups typically fall into one of two distinct groups, those who have conceived following assisted reproductive techniques, using ovum donation and those who have conceived spontaneously. While both have age in common, they differ in terms of additional risk factors. Recipients of assisted reproductive technologies have pregnancy risks associated with that treatment, but are at lower risks of a fetus affected by aneuploidy. Furthermore, they have been rigorously screened for medical complications, but are more likely to be primiparous and have multiple pregnancies. In contrast, women conceiving spontaneously are more likely to be of high parity and have additional medical complications such as obesity, hypertension or diabetes. In addition to the increased risk of antenatal complications such as miscarriage, ectopic pregnancies, gestational diabetes and hypertension, these women have a high risk of unexplained stillbirth. They also have a very high rate of Caesarean section. All these risk factors interact to modify clinical management. However, there are no randomized trials available to guide clinical management, thus decisions must be made on a case-by-case basis.
Menopause Int
· 2009 Dec · PMID 19933468
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Postmenopausal bleeding (PMB) is a symptom of possible gynaecological malignancy. According to present guidelines, women presenting with this symptom should be referred urgently to a team specializing in the management o...Postmenopausal bleeding (PMB) is a symptom of possible gynaecological malignancy. According to present guidelines, women presenting with this symptom should be referred urgently to a team specializing in the management of gynaecological cancer, and be seen within two weeks of referral. Examination and investigation of these women should be able to exclude malignancy, while being acceptable to the patient and cost-effective. The gold standard modality of investigation to visualize the uterine cavity is hysteroscopy, but transvaginal scanning is recommended as the first-line investigation to select those who need further diagnostic evaluation. Hysteroscopy should be performed in women with a thickened endometrium on scan and women with recurrent episodes of bleeding despite negative scan findings. There have been very few studies that have examined women's knowledge, attitudes or concerns about PMB or its assessment. Further research would inform information and support strategies for women presenting and undergoing assessment for this symptom.
Menopause Int
· 2009 Dec · PMID 19933467
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The evolving role of the menopause nurse is essential to the provision of expert clinical care, and for the education of both patients and health-care professionals. The new Royal College of Nursing integrated competence...The evolving role of the menopause nurse is essential to the provision of expert clinical care, and for the education of both patients and health-care professionals. The new Royal College of Nursing integrated competence framework for health-care support workers and nurses working in menopause has been developed to provide specialist guidance and can be used to ensure practice is safe, effective and accountable. It supports acknowledgement for knowledge, skills and competence in their daily roles whilst caring for women at the time of menopause. It aims to ensure consistent standards across all settings whilst increasing the effectiveness of menopause service provision. Using the competences will help nursing staff identify their own level of practice, career plan in a more structured way and pinpoint education and development needs. The framework is a dynamic document that will continuously evolve in light of changes in menopausal healthcare.
Mendoza N, Sánchez-Borrego R, Galiano D
… +6 more, Salamanca A, Mozas J, Quereda F, Vázquez F, Martínez-Astorquiza T, Moron F
Menopause Int
· 2009 Dec · PMID 19933466
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OBJECTIVE: Age at natural menopause (ANM) can be considered a complex parameter that depends on the interaction of multiple factors. In the present study, the role of interaction between genetic variants within estrogen...OBJECTIVE: Age at natural menopause (ANM) can be considered a complex parameter that depends on the interaction of multiple factors. In the present study, the role of interaction between genetic variants within estrogen synthesis and signalling pathways in the ANM in Spanish women is studied. MATERIAL AND METHODS: Nine single nucleotide polymorphisms (SNPs) located at different candidate genes related to the estrogen signalling pathway were analysed in 1980 Spanish postmenopausal women. RESULTS: Independently, none of the nine markers were significantly associated with early ANM. Only heterozygosis at the NRIP rs2229741 locus could be associated with early menopause; however, this marker does not maintain statistical significance. In contrast, linear regression analysis suggests several epistatic interactions including these markers in relation to ANM, especially between ESR2, NRIP1 and BMP15. The genetic variant that appears most in these interactions is that of the BMP15 rs3897937. It was observed that AA-TC combined genotype for NRIP-BMP15 (rs3897937), respectively, appears to be associated with a lower ANM than other possible combinations of these SNP (46.1+/-5.9 versus 50.4+/-3.3; P = 0.002). In the multilocus analysis, the multigenic interaction formed by ESR2 (AA), BMP15 rs3897937 (TC) and NRIP1 (AA) has the lower ANM (45.37+/-6.8 versus 48.69+/-5; P = 0.038). CONCLUSIONS: The results suggest that epistatic interactions of estrogen-related alleles may contribute to variance in ANM in Spanish women. Moreover, BMP15 and NRIP1 also appear as attractive candidate genes for premature menopause but require further investigation to confirm them.
