Selección de Resúmenes
de Menopausia
Mayo de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de
Chile
Semana del 28 de
Abril al 5 de Mayo de 2009
Horm
Metab Res. 2009 Apr 30. [Epub ahead of print
Plasma CRP Levels in Premenopausal Women
with Major Depression: A 12-Month Controlled Study.
Cizza G, Eskandari F, Coyle M, Krishnamurthy P, Wright EC, Mistry S, Csako G.
1Clinical
Endocrine Section, Clinical Endocrinology Branch, NIDDK, NIH, DHHS, Bethesda,
MD, USA.
C-reactive
protein (CRP), an inflammatory marker of cardiovascular risk, is often elevated
in major depressive disorder (MDD). The magnitude and consistency of this
elevation have not been previously characterized in premenopausal women with
MDD. The aim of the study was to prospectively assess plasma CRP levels, body composition,
endocrine and metabolic parameters, and depressive status in premenopausal
women with MDD (n=77) and controls (n=41), aged 21 to 45. Women were enrolled
in a 12-month, controlled study of bone turnover, the P.O.W.E.R. (
Premenopausal, Osteoporosis, Women, Al Endronate, Dep Ression) Study. Blood
samples were taken at Baseline, Month 6, and Month 12. Most subjects with MDD
were in clinical remission. These women tended to have consistently higher CRP
levels than controls over 12 months (p=0.077). BMI was positively related to
log[CRP] in women with MDD only. Nine women with MDD had CRP levels greater
than 10 mg/l, a value associated with a very high cardiovascular risk. This
subset was obese and had significantly higher triglycerides, total cholesterol,
LDL-cholesterol, fasting insulin, and HOMA-IR than the rest of women with MDD.
The variations in CRP levels over time were high (intra- and inter-individual
coefficients of variations of approximately 30-50% and approximately 70-140%,
respectively). No control had CRP levels greater than 10 mg/l. Depression was
associated with increased plasma CRP in women with MDD. The clinical
significance of abnormal plasma CRP for cardiovascular risk needs to be
assessed in large prospective studies of women with depression
Ann Clin
Biochem. 2009 May;46(Pt 3):218-21
The mean and the biological variation of
insulin resistance does not differ between polycystic ovary syndrome and type 2
diabetes.
Cho LW, Jayagopal V, Kilpatrick ES, Atkin SL.
Department
of Medicine University of Hull.
BACKGROUND:
There is an assumption that the mean and biological variation of insulin
resistance (IR) is less in polycystic ovary syndrome (PCOS), and intuitively
higher in type 2 diabetes (T2DM). To test this hypothesis we compared the mean
and biological variation in IR in PCOS to that of T2DM and to age- and
weight-matched controls. METHODS: Twelve PCOS, 11 matched healthy women; 12
postmenopausal diet-controlled T2DM and 11 matched healthy postmenopausal women
were recruited. Blood samples were collected at 4-d intervals on 10 consecutive
occasions. The biological variability of IR was derived on duplicate samples.
RESULTS: Mean and biological variability of HOMA-IR for PCOS did not differ
from T2DM. Both measures were higher than the matched controls. There was no
difference in insulin or IR measures between the body mass index matched pre-
and postmenopausal women. Percentage beta cell function were 208.8%, 62.3%,
106.5% and 111.9%, respectively, in PCOS, postmenopausal women with T2DM,
healthy premenopausal and healthy postmenopausal women. CONCLUSIONS: The
progression from PCOS to the development of T2DM is unlikely to be due to a
further increase in IR (or variability), but rather the progressive failure of
pancreatic beta cells with a decrease in insulin production.
Menopause. 2009 Jan 16. [Epub ahead of print
An open-label randomized trial to determine
the most effective regimen of vaginal estrogen to reduce the prevalence of
atrophic changes reported in postmenopausal cervical smears.
From
Family Planning NSW, Sydney Centre for Reproductive Health Research, Ashfield,
NSW, Australia.
OBJECTIVE::
Atrophic Papanicolaou (Pap) smears from postmenopausal women may be
unsatisfactory for assessment or result in a false-positive diagnosis of a
cytological abnormality. We investigated the effect of vaginal estrogen
treatment before the Pap test on the odds of an atrophic smear. METHODS:: An
open-label randomized controlled trial was conducted to compare the proportion
of atrophic Pap smears from postmenopausal women assigned to either (1) a
regimen of one 25-mug vaginal estradiol tablet inserted nightly for five nights
before their Pap test, (2) a single 25-mug vaginal estradiol tablet before the
test, or (3) a control group with no previous estrogen administration. All
smears were reread and classified as atrophic or nonatrophic at the conclusion
of the study by a single cytopathologist who was blinded to the study arms.
