OBJECTIVES: Determine women's experiences of premenstrual symptoms. STUDY DESIGN: Cross-sectional survey. Sample In all, 4085 women aged 14-49 years recruited by random telephone digit dialing in France, Germany, Hungary...OBJECTIVES: Determine women's experiences of premenstrual symptoms. STUDY DESIGN: Cross-sectional survey. Sample In all, 4085 women aged 14-49 years recruited by random telephone digit dialing in France, Germany, Hungary, Italy, Spain, UK, Brazil and Mexico. Main outcome measures Telephone interview checklist of 23 premenstrual symptoms, sociodemographic variables and lifestyle variables. RESULTS: The most prevalent symptoms were abdominal bloating, cramps or abdominal pain, breast tenderness, irritability and mood swings. Severity of symptoms is directly proportional to duration (R = 0.79). Hierarchical clustering found the following mental and physical domains and a typology: 'Mild' type (40.8%) with minimal symptoms; 'Moderate M' type (28.7%) with moderately severe, mostly mental symptoms; 'Moderate P' type (21.9%) with moderately severe, mostly physical symptoms; and 'Severe' type (8.6%) with severe intensity of both mental and physical symptoms. Multiple stepwise regression found significant effects on symptom duration severity index of age (linear and quadratic effects), current smoking and country. CONCLUSIONS: Further research is needed on the impact of premenstrual symptoms on quality of life, and whether a brief symptom list could be developed as a valid and reliable tool globally.
OBJECTIVE: The aim of this study was to evaluate the knowledge, attitudes and expectations of patients receiving treatment for postmenopausal osteoporosis, analysing the factors related to good compliance with treatment....OBJECTIVE: The aim of this study was to evaluate the knowledge, attitudes and expectations of patients receiving treatment for postmenopausal osteoporosis, analysing the factors related to good compliance with treatment. METHODS: A national, epidemiological, cross-sectional study collected information on personal medical history, family history, bone densitometry, and treatment and compliance of patients over 45 years who were receiving treatment for osteoporosis and provided their informed consent. The patients anonymously completed a questionnaire about their knowledge of osteoporosis and the Morisky and Green treatment compliance evaluation test. RESULTS: Three hundred and fifteen specialists in gynaecology participated, recruiting 1179 patients with postmenopausal osteoporosis. The mean age was 59.9 years (standard deviation [SD] = 7.5). Only 22.6% of the patients showed an acceptable knowledge of osteoporosis (the criterion established was correct response to 80% of the questions). Treatment compliance was evaluated using a combination of Morisky-Green and Haynes-Sackett criteria. Of the patients 39.2% were classified as compliant, 74.6% of the patients were very or quite concerned about their condition and 53.3%; described their health status as excellent or good. However, 63.6% of the patients indicated that they needed more information about osteoporosis. The factors related to good compliance were the existence of one or no concomitant disease (odds ratio [OR] = 1.38, P = 0.025) and the type of knowledge about their disease (acceptable knowledge: OR = 1.33, P = 0.043). CONCLUSIONS: Correct knowledge about osteoporosis would increase the possibility of appropriate compliance with the prescribed treatment, thus reducing the risk of osteoporotic fractures.
OBJECTIVE: The effect of menopause on breathing is not fully understood. We have previously shown that postmenopausal women have a higher sleep-induced increase in transcutaneously measured carbon dioxide tension (TcCO(2...OBJECTIVE: The effect of menopause on breathing is not fully understood. We have previously shown that postmenopausal women have a higher sleep-induced increase in transcutaneously measured carbon dioxide tension (TcCO(2)) than premenopausal women. Therefore, we hypothesized that estrogen therapy (ET) would normalize this sleep-induced TcCO(2) increase. METHODS: Nine postmenopausal ET users and nine non-users went through an overnight polygraphic sleep study including continuous monitoring of TcCO(2). RESULTS: TcCO(2) levels were higher during sleep than evening wakefulness (awake median 6.55 kPa versus sleep median 6.90 kPa, P = 0.001). ET users had a greater sleep-induced increase in TcCO(2) than non-users when comparing the difference between wakefulness and slow-wave sleep (0.85 kPa versus 0.28 kPa, P = 0.004). Lower sleep efficiency was associated with higher sleep-induced increase in TcCO(2). CONCLUSIONS: In contrast to our initial hypothesis, postmenopausal ET users have a higher sleep-induced increase in TcCO(2) than women without ET. Thus, TcCO(2) may be sensitive in measuring the peripheral estrogen effect. These findings warrant placebo-controlled intervention studies to confirm the effects of ET on TcCO(2) measurements.
