Selección de Resúmenes
de Menopausia
Enero de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Semana del 31 de Diciembre de 2008 al 6 de Enero de
2009
Maturitas. 2008
Dec 30. [Epub
ahead of print]
Progestogen use in women approaching the
menopause and breast cancer risk.
Campagnoli
C, Ambroggio
S, Lotano MR, Peris C.
S.C. Ginecologia
Endocrinologica Ospedale Ostetrico Ginecologico, ASO OIRM-S.Anna,
Torino, Corso Spezia 60, Italy.
OBJECTIVE:
Progestogens, particularly synthetic progestins, are widely used to contrast
the clinical consequences of the relative hyperestrogenism that characterizes
the years preceding the menopause. As a large body of data on postmenopausal
hormone therapy (HT) demonstrates that the addition of synthetic progestins to
estrogen increases the breast cancer risk compared to estrogen alone, it is
important to evaluate if the use of progestogens in premenopausal years is
associated with the risk of breast cancer. METHODS: Main literature data on the
association with breast cancer risk of progestogens, either used alone in
premenopausal years or added to estrogen in postmenopausal HT, were reviewed.
RESULTS: Available data suggest that long-term current use of progestogens in
premenopausal women after the age of 40 years can increase the risk of breast
cancer. Consistently with the data on postmenopausal HT, the risk increase is
higher for lobular cancer than for ductal cancer. CONCLUSIONS: The most
important and widely accepted indications to the use of progestogens in the
years preceding the menopause are anovulatory menstrual disorders, for which a
limited period of treatment is generally sufficient. Awaiting
for further data, when using progestogens for longer periods to treat other
problems (endometriosis, cyclical mastalgia, etc.), the possibility of
increased breast cancer risk and clinical benefits have to be weighed. Anyway,
as micronized progesterone and dydrogesterone, at least when they were used in
postmenopausal HT, seem to have, according to a large observational study, a
safer risk profile on the breast, the preferential use of these preparations
could be suggested.
Pharmacotherapy. 2009 Jan;29(1):74-81
Use of gabapentin in patients experiencing
hot flashes.
1
Pharmacy Service,
Abstract Hot
flashes occur frequently in menopausal women and in women with breast cancer,
diminishing their quality of life. A report from the Women's Health Initiative
published in 2002 raised concerns about the long-term safety of estrogen
therapy. As a result, nonhormonal alternatives have emerged as preferred
treatments. Gabapentin is an anticonvulsant that the United States Food and
Drug Administration approved as an adjunct therapy for partial seizures and
postherpetic neuralgia. Somnolence, dizziness, ataxia, fatigue, nystagmus, and
peripheral edema are adverse effects commonly associated with gabapentin in the
treatment of epilepsy and postherpetic neuralgia. The North American Menopause
Society and the
Climacteric. 2008
Dec 31:1-9. [Epub ahead of print]
Assessment of sexuality among middle-aged
women using the Female Sexual Function Index.
Chedraui P, Perez-Lopez
FR, San Miguel
G, Avila C.
Collaborative
Group for Research of the Climacteric in
Objective The purpose of the present investigation was to assess
sexual function among middle-aged women and determine related risk factors
(personal and partner) for sexual dysfunction. Methods In this cross-sectional
study, women aged 40-59 years were requested to fill out the Female Sexual
Function Index (FSFI) and a general demographic questionnaire containing
personal and partner data. Results A total of 409 women with a mean age of 47
+/- 5.3 years were surveyed. Of these, 42.1% were premenopausal, 24.4%
perimenopausal and 33.5% postmenopausal. At the time of survey, 10.5% of women
were hysterectomized, 1.5% used psychotropic drugs, and 9.8% were on hormone
therapy (HT) for the menopause; 28.1% had less than 12 years of schooling and
80.4% had only one partner at the moment of survey. Among their male partners,
7.3% abused alcohol, 10.3% had erectile dysfunction, 11.2% premature
ejaculation and 63.83% were faithful partners. Mean (+/- standard deviation)
scores for the FSFI domains were: desire (3.7 +/- 1.2), arousal (3.1 +/- 2.5),
lubrication (3.3 +/- 2.6), orgasm (2.6 +/- 2.3), satisfaction (4 +/- 1.7), and
pain/dyspareunia (3.2 +/- 2.6). The mean total FSFI score was 20.1 +/- 12.4
(median 24.7). In this series, the prevalence of female sexual dysfunction
(FSFI score </=26.55) was 55.7%, with women presenting difficulties across
all domains of female sexual function but mostly in the dyspareunia and
lubrication domains. Logistic regression analysis determined that female age
(odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-6.8), p = 0.001),
postmenopausal status (OR 2.8, 95% CI 1.3-6.1, p = 0.007), partner's age (OR
2.0, 95% CI 1-4, p = 0.03), educational level (OR 2.7, 95% CI 1.5-5, p =
0.001), and the presence of erectile dysfunction (OR 3.8, 95% CI 1.3-10.9, p =
0.01) and premature ejaculation (OR 4.1, 95% CI 1.4-11.7, p = 0.0001)
significantly increased the risk for female sexual dysfunction. Partner
faithfulness (OR 0.2, 95% CI 0.1-0.4, p = 0.001) and menopausal HT use (OR 0.4,
95% CI 0.1-1, p = 0.04) decreased this risk. Conclusions In this series, male
sexual health and demographic profile and female HT use were relevant
determinants for sexual functioning among middle-aged women.
Int J Cancer. 2008
Nov 7. [Epub ahead of print]
Does the increase of endogenous steroid hormone levels also affect
breast cancer risk in Chinese women? A case-control study in
Wang B, Mi M, Wang J, Wei N, Zhang Q, Zhu J, Yang S, Guo B, Xu J, Yang X.
Department of
Nutrition and Food Hygiene, Third Military Medical University, Chongqing Key
Laboratory of Nutrition and Food Safety, Chongqing, People's Republic of China.
Accumulating
epidemiological evidence suggests that sex steroid hormones are positively
associated with the development of breast cancer. However, most of these
studies were conducted among Caucasian women and few have been carried out in
Med Sci
Monit. 2009 Jan;15(1):CR5-9.
Decreased bone mineral density in men with metabolic syndrome alone and
with type 2 diabetes.
Yaturu S, Humphrey S, Landry C, Jain SK.
Department
of Endocrinology,
BACKGROUND:
Metabolic syndrome is associated with decreased physical activity and increased
incidence of diabetes. Bone Mineral density (BMD) is positively associated with
physical activity.
J Bone Miner Res. 2008 Dec 29. [Epub
ahead of print]
Dietary Calcium and Serum 25-hydroxyvitamin D Status in Relation to Bone
Mineral Density Among
Bischoff-Ferrari
HA, Kiel DP, Dawson-Hughes
B, Orav JE, Li R, Spiegelman
D, Dietrich T, Willett WC.
Abstract A higher calcium intake is still the primary recommendation
for the prevention of osteoporosis, while vitamin D deficiency is often not
addressed. To study the relative importance of dietary calcium intake and serum
25-hydroxyvitamin D (25(OH)D) status in regard to hip bone mineral density
(BMD) in 4958 community-dwelling women and 5003 men age 20 years + from the US
NHANES III population-based survey. Calcium supplement users and individuals
with a prior radius or hip fracture were excluded. We calculated standardized
means for BMD by quartiles of gender-specific calcium intake for three 25(OH)D categories (< 50, 50-74, 75+ nmol/l) among men and
women separately controlling for other important predictors of BMD . Only for
women with 25(OH)D status below 50 nmol/l , a higher calcium intake was
significantly associated with higher BMD (p-value for trend: p = 0.005),
whereas calcium intake beyond the upper end of the lowest quartile ( > 566
mg/d) was not significantly associated with BMD at 25(OH)D concentrations above
50 nmol/l. Among men, there was no significant association between a higher
calcium intake beyond the upper end of the lowest quartile (626 mg/d) and BMD
within all 25(OH)D categories. Among both genders, BMD
increased stepwise and significantly with higher 25(OH)D
concentrations(< 50, 50-74, 75+ nmol/l; p-value for trend: women <
0.0001; men = 0.0001). Among men and women, 25(OH)D
status appears to be the dominant predictor of BMD relative to calcium intake.