RESULTS:: One hundred fifty-four (94%) of the 164 postmenopausal women who consented
to the study were included in the final analysis. Fifty-one women had received
the five-night course of tablets, 50 had received one tablet, and 53 were
assigned to the group with no previous estrogen use. The odds of an atrophic
smear were significantly lower in women who used the five-night estrogen
regimen than in women who did not use estrogen. The estimated odds ratio of an
atrophic smear in the five-night regimen was 0.01 (95% CI, 0.03-0.26) compared
with the no-estrogen control group. Moreover, using one tablet of estrogen had
no significant effect on the likelihood of an atrophic smear compared with
using none. The odds ratio of an atrophic smear in the single estrogen tablet
group was 1.05 (95% CI, 0.48-2.29) compared with the no-estrogen group.
CONCLUSIONS:: The odds of an atrophic smear are significantly reduced for
postmenopausal women who use a five-night regimen of vaginal estrogen before
their Pap test.
J Clin
Endocrinol Metab.
2009 Apr 28. [Epub ahead of print
Low Serum Testosterone and Estradiol
Predict Mortality in Elderly Men.
Tivesten A, Vandenput L, Labrie F, Karlsson MK, Ljunggren O, Mellström D, Ohlsson C.
Context:
Age-related reduction of serum testosterone may contribute to the signs and
symptoms of aging, but previous studies report conflicting evidence about
testosterone levels and male mortality. No large prospective cohort study has
determined a possible association between serum estradiol and mortality in men.
Objective: The main objective was to examine the association between serum
testosterone and estradiol and all-cause mortality in elderly men. Design,
setting and participants: We used specific gas chromatography-mass spectrometry
to analyze serum sex steroids at baseline in older men who participated in the
prospective population-based MrOS
Menopause. 2009 Apr 22. [Epub
ahead of print]
Efficacy and safety of vaginal estriol and
progesterone in postmenopausal women with atrophic vaginitis.
Chollet JA, Carter G, Meyn LA, Mermelstein F, Balk JL.
From
the 1Beth Israel Deaconess Medical Center, Boston, MA; 2University of
Pittsburgh Medical Center, Pittsburgh, PA; and 3Peartree Women's Healthcare,
Cambridge, MA.
OBJECTIVE::
The aim of this study was to assess the efficacy and safety of intravaginal
estriol and progesterone on atrophic vaginitis in postmenopausal women.
METHODS:: Under a physician-sponsored Investigational New Drug application, 19
healthy postmenopausal women with atrophic vaginitis received vaginal
suppositories containing estriol (1 mg) and progesterone (30 mg). The
participants were instructed to insert one suppository intravaginally once
daily for 2 weeks and thrice weekly for a total of 6 months. Vaginal pH,
Vaginal Maturation Index, urinalysis, self-reported vaginal dryness, menopausal
quality of life, and serum estriol and progesterone levels were measured at
enrollment and after 3 and 6 months of suppository use. Endometrial biopsies
were obtained at enrollment and at 6 months. After 2 weeks of therapy, six
participants had serum estriol and progesterone measured. RESULTS:: The Vaginal
Maturation Index, vaginal pH, and vaginal dryness rating improved significantly
at 3 and 6 months compared with baseline. Menopausal quality of life scores
improved significantly in all domains, with the sexual subscale showing the
most improvement. There were no cases of endometrial hyperplasia after 6 months
of suppository use. Serum preinsertion estriol at week 2 and months 3 and 6
were similar to baseline levels. Serum preinsertion progesterone increased but
returned to baseline preinsertion levels at month 6, and preinsertion levels
were significantly less at month 6 compared with month 3. CONCLUSIONS:: Intravaginal
administration of a combination estriol and progesterone agent to women with
atrophic vaginitis may represent a safe and effective alternative to systemic
hormone replacement, although this study was not adequate to provide proof of
efficacy given that it was uncontrolled.
Int J Gynaecol Obstet. 2009 Apr 24. [Epub ahead of print
Compared effects of surgical and natural
menopause on climacteric symptoms, osteoporosis, and metabolic syndrome.
Ozdemir S, Celik C, Görkemli H, Kıyıcı A, Kaya B.
Department
of Gynecology and Obstetric, Meram Medical Faculty, Selçuk University, Konya,
Turkey.
OBJECTIVE:
To compare the effects of surgical (ie, earlier) and natural (ie, later)
menopause on climacteric symptoms, osteoporosis, and metabolic syndrome.