OBJECTIVE: To establish whether treatment for three years with pro-juven progesterone cream affects progression of atherosclerotic plaques or bone density in postmenopausal women. Design Randomized double-blind placebo-c...OBJECTIVE: To establish whether treatment for three years with pro-juven progesterone cream affects progression of atherosclerotic plaques or bone density in postmenopausal women. Design Randomized double-blind placebo-controlled trial. Sample One hundred and thirty-one healthy postmenopausal women aged between 50 and 75 years with at least one asymptomatic arterial plaque visible on ultrasound of the carotid or femoral bifurcation. METHODS: Women were randomly allocated to receive pro-juven progesterone cream, 20 mg twice daily, or placebo, for three years. Main outcome measure Rate of change of plaque thickness, intima-media thickness and bone density of lumbar spine and femoral neck. RESULTS: There was no difference between the groups. CONCLUSION: Pro-juven progesterone cream 20 mg twice daily did not affect progression of asymptomatic atherosclerosis or deterioration in bone density over three years.
The UK National Dementia Strategy 2009 outlines the problems of cognitive decline and dementia; among which it stresses the importance of early diagnosis. This is an area in which menopause services and clinics could and...The UK National Dementia Strategy 2009 outlines the problems of cognitive decline and dementia; among which it stresses the importance of early diagnosis. This is an area in which menopause services and clinics could and should have an important input to the strategy. Cognitive change, osteoporosis and cardiovascular disease are recognized late complications of the menopause, and severe conditions in untreated premature menopause. Two to three times more women than men are affected by dementia; the situation regarding measuring cognitive change is explored.
Menopause Int
· 2009 Jun · PMID 19465676
·
Publisher ↗
Androgens exert effects on virtually all bodily tissues, and have a multitude of physiological roles in health. Testosterone, the predominant androgen in men, when deficient (hypogonadism), leads to a multiplicity of sym...Androgens exert effects on virtually all bodily tissues, and have a multitude of physiological roles in health. Testosterone, the predominant androgen in men, when deficient (hypogonadism), leads to a multiplicity of symptoms and signs that are corrected with physiological substitution. The impact of hypogonadism depends on the age at which it occurs. In any case, when testosterone replacement is initiated close monitoring for efficacy and safety is advised. The relation of ageing, the metabolic syndrome, type 2 diabetes, obesity and survival with plasma testosterone has been closely examined in recent studies. However, the effect of testosterone replacement therapy on the above clinical states needs to be clarified in large long-term duration/outcome studies. Recent research has shed light on possible molecular testosterone targets. Based on those research outcomes, drugs targeting the androgen receptor, which spare androgenic effects and preserve anabolic tissue effects, called selective androgen receptor modulators (SARMS), are under clinical trials. The role of testosterone in regulating erectile function has been studied in animal models and critical tissue testosterone targets have been elucidated.