Only women with 25(OH)D concentrations below 50 nmol/l
appear to benefit from a higher calcium intake.
Atherosclerosis. 2008
Nov 18. [Epub ahead of print]
Visceral adipose tissue, adiponectin levels and insulin resistance are
related to atherosclerosis as assessed by whole-body magnetic resonance
angiography in an elderly population.
Hansen T, Ahlström H, Söderberg
S, Hulthe J, Wikström J, Lind L, Johansson
L.
Dept.
of Radiology,
OBJECTIVE: The
principal aim of this study was to determine whether the amount of visceral
adipose tissue (VAT) is more related than subcutaneous adipose tissue (SAT) to
atherosclerosis assessed by whole-body MRA (WBMRA). A further objective was to
investigate whether traditional risk factors, inflammation, or adipokines could
explain the hypothesized relationship between VAT and atherosclerosis. METHODS:
Men and women aged 70 were recruited from the general population into the Prospective
Investigation of The Vasculature in Uppsala Seniors (PIVUS) and 306 of them
underwent WBMRA in a clinical 1.5-T scanner. The arterial tree was assessed for
degree of stenosis or occlusion and a total atherosclerotic score (TAS) was
established. Information on risk factors and BMI and on SAT and VAT, segmented
on an axial MR scan was collected. Adiponectin, leptin, and high sensitive
C-reactive protein (hsCRP) were measured in serum. HOMA index was used as a
marker of insulin resistance. RESULTS: VAT was related to TAS independently of
gender, total obesity (BMI), amount of SAT, hsCRP and also to the traditional
risk factors included in the Framingham risk score (FRS) in an elderly
population. Adiponectin or the HOMA insulin resistance, but not leptin or VAT,
together with FRS was significantly related to TAS in a multiple censored
regression model. CONCLUSION: Adiponectin attenuated the relationship between
VAT and TAS, suggesting that adiponectin and insulin resistance is an important
link between visceral adiposity and atherosclerosis.
Semana del 7 al 13 de Enero de 2009
Maturitas. 2009 Jan 2. [Epub
ahead of print]
Hysteroscopy for
asymptomatic postmenopausal women with sonographically thickened endometrium.
Schmidt T, Breidenbach
M, Nawroth F, Mallmann P, Beyer IM, Fleisch MC, Rein DT.
Department
of Gynecology and Obstetrics, University of
Endometrial
carcinoma is the most common genital cancer in women. While patients usually
present with vaginal bleeding, in 10-20% this characteristic symptom is absent.
Endometrial thickness (double layer) is measured by transvaginal sonography and
thickening indicates an increased risk of malignancy or other pathology
(hyperplasia or polyps). Objective: We sought to correlate hysteroscopic and
pathological findings in asymptomatic postmenopausal women with sonographically
thickened endometrium (>6mm). Study design: A prospective observational
study in a university hospital of 304 postmenopausal women referred between
1996 and 2006 because of a sonographically thickened endometrium in the absence
of abnormal bleeding, who underwent continuous flow hysteroscopy (4.5mm Storz
hysteroscope) and fractionated curettage of the uterine cervix and corpus (D &
C) in addition to vaginal sonography (5MHz probe). Results: The mean age of the
women was 64.8 (range 57.7-71.9) years. Average endometrial thickness measured
by ultrasound was 12mm+/-6.7mm. Hysteroscopy suggested the presence of
endometrial polyps in 226 women (74.3%), simple endometrial hyperplasia in 34
(11.2%), atrophic endometrium in 18 (5.9%), complex endometrial hyperplasia in
2 (0.7%), atypical hyperplasia in 3 (1%) and leiomyoma in 9 (3.0%). In 12 women
(3.9%), the hysteroscopic appearance suggested malignancy and histology
revealed endometrial adenocarcinoma. All hysteroscopic results were confirmed
by histological examination. Conclusion: Hysteroscopy represents an easy, safe
and effective method for the investigation of asymptomatic women with a thickened
endometrium found with transvaginal ultrasound. The commonest pathology was
endometrial polyps.
Bone. 2008 Dec 16. [Epub ahead of print]
Efficacy and safety
of pharmacological agents in managing osteoporosis in the old old: Review of
the evidence.
Inderjeeth
CA,
Foo AC, Lai MM, Glendenning
P.
INTRODUCTION:
Osteoporosis and fracture risk increase exponentially in postmenopausal
females. This places a significant burden in terms of morbidity, mortality and
costs that are likely to increase with an ageing population. Despite this there
is very limited data on pharmacological management of osteoporosis in this high
risk group. OBJECTIVES OF THIS REVIEW: To review the published literature on
the clinical efficacy and safety of specific anti osteoporosis treatments in
the reduction in fracture risk in females >75 years of age. The following
major endpoints were used in this review: SEARCH METHODS FOR IDENTIFICATION OF
STUDIES: We performed an electronic search of Medline (1970 to June 2007) and the
Cochrane Library (1996 to June 2007). Our search strategy included MeSH terms
for osteoporosis and treatments. We reviewed the reference list of identified
articles for additional relevant published trials. RESULTS: Two hundred and
fifty-two potentially relevant abstracts were identified. Only six publications
were deemed to meet full eligibility criteria and one met most criteria. There
is evidence for significant vertebral fracture relative risk reduction(RR)
at 1 year for Risedronate (RR 81%; p<0.001), Teriparatide (RR 65%;
p<0.05) and Strontium Ranelate (RR 59%; p=0.002) and 3 years for Risedronate
(RR 44%; p=0.003), Alendronate (RR 38%; p<0.05) and Strontium Ranelate (RR
32%; p=0.013). There is evidence for significant non-vertebral fracture relative
risk reduction at 1 year for Strontium Ranelate (RR 41%; p=0.027) but not
Teriparatide (p=0.66) and 3 years for Strontium Ranelate (RR 31%; p=0.011) but
not Risedronate (p=0.66). The only study to report a reduction in hip fracture
at 3 years is the TROPOS study with Strontium Ranelate (RR 36%; p=0.046).
DISCUSSION: This review reinforces the irony that the least evidence is
available for fragility fracture reduction in the group at greatest risk; the
old old and those with non vertebral and hip fracture. Although there is good
evidence for the benefit of the bisphosphonates (Alendronate and Risedronate),
Teriparatide and Strontium Ranelate in vertebral fracture reduction, there are
very limited data for non vertebral and hip fracture reduction. Strontium Ranelate
is the only agent to date that has demonstrated a reduction in non vertebral
and hip fracture events in this high risk elderly female population. Perhaps we
need to adopt different strategies in managing older patients with osteoporosis
as their fracture risks and treatment strategies may be quite different from
younger populations.
J Womens Health (Larchmt). 2009
Jan-Feb;18(1):105-13
Dose-Response Relationship
between Moderate-Intensity Exercise Duration and Coronary Heart Disease Risk
Factors in Postmenopausal Women.
Dalleck LC, Allen BA, Hanson BA, Borresen
EC, Erickson
ME, De Lap SL.
