Selección de Resúmenes
de Menopausia
Febrero de 2009
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad
de Chile
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.,
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,
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
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:
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
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
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,
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.
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:
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,
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
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.
Semana del 4 al 10 de Febrero de 2009
Arq Bras Endocrinol
Metabol. 2008 Dec;52(9):1439-47.
Risk
of late-onset hypogonadism (andropause)
in Brazilian men over 50 years of age with osteoporosis: usefulness of
screening questionnaires.
Clapauch R, Braga DJ, Marinheiro LP, Buksman S, Schrank Y.
Division of Female
Endocrinology and Andrology, Endocrinology Sector,
Hospital da Lagoa, Instituto Fernandes Figueira, Fiocruz, Rio de
Janeiro, RJ, Brazil.
OBJECTIVE: To
analyze the relative risk of late-onset hypogonadism
in men with osteoporosis and the usefulness of screening questionnaires.
METHODS: We correlated the Aging Male's Symptoms (AMS), Androgen Deficiency in
Aging Male (ADAM) and International Index of Erectile Function (IIEF-5)
questionnaires and the laboratory diagnosis of hypogonadism
in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone
density, paired by age and ethnicity). RESULTS: Hypogonadism
presented in 25% of the osteoporotic and in 12.2 % of normal bone density men
(OR 2.08; IC95%: 1.14-3.79) and was associated with ADAM first question (low
libido, p=0.013). Levels of TT below 400 ng/dl
correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation
with testosterone levels. CONCLUSION: Hypogonadism
was 2.08 times more prevalent in osteoporotic men. The symptom that best
correlated with late-onset hypogonadism was low
libido (ADAM 1 positive).
Menopause. 2009 Feb 3. [Epub ahead of print]
Is the immunological noise of
abnormal autoimmunity an independent risk factor for premature ovarian aging?
Gleicher N, Weghofer A, Oktay K, Barad DH.
OBJECTIVE:: The risk for premature ovarian failure increases in association
with two principal known etiologies: in the presence of excessive triple CGG
expansions on the FMR1 (fragile X) gene (genetic etiology) and in association
with a variety of autoimmune conditions (autoimmune etiology). To what degree
milder forms of premature ovarian aging are also associated with these two
etiologies is, however, unknown. METHODS:: We, therefore, investigated 119
consecutive, so identified, infertile women and statistically correlated by
linear and logistic regression analyses ovarian function parameters to markers
of a possible genetic etiology (number of CGG triple repeats on the FMR1 gene)
and to markers of possible abnormal immune function (immune panel). RESULTS:: Sixty (50.4%) of 119 participants demonstrated at least
one immune abnormality. Both groups did not differ statistically in age, mean
follicle-stimulating hormone, estradiol, and antimüllerian hormone levels, although antimüllerian
hormone suggested a trend toward higher levels in autoimmune participants (P =
0.19). Autoimmune participants also demonstrated lower mean triple CGG
expansion sizes (P < 0.05) and included fewer women with greater than or
equal to 35 triple repeats (relative risk, 4.0; 95% CI, 1.3-11.9; P < 0.01),
previously reported to demarcate increased risk for premature ovarian aging.
CONCLUSIONS:: Even minimal evidence of abnormal
autoimmune function ("immunological noise") seems to increase risk
toward premature ovarian aging, often manifesting as infertility. Evidence of
abnormal autoimmune function, such as increased CGG triple expansion sizes, in
young women, therefore, warrants vigilance for development of prematurely
diminished ovarian reserve and infertility.
N Engl J
Med. 2009 Feb 5;360(6):573-87.
Breast
cancer after use of estrogen plus progestin in postmenopausal women.
Chlebowski RT, Kuller LH, Prentice RL, Stefanick ML, Manson JE, Gass M, Aragaki AK, Ockene JK, Lane DS, Sarto GE, Rajkovic A, Schenken R, Hendrix SL, Ravdin PM, Rohan TE, Yasmeen S, Anderson G; WHI Investigators.
Los
Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance,
CA 90502, USA. rchlebowski@gmail.com
BACKGROUND:
Following the release of the 2002 report of the Women's Health Initiative (WHI)
trial of estrogen plus progestin, the use of menopausal hormone therapy in the
United States decreased substantially. Subsequently, the incidence of breast
cancer also dropped, suggesting a cause-and-effect relation between hormone
treatment and breast cancer. However, the cause of this decrease remains
controversial. METHODS: We analyzed the results of the WHI randomized clinical
trial--in which one study group received 0.625 mg of conjugated equine
estrogens plus 2.5 mg of medroxyprogesterone acetate
daily and another group received placebo--and examined
temporal trends in breast-cancer diagnoses in the WHI observational-study
cohort. Risk factors for breast cancer, frequency of mammography, and time-specific
incidence of breast cancer were assessed in relation to combined hormone use.
RESULTS: In the clinical trial, there were fewer breast-cancer diagnoses in the
group receiving estrogen plus progestin than in the placebo group in the
initial 2 years of the study, but the number of diagnoses increased over the
course of the 5.6-year intervention period. The elevated risk decreased rapidly
after both groups stopped taking the study pills, despite a similar frequency
of mammography. In the observational study, the incidence of breast cancer was
initially about two times as high in the group receiving menopausal hormones as
in the placebo group, but this difference in incidence decreased rapidly in
about 2 years, coinciding with year-to-year reductions in combined hormone use.
During this period, differences in the frequency of mammography between the two
groups were unchanged. CONCLUSIONS: The increased risk of breast cancer
associated with the use of estrogen plus progestin declined markedly soon after
discontinuation of combined hormone therapy and was unrelated to changes in
frequency of mammography.
Menopause. 2009 Feb 3. [Epub ahead of print]
Angeliq versus Activelle in normotensive
postmenopausal women: a prospective, randomized pilot study.
Battaglia C, Cianciosi A, Mancini F, Persico N, Sisti G, Facchinetti F, Busacchi P.
From the
1Department of Obstetrics and Gynecology, Alma Mater Studiorum,
University of Bologna, Bologna, Italy; and 2Department of Obstetrics and
Gynecology, University of Modena and Reggio Emilia, Modena, Italy.