Nappi RE, Sances G, Detaddei S
… +3 more, Ornati A, Chiovato L, Polatti F
Menopause Int
· 2009 Jun · PMID 19465675
·
Publisher ↗
In this review, we underline the importance of linking migraine to reproductive stages for optimal management of such a common disease across the lifespan of women. Menopause has a variable effect on migraine depending o...In this review, we underline the importance of linking migraine to reproductive stages for optimal management of such a common disease across the lifespan of women. Menopause has a variable effect on migraine depending on individual vulnerability to neuroendocrine changes induced by estrogen fluctuations and on the length of menopausal transition. Indeed, an association between estrogen 'milieu' and attacks of migraine is strongly supported by several lines of evidence. During the perimenopause, it is likely to observe a worsening of migraine, and a tailored hormonal replacement therapy (HRT) to minimize estrogen/progesterone imbalance may be effective. In the natural menopause, women experience a more favourable course of migraine in comparison with those who have surgical menopause. When severe climacteric symptoms are present, postmenopausal women may be treated with continuous HRT. Even tibolone may be useful when analgesic overuse is documented. However, the transdermal route of oestradiol administration in the lowest effective dose should be preferred to avoid potential vascular risk.
Menopause Int
· 2009 Jun · PMID 19465674
·
Publisher ↗
BACKGROUND: Gender differences, related to varying sexual hormone levels and hormone secretion patterns across the lifespan, contribute to women's vulnerability to mood disorders and major depression. Women are more pron...BACKGROUND: Gender differences, related to varying sexual hormone levels and hormone secretion patterns across the lifespan, contribute to women's vulnerability to mood disorders and major depression. Women are more prone than men to depression, from puberty onwards, with a specific exposure across the menopausal transition. However, controversy still exists in considering fluctuation/loss of estrogen as a specific aetiologic factor contributing to depression in perimenopause and beyond. AIMS: To briefly review the interaction between changes in menopausal hormone levels, mood disorders, associated neuropsychological co-morbidities and ageing, and to evaluate the currently available therapeutic options for perimenopausal mood disorders: (a) treatment of light to moderate mood disorders with hormonal therapy (HT); (b) treatment of major depression with antidepressants; (c) the synergistic effect between HT and antidepressants in treating menopausal depression. RESULTS: Depression across the menopause has a multifactorial aetiology. Predictive factors include: previous depressive episodes such as premenstrual syndrome and/or postpartum depression; co-morbidity with major menopausal symptoms, especially hot flashes, nocturnal sweating, insomnia; menopause not treated with HT; major existential stress; elevated body mass index; low socioeconomic level and ethnicity. Postmenopausal depression is more severe, has a more insidious course, is more resistant to conventional antidepressants in comparison with premenopausal women and has better outcomes when antidepressants are combined with HT. CONCLUSION: The current evidence contributes to a re-reading of the relationship between menopause and depression. The combination of the antidepressant with HT seems to offer the best therapeutic potential in terms of efficacy, rapidity of improvement and consistency of remission in the follow-up.
Menopause Int
· 2009 Jun · PMID 19465673
·
Publisher ↗
Premature ovarian failure (POF) is the occurrence of hypergonadotropic hypoestrogenic amenorrhoea in women under the age of 40 years. POF is idiopathic in 74-90% of cases but can be familial (4-33%) or sporadic. The know...Premature ovarian failure (POF) is the occurrence of hypergonadotropic hypoestrogenic amenorrhoea in women under the age of 40 years. POF is idiopathic in 74-90% of cases but can be familial (4-33%) or sporadic. The known causes are: genetic aberrations; autoimmune ovarian damage; iatrogenic following surgery, radiotherapy or chemotherapy; environmental factors (viruses, toxins, etc.); and metabolic (galactosaemia, 17 OH deficiency, etc.) Genetic aberrations could involve the X chromosome (monosomy, trisomy or translocations) or be autosomal. Genetic mechanisms include reduced gene dosage and non-specific chromosome effect impairing meiosis, decreasing the pool of primordial follicles and increasing atresia due to apoptosis or failure of follicle maturation. The genes for POF-1 are localized to Xq 21.3-Xq27 and for POF-2 to Xq13.3-21.1. The FMR1 gene is responsible for the fragile X syndrome. It occurs due to CGG expansion of more than 55 repeats at the 5'UTR (Xq 27.3), which is associated with gene silence resulting in mental retardation in males, and POF in female carriers. Autoimmune ovarian damage is caused by the alteration of T-cell subsets and T-cell-mediated injury, increase of autoantibody producing B-cells and a low number of effector suppressor/cytotoxic lymphocyte and a decrease of number and activity of natural killer cells. POF can be associated with other non-endocrine and endocrine diseases. The mutations of AIRE gene are responsible for polyendocrinopathies (APS I-III). As the cause of POF is unknown in the majority of cases and the number of women with POF is increasing, the primary goal of scientific groups worldwide should be focused on the study of the aetiology of POF.