PURPOSE: This study
was designed to investigate whether, in a dose-response manner, there would be
greater health benefits in a group of postmenopausal women completing 45
minute- vs. 30 minutes of moderate intensity (50% maximal oxygen uptake
reserve, VO2R) exercise 5 days . wk(-1). METHODS:
Apparently healthy but sedentary postmenopausal women (n = 33) were randomized
to a nonexercise control group, a 30-minute exercise duration group, or a
45-minute exercise duration group. Exercise training was performed 5 days . wk(-1) for 12 weeks at 50%
VO2R. Participants were instructed to not change their usual diet throughout
the study. RESULTS: Twenty-six women completed the study. After 12 weeks,
VO2max increased significantly (p < 0.05) in both 30-minute (0.20 +/- 0.21 L . min(-1)) and 45-minute (0.41 +/- 0.10 L . min(-1))
groups. Repeated measures ANOVA identified a significant interaction between
exercise duration and VO2max values (F = 4.72, p < 0.05), indicating that
VO2max responded differently to 30-minute and 45-minute exercise durations.
Trend analysis showed that body mass, body composition, waist circumference,
and high-density lipoprotein cholesterol (HDL-C) changed favorably (p <
0.05) across control, 30-minute, and 45-minute groups. CONCLUSIONS: Although
most health organizations agree that 150 min . wk(-1)
of physical activity will reduce the risk of all-cause and cardiovascular
mortality, few randomized, controlled studies have examined whether completing
more physical activity than the recommended amount will yield additional
benefits. Findings from the present study suggest that there is a dose-response
relationship between exercise duration and numerous health outcomes in
postmenopausal women, including cardiorespiratory fitness, body mass, body
composition, waist circumference, and HDL-C.
Menopause. 2009
Jan-Feb;16(1):104-9
Vascular
effects of estrone and diethylstilbestrol in porcine coronary arteries.
Teoh H, Quan A, Leung SW, Man RY.
From the
Department of Pharmacology,
OBJECTIVE:: To explore the effects of different estrogens on vascular
function, we compared the vasorelaxant effects of 17beta-estradiol,
17alpha-estradiol, estrone, and the synthetic estrogen diethylstilbestrol (DES)
on porcine coronary arterial segments. DESIGN::
Porcine coronary arterial rings were contracted with the stable thromboxane A2
analogue U46619 (3 x 10 M), and direct relaxation was examined by the addition
of increasing concentrations of 17beta-estradiol, 17alpha-estradiol, estrone,
or DES (10 to 10 M). Modulation of agonist-induced contraction and relaxation
was studied in coronary arterial rings incubated for 20 minutes with DES or
estrone (10-10 M) with 17beta-estradiol (10 M) as comparison. RESULTS:: Direct relaxation of arterial rings potentiated by these
estrogens was recorded with a rank order potency of DES > 17beta-estradiol
> estrone > 17alpha-estradiol. 17beta-Estradiol potentiated relaxation
responses to sodium nitroprusside and levcromakalim but not bradykinin or
A23187 while reducing contractions to 5-hydroxytryptamine and U46619. DES and
estrone, both at 10 M, mimicked the 17beta-estradiol-potentiated sodium
nitroprusside and levcromakalim relaxation responses. Additionally, the
inhibitory effects of 17beta-estradiol (10 M) on 5-hydroxytryptamine- and
U46619-induced contractions were partially reproducible by DES (10 M) and
estrone (10 M). CONCLUSIONS:: Although DES is the most
potent among the tested estrogenic compounds in eliciting relaxation,
17beta-estradiol is more effective than estrone and DES at enhancing
endothelium-independent relaxation and reducing vascular contraction in porcine
coronary arteries.
Cancer. 2009 Jan 6. [Epub ahead of print]
Body
mass index and risk of ovarian cancer.
Leitzmann
MF,
Koebnick C, Danforth
KN, Brinton LA, Moore SC, Hollenbeck
AR, Schatzkin
A, Lacey JV
Jr.
Nutritional
Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, Department of Health and Human
Services, Bethesda, Maryland.
BACKGROUND:: Convincing epidemiologic evidence links excess body mass
to increased risks of endometrial and postmenopausal breast cancers, but the
relation between body mass index (BMI) and ovarian cancer risk remains
inconclusive. Potential similarities regarding a hormonal mechanism in the
etiology of female cancers highlight the importance of investigating
associations according to menopausal hormone therapy (MHT) use. However, to the
authors' knowledge, data addressing whether the relation between BMI and
ovarian cancer differs by MHT use are very sparse. METHODS::
The authors prospectively investigated the association between BMI and ovarian
cancer among 94,525
J
Clin Endocrinol Metab. 2009 Jan 6. [Epub ahead of print
Adipokines,
Inflammation, and Visceral Adiposity Across The
Menopausal Transition: A Prospective Study.
Lee CG, Carr MC, Murdoch SJ, Mitchell E, Woods NF, Wener MH, Chandler
WL, Boyko EJ, Brunzell
JD.
University of
Washington Medical Center, Department of Medicine, Division of Metabolism,
Endocrinology and Nutrition, 1959 NE Pacific St., Box 356426, Seattle, WA
98195; University of Washington, Family and Child Nursing, WA 98195; University
of Washington, Department of Laboratory Medicine, 1959 NE Pacific St., Box
357110, Seattle, WA 98195; VA Puget Sound Health Care System (S-152E), 1660 S.
Columbian Way, Seattle, WA 98108.
Context:
Postmenopausal women have greater visceral adiposity compared to premenopausal
women. Adipokines are associated with increased adiposity, insulin-resistance
and atherosclerosis. Objective: To assess changes in adipokines and
inflammatory markers through the menopausal transition and to correlate them
with changes in visceral adiposity. Design and Setting: This is a prospective
cohort study of women through the menopausal transition conducted at the
Semana del 20 al 27 de Enero de 2009
Cochrane Database Syst
Rev. 2009 Jan 21;(1):CD005997.
Hormone therapy for endometriosis and
surgical menopause.
Al Kadri H, Hassan S, Al-Fozan
HM, Hajeer A.
Obstetrics
& Gynaecology, KFNGH,
BACKGROUND:
Endometriosis is characterized by the presence of ectopic endometrial tissue
that might lead to many distressing and debilitating symptoms. Despite
available studies supporting standard hormone therapy for women with
endometriosis and post-surgical menopause, there is still a concern that
estrogens may induce a recurrence of the disease and its symptoms. OBJECTIVES:
This review aimed to look at pain and disease recurrence in women with
endometriosis who used hormone therapy for post-surgical menopause. SEARCH
STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group
Specialized Register (March 2008), Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1966 to March
2008), EMBASE (1980 to March 2008), and references lists of articles. Relevant
journals and conference proceedings were handsearched. SELECTION CRITERIA:
Randomized controlled trials studying hormone therapy for women with
endometriosis in post-surgical menopause. DATA COLLECTION AND ANALYSIS: Review
authors assessed the eligibility of trials and their quality. MAIN RESULTS: Two
studies fulfilled our inclusion criteria. One trial compared the nonstop
transdermal application of 17beta-estradiol (0.05 mg/day) combined with cyclic
medroxy progesterone acetate (10 mg per day) for 12 days per month in women
with a conserved uterus with nonstop tibolone (2.5 mg/day). The second trial
used sequential administration of estrogens and progesterone with two 22 cm(2) patches applied weekly to produce a controlled release
of 0.05 mg/day. Micronized progesterone was administered orally (200 mg/day)
for 14 days with a 16-day interval free of treatment. Pain and dyspareunia The first trial reported recurrence of pain in the estrogen
and progesterone arm in 4/10 of women compared with 1/11 in the tibilone arm.
In the latter, 4/115 women reported recurrence of pain in the treatment group
compared with 0/57 patients in the no-treatment arm. Neither finding was
statistically different.Confirmed recurrence or exacerbation of endometriosis This outcome was not reported in the first trial. The second
found that 2/115 of the treatment group developed recurrence of endometriosis
with no recurrence reported in the no-treatment group. This was not
statistically significant. No woman was re-operated on in the no-treatment
group compared with 2/115 in the treatment group. AUTHORS' CONCLUSIONS: Hormone
replacement therapy for women with endometriosis in post-surgical menopause
could result in pain and disease recurrence. However, the evidence in the
literature is not strong enough to suggest depriving severely symptomatic
patients from this treatment. There is a need for more randomised
controlled studies.