OBJECTIVE:: The aim of this study was to compare, in normotensive postmenopausal women, the effects of drospirenone/estradiol and norethisterone acetate/estradiol
on blood pressure and other surrogate markers of cerebrovascular
and cardiovascular risk. METHODS:: Thirty
postmenopausal women were submitted to utero-ovarian ultrasonography and to color Doppler evaluation of
ophthalmic arteries. Ultrasonographic and Doppler
analysis of brachial artery flow-mediated vasodilatation and 24-hour ambulatory
blood pressure monitoring were performed. Plasma concentrations of
nitrites/nitrates were assayed. The participants were randomly assigned to drospirenone 2 mg/estradiol 1 mg
(group 1; n = 15) or norethisterone acetate 0.5 mg/estradiol 1 mg (group 2; n = 15) treatment. The duration of
the study was 6 months. RESULTS:: The basal pulsatility index and the back pressure of the ophthalmic
artery were similar in groups 1 and 2. After 6 months, no changes were
observed. The nitrites/nitrates values were not different between groups 1 and
2 both in basal conditions and after therapy. The brachial artery flow-mediated
vasodilatation and the pulsatility index of the
brachial artery did not show any difference in groups 1 and 2 both in basal
conditions and after the therapy. The 24-hour blood pressure monitoring showed
no significant differences in the 24-hour time, daytime, and nighttime values
either in basal conditions or after therapy. All participants were found to be
dippers normally (nocturnal reduction >/=10% in comparison with diurnal
values). The wake-up blood pressure values were similar in the studied
participants. CONCLUSIONS:: A 6-month hormone therapy
with drospirenone/estradiol
or norethisterone acetate/estradiol
is equally effective and does not seem to alter the surrogate markers of
cardiovascular and cerebrovascular risk.
Value Health. 2009 Jan 12. [Epub ahead of print
Hypoactive
Sexual Desire Disorder in Postmenopausal Women: Quality of Life and Health
Burden.
Biddle AK, West SL, D'Aloisio AA, Wheeler SB, Borisov NN, Thorp J.
Department of
Health Policy and Management, Gillings, School of
Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill,
NC, USA.
ABSTRACT
Objectives: To describe the health-related quality of life (HRQOL) implications
of hypoactive sexual desire disorder (HSDD) in a national sample of
postmenopausal women ages 30-70. Methods: The Nationwide Survey of Female
Sexual Health, a random-digit telephone survey of US households, collected
information on female sexual function, demographic characteristics, HRQOL, and
the presence of specific medical disorders from 1189 naturally or surgically
postmenopausal women in stable relationships of >/=3 months duration. HSDD
was defined as <40 on the Profile of Female Sexual Function((c))
scale and <60 on the Personal Distress Scale((c)). Short Form-12 Health
Survey (SF-12) summary and domain scores, and EuroQol
(EQ-5D) index score and dimensions were compared with population-based norms
for healthy individuals and selected chronic conditions. Results: HSDD was
associated with significant HRQOL decrements, with the largest SF-12 score
differences in mental health (HSDD: 45.4 [standard error 1.9] vs. no HSDD: 51.0
[0.6], P < 0.01), vitality (HSDD: 47.7 [1.3] vs. no HSDD: 52.0 [0.7], P <
0.01), social function (HSDD: 47.3 [1.4] vs. no HSDD: 50.9 [0.7], P < 0.05),
and bodily pain (HSDD: 41.4 [2.2] vs. no HSDD: 46.7 [0.9], P < 0.05). EQ-5D
index was 0.08 points lower (HSDD: 0.76 [0.03] vs. no HSDD: 0.84 [0.02], P <
0.05) for those with HSDD compared with those without. HSDD was associated with
a 0.1-point decrement in naturally menopausal women (HSDD: 0.78 [0.03] vs. no
HSDD 0.88 [0.01], P < 0.01). Women with HSDD showed more HRQOL impairment
than healthy population norms but were similar to adults with other chronic
conditions such as diabetes and back pain. Conclusions: Women with HSDD showed
substantial impairment in HRQOL. Given a prevalence of 6.6% to 12.5% among US
women, HSDD represents an important burden on quality of life.
Menopause. 2009 Feb 2. [Epub ahead of print]
Duration of vasomotor symptoms
in middle-aged women: a longitudinal study.
Col NF, Guthrie JR, Politi M, Dennerstein L.
From the 1Center
for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME;
2Office for Gender and Health, Department of Psychiatry, The University of
Melbourne, Victoria, Australia; and 3Department of Behavioral and Preventive
Medicine, Brown Medical School, Providence, RI.
OBJECTIVE:: Vasomotor symptoms adversely affect the quality of life
and functional status of most women during the menopausal transition, but
little is known about how long these symptoms last. The most effective
treatment, hormone therapy (HT), carries risks and benefits that depend on the
timing and duration of use. In this study we sought to estimate the duration of
vasomotor symptoms in a longitudinal study. METHODS::
We reanalyzed primary data from 438 women in the longitudinal cohort of the
population-based Melbourne Women's Midlife Health Project. Two hundred and five
women who had completed 13 years of follow-up were included in the analyses.
The onset and cessation of vasomotor symptoms were reported, stratifying
analyses according to ever use of HT. Symptom duration was calculated as the
time between the first and last bothersome hot flush reported. RESULTS:: The
mean (SD) duration of bothersome menopausal symptoms for women who completed 13
years of follow-up and who never used HT was estimated to be 5.2 (3.8) years
(median, 4 years). If women who used HT were included, the mean (SD) duration
was 5.5 (4.0) years (median, 4 years). The estimated duration of symptoms
varied according to the duration of longitudinal follow-up, with a mean
estimate of 3.4 years (median, 3 years) when only 8 years of follow-up data
were analyzed. The only factor associated with duration of hot flushes was
regular exercise-more exercise was associated with shorter symptom duration.
CONCLUSIONS:: The average duration of vasomotor
symptoms in this sample is more than 5 years, substantially longer than had
been previously reported.
Menopause. 2009 Feb 2. [Epub ahead of print]
Temporal
associations of hot flashes and depression in the transition to menopause.
From the
Departments of 1Obstetrics/Gynecology, 2Psychiatry, 3Center for Clinical Epidemiology
and Biostatistics, and 4Center for Research in Reproduction and Women's Health,
University of Pennsylvania School of Medicine, Philadelphia, PA.