Menopause Int
· 2009 Jun · PMID 19465672
·
Publisher ↗
Iron overload in female patients with sickle cell disease (SCD) has been reported to result in gonadal dysfunction. To date there has been no report in the literature of ovarian sickling being a reason for gonadodysgenes...Iron overload in female patients with sickle cell disease (SCD) has been reported to result in gonadal dysfunction. To date there has been no report in the literature of ovarian sickling being a reason for gonadodysgenesis (premature ovarian failure [POF]) in women. This case report describes POF in a woman with SCD and suggests ovarian sickling as its cause. We propose that frequent episodes of intravascular sickling, vessel occlusion and infarction as well as tissue hypoxia associated with chronic anaemia could account for the ovarian dysgenesis and hence POF.
Benster B, Carey A, Wadsworth F
… +3 more, Vashisht A, Domoney C, Studd J
Menopause Int
· 2009 Jun · PMID 19465671
·
Publisher ↗
OBJECTIVE: To evaluate the effect on climacteric symptoms and quality of life, and the safety of four doses of progestelle progesterone cream administered for 24 weeks to postmenopausal women complaining of moderate to s...OBJECTIVE: To evaluate the effect on climacteric symptoms and quality of life, and the safety of four doses of progestelle progesterone cream administered for 24 weeks to postmenopausal women complaining of moderate to severe menopausal symptoms. Design Single-centre, double-blind, randomized, placebo-controlled study. Population Two hundred and twenty-three healthy postmenopausal women, aged between 40 and 60 years and complaining of severe menopausal symptoms were recruited through newspaper advertisements. METHODS: Women were randomly allocated to progestelle progesterone cream 60, 40, 20, 5 mg or placebo, to be applied daily for six months. Main outcome measures The primary efficacy variable was the psychological, somatic and vasomotor components of the Greene Climacteric Scale after six months. Secondary endpoints were incidence of hot flushes and night sweats, the nine subscales of the Medical Outcome Survey Short Form-36 (SF-36), serum progesterone, endometrial thickness and histology after six months. Adverse events were sought and recorded and followed up to resolution. RESULTS: There were no statistically significant differences between any of the treatment groups and placebo for any of the components of the Greene Score. A statistically significant difference between the 20 mg group and placebo was found for the physical functioning (95% confidence interval [CI] 1.7-12.3; P=0.01) and social functioning (95% CI 1.9-16.7; P=0.01) scales of SF-36 after six months. No other statistically significant differences were found between any treatment group and placebo for any of the other secondary efficacy variables. There appeared to be a higher incidence of headache in the groups treated with progesterone cream. CONCLUSIONS: Progesterone cream was no more effective than placebo for relief of menopausal symptoms.