Llaneza P, González C, Fernandez-Iñarrea J
… +3 more, Alonso A, Arnott I, Ferrer-Barriendos J
Menopause Int
· 2009 Dec · PMID 19933465
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OBJECTIVES: The objective of this study was to evaluate whether there is a relation between serum selenium levels and health-related quality of life (HRQoL) in overweight and obese postmenopausal women. STUDY DESIGN: A c...OBJECTIVES: The objective of this study was to evaluate whether there is a relation between serum selenium levels and health-related quality of life (HRQoL) in overweight and obese postmenopausal women. STUDY DESIGN: A cross-sectional study was carried out in 104 overweight and obese postmenopausal women attending a gynaecological clinic for their annual gynaecological examination. MAIN OUTCOME MEASURES: Age, anthropometric parameters, educational level, smoking habits, serum glucose, insulin, lipid profile, C-reactive protein, folic acid, vitamin B12, homocysteine and selenium levels were determined, and the Cervantes Scale was used to evaluate HRQoL. RESULTS: Serum selenium mean value levels were similar in the different groups of HRQoL and there were no differences in the four domains of the Cervantes Scale. When women were classified according to serum selenium tertiles, higher levels of serum cholesterol, low-density lipoprotein cholesterol (LDLc) and triglycerides were found in women in the lowest serum selenium tertile. CONCLUSIONS: In overweight and obese postmenopausal women, serum selenium level is not related to HRQoL but higher levels of cholesterol, LDLc and triglyceride values were detected in women in the lowest serum selenium tertile.
The life-expectancy for women has increased significantly in the 20th century, although the time of onset of menopause has not. Almost a third of a woman's life is now postmenopausal and therefore many postmenopausal wom...The life-expectancy for women has increased significantly in the 20th century, although the time of onset of menopause has not. Almost a third of a woman's life is now postmenopausal and therefore many postmenopausal women consider using hormone replacement therapy (HRT) to improve their quality of life. Most cases of endometrial carcinoma arise in postmenopausal women and this raises concern among patients and clinicians with regard to the safety of HRT in this age group. Whenever the use of HRT is considered, a careful consideration of the actual benefit in terms of symptom relief and quality of life must be balanced against the risks for each individual woman. This review discusses the effects of HRT on the endometrium and the evidence regarding HRT use and risk of endometrial cancer.
The menopause is an important transition point for women in terms of their experience of sex. Higher expectations of a longer, healthier lifespan means that access to health professionals with the skills to address sexua...The menopause is an important transition point for women in terms of their experience of sex. Higher expectations of a longer, healthier lifespan means that access to health professionals with the skills to address sexual issues is more important than ever. This review of the literature considered four broad areas: the influence of patient and practitioner characteristics on consultations about sexual issues for peri- and postmenopausal women; perceived barriers to discussion of sexual issues; the role and effectiveness of communication training; and examples of good practice in the field. This is an under-researched area with few papers focusing on the specific needs of this group of patients or practitioners. In order to improve the quality of life of mid-life and older women, more high-quality research is needed that can inform both education and training for gynaecologists, and the development of high-quality services.
Intervertebral discs are an integral part of the vertebral column. It has been shown that menopause has a negative effect on bone and on intervertebral discs. Estrogen has a beneficial effect of preserving the health of...Intervertebral discs are an integral part of the vertebral column. It has been shown that menopause has a negative effect on bone and on intervertebral discs. Estrogen has a beneficial effect of preserving the health of collagen-containing tissues, including the intervertebral disc. The intervertebral disc allows for mobility of the spine, and maintains a uniform stress distribution of the area of the vertebral endplates. Also, the disc influences spinal height. The disc tissue is adapted for this biomechanical function. The function of the spine is impaired if there is a loss of disc tissue. Narrowing of the disc space due to degeneration of intervertebral discs is associated with a significantly increased risk of vertebral fractures. Estrogen should be seen as the first-choice therapy for bones and other collagen-rich tissues, such as intervertebral discs, because it maintains homeostasis of the bone-remodelling unit. Unlike bisphosphonates, estrogen is unique in its ability to regenerate bone collagen after its disintegration, apart from suppressing osteoclastic activity. Besides, there is insufficient data on deterioration in bone qualities and micro-cracks in patients on long-term bisphosphonates.