OBJECTIVE:: The aim of this study was to evaluate associations
between hot flashes and depressed mood in the menopausal transition and
associations of these symptoms with reproductive hormone changes. METHODS:: A 10-year follow-up in a population-based cohort of women
who had no experience of hot flashes or depressed mood at baseline was
conducted. RESULTS:: The incidence of hot flashes
significantly increased compared with the incidence of depressed mood in the
10-year follow-up (P < 0.001). Sixty-seven percent of the women reported hot
flashes, 50% reported depressed mood, and 41% reported both symptoms during the
study interval. Reporting of both hot flashes and depressed mood was greater
than expected if the processes operated independently (P < 0.001). Of the
women who experienced both symptoms, depressed mood was more likely to precede
hot flashes (relative risk = 2.1; 95% CI, 1.5-2.9). Within-woman increases in
follicle-stimulating hormone levels were associated with the onset of depressed
mood in unadjusted analysis (P = 0.05). Increased follicle-stimulating hormone
levels, decreased inhibin B levels, and the
variability of estradiol were significantly
associated with hot flashes. Follicle-stimulating hormone and inhibin B remained significantly associated with hot
flashes in the final multivariable models (P < 0.001). CONCLUSIONS:: Both hot flashes and depressive symptoms occur early in
the menopausal transition in women with no previous experience of these
symptoms. Depressive symptoms are more likely to precede hot flashes in women
who report both symptoms. The findings support the concept that the changing
hormonal milieu of the menopausal transition is one of multiple factors
associated with the onset of symptoms.
Bone. 2008
May 15. [Epub ahead of print]
Alendronate/vitamin D(3) 70 mg/2800 IU with and
without additional 2800 IU vitamin D(3) for osteoporosis: Results from the
24-week extension of a 15-week randomized, controlled trial.
Binkley N, Ringe JD, Reed JI, Ljunggren O, Holick MF, Minne HW, Liu M, Lamotta A, West JA, Santora AC.
University
of Wisconsin-Madison, Osteoporosis Clinical Center and Research Program,
Although vitamin D
supplementation is a fundamental part of osteoporosis treatment, many patients
do not regularly take adequate amounts. A once-weekly (OW) alendronate
(ALN) preparation that includes 2800 IU of vitamin D(3) in a single combination
tablet (ALN+D2800) is available for treating patients and ensuring intake of
vitamin D that is consistent with existing guidelines. This randomized,
double-blind study extension was conducted to evaluate the safety and
tolerability of ALN+D2800 and ALN+D2800 plus an additional 2800 IU vitamin D(3)
single tablet supplement (ALN+D5600) administered for 24 weeks in men and
postmenopausal women with osteoporosis previously treated OW for 15 weeks with
either ALN or ALN+D2800. The primary endpoint was the proportion of participants
who developed hypercalciuria (defined as a 24-hour
urine calcium >300 mg in women or >350 mg in men and an increase of
>25% versus randomization baseline) at week 39. The key secondary endpoint
was the proportion of participants with vitamin D insufficiency (serum 25(OH)D <15 ng/mL
[37.4 nmol/L]) at the end of the study. Hypercalciuria incidence (4.2% [ALN+D5600] vs. 2.8%
[ALN+D2800]), did not differ between groups (p = 0.354). No participants
developed hypercalcemia. Among the participants with
vitamin D insufficiency at the week 0 baseline, the prevalence of insufficiency
at the end of the study was reduced by 92% in the ALN+D5600 group and by 86% in
the ALN+D2800 group. The incidences of clinical adverse experiences, including
drug-related adverse experiences, were similar in both groups. In subjects
previously treated with ALN+D2800 for 15 weeks, the addition of 2800 IU D(3) for 24 weeks did not produce hypercalcemia
nor increase the risk of hypercalciuria.
Semana del 11 al 17 de Febrero de 2009
Psychoneuroendocrinology. 2009
Feb 10. [Epub ahead of print
Chronic estradiol replacement to aged female
rats reduces anxiety-like and depression-like behavior
and enhances cognitive performance.
Department
of
Decline in the
ovarian steroid, estradiol (E(2)), with the menopause
transition may influence cognitive and affective processing of older women and
there is evidence that hormone replacement therapies (HRTs) with E(2)-mimetics may provide benefit in some, but not all, women.
The parameters that play a role in determining whether the response to HRTs is
positive are of interest. It may be that the likelihood for positive responses
is related to the timing of E(2)-replacement following
E(2) decline. As such, in the present study an animal model was utilized to
investigate this. We investigated the effects of long- versus short-term
E(2)-replacement by examining cognitive (object placement task), anxiety (open
field, mirror maze, light-dark transition task), and depression (forced swim
task) behavior of female rats that were ovariectomized (OVX) at middle-age (14 months) or older (19
months) and implanted with E(2)-filled implants at the time of surgery or after
a delay of 5 months, or OVX at 14 months of age and never replaced with E(2).
Rats were tested at 20 months of age. The hypothesis that was tested was that
rats would have reduced anxiety and depression behavior
and improved cognitive performance with E(2)-replacement
at ovarian cessation, compared to a delay in E(2)-replacement. Performance in
the object placement task was improved in rats that were OVX and then received
continuous E(2)-replacement, compared to those that
were OVX and continuously administered placebo vehicle. In the open field and
forced swim task, there was an increase in anti-anxiety and anti-depression behavior, respectively, among rats that were OVX and then
received continuous E(2)-replacement, compared to OVX
rats administered vehicle or those that experienced a delay in
E(2)-replacement. In the mirror maze and light-dark transition task, E(2)-replacement at OVX, or after a delay, reduced
anxiety-like behavior. Thus, E(2)-replacement reduced
anxiety and depression behavior and improved
cognitive performance of aged female rats; however, delay in E(2) treatment
influenced whether there were favorable effects of
E(2) in some tasks.
Menopause. 2009
Feb 10. [Epub ahead of print
Longitudinal changes in sexual functioning as women transition through
menopause: results from the Study of Women's Health Across
the Nation.
Avis NE, Brockwell S, Randolph JF Jr, Shen S, Cain VS, Ory M, Greendale GA.