Menopause Int
· 2009 Jun · PMID 19465670
·
Publisher ↗
OBJECTIVE: To assess the correlation between vertebral body T-score and intervertebral disc height in premenopausal and postmenopausal women. METHODS: A total of 203 women were recruited from a large bone densitometer di...OBJECTIVE: To assess the correlation between vertebral body T-score and intervertebral disc height in premenopausal and postmenopausal women. METHODS: A total of 203 women were recruited from a large bone densitometer directory. The disc heights measured were those between the 12th thoracic and third lumbar vertebra. The discs were assigned the symbols D, whereby D1 applies for the disc between the 12th thoracic and first lumbar vertebra. The disc height of the group of women (n=38) with osteoporotic vertebral fractures was compared with the disc heights of hormone-treated women (n=47), untreated postmenopausal women (n=77) and another group of premenopausal women (n=41). Bone density measurements were taken by a Norland Bone Densitometer (DEXA 586). RESULTS: The lowest disc heights were found in the fracture group. The total disc height in the fracture group was 1.42+/-0.25 cm, significantly lower (P<0.0001) than the untreated group (1.82+/-0.3 cm), which in turn was significantly (P<0.0001) lower than the hormone-treated group (2.2+/-0.26 cm) and the premenopausal group (2.11+/-0.21 cm). The lowest T-scores were also noted in the vertebral fracture group (T-score=-3.1+/-0.3) (P<0.0001). The highest T-score recorded for the premenopausal group was -0.38+/-45, higher than that of the untreated menopausal -1.4+/-0.32 and hormone treated women -0.65+/-0.3, all three significantly higher than the fracture group (P<0.0001). The lowest T-scores were also noted in the vertebral fracture group (T-score=-3.1+/-0.3) (P<0.0001). The highest T-score recorded for the premenopausal group was -0.38+/-45, higher than that of the untreated menopausal -1.4+/-0.32 and hormone treated women -0.65+/-0.3, all three significantly higher than the fracture group (P<0.0001). Bone density across all groups revealed a correlation with disc height (R=0.29) (P<0.05). The group with vertebral osteoporotic fractures was the only group to show a negative correlation (-0.21) between disc height and vertebral bone density. Conversely, a significant correlation (R=0.47) (P<0.001) between the T-score and the total lumbar intervertebral disc height was noted in the premenopausal group of women. The menopausal group of untreated women also showed a significant correlation between the T-score and disc height (R=0.25 P<0.05); however, an insignificant positive correlation was found in the hormone-treated group. CONCLUSION: The fracture group was noted to have the lowest intervertebral disc height and lowest T-scores compared with the other three groups. The hormone-treated and the premenopausal women had the highest disc heights and T-scores recorded. Positive correlations between T-score and disc height were noted for all the groups except for the fracture group. These results suggest a coupling between the vertebral body and intervertebral disc, which if disrupted may lead to increased risk for fracture. The combination of both T-score and disc height may improve the screening sensitivity for vertebral body fracture risk.
Menopause Int
· 2009 Jun · PMID 19465669
·
Publisher ↗
Controversy still rages about whether hormone replacement therapy (HRT) confers cardiovascular benefit or harm. There is a wealth of biological evidence that estrogen has a beneficial effect, supporting a large body of e...Controversy still rages about whether hormone replacement therapy (HRT) confers cardiovascular benefit or harm. There is a wealth of biological evidence that estrogen has a beneficial effect, supporting a large body of epidemiological evidence demonstrating reduction in coronary events with HRT. A large randomized placebo-controlled clinical trial of preventive strategies for coronary heart disease (CHD) in postmenopausal women, the Women's Health Initiative (WHI), included HRT arms. The published preliminary findings of this trial showed a significant increase in coronary events, stroke, venous thromboembolism and breast cancer with estrogen-progestogen, leading to the conclusion that HRT was unsafe to use other than for short-term relief of menopausal symptoms. But subsequent publications of the more complete data from WHI have shown no significant increase in CHD, and a tendency to a reduction in those initiating HRT below age 60 years. This is important because other therapeutic strategies for the primary prevention of CHD, such as aspirin and statins, are not of proven benefit in women, in contrast to men. Subsequent WHI findings have not shown a clear increase in breast cancer, and any potential increase from HRT is similar to that seen with many lifestyle factors and other commonly used medications. The preliminary WHI results do not reflect accurately true benefits and risks, and HRT should remain a potential preventive treatment for CHD.