METHOD: The study was conducted with 94 women who underwent hysterectomy and
bilateral oophorectomy and 95 women who were older than 40 years and in natural
menopause. None had received hormone theraphy or osteoporosis treatment.
Metabolic syndrome was defined according to the National Cholesterol Education
Program Adult Treatment Panel III. RESULTS: The rates of hot flushes (P=0.001),
sweating (P=0.001), poor memory (P=0.04), change in sexual desire (P=0.04), and
osteoprosis (diagnosed in the hip bone, P=0.005) were significantly higher
among the women in surgical menopause, but the rate of metabolic syndrome was
similar in the 2 groups (47.8% and 40%; P=0.28). CONCLUSION: Compared with
natural menopause, surgical menopause was found to be associated with highter
rates of climacteric symptoms and osteoporosis but not of of metabolic
syndrome.
Brain Res. 2009 Jan 19. [Epub ahead of print
Effects of Two Years of Conjugated Equine
Estrogens on Cholinergic Neurons in Young and Middle-Aged Ovariectomized
Monkeys.
Browne C, Tobin JR, Voytko ML.
Department
of Biology, Wake Forest University, Winston-Salem, North Carolina, ZIP, United
States.
The
effect of estrogen on the number and size of cholinergic neurons in the basal
forebrain was examined in surgically menopausal young and middle-aged
cynomolgus monkeys. Young and middle-aged female monkeys were ovariectomized
and treated with conjugated equine estrogens (Premarin) at doses that are
equivalent to those currently prescribed to postmenopausal women. In the medial
septum/diagonal band (MS/DB), no effect of treatment with Premarin was observed
in the cholinergic neurons in either ovariectomized young or middle-aged
monkeys. However, the number and size of cholinergic neurons in the MS/DB of
middle-aged monkeys was greater than that in the young monkeys. In the nucleus
basalis of Meynert (NBM) of middle-aged monkeys, the number of cholinergic
neurons in the intermediate region (Ch4i) was greater in Premarin-treated
monkeys as compared to controls and numbers of neurons in this region were
greater at higher levels of estrogen. No effects of estrogen were observed in
other NBM regions in the middle-aged monkeys and the size of cholinergic
neurons was unaffected by Premarin. These findings suggest that treatment with
Premarin has selective beneficial effects on cholinergic neurons in the basal
forebrain but that these effects are both age and region specific.
Maturitas. 2009
Apr 23. [Epub ahead of print]
Use of calcium supplements and the risk of
coronary heart disease in 52-62-year-old women: The
Pentti K, Tuppurainen MT, Honkanen R, Sandini L, Kröger H, Alhava E, Saarikoski S.
BACKGROUND:
To analyse prospectively the effect of calcium or calcium+D supplementation on
coronary heart disease (CHD) in 52-62-year-old women. METHODS AND RESULTS:
10,555 52-62-year-old women from the population-based Kuopio Osteoporosis Risk
Factor and Prevention Study (OSTPRE) who did not have CHD at baseline were
followed for nearly 7 years in 1994-2001. Information about use of calcium
supplements and health events was obtained from two repeated questionnaires in
1989 and 1994. Information about causes of death during the follow-up was
obtained from the Statistics Finland. Information about CHD and other disease morbidity
before and during the follow-up was obtained from the Registry of Specially
Refunded Drugs of the Finnish Social Insurance Institution (SII). Cox's
proportional-hazards models were used to estimate the risk of CHD morbidity
related to the use of calcium supplements. At baseline, 2723 women reported
current use of calcium or calcium+D supplementation. During the follow-up, CHD
was diagnosed in 513 women. Compared to non-users of calcium/calcium+D
supplements, the multivariate adjusted hazard ratio (HR) of CHD was 1.24 (95%
CI 1.02-1.52) in women who used these supplements. The multivariate adjusted HR
for CHD morbidity in postmenopausal women who used calcium/calcium+D
supplements was 1.26 (95% CI 1.01-1.57). CONCLUSIONS: Calcium or calcium+D
supplementation appears to increase the risk of CHD among women before old age.
Semana del 6 al 12 de Mayo de 2009
Horm Metab Res. 2009 Apr 30. [Epub
ahead of print
Plasma
Menopause. 2009 May
6. [Epub ahead of print]
Effect of
intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual
dysfunction in postmenopausal women.
Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, et
al.