From the
1Department of Social Sciences and Health Policy, Wake Forest University School
of Medicine, Winston-Salem, NC; 2Epidemiology Data Center,
University of Pittsburgh, Pittsburgh, PA; 3Division of Reproductive
Endocrinology, University of Michigan Health System, Ann Arbor,
MI; 4Centers for Disease Control, Washington, DC; 5School of Rural Public
Health, Texas A&M University System Health Sciences Center,
College Station, TX; and 6Geffen School of Medicine at University of California
Los Angeles, Los Angeles, CA.
OBJECTIVE:: Sexual functioning is an important component of women's
lives. The extent to which the menopausal transition is associated with
decreased sexual functioning remains inconclusive. This study seeks to
determine if advancing through the menopausal transition is associated with
changes in sexual functioning. METHODS:: This was a prospective, longitudinal
cohort study of women aged 42 to 52 years at baseline recruited at seven US
sites (N = 3,302) in the Study of Women's Health Across the Nation (SWAN).
Cohort-eligible women had an intact uterus, had at least one ovary, were not
currently using exogenous hormones, were either premenopausal or early perimenopausal, and self-identified as one of the study's
designated racial/ethnic groups. Data from the baseline interview and six
annual follow-up visits are reported. Outcomes are self-reported ratings of
importance of sex; frequency of sexual desire, arousal, masturbation, sexual
intercourse, and pain during intercourse; and degree of emotional satisfaction
and physical pleasure. RESULTS:: With adjustment for baseline age,
chronological aging, and relevant social, health, and psychological parameters,
the odds of reporting vaginal or pelvic pain increased and desire decreased by
late perimenopause. Masturbation increased at early perimenopause but declined during postmenopause.
The menopausal transition was unrelated to other outcomes. Health,
psychological functioning, and importance of sex were related to all sexual
function outcomes. Age, race/ethnicity, marital status, change in relationship,
and vaginal dryness were also associated with sexual functioning. CONCLUSIONS:: Pain during sexual intercourse increases and sexual
desire decreases over the menopausal transition. Masturbation increases during
the early transition, but then declines in postmenopause.
With adjustment for other factors, the menopausal transition was not
independently associated with reports of the importance of sex, sexual arousal,
frequency of sexual intercourse, emotional satisfaction with partner, or
physical pleasure.
Clin Exp Rheumatol. 2008 Nov-Dec;26(6):986-91.
Idiopathic osteoporosis in premenopausal
women.
Clinical characteristics and bone remodelling abnormalities.
Peris P, Ruiz-Esquide V, Monegal A, Alvarez L, Martínez de Osaba
MJ, Martínez-Ferrer A, Reyes R, Guañabens N.
Services
of 1Rheumatology, Hospital Clínic,
OBJECTIVE:
Osteoporosis is infrequent in young premenopausal women and is often associated
with secondary disorders. However, idiopathic osteoporosis may be found in this
setting and few data are known on this condition. Therefore, the aim of this
study was to analyse the clinical characteristics and bone remodelling
abnormalities in premenopausal women with idiopathic osteoporosis.METHODS:28
premenopausal women with idiopathic osteoporosis (aged 38.3+/-7.6 years) were
included. The patients had one or more fragility fractures and/or decreased
bone mass (z-score <-2 in the lumbar spine or femur). In all patients,
secondary causes of osteoporosis were excluded and previous skeletal fractures,
family history and risk factors for osteoporosis were recorded. In addition,
bone mineral density at the lumbar spine and hip, spinal x-rays, and laboratory
tests including PTH, 25-hydroxyvitamin D, 1,25 (OH)<inf>2</inf> vitamin D and urinary calcium excretion were
measured. Bone markers such as serum bone alkaline phosphatase
(bone AP) and P1NP, and urinary hydroxyproline (HYP),
NTx and CTx were measured
and results were compared with those observed in a control group of 28 healthy
premenopausal women. RESULTS:46% of the patients had
previous fragility fractures, 53% had family history of osteoporosis, 36% had
associated hypercalciuria and 30% had a BMI <20
Kg/m<sup>2</sup>. Patients with idiopathic osteoporosis had
increased bone resorption markers (NTx and HYP) but normal bone formation markers when
compared with healthy controls. No significant differences in the clinical and
biochemical parameters were observed between patients with or without hypercalciuria. CONCLUSION:Young women with idiopathic osteoporosis have an
increased bone resorption without changes in bone
formation when assessed by biochemical markers.
Arch Intern Med. 2009 Feb 9;169(3):294-304
Multivitamin use and risk of cancer and
cardiovascular disease in the Women's Health Initiative cohorts.
Neuhouser ML, Wassertheil-Smoller S, Thomson C, Aragaki A, Anderson GL, Manson JE, Patterson RE, Rohan TE, van Horn L, Shikany JM, Thomas A, LaCroix A, Prentice RL.
Division of Public
Health Sciences, Fred Hutchinson Cancer Research Center,
1100 Fairview Ave N., Seattle, WA 98109-1024, USA. mneuhous@fhcrc.org
BACKGROUND:
Millions of postmenopausal women use multivitamins, often believing that
supplements prevent chronic diseases such as cancer and cardiovascular disease
(CVD). Therefore, we decided to examine associations between multivitamin use
and risk of cancer, CVD, and mortality in postmenopausal women. METHODS: The
study included 161 808 participants from the Women's Health Initiative clinical
trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary
modification, and calcium and vitamin D supplements) or an observational study
(N = 93 676). Detailed data were collected on multivitamin use at baseline and
follow-up time points. Study enrollment occurred
between 1993 and 1998; the women were followed up for a median of 8.0 years in
the clinical trials and 7.9 years in the observational study. Disease end
points were collected through 2005. We documented cancers of the breast
(invasive), colon/rectum, endometrium, kidney,
bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and
venous thromboembolism); and total mortality.
RESULTS: A total of 41.5% of the participants used multivitamins. After a
median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in
the observational study cohort, 9619 cases of breast, colorectal, endometrial,
renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865
deaths were reported. Multivariate-adjusted analyses revealed no association of
multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95%
confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI,
0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for
endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR,
1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI,
0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for
stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism);
or mortality (HR, 1.02, and 95% CI, 0.97-1.07). CONCLUSION: After a median
follow-up of 8.0 and 7.9 years in the clinical trial and observational study
cohorts, respectively, the Women's Health Initiative study provided convincing
evidence that multivitamin use has little or no influence on the risk of common
cancers, CVD, or total mortality in postmenopausal women.