Menopause Int
· 2009 Jun · PMID 19465668
·
Publisher ↗
The reluctance of physicians to use estrogens in women with hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to estrogen therapy antedated these studies, the flawed data is...The reluctance of physicians to use estrogens in women with hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to estrogen therapy antedated these studies, the flawed data is now used as justification for the denial of estrogens for treatment of low bone density and various types of hormone responsive depression in women. Estrogens should be first choice therapy for osteoporosis in women under the age of 60 years, but in practice bisphosphonates, with its increasing number of long-term side-effects, has become first-line therapy for physicians. These side-effects include osteonecrosis of the jaw, mid-shaft femoral fractures and the need for proton pump inhibitors, which further reduce bone density and add to the fracture risk. Psychiatrists fail to use transdermal estradiol for postnatal depression, premenstrual depression and perimenopausal depression in spite of randomized trials demonstrating their efficacy. Selective serotonin reuptake inhibitor therapy for depression independently decreases bone density and is also responsible for loss of libido, loss of mental acuity and dependence. Thus postmenopausal women with vasomotor symptoms, depression, loss of libido, vaginal dryness or low bone density are frequently denied effective estrogen therapy and given a combination of low-cost generic prozac and fosamax, which is in danger of becoming a post-WHI nightmare drug PROFOX (PROzacFOsamaX). This can only be avoided if advisory bodies review the reassuring evidence concerning estrogen therapy in women under the age of 60 years and advise accordingly.
Menopause Int
· 2009 Mar · PMID 19237622
·
Publisher ↗
Episodic memory is affected by cognitive ageing, and memory impairment beyond that expected on the basis of usual ageing may be an early indicator of Alzheimer's disease. Although memory complaints are common in midlife,...Episodic memory is affected by cognitive ageing, and memory impairment beyond that expected on the basis of usual ageing may be an early indicator of Alzheimer's disease. Although memory complaints are common in midlife, it is reassuring that the natural menopausal transition is unaccompanied by objective memory loss. Less is known about memory after surgical menopause. Estrogen-containing hormone therapy initiated during the late postmenopause increases dementia risk and does not improve memory. It is unclear whether hormone use during the menopausal transition or early postmenopause affects Alzheimer risk. Observational studies imply a protective association consistent with the so-called critical window hypothesis, but these findings could be biased. Clinical practice implications are presented.
Menopause Int
· 2009 Mar · PMID 19237621
·
Publisher ↗
Among the numerous positive effects of probiotic microorganisms and prebiotic carbohydrates observed in clinical studies--the majority of which, however, does not fulfil the criteria of pharmaceutical verification--some...Among the numerous positive effects of probiotic microorganisms and prebiotic carbohydrates observed in clinical studies--the majority of which, however, does not fulfil the criteria of pharmaceutical verification--some are of specific relevance to female health. The present review addresses--besides some notes concerning the potential microbiota-hormone interactions--the first line with preventive and/or therapeutic applications of probiotic bacteria in order to maintain a balanced intestinal and urogenital flora, as well as in the case of irritable bowel syndrome, constipation (idiopathic slow-transit) and urogenital tract infections. Further aspects are the promotion of bone health and osteoporosis prevention brought about by inulin, oligofructose and galactooligosaccharides. Some further conditions, namely anorexia nervosa, the premenstrual syndrome as well as prevention or alleviation of climacteric and menopausal disorders, for which the use of probiotics is rather hypothetical or is largely studied by alternative medicine practising physicians, are addressed briefly.
Menopause Int
· 2009 Mar · PMID 19237620
·
Publisher ↗
Homeopathy is a system of therapeutics placed outside the boundaries of orthodox medicine and regarded as a complementary and alternative medicine. Homeopathy has been used to alleviate menopausal symptoms both in the cl...Homeopathy is a system of therapeutics placed outside the boundaries of orthodox medicine and regarded as a complementary and alternative medicine. Homeopathy has been used to alleviate menopausal symptoms both in the climacteric and in breast cancer survivors. Individualized treatment by a homeopath, regarded as the gold standard of homeopathic care, is a complex intervention where the homeopathic medicine is matched to the individual using holistic principles. This review article describes and interprets the existing evidence from observational studies and clinical trials and makes recommendations for trial design in the future.