Cochrane Database Syst
Rev. 2009 Jan 21;(1):CD003799
Hormone replacement therapy to maintain
cognitive function in women with dementia.
Hogervorst
E, Yaffe K, Richards M, Huppert FA.
Department
of Human Sciences,
BACKGROUND: As
estrogens have been shown to have several potentially beneficial effects on the
central nervous system, it is biologically plausible that maintaining high
levels of estrogens in postmenopausal women by means of estrogen replacement
therapy (ERT) could be protective against cognitive decline in women with
Alzheimer's disease (AD) or other dementia syndromes. OBJECTIVES: To
investigate the effects of ERT (estrogens only) or HRT (estrogens combined with
a progestagen) compared with placebo in randomized controlled trials (RCTs) on
cognitive function of postmenopausal women with dementia. SEARCH STRATEGY: The
Cochrane Dementia and Cognitive Improvement Group Specialized Register, which
contains records from many medical databases, The Cochrane Library, EMBASE,
MEDLINE, CINAHL, PsycINFO and LILACS were searched on 7 November 2007 using the
terms ORT, PORT, ERT, HRT, estrogen*, oestrogen* and progesterone*. SELECTION
CRITERIA: All double-blind randomized controlled trials (RCTs) into the effect
of ERT or HRT for cognitive function with a treatment period of at least two
weeks in postmenopausal women with AD or other types of dementia. DATA
COLLECTION AND ANALYSIS: Abstracts of the references retrieved by the searches
were read by two reviewers (EH and KY) independently in order to discard those
that were clearly not eligible for inclusion. The two reviewers studied the
full text of the remaining references and independently selected studies for
inclusion. Any disparity in the ensuing lists was resolved by discussion with
all reviewers in order to arrive at the final list of included studies. The
selection criteria ensured that the blinding and randomization of the included
studies was adequate. The two reviewers also assessed the quality of other
aspects of the included trials. One reviewer (EH) extracted the data from the
studies, but was aided and checked by JB from Cochrane. MAIN RESULTS: A total
of seven trials including 351 women with AD were analysed. Because different
drugs were used at different studies it was not possible to combine more than
two studies in any analysis.On a clinical global rating, clinicians scored
patients taking CEE as significantly worse compared with the placebo group on
the Clinical Dementia Rating scale after 12 months (overall WMD = 0.35, 95% CI =
0.01 to 0.69, z = 1.99, P < 0.05).Patients taking CEE had a worse
performance on the delayed recall of the Paragraph Test (overall WMD = -0.45,
95% CI = -0.79 to -0.11, z = 2.60, P < 0.01) after one month than those
taking placebo. They had a worse performance on Finger Tapping after 12 months
(WMD = -3.90, 95% CI = -7.85 to 0.05, z = 1.93, P < 0.05).Limited positive
effects were found for the lower dosage of CEE (0.625 mg/day) which showed a
significant improvement in MMSE score only when assessed at two months, and
disappeared after correction for multiple testing. No significant effects for
MMSE were found at longer end points (3, 6 and 12 months of treatment). With a
dosage of 1.25 mg/d CEE, short-term significant effects were found for
Trial-Making test B at one month and Digit Span backward at four months. After
two months of transdermal diestradiol (E2) treatment, a highly significant
effect was observed for the word recall test (WMD = 6.50, 95% CI = 4.04 to
8.96, z = 5.19, P < 0.0001). No other significant effects were found for
other outcomes measured. AUTHORS' CONCLUSIONS: Currently, HRT or ERT for
cognitive improvement or maintenance is not indicated for women with AD.
Maturitas. 2009 Jan
19. [Epub
ahead of print
Influence of menopause on biochemical markers of endothelial
dysfunction-A case-control pilot study in North Indian population.
Salhotra S, Arora S, Anubhuti, Trivedi SS, Bhattacharjee
J.
Department
of Biochemistry,
OBJECTIVE:
Menopause, an estrogen deficient state, is known to increase the cardiovascular
risk. Lipid changes accompanying menopause account for only few cases of
coronary artery disease (CAD). Endothelium-dependent nitric oxide-mediated
vasodilatory mechanisms are also known to play a role in development of
coronary artery disease, but studies in menopausal women are very few. This
study was hence undertaken to see if nitric oxide (NO)-cyclic guanidine
monophosphate (c-GMP) pathway is influenced by menopause. DESIGN: This study
was a hospital-based case-control study involving 100 women in age group 40-55
years. Of these, 50 women were postmenopausal and 50 were premenopausal. Women
with known risk factors for CAD were excluded. Fasting blood samples from these
women were collected and analyzed for estradiol levels, lipid profile,
apolipoprotein B, plasma nitric oxide, c-GMP and platelet nitric oxide using
standard kits and reagents. Statistical analysis was done on SPSS and
two-tailed p-value <0.05 was considered significant. RESULT: Postmenopausal
women had significantly lower estradiol, plasma NO, and c-GMP levels as
compared to premenopausal women (p<0.05). Cholesterol, low-density
lipoprotein (LDL) cholesterol and apolipoprotein B (apo-B) levels were higher
and HDL levels were lower in postmenopausal as compared to premenopausal women
(p<0.05). Plasma NO showed a significant positive correlation with
estradiol, HDL levels and negative correlation with apo-B levels. CONCLUSION:
Menopause tends to downregulate NO-c-GMP pathway resulting in endothelial
dysfunction. The mechanism may be directly through estrogen receptors or
indirectly through potentiation of dyslipidemia.
Climacteric. 2009
Jan 15:1-8. [Epub ahead of print
Food groups and risk of forearm fractures
in postmenopausal women in
Xu L, Dibley M, D'Este C, Phillips M, Porteous J, Attia J.
Background Forearm
fractures are a major cause of disability in postmenopausal women. However, no
prior report on the relationship of dietary patterns and forearm fracture in
mainland
Acta
Obstet Gynecol Scand. 2009 Jan 22:1-6. [Epub ahead of
print]
Physical training decreases waist circumference in postmenopausal borderline
overweight women.
Bergstrom
I, Lumbardo C, Brinck J.
Department
of Endocrinology, Metabolism and Diabetes,
Objective. To
examine if healthy borderline overweight postmenopausal women with osteoporosis
can improve their waist circumference and lipid profile with a moderate
physical training program. Design. Randomized
controlled trial. Setting. One hundred and
twelve postmenopausal women were randomized to normal sedentary life or one
year of physical training consisting of three brisk walks and 1-2 aerobic
exercises/week. Main Outcome Measures. Waist
circumference reduction, waist circumference reduction in relation to observed
level of participation in physical intervention and changes in cholesterol,
triglycerides, apolipoproteins B and A1 and high-sensitivity C-reactive protein
(hs-CRP). Results. At start the mean (SD) waist
circumference was 83.6 (7.7) and 81.8 (7.5) cm in the control and training
groups, respectively. In relation to baseline, the 12 months intervention led
to a waist reduction of 0.3 cm (2.7) (p=0.36) and 1.6 cm (4.7) (p=0.02) in the
respective groups but the inter-group comparison was not significant in an
intention-to-treat analysis (p=0.09). The ninety-two women completing the study
intervention were analyzed per protocol. A tendency for better waist reduction
in relation to the women's observed physical intensity level was observed
(p=0.07, ANOVA for linear trend across training intensity levels). Training
women improved their waist circumference 1.7 cm (p=0.01) compared to baseline
and was borderline significantly better than controls (p=0.059). No significant
changes in response to the intervention were observed for blood pressure,
cholesterol, triglycerides, apolipoproteins and hs-CRP. Conclusions.