Arch Intern Med. 2009 Feb 9;169(3):269-78
Exercise dose and quality of life: a randomized controlled trial.
Martin CK, Church TS, Thompson AM, Earnest CP, Blair SN.
Pennington
Biomedical Research Center, Louisiana State
University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
Martin@pbrc.edu
BACKGROUND:
Improved quality of life (QOL) is a purported benefit of exercise, but few
randomized controlled trials and no dose-response trials have been conducted to
examine this assertion. METHODS: The effect of 50%, 100%, and 150% of the
physical activity recommendation on QOL was examined in a 6-month randomized
controlled trial. Participants were 430 sedentary postmenopausal women (body
mass index range, 25.0-43.0 [calculated as weight in kilograms divided by height
in meters squared]) with elevated systolic blood pressure randomized to a nonexercise control group (n = 92) or 1 of 3 exercise
groups: exercise energy expenditure of 4 (n = 147), 8 (n = 96), or 12 (n = 95)
kilocalories per kilogram of body weight per week. Eight aspects of physical
and mental QOL were measured at baseline and month 6 with the use of the
Medical Outcomes Study 36-Item Short Form Health Survey. RESULTS: Change in all
mental and physical aspects of QOL, except bodily pain, was dose dependent
(trend analyses were significant, and exercise dose was a significant predictor
of QOL change; P < .05). Higher doses of exercise were associated with
larger improvements in mental and physical aspects of QOL. Controlling for
weight change did not attenuate the exercise-QOL association. CONCLUSION:
Exercise-induced QOL improvements were dose dependent and independent of weight
change.
Semana del 18 al 24 de Febrero de 2009
Maturitas. 2009 Feb 12. [Epub
ahead of print
Is the Menopause Rating Scale accurate for diagnosing sexual dysfunction
among climacteric women?
Jara D, Fuenzalida A, Figueroa R, Del Prado M, Flores D, Blümel JE, Chedraui P.
Universidad Diego Portales, Santiago, Chile.
BACKGROUND:
Although several tools have been designed to assess quality of life (QoL) among middle-aged women their capacity to specifically
assess sexual dysfunction (SD) remains uncertain. Moreover, if SD impairs QoL within this population, then sexual assessment becomes
a key issue. OBJECTIVES: To evaluate the accuracy of the Menopause Rating Scale
(MRS) in diagnosing SD among climacteric women. METHODS: In this
cross-sectional study 370 women aged 40-59 years filled out the MRS and the
Female Sexual Functioning Index (FSFI) simultaneously. SD among surveyed women
was defined as those obtaining a total FSFI score of </=26.55. A
receiver-operator curve (ROC) was used to plot and measure the diagnostic
accuracy of one MRS item (item 8, assessing sexual problems) using the FSFI
total score as a gold standard. RESULTS: Mean age of surveyed women was
49.3+/-5.8 years. A 56.5% of them were married, 44.3% were postmenopausal,
66.8% were sexually active and 57% had SD (FSFI total score </=26.55). ROC
curve determined a score >/=1 in the MRS item 8 as a cut-off value for
discriminating women with SD (78% sensitivity and 62% specificity with an area
below the curve of 0.70 Swett). CONCLUSIONS: The MRS
was moderately accurate for diagnosing SD among climacteric women. More
research is warranted in this regard.
J Prev Med Public Health. 2009 Jan;42(1):29-34
C-reactive Protein and Carotid Intima-media
Thickness in a Population of Middle-aged Koreans.
Suh M, Lee JY, Ahn SV, Kim HC, Suh I.
Department
of Preventive Medicine,
OBJECTIVES: This
study was performed to evaluate the relationship between C-reactive protein
(CRP) and carotid intima-media thickness (carotid
IMT) in a population of middle-aged Koreans. METHODS: A total of 1,054 men and
1,595 women (aged 40-70 years) from
Clin Endocrinol
(Oxf). 2009 Feb 18. [Epub ahead of print
Lower bone mineral density is associated with higher coronary
calcification and coronary plaque burdens by multidetector
row coronary computed tomography in pre- and post-menopausal women.
Choi SH, An JH, Lim S, Koo BK, Park SE, Chang HJ, Choi SI, Park YJ, Park KS, Jang HC, Shin CS.
Department
of Internal Medicine (S.H.C., J.H.A., S.L., H.J.C., Y.J.P., K.S.P., H.C.J.,
C.S.S.),
SUMMARY Objectives:
There is growing evidence about the association between bone mineral density
(BMD) and vascular calcification, which is related to cardiovascular disease.
Coronary multidetector row computed tomography (MDCT)
is a non-invasive tool developed to precisely evaluate coronary status. We used
MDCT to evaluate this association. Design and patients: Eight hundred and
fifteen subjects received routine checkups. After excluding subjects with
factors affecting bone metabolism and cardiovascular disease, 467 subjects were
analysed. Measurements: Coronary calcification was measured with MDCT and BMD
was measured with dual X-ray absorptiometry. Results:
The BMD of the femur and the lumbar spine were negatively associated with the
coronary calcium score (CCS) after adjusting for age in women but not in men.
This inverse correlation was stronger in women with a greater time since
menopause (r =-0.35 at femur, post-menopausal women vs. r=-0.10 at femur,
pre-menopausal women, P < 0.05), and it was stronger at the femur than in
the lumbar spine (r =-0.35 at femur vs. r =-0.16 at lumbar spine, P < 0.01).
The relationship was also stronger in post-menopausal women with osteoporosis
and osteopaenia than women with normal BMD. The lower
BMD associated with higher coronary plaque burdens and multi-diseased coronary
vessels in both men and women (P < 0.01) Conclusions: Increased CCS and
subclinical atherosclerosis of plaque burdens as seen by MDCT was associated
with a low BMD in all women, independent of cardiovascular risk factors and
age.
Br J
Cancer. 2009 Feb 24;100(4):578-82
Circulating levels of leptin, adiposity and
breast cancer risk.
Wu MH, Chou YC, Chou WY, Hsu GC, Chu CH, Yu CP, Yu JC, Sun CA.