OBJECTIVE:: The
objective of this study was to provide evidence that the transformation of DHEA
into both androgens and/or estrogens locally in cells of the three layers of
the vagina (epithelium, lamina propria, and muscularis) would have effects of
greater impact, including effects on sexual function, than only effects on
superficial epithelial cells as achieved with estrogens. METHODS:: This
prospective, randomized, double-blind, and placebo-controlled phase III
clinical trial has evaluated the effect of daily local intravaginal application
of Prasterone (dehydroepiandrosterone; DHEA) for 12 weeks on the domains of
sexual dysfunction, namely, desire/interest, arousal, orgasm, and pain at sexual
activity, in 216 postmenopausal women with moderate to severe symptoms of
vaginal atrophy. RESULTS:: A time- and dose-dependent improvement of the four
domains of sexual function was observed. At the 12-week time interval, the 1.0%
DHEA dose led, compared with placebo, to 49% (P = 0.0061) and 23% (P = 0.0257)
improvements of the desire domains in the Menopause Specific Quality of Life
and Abbreviated Sex Function questionnaires, respectively. Compared with
placebo, the Abbreviated Sex Function arousal/sensation domain was improved by
68% (P = 0.006), the arousal/lubrication domain by 39% (P = 0.0014), orgasm by
75% (P = 0.047), and dryness during intercourse by 57% (P = 0.0001).
CONCLUSIONS:: By a local action in the vagina, DHEA applied daily at doses at
which serum steroids remain well within normal postmenopausal values exerts
relatively potent beneficial effects on all four aspects of sexual dysfunction.
Such data indicate that combined androgenic/estrogenic stimulation in the three
layers of the vagina exerts important beneficial effects on sexual function in
women without systemic action on the brain and other extravaginal tissues.
Cancer Epidemiol Biomarkers Prev. 2009
May;18(5):1531-7
Colorectal Cancer
in Relation to Postmenopausal Estrogen and Estrogen Plus Progestin in the
Women's Health Initiative Clinical Trial and Observational Study.
Prentice
RL, Pettinger M, Beresford SA, Wactawski-Wende J, Hubbell FA, Stefanick ML, Chlebowski RT.
Director, Public
Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
BACKGROUND:
Colorectal cancer incidence was reduced among women assigned to active
treatment in the Women's Health Initiative (WHI) estrogen plus
progestin-randomized trial, but the interpretation was obscured by an
associated later stage of diagnosis. In contrast, the estrogen-alone trial
showed no incidence reduction or differential stage at diagnosis. Here, data
from the WHI observational study are considered, in conjunction with colorectal
cancer mortality data from the hormone therapy trials, in an attempt to clarify
postmenopausal hormone therapy effects. Participants and METHODS:
Postmenopausal women ages 50 to 79 years at WHI enrollment. Estrogen-alone
analyses include 21,552 and 10,739 women who were posthysterectomy from the
observational study and clinical trial, respectively. Estrogen plus progestin
analyses include 32,084 and 16,608 observational study and clinical trial women
with uterus. Colorectal cancers were verified by central medical and pathology
report review. RESULTS: Hazard ratios (95% confidence intervals) from the WHI
observational study were 0.80 (0.53-1.20) for estrogen and 1.15 (0.74-1.79) for
estrogen plus progestin, with, respectively, 168 and 175 women diagnosed with
colorectal cancer. Delayed diagnosis with estrogen plus progestin is not
evident in the observational study. No protective effect on colorectal cancer
mortality in the estrogen plus progestin trial is seen over an 8-year
intervention and follow-up period. CONCLUSION: Hazard ratio patterns in the WHI
clinical trial and observational study do not provide strong evidence of a
clinically important colorectal cancer benefit with either estrogen-alone or
estrogen plus progestin over 7 to 8 years of treatment and follow-up.
Menopause. 2009 May
6. [Epub ahead of print]
Acupuncture for
vasomotor menopausal symptoms: a systematic review.
From the
OBJECTIVE:: The
aim of this study was to critically assess whether acupuncture therapy reduces
vasomotor menopausal symptoms and to evaluate the adverse effects of
acupuncture therapy on the basis of the results of randomized controlled trials
(RCTs). METHODS:: Nineteen electronic databases, including English, Korean,
Japanese, and Chinese databases, were systematically searched for RCTs in which
acupuncture was used to reduce vasomotor menopausal symptoms before July 2008.
There were no language restrictions. The methodological quality of the eligible
studies was assessed using the categories provided by the Menstrual Disorders
and Subfertility Review Group. RESULTS:: Eleven studies, which included a total
of 764 individual cases, were systematically reviewed. The methodological
quality of the trials varied substantially. Six trials compared acupuncture
treatment to sham or placebo acupuncture. Only one study using a nonpenetrating
placebo needle found a significant difference in the severity outcomes of hot
flashes between groups (mean difference, 0