A moderate physical exercise program for healthy postmenopausal women during one
year reduced the waist circumference in a training intensity dependent manner.
Biochim
Biophys Acta. 2008 Dec 29. [Epub
ahead of print
An attempt to prevent senescence: A mitochondrial approach.
Skulachev
VP, Anisimov
VN, Antonenko
YN, Bakeeva LE, Chernyak
BV, Erichev VP, et
al.
Antioxidants
specifically addressed to mitochondria have been studied to determine if they
can decelerate senescence of organisms. For this purpose, a project has been
established with participation of several research groups from
Geriatr Gerontol Int. 2008 Dec;8(4):259-64
Effects of long-term transdermal hormone
replacement therapy on the renin-angiotensin- aldosterone system, plasma
bradykinin levels and blood pressure in normotensive postmenopausal women.
Ichikawa A, Sumino H, Ogawa T, Ichikawa S, Nitta K.
Department
of Internal Medicine,
AIM: This study
was designed to investigate the effects of 24-month long-term transdermal
hormone replacement therapy (HRT) on the circulating levels of components of
the renin-angiotensin-aldosterone system (RAAS) and bradykinin, blood pressure
(BP) and lipid profile in normotensive postmenopausal women (PMW). METHODS:
Twenty-two normotensive PMW were randomized to receive transdermal HRT
(continuous 17-beta estradiol patch at 36 microg/day plus cyclic oral
medroxyprogesterone acetate 2.5 mg/day for 12 days/month) (n = 12) or control
(n = 10). The plasma renin activity (PRA), serum angiotensin-converting enzyme
(ACE) activity, plasma angiotensin (Ang) I, Ang II, aldosterone, bradykinin,
and BP were measured before, and 12 and 24 months after, the start of the HRT.
RESULTS: In the HRT group, the diastolic BP and mean BP were significantly
decreased at 12 and 24 months (both P < 0.05) after the start of therapy,
however, no significant change of the systolic BP was noted during the study
period. No changes in the RAAS components or lipid profile were noted in either
group. The plasma bradykinin levels were significantly reduced at 12 (P <
0.05) and 24 months (P < 0.01), while no changes were observed in the
control group. CONCLUSION: More than 12 months of long-term transdermal HRT
kept diastolic BP, mean BP and plasma bradykinin levels decreased in
normotensive PMW, without influencing any of the components of the RAAS. This
therapy may allow optimal blood pressure control and prevent elevation of the
cardiovascular risk.
Ann Endocrinol (Paris). 2009
Jan 20. [Epub ahead of print
Etiologic discussion and clinical relevance
of thyroid ultrasonography in subclinical hypothyroidism. A retrospective study in
1845 patients.
Nys P, Cordray JP, Merceron
RE.
Groupe de
recherches cliniques en endocrinologie, 5, rue Dupin, 75006
BACKGROUND: Acquired
subclinical hypothyroidism in adulthood is mainly due to autoimmune
thyroiditis. In the absence of a goiter or a palpable firm thyroid, measurement
of thyroid antibodies can improve the diagnosis. Whether thyroid antibodies are
detected or not, what might be the clinical relevance of ultrasonography in
this setting? METHODS: We studied 1845 cases of subclinical hypothyroidism in
adults recruited for symptoms indicative of hypothyroidism or thyroid
pathology. All patients were screened for thyroid antibodies and underwent an
ultrasonographic thyroid examination. LOCALISATION: Multicentric retrospective
study. RESULTS: Chronic autoimmune thyroiditis was confirmed in 70% of
patients. Thyroid antibodies were undetectable in 30% of patients. In all
patients, thyroid ultrasound facilitated measurement of the thyroid volume and
detection of non-palpable nodules and therefore allowed biopsy. In patients
negative for thyroid antibodies, ultrasonography suggested autoimmune
thyroiditis in 31% of cases. Ultrasonography did not contribute to diagnosis in
a large number of patients without nodules and in case of normal echostructure.
The strategy of thyroid hormone replacement therapy was not influenced by
ultrasonographic data. Thyroid biopsies detected smears suspected to be
cancerous in 10 patients (4%). Cancer was confirmed in nine patients after
surgery. Ultrasonography displayed suspicious aspects in six patients.
CONCLUSION: In subclinical hypothyroidism, thyroid ultrasonography is not
required for the diagnosis of autoimmune thyroiditis but is useful for patients
with abnormal thyroid palpation and allows detection of non-palpable thyroid
nodules. For patients that were negative for thyroid antibodies, thyroid
ultrasonography can improve diagnosis for some patients, allowing detection of
autoimmune thyroiditis.
Cancer. 2009
Jan 20. [Epub ahead of print
Postmenopausal hormone use and breast cancer associations differ by hormone
regimen and histologic subtype.
Calle EE, Feigelson HS, Hildebrand JS, Teras LR, Thun MJ, Rodriguez C.
Department
of Epidemiology and Surveillance Research, American Cancer Society,
BACKGROUND:: Data from large prospective studies are needed to fully
characterize the impact of exogenous hormones on breast cancer incidence by
type of hormone preparation and histology of the cancer. METHODS:: In a
prospective cohort of 67,754 postmenopausal women in the US, 1821 cases of
invasive ductal cancer and 471 cases of invasive lobular or mixed lobular
cancer occurred during 13 years of follow-up. The authors computed age-adjusted
rates, as well as age-adjusted and multivariate-adjusted rate ratios (RR) for
ductal and lobular breast cancer and for the use of estrogen only (E-only) and
estrogen and progesterone (E + P) for current and former hormone users by
duration of use and years since last use. RESULTS::
Current use of E + P was associated with an increased risk of both ductal (RR
of 1.75; 95% confidence interval [95% CI], 1.53-2.01) and lobular (RR of 2.12;
95% CI, 1.62-2.77) breast cancer. Risk increased within the first 2 to 3 years
of use and attenuated 2 years after cessation. In contrast, current use of
E-only was not associated with an overall increased risk of invasive ductal
cancer. The only exceptions to this finding were in lean (body mass index
<25) women and for ductal cancers diagnosed at the regional/distant stage,
where in both cases the use of E-only was associated with an increased risk.
E-only use was associated with a 50% increased risk of invasive lobular cancer
after >/=10 years of use. CONCLUSIONS:: Use of E +
P is more detrimental to the breast than E-only use, in terms of both ductal
and lobular cancer. The findings from the current study suggest a window of 2
to 3 years for the risks of E + P both to become apparent after initial use and
to attenuate after cessation. Cancer 2009. (c) 2009
American Cancer Society.
Nat Clin Pract Endocrinol
Metab. 2009 Feb;5(2):113-121
Testosterone and ill-health in aging men.
Department
of Endocrinology and Diabetes,
As men age,
testosterone levels decline, and decreased testosterone levels are associated
with increased risks of osteoporosis, metabolic syndrome, type 2 diabetes
mellitus and mortality. Nevertheless, it is still uncertain whether reduced
testosterone level is a cause of ill-health or a marker of pre-existing
disease, as systemic illness lowers testosterone levels. Most circulating
testosterone is bound to sex-hormone-binding globulin (SHBG) and albumin,
whereas a small proportion circulates as free testosterone. Decreased SHBG
level is associated with increased risks for insulin resistance and metabolic
syndrome, although it would also be expected to be associated with increased
free testosterone level. During male aging, total and free testosterone levels
fall while SHBG level rises. Thus, associations between decreasing androgens
and negative health outcomes might differ across men of various ages. Trials of
testosterone therapy report benefits for body composition and BMD, but there
are limited data on the effect of testosterone supplementation on
cardiovascular risk. Whereas men who have androgen deficiency should be
considered for testosterone therapy, the role of testosterone supplementation
in older men who are not clearly hypogonadal requires further clarification.