Graduate
Institute of Life Sciences,
The present
case-control study was to investigate the relationships of plasma leptin level and anthropometric measures of adiposity with
the risk of breast cancer. Questionnaire information, anthropometric measures
and blood samples were taken before treatment from 297 incident cases with
breast cancer and 593 controls admitted for health examination at the
J Gerontol
A Biol Sci Med Sci. 2009 Feb 16. [Epub ahead of print]
Calcium Plus Vitamin D Supplementation and
Mortality in Postmenopausal Women: The Women's Health Initiative
Calcium-Vitamin D Randomized Controlled Trial.
Lacroix AZ, Kotchen J, Anderson G, Brzyski R, Cauley JA, Cummings SR, Gass M, Johnson KC, Ko M, Larson J, Manson JE, Stefanick ML, Wactawski-Wende J.
WHI Clinical
Coordinating Center,
BACKGROUND:
Calcium and vitamin D (CaD) supplementation trials
including the Women's Health Initiative (WHI) trial of CaD
have shown nonsignificant reductions in total mortality.
This report examines intervention effects on total and cause-specific mortality
by age and adherence. METHODS: The WHI CaD trial was
a randomized, double-blind, placebo-controlled trial that enrolled 36,282
postmenopausal women aged 51-82 years from 40
Med J Aust. 2009 Feb 16;190(4):S37-8
Oestrogen - a new treatment approach for schizophrenia?
Alfred Psychiatry
Research Centre,
The oestrogen
protection hypothesis proposes that oestrogen has a protective effect against
onset of schizophrenia. In support of this: Epidemiological studies have shown
that young women are less likely to develop schizophrenia than men of the same
age, and women are more likely to develop late-onset schizophrenia after
menopause. Clinical studies have shown higher psychotic symptoms in perimenopausal women, and women at the low oestrogen phase
of the menstrual cycle. Animal studies provide further evidence in support of
the oestrogen protection hypothesis. Three randomised double-blind
placebo-controlled trials and an open-label study showed that adding oestradiol to women's usual antipsychotic medications was
associated with significant abatement of schizophrenia symptoms. A small study
of men with schizophrenia who received oral oestradiol
valerate also showed a significant abatement in
psychotic symptoms. Although oestrogen appears to be a useful treatment for
schizophrenia, further research is required to determine the correct dose and
duration of use of oestradiol. New types of oestrogen
compounds may provide a safer, non-feminising approach for the treatment of
schizophrenia.
Semana del 25 de febrero al 3 de Marzo de 2009
Acta Ortop
Mex. 2008 Sep-Oct;22(5):292-302.
Osteoporosis and osteopenia in female health workers from Mexico City
Gómez-García F, Vázquez-Martínez JL, Lara-Rodríguez Mde L.
Hospital Angeles Mocel, Delegación Miguel
Hidalgo, DF México. sla@prodigy.net.mx
INTRODUCTION: The
prevalence of osteoporosis (OP) in Mexican population is not well known. This
disease constitutes a risk factor for fractures due to OP, which result in
disability, poor quality of life and increased mortality rates. OBJECTIVES: To
determine prevalence of OP and osteopenia in a group
of female health workers from Mexico City using central densitometry (Dual X
Ray Absorptiometry-DXA); to compare the Hispanic
reference database from the LUNAR DPX L unit vs. the study population; to
determine the age at which the peak bone mass is reached and to explore the
relationship between some well known factors for osteoporosis and bone mass.
MATERIAL AND METHODS: In this prolective,
cross-sectional observational study 588 healthy females older than 18 years
were selected at different stages and a hip and spine densitometry (DXA) was
undertaken with a LUNA DPX L unit. To determine the prevalence of osteoporosis
and osteopenia we used the criteria of the Committee
of Experts on Osteoporosis from the World Health Organization. RESULTS: The
mean age of our study population was 42.3 years +/- 9.6 (20-65); the weight 66
kg +/- 12.1 (41-139) and height 153.9 cm +/- 5.7 (138-177). The prevalence of
osteoporosis on the lumbar spine was 13.5% (IC 95%: 10.5-16) and osteopenia 27.7 (IC 95%: 24-31). On the femoral neck, the
prevalence of osteoporosis was 2% (IC 95%: 1.0-3) and osteopenia
26.1% (IC 95%: 22-29). The peak bone mass on the femoral neck was found between
31 to 35 years and in the lumbar spine between 26-30 years. In these groups,
the bone mineral density falls as age rises. When we compare our results to
reference population from the LUNAR densitometer database and to our same study
group, there is an overestimation of the prevalence of OP and osteopenia on the lumbar spine and osteopenia
on the femoral neck. We found a prevalence of overweight and obesity higher to
reported at the Mexican National Survey of Nutrition.
Am J Surg. 2009 Mar;197(3):403-7.
The
effects of hormone replacement therapy on postmenopausal breast cancer biology
and survival.
Sener SF, Winchester DJ, Winchester DP, Du H, Barrera E, Bilimoria M, Krantz S, Rabbitt S.
Department of
Surgery and the Center on Outcomes Research and
Education, NorthShore University Health System,
Evanston, and Northwestern University Feinberg School
of Medicine, Chicago, IL, USA.
BACKGROUND: The
goal of this study was to compare the characteristics of breast cancers and
survival rates in HRT users versus nonusers. METHODS: Data were analyzed for
1055 patients >/=50 years of age who had definitive therapy for breast
cancer from 1994 through 2002. RESULTS: There were 471 (45%) HRT
users. The median age at diagnosis was 61.0 years for HRT users and 68.0
years for HRT nonusers (P < .001). HRT users more often had tumors that were <1 cm (P = .007), node negative (P =
.033), and grade I (P = .016). HRT users had a decreased risk of death versus
nonusers (hazard ratio = .438, 95% confidence limit = .263 to .729, P = .002).
CONCLUSIONS: HRT users developed breast cancer at a younger age than nonusers;
HRT use was associated with the development of biologically more favorable cancers than those that developed in nonusers;
and overall and disease-free survival rates were higher in HRT users than
nonusers.
Ultrasound Obstet Gynecol. 2009 Feb
26;33(3):344-348.
Value of
endometrial thickness measurement for diagnosing focal intrauterine pathology
in women without abnormal uterine bleeding.
Dreisler E, Sorensen SS, Ibsen PH, Lose G.
Department of
Obstetrics and Gynecology, Glostrup
Hospital, Glostrup, Denmark.