Further studies are also needed to establish whether the age-related decline in
circulating testosterone level in men can be modified or prevented.
Semana del 28 de Enero al 3 de Febrero de 2009
Postgrad
Med. 2009 Jan;121(1):73-85.
The bioidentical hormone debate:
are bioidentical hormones (estradiol, estriol, and progesterone) safer or more
efficacious than commonly used synthetic versions in hormone replacement
therapy?
Holtorf Medical
Group, Inc., Torrance, CA, 90505, USA. kholtorf@cox.net.
Background: The use
of bioidentical hormones, including progesterone, estradiol, and estriol, in
hormone replacement therapy (HRT) has sparked intense debate. Of special
concern is their relative safety compared with traditional synthetic and
animal-derived versions, such as conjugated equine estrogens (CEE),
medroxyprogesterone acetate (MPA), and other synthetic progestins. Proponents
for bioidentical hormones claim that they are safer than comparable synthetic
and nonhuman versions of HRT. Yet according to the US Food and Drug
Administration and The Endocrine Society, there is little or no evidence to
support claims that bioidentical hormones are safer or more effective.
Objective: This paper aimed to evaluate the evidence comparing bioidentical
hormones, including progesterone, estradiol, and estriol, with the commonly
used nonbioidentical versions of HRT for clinical efficacy, physiologic actions
on breast tissue, and risks for breast cancer and cardiovascular disease.
Methods: Published papers were identified from PubMed/MEDLINE, Google Scholar,
and Cochrane databases, which included keywords associated with bioidentical
hormones, synthetic hormones, and HRT. Papers that compared the effects of
bioidentical and synthetic hormones, including clinical outcomes and in vitro
results, were selected. Results: Patients report greater satisfaction with HRTs
that contain progesterone compared with those that contain a synthetic
progestin. Bioidentical hormones have some distinctly different, potentially
opposite, physiological effects compared with their synthetic counterparts,
which have different chemical structures. Both physiological and clinical data
have indicated that progesterone is associated with a diminished risk for
breast cancer, compared with the increased risk associated with synthetic
progestins. Estriol has some unique physiological effects, which differentiate
it from estradiol, estrone, and CEE. Estriol would be expected to carry less
risk for breast cancer, although no randomized controlled trials have been documented.
Synthetic progestins have a variety of negative cardiovascular effects, which
may be avoided with progesterone. Conclusion: Physiological data and clinical
outcomes demonstrate that bioidentical hormones are associated with lower
risks, including the risk of breast cancer and cardiovascular disease, and are
more efficacious than their synthetic and animalderived counterparts. Until
evidence is found to the contrary, bioidentical hormones remain the preferred
method of HRT. Further randomized controlled trials are needed to delineate
these differences more clearly.
Gynecol Endocrinol. 2008 Dec;24(12):718-23.
Effects of two
estroprogestins containing ethynilestradiol 30 microg and drospirenone 3 mg and
ethynilestradiol 30 microg and chlormadinone 2 mg on skin and hormonal
hyperandrogenic manifestations.
Lello S, Primavera G, Colonna L, Vittori G, Guardianelli F, Sorge R, Raskovic D.
Endocrinological Gynecology and
Pathophysiology of Menopause Unit, IRCCS-Istituto Dermopatico dell'Immacolata,
Rome, Italy. lellostefano@libero.it
Hyperandrogenic manifestation in women,
such as seborrhea, acne and increased hair growth are common reasons of
psychological distress. Skin appearance is very important for young women. This
study evaluated the hormonal and skin effects of two estroprogestins (EPs)
containing ethinyl-estradiol (EE) 30 microg associated with drospirenone (DRSP)
3 mg or chlormadinone acetate (CMA) 2 mg, respectively. Fifty-five women with
signs and symptoms of hyperandrogenism (seborrhea, acne and increased hair
growth) were enrolled in the study; randomly, 30 women were treated with EE 30
microg + DRSP 3 mg and 25 with EE 30 microg + CMA 2 mg. Follicle-stimulating
hormone (FSH), luteinising hormone (LH), 17-hydroxyprogesterone (17OHP),
androstenedione (A), testosterone (T), dehydroepiandrosterone sulfate (DHEAS),
sex hormone binding globulin (SHBG) and free androgen index (T x 100/SHBG, FAI)
were assessed at baseline, and after 3 and 6 months of treatment with EPs.
Effects on seborrhea, acne and increased hair growth (as Ferriman-Gallwey
score) were also evaluated at the same time points. Finally, skin hydration,
transepidermal water loss (TEWL) and skin homogeneity were studied with
non-invasive technique during the study. Treatment for 6 months with both EPs
decreased significantly the circulating androgen levels (A, T, DHEAS) and FAI,
and increased SHBG levels; also skin pattern was improved. EP containing EE and
DRSP was better than EP containing EE and CMA as for skin changes, as
seborrhea, acne, increased hair, hydration, homogeneity and overall quality of
the skin; moreover, hormonal changes (as FAI) under therapy were more
pronounced with EE/DRSP than EE/CMA. These effects may be considered in EP
choice and could be important in improving patient's compliance and quality of
life in hyperandrogenic women.
Gynecol Endocrinol. 2008 Dec;24(12):696-700
Coronary heart disease and
HRT in France: MISSION study prospective phase results.
Mares P, Chevallier T, Micheletti MC,
Daures JP, Postruznik D, De Reilhac P.
Service de Gynecologie Obstetrique, CHU
Hopital Caremeau, Nimes, France.
OBJECTIVE: To determine the morbidity
incidence associated with Hormone Replacement Therapy (HRTs) in postmenopausal
women. This paper presents the results concerning the incidence of coronary
heart disease (CHD). DESIGN: MISSION study started on 5 January 2004, the
cutoff for data collection was June 2006 (follow-up no. 1). 'Exposed group':
postmenopausal women currently on HRT, commonly prescribed in France or stopped
< or =5 years previously. 'Unexposed group': never received HRT or stopped
>5 years previously. RESULTS: Data were available for 4949 patients (without
CHD at the beginning of the follow-up): 2693 Exposed group and 2256 Unexposed
group. The incidence during follow-up no. 1 of postmenopausal CHD was not
significantly different in the Exposed group (0.11%) compared with the
Unexposed group (0.13%). In the Exposed group the time between start of HRT and
menopause was 2.93 +/- 4.46 years in those who experienced CHD and 1.53 +/-
3.20 years in those who had no incidence of CHD (p = 0.3). CONCLUSION: In the
MISSION cohort, no increased risk of CHD was found in the Exposed group
compared with the Unexposed group.
Gynecol Endocrinol. 2008
Dec;24(12):691-5
Effect of androgens combined
with hormone therapy on quality of life in post-menopausal women with sexual
dysfunction.
Blümel JE, Del Pino M, Aprikian D,
Vallejo S, Sarrá S, Castelo-Branco C.
Facultad Medicina, Departamento Medicina
Sur, Universidad de Chile, Santiago de Chile, Chile.
AIM: To evaluate with validated
instruments changes in quality of life and sexuality in women receiving
hormonal replacement therapy (AHT). DESIGN: Randomised, double-blind,
double-dummy study with two parallel treatment arms. PATIENTS AND METHODS:
Forty-seven healthy post-menopausal women, aged 45-64 years, were evaluated
using the Female Sexual Function Index (FSFI) and the menopause-specific
quality of life questionnaire (MENQOL). Of them, 40 diagnosed with sexual
dysfunction were randomised (1:1) to receive daily 0.625 mg of conjugated
estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised
progesterone or placebo. After 3 months follow-up, FSFI and MENQOL
questionnaires were administered for a second time. RESULTS: Quality of life
was unchanged in the placebo group whereas AHT significantly improved scores of
vasomotor, psychological, physical and sexual symptoms. As expected, FSFI was
not modified in the placebo group while in AHT group the FSFI score improved
significantly. In addition, at the end of the study, 68.7% of subjects of the
AHT group did not fit did not fit the criteria for sexual dysfunction as per
the FSFI (p < 0.0001). CONCLUSIONS: Adding methyl-testosterone to hormone therapy
improves quality of life and sexuality in post-menopausal women with sexual
dysfunction.