OBJECTIVE: To
assess the diagnostic value of transvaginal sonographic (TVS) measurement of endometrial thickness for
diagnosing focal intrauterine pathology in women without abnormal uterine
bleeding (AUB). METHODS: A random selection from the Danish Civil Registration
System was made: 1660 women aged 20-74 years were invited to participate and
686 women were eligible and accepted inclusion (429 pre- and 257
postmenopausal). The women underwent TVS measurement of endometrial thickness
and saline contrast sonohysterography (SCSH). Hysteroscopic resection with histopathology (gold standard)
was performed when focal intrauterine pathology was suspected at SCSH. We
excluded women with AUB (n = 237), failure of SCSH (n = 50), a scan that was
not in the follicular phase (n = 11), hysteroscopy contraindicated (n = 2), and
users of sequential hormone therapy (n = 9) or selective estrogen
receptor modulators (n = 2). Thus, 375 women without AUB were included (217
pre- and 158 postmenopausal). Receiver-operating characteristics (ROC) curves
for endometrial thickness and focal lesion were analyzed. RESULTS: Focal
intrauterine pathology was confirmed in 41 women (35 with polyps, five with submucosal myomas and one with polypoidal growing cancer). For premenopausal women, the
area under the ROC curve (AUC) was 0.79 (95% CI, 0.68-0.89) and for
postmenopausal women it was 0.84 (95% CI, 0.76-0.92). For premenopausal women,
the best negative likelihood ratio (LR- = 0.11) was obtained at an endometrial
thickness of 5.2 mm, with a negative predictive value (NPV) of 99% and a
positive predictive value (PPV) of 10%. For postmenopausal women the best LR-
(0.08) was obtained at an endometrial thickness of 2.8 mm, with a NPV of 99%
and a PPV of 26%. CONCLUSIONS: In women without AUB, TVS measurement of
endometrial thickness is a poor diagnostic test, but is apparently efficacious
in excluding focal intrauterine pathology, especially in postmenopausal women.
The 4-5-mm threshold conventionally used to exclude endometrial malignancy in
women with postmenopausal bleeding is not transferable to women without AUB for
excluding focal intrauterine pathology.
Am
J Clin Nutr. 2009 Feb 25. [Epub
ahead of print]
Effects
of beer, wine, and liquor intakes on bone mineral density in older men and
women.
Tucker KL, Jugdaohsingh R, Powell JJ, Qiao N, Hannan MT, Sripanyakorn S, Cupples LA, Kiel DP.
Jean Mayer US
Department of Agriculture Human Nutrition Research Centre on Aging, Tufts University,
Boston, MA.
BACKGROUND:
Moderate intake of alcohol has been reported to have beneficial effects on
bone. However, different classes of alcoholic beverages have not been
investigated. OBJECTIVE: Our aim was to determine the association between intake
of total alcohol or individual alcoholic beverages and bone mineral density
(BMD). DESIGN: Adjusting for potential confounding factors, we examined alcohol
intakes and BMD at 3 hip sites and the lumbar spine in 1182 men and in 1289
postmenopausal and 248 premenopausal women in the population-based Framingham
Offspring cohort (age: 29-86 y). RESULTS: Men were predominantly beer drinkers,
and women were predominantly wine drinkers. Compared with nondrinkers,
hip BMD was greater (3.4-4.5%) in men consuming 1-2 drinks/d of total alcohol
or beer, whereas hip and spine BMD were significantly greater (5.0-8.3%) in
postmenopausal women consuming >2 drinks/d of total alcohol or wine. Intake
of >2 drinks/d of liquor in men was associated with significantly lower (3.0-5.2%)
hip and spine BMD than was intake of 1-2 drinks/d of liquor in men. After
adjustment for silicon intake, all intergroup differences for beer were no
longer significant; differences for other alcohol sources remained significant.
Power was low for premenopausal women, and the associations were not
significant. CONCLUSIONS: Moderate consumption of alcohol may be beneficial to
bone in men and postmenopausal women. However, in men, high liquor intakes
(>2 drinks/d) were associated with significantly lower BMD. The tendency
toward stronger associations between BMD and beer or wine, relative to liquor,
suggests that constituents other than ethanol may contribute to bone health.
Silicon appears to mediate the association of beer, but not that of wine or liquor,
with BMD. Other components need further investigation.
Fertil Steril. 2009 Feb 23. [Epub ahead of print
Short-term hormone
treatment modulates emotion response circuitry in postmenopausal women.
Love T, Smith YR, Persad CC, Tkaczyk A, Zubieta JK.
Department of
Psychiatry, University of Michigan, Ann Arbor,
Michigan; Molecular and Behavioral Neuroscience
Institute, University of Michigan, Ann Arbor,
Michigan.
OBJECTIVE: To
study the effects of combination hormone therapy (HT) on emotional processing
in postmenopausal women with use of functional neuroimaging.
DESIGN: A randomized, double-blind, placebo-controlled crossover study was
performed. SETTING: A tertiary care university medical center.
PARTICIPANT(S): Ten healthy postmenopausal women (mean age 56.9 years, SD = 1.4
years) were recruited. INTERVENTION(S): Women were assigned randomly to the
order they received combined HT, 5 mug ethinyl E(2) and 1 mg norethindrone
acetate, and placebo. Volunteers received HT or placebo for 4 weeks, followed
by a 1-month washout period, and then received the other treatment for 4 weeks.
Subjects participated in a functional magnetic resonance imaging emotional
processing task, where they were asked to rate emotional pictures as positive,
negative, or neutral. MAIN OUTCOME MEASURE(S): Brain activation patterns were
compared between HT and placebo conditions within subjects. RESULT(S): During negative
emotional presentations, after subtracting the effect of neutral images, areas
of significant differences between HT and placebo conditions were identified in
the orbital, frontal, cingulate, and occipital
cortices. During positive emotional image presentation there were significant
differences between placebo and HT conditions within the medial frontal cortex.
CONCLUSIONS: Short-term menopausal treatment with combination HT affects
regional brain activity within areas implicated in emotional processing.
Menopause. 2009 Feb 20. [Epub ahead of print
The
effect of alendronate sodium on carotid artery intima-media thickness and lipid profile in women with
postmenopausal osteoporosis.
Celiloglu M, Aydin Y, Balci P, Kolamaz T.
Obstetrics
and Gynecology and 2Radiology, Dokuz
Eylul University Medical Faculty, Izmir, Turkey.