Arch Intern Med. 2009
Jan 26;169(2):132-40.
Loop diuretic use and
fracture in postmenopausal women: findings from the Women's Health Initiative.
Carbone LD, Johnson KC, Bush AJ, Robbins
J, Larson JC, Thomas A, LaCroix AZ.
Department of Veterans Affairs Medical
Center, Memphis, TN, USA. LCarbone@utmem.edu
BACKGROUND: The relationship of loop
diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal
women has not been established. METHODS: We examined whether loop diuretics are
associated with changes in BMD, falls, and fractures in women enrolled in the
Women's Health Initiative. We included the 133,855 women (3411 users and
130,444 nonusers of loop diuretics) who were enrolled in the WHI from October
29, 1993 to December 31, 1998 and determined incident falls and fractures for a
mean of 7.7 years. Women who had BMD measurements at baseline and at year 3
(300 users and 9124 nonusers of loop diuretics) were also examined. RESULTS:
After adjustment for covariates, no significant association was found between
ever use of loop diuretics and total (hazard ratio [HR], 1.09; 95% confidence
interval [CI], 1.00-1.19), hip (HR, 1.21; 95% CI, 0.91-1.60), and clinical
vertebral fractures (HR, 1.17; 95% CI, 0.92-1.48) and falls (1.02; 0.96-1.08).
An increased risk was found for other clinical fractures (1.16; 1.01-133) and
total fractures (1.16; 1.03-1.31) with more than 3 years' use of loop
diuretics. The BMD changes were not associated with loop diuretic use.
CONCLUSIONS: After adjustment for confounding variables, no significant
association was found between ever use of loop diuretics and changes in BMD,
falls, and fractures. Loop diuretics were used by women in poor health who were
already at risk for fractures. However, prolonged use of loop diuretics was
associated with higher fracture risk in postmenopausal women.
Appl Nurs Res. 2009 Feb;22(1):35-41.
Incidence of bone loss,
falls, and fractures after Roux-en-Y gastric bypass for morbid obesity.
Berarducci A, Haines K, Murr MM.
University of South Florida Colleges of
Medicine and Nursing, Tampa, FL 33612, USA. aberardu@health.usf.edu
The objectives of this study were to
determine the incidence of and associated risks for falls and fractures after
gastric bypass surgery for morbid obesity and to determine the clinical signs
of bone loss. The sample consisted of 167 individuals at a mean age of 47 years
(SD = 10). Ten participants (6%) reported a decrease in height since surgery,
and 33 (20%) reported a decrease in height since they were 20 years old. Eight
participants (5%) reported postoperative fractures. Twenty-three participants
(13.8%) reported falling once since surgery, and 34 (20.4%) reported falling
two or more times since surgery. Twelve participants reported a new diagnosis
of osteoporosis postoperatively, and 1 participant reported a new diagnosis of
osteopenia. Sixty-seven percent (n = 112) of the participants were never
advised to undergo a bone density test postoperatively. The findings from this
study suggest that bone loss is a critical issue in this patient population,
with 25% (n = 42) reporting a decrease in height, 8% (n = 13) reporting a new
diagnosis of osteoporosis or osteopenia, and 5% (n = 8) reporting fractures
during a mean postoperative interval of 2.4 years. In addition, risk for
skeletal fragility is profound in this cohort of individuals, with 34% (n = 57)
indicating a history of one or more falls postoperatively. The results from
this study clearly indicate a need for early recognition of bone loss in this
population so that timely interventions can be initiated to prevent further
loss and subsequent fractures.
J Sex Med. 2009 Jan;6(1):175-83
Clinically relevant changes
in sexual desire, satisfying sexual activity and personal distress as measured
by the profile of female sexual function, sexual activity log, and personal
distress scale in postmenopausal women with hypoactive sexual desire disorder.
DeRogatis LR, Graziottin A, Bitzer J,
Schmitt S, Koochaki PE, Rodenberg C.
Johns Hopkins University School of
Medicine and Center for Sexual Medicine at Sheppard Pratt-Department of
Psychiatry, Baltimore, MD, USA. DeRogatis@sheppardpratt.org
INTRODUCTION: Transdermal testosterone
patch (TTP) treatment produced statistically significant improvements in a
satisfying sexual activity (SSA), sexual desire, and personal distress in
postmenopausal women suffering from hypoactive sexual desire disorder (HSDD),
but clinical significance of these changes was not determined. AIM: To quantify
the magnitude of change in three principal outcomes measures determined by HSDD
patients as associated with the perception of meaningful benefit with TTP
therapy. METHODS: The criteria for defining responders were determined using
anchoring methodology and receiver operating characteristics analysis to
establish minimum important differences (MIDs) in a representative subsample of
132 patients in two randomized, controlled trials in surgically menopausal women
with HSDD (N = 1,094). Perceived benefit was established based upon the
question "Overall, would you say that you experienced a meaningful benefit
from the study patches?". These data defined responders and established
MIDs for changes in sexual desire, SSA, and personal distress. The MIDs were
applied to the two trials to establish responder rates in each treatment group.
MAIN OUTCOME MEASURES: Changes in score that correspond to the MID for sexual
desire, SSA, and personal distress, and responder rates in each treatment group
based upon these values. RESULTS: Increases in frequency of SSA of greater than
1 activity/4 weeks, increases in sexual desire score of > or = 8.9, and
decreases in the personal distress score of > or = 20.0 were identified as
threshold improvements best able to differentiate responders and nonresponders.
The responder rate was significantly higher (P < 0.001) in the testosterone
group vs. placebo for all three outcomes measures
(sexual desire, 50% vs. 34%; SSA, 44% vs. 30%; personal distress, 51% vs. 39%).
CONCLUSIONS: Changes in sexual desire, SSA, and personal distress observed with
TTP treatment in surgically menopausal women with HSDD were clinically
significant and were associated with a meaningful treatment benefit.
J Sex Med. 2009 Jan;6(1):30-9
The effects of
hypoestrogenism on the vaginal wall: interference with the normal sexual
response.
Lara LA, Useche B, Ferriani RA, Reis RM,
de Sá MF, de Freitas MM, Rosa e Silva JC, Rosa e Silva AC.
Ribeirão Preto School of Medicine, University
of São Paulo-Department of Gynaecology and Obstetrics, Ribeirão Preto, Brazil.
luciaalvess@yahoo.com.br
INTRODUCTION: The sexual response
depends on the adequate function of all systems related to the genital and
extra-genital organs. Physiological conditions such as menopause can interfere
with sexual expression because of central and peripheral changes. Genital
effects of estrogen include vaginal trophism, lubrication, and local pleasure
sensation in the sexual arousal phase. Hypoestrogenism causes changes in the
four layers of the vaginal wall that may result in dyspareunia and a loss in
the quality of the genital arousal response. AIM: The purpose of this review is
to highlight the changes in the vaginal wall caused by hypoestrogenism, its possible
relationship with dyspareunia, and its repercussions for genital arousal.
Treatments for hypoestrogenism are also discussed. METHODS: We evaluated the
data available in PubMed (1982-2008) and surveyed the reference list for
relevant studies. Two reviewers analyzed the data independently. A study was
considered to be of high quality if it had all three of the following
characteristics: (i) prospective design; (ii) valid data; and (iii) adequate
sample size. Reviews and experimental animal studies were also considered. MAIN
OUTCOME MEASURES: Normal genital morphology, hypoestrogenism and hormone
replacement therapy were the focus of the studies reviewed in this paper.