OBJECTIVE:: Observational and experimental studies support that
osteoporosis and atherosclerosis are two related phenomena. The aim of the
present study was to investigate the probable effect of alendronate
sodium, which is used in the treatment of osteoporosis, on carotid artery intima-media thickness (IMT), the lipid profile, and apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) levels,
which are known to have a role in the atherosclerotic process. METHODS:: Carotid artery IMT was measured in 39 women in whom alendronate 70 mg/week was started due to osteoporosis and
in 33 control participants at the start and the 6th and 12th months of the
study. Triglyceride, high-density lipoprotein, low-density lipoprotein, ApoA-I, and ApoB levels were also
measured at the same time points, and ApoB/ApoA-I rates were calculated. RESULTS::
Among the basal values, only the ApoA-I level was
significantly lower in the alendronate group (P <
0.01). IMT measurement results (mean [SE]) of the alendronate
group were 0.622 [0.015], 0.616 [0.014], and 0.597 [0.013] mm; those of the
control group were 0.600 [0.010], 0.611 [0.011], and 0.620 [0.011] mm,
respectively. In both groups, the difference between the start and 12-month
values was significant (P < 0.05). A significant difference was not
determined in the triglyceride and lipid measurement results between the groups
and also within groups. ApoA and ApoB
levels at the start and the 12th month of the study were as follows: 159.8
[3.6], 162.2 [3.4] (P > 0.05) and 96.2 [4.2], 101.5 [4.5] (P > 0.05) in
the control group and 145.1 [4.0], 173.7 [4.3] (P < 0.05) and 98.7 [3.9],
84.6 [3.3] (P < 0.05) in the alendronate group,
respectively. The ratios of ApoB/ApoA-I
were 0.611 [0.029] is to 0.636 [0.031] (P > 0.05) in the control group and
0.703 [0.04] is to 0.498 [0.0] (P < 0.05) in the alendronate
group. CONCLUSIONS:: We concluded that alendronate sodium resulted in a significant decrease in
IMT during a 1-year period compared with matched controls. Also, alendronate was associated with a positive effect on the ApoB/ApoA-I ratio.
Stroke. 2009 Feb 20. [Epub ahead of print
Age at
Natural Menopause and Risk of Ischemic Stroke. The Framingham Heart Study.
Lisabeth LD, Beiser AS, Brown DL, Murabito JM, Kelly-Hayes M, Wolf PA.
National
Heart, Lung and Blood Institute's Framingham Heart Study, Bethesda, Md.
BACKGROUND AND
PURPOSE: Women have increased lifetime stroke risk and more disabling strokes
compared with men. Insights into the association between menopause and stroke
could lead to new prevention strategies for women. The objective of this study
was to examine the association of age at natural menopause with ischemic stroke
risk in the Framingham Heart Study. METHODS: Participants included women who
survived stroke-free until age 60, experienced natural menopause, did not use estrogen before menopause, and who had complete data
(n=1430). Participants were followed until first ischemic stroke, death, or end
of follow-up (2006). Age at natural menopause was self-reported. Cox
proportional hazards models were used to examine the association between age at
natural menopause (<42, 42 to 54, >/=55) and ischemic stroke risk adjusted
for age, systolic blood pressure, atrial
fibrillation, diabetes, current smoking, cardiovascular disease and estrogen use. RESULTS: There were 234 ischemic strokes
identified. Average age at menopause was 49 years (SD=4). Women with menopause
at ages 42 to 54 (hazard ratio=0.50; 95% CI: 0.29 to 0.89) and at ages >/=55
(hazard ratio=0.31; 95% CI: 0.13 to 0.76) had lower stroke risk compared with
those with menopause <42 years adjusted for covariates. Women with menopause
before age 42 had twice the stroke risk compared to all other women (hazard
ratio=2.03; 95% CI: 1.16 to 3.56). CONCLUSIONS: In this prospective study, age
at natural menopause before age 42 was associated with increased ischemic
stroke risk. Future stroke studies with measures of endogenous hormones are
needed to inform the underlying mechanisms so that novel prevention strategies
for midlife women can be considered.
Menopause Int. 2009 Mar;15(1):19-25
Cost-effectiveness
of hormone replacement therapy for menopausal symptoms in the UK.
Lekander I, Borgström F, Ström O, Zethraeus N, Kanis JA.
i3 Innovus, Klarabergsviadukten 90
Hus D, SE-111 64 Stockholm, Sweden. ingrid.lekander@i3innovus.com.
OBJECTIVE: To
estimate the cost-effectiveness of five-year treatment of hormone replacement
therapy (HRT) compared with no treatment for women with menopausal symptoms in
the
Nutrition. 2009 Feb 19. [Epub ahead of print
Association of
total calcium and dietary protein intakes with fracture risk in postmenopausal
women: The 1999-2002 National Health and Nutrition Examination Survey (NHANES).
OBJECTIVE: We
examined the associations of total calcium intake (TCI) and dietary protein
intake (DPI) with risk of fracture. METHODS: A total of 2006 postmenopausal
women >/=50 y of age who were measured in the 1999-2002 National Health and
Nutrition Examination Survey were included in the study. Weighted mean TCI and
DPI and percentage of distributions of selected characteristics were estimated
by TCI category and fracture status. Multivariate logistic regression models were
used to assess the effect of TCI and DPI on risk of fracture. RESULTS: Thirteen
percent of participants reported a fracture history, of whom 17.8% consumed a
total of >/=1200 mg of calcium per day and 23.8% consumed <400 mg/d. TCI
was not associated with fracture risk when controlling for all selected
covariates. In women who consumed <46 g/d of dietary protein, those with a
TCI >/=1200 mg/d had a significantly higher risk of fracture than those with
the lowest TCI (adjusted odds ratio 5.98, 95% confidence interval 1.15-31.13),
whereas in women who consumed >70 g/d of dietary protein, those with a TCI
>/=1200 mg/d had an insignificant lower risk of fracture (adjusted odds
ratio 0.69, 95% confidence interval 0.20-2.39). CONCLUSION: TCI is not associated
with risk of fracture among postmenopausal women. Adequate TCI in the presence
of inadequate DPI may not be protective against fractures. Optimal proportion
of TCI and DPI warrants further investigation among older women.