RESULTS: Atrophy of the vaginal wall may be associated with dyspareunia and
genital sexual arousal disorder, but psychological and sociocultural aspects
must also be considered. Regardless, however, local estrogen therapy is useful
in improving vaginal wall trophism and, thus, in improving the sexual response.
CONCLUSIONS: There are many possible alterations in the structure of the
vaginal wall that are related to estrogen deficiency that may require medical
intervention beyond the usual strategies used to attain adequate sexual
function. Physicians should attempt to treat these alterations, and more
research is needed to elucidate the physiopathology of dyspareunia and genital
sexual arousal physiology.
J Sex Med. 2009 Jan;6(1):8-18; quiz 19-20
Testosterone replacement
therapy in naturally and surgically menopausal women.
Panzer C, Guay A.
Rose Medical Center-Department of
Endocrinology, Denver, Colorado, USA.
INTRODUCTION: Testosterone replacement
therapy in naturally and surgically menopausal women is a complex and currently
highly debated topic. Opposing guidelines for the use of testosterone exist,
which create a therapeutic dilemma for clinicians confronted by severely
distressed women who experience a decrease in sexual desire after surgical or
natural menopause. AIM: In this review, we will address the current knowledge
on androgen physiology, conditions associated with a low androgen state, and
risks and benefits of androgen therapy. METHODS: An English-language Medline
review was performed. MAIN OUTCOME MEASURE: Review of available literature.
RESULTS: A review of normal androgen physiology in women is summarized and a
brief review of prior use of androgens over the last six decades is included.
The data on the use of androgen replacement in pre- and postmenopausal women is
evaluated, especially its relationship to sexual functioning. Special concerns
about the effect of androgens on cardiovascular disease, breast, and
endometrial tissue are discussed. The balance of evidence seems to show that
androgens have more of a positive effect than a negative effect in women if
used properly. CONCLUSIONS: Testosterone replacement therapy for surgically and
naturally menopausal women with low sexual desire can be accomplished
physiologically and effectively after ruling out other medical conditions
leading to low sexual desire and after proper information of the patient that
testosterone therapy is not an FDA-approved medication in the United States.
The majority of available data suggests that testosterone replacement in women
can be used safely without increased risk of endometrial or breast cancer.
BMC Public Health. 2009
Jan 26;9(1):37. [Epub ahead of print
Age-specific symptom
prevalence in women 35-64 years old . A
population-based study.
Bardel A, Wallander MA, Wedel H,
Svardsudd K.
ABSTRACT: BACKGROUND: Symptom prevalence
is generally believed to increase with age. The aim of this study was to
evaluate the age specific prevalence of 30 general symptoms among Swedish
middle-aged women. METHODS: A cross-sectional postal questionnaire study in
seven Swedish counties in a random sample of 4,200 women 35-64 years old, with
2,991 responders. Thirty general symptoms included in the Complaint Score
subscale of the Gothenburg Quality of Life Instrument were used. RESULTS: Four
groups of age specific prevalence patterns were identified after adjustment for
the influence of educational level, perceived health and mood, body mass index,
smoking habits, use of hormone replacement therapy, and use of other symptom
relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye
problems and impaired hearing) increased significantly with age. Eleven
symptoms (general fatigue, headache, irritability, melancholy, backache,
exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea)
decreased significantly with age. Two symptoms (sweating and impaired
concentration) had a biphasic course with a significant increase followed by a
significant decrease. The remaining twelve symptoms (difficulty in relaxing,
restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain,
constipation, nervousness, poor appetite, weight loss, and difficulty in
urinating) had stable prevalence with age. CONCLUSIONS: Symptoms did not
necessarily increase with age instead symptoms related to
stress-tension-depression decreased.
Menopause. 2009 Jan 23.
[Epub ahead of print]
Additive effect of
depressed mood and vasomotor symptoms on postmenopausal insomnia.
Zervas IM, Lambrinoudaki I, Spyropoulou
AC, Koundi KL, Voussoura E, Tzavara C, Verdeli H, Aravantinos L, Creatsa M,
Paparrigopoulos T.
From the 1Women's Mental Health Clinic;
2IPT Unit, First Department of Psychiatry, Eginition Hospital; and 3Menopause
Clinic, Second Department of Obstetrics and Gynecology, Aretaieion Hospital,
Athens University Medical School, Athens, Greece; 4Department of Counseling and
Clinical Psychology, Teachers College; and 5College of Physicians and Surgeons,
Columbia University, New York, NY; and 6Sleep Research Unit, First Department
of Psychiatry, Eginition Hospital, Athens University Medical School, Athens,
Greece.
OBJECTIVE:: The
aim of this study was to investigate the role of vasomotor and mood symptoms on
insomnia in postmenopausal women. METHODS:: One
hundred sixty-three postmenopausal women, not receiving hormone therapy,
attending a menopause clinic at the University of Athens, Greece, were included
in this cross-sectional study. Climacteric symptoms were assessed by Greene's
scale, whereas psychological morbidity was measured by Zung Self-Assessment
Depression Scale, Symptom Checklist-90-R, and Athens Insomnia Scale. RESULTS:: Vasomotor symptoms were significantly associated with
insomnia (P = 0.001). When depressive symptomatology was added to the logistic
regression analysis, the predictive ability of the model was significantly
improved as defined by the increase in the log likelihood (P < 0.001) and
the increase in the area under the receiver operating characteristic curve.
CONCLUSIONS:: Insomnia in postmenopausal women
attending a menopause clinic is related both to the effects of vasomotor
symptoms and depressive symptomatology. Mood symptoms seem to affect sleep
independently of vasomotor symptoms, suggesting that depression should be
carefully assessed and treated in postmenopausal women with insomnia.
Menopause. 2009 Jan 21.
[Epub ahead of print
A
prospective study of the association between endogenous hormones and depressive
symptoms in postmenopausal women.
Ryan J, Burger HG, Szoeke C, Lehert P,
Ancelin ML, Dennerstein L.
From 1The University of Melbourne,
Parkville, Victoria, Australia; 2Inserm U888, Montpellier, F-34093 France;
3University of Montpellier, Montpellier, F-34000 France; 4Prince Henry's
Institute of Medical Research, Clayton, Victoria, Australia; and 5University of
Mons, Belgium.
OBJECTIVE::
Across a woman's lifetime, variations in hormone levels are known to influence
mood and well-being. Whether absolute or changes in hormone levels over time
are associated with depression among postmenopausal women remains unclear.
METHODS:: The Melbourne Women's Midlife Health Project
is a longitudinal population-based study of women who were followed through the
menopausal transition. This analysis is based on data collected from 138
postmenopausal women in years 11 and 13 of the study, who were assessed for the
presence of depressive symptoms using the Center for Epidemiological Studies
Depression Scale. Logistic regression models were developed to determine
whether absolute or changes in hormone levels were associated with depression.
RESULTS:: No significant associations were found
between depressive symptoms and the absolute levels of sex hormone-binding
globulin, testosterone, free androgen index, estradiol, free estradiol, or
follicle-stimulating hormone (FSH). On the other hand, women with a decline in
total serum estradiol over the 2-year period had a more than threefold
increased risk of depressive symptoms (odds ratio, 3.5; 95% CI, 1.2-9.9). A
large increase in FSH levels over this period was also associated with
depressive symptoms (odds ratio, 2.6; 95% CI, 1.0-6.7). These associations
remained even after adjustment for initial depression score, as well as a range
of potential confounding factors. CONCLUSIONS::
Changes in estradiol and, to a lesser extent, in FSH levels are associated with
an increased risk of depressive symptoms in postmenopausal women. These results
further support a role for fluctuating rather than absolute hormone levels in
depression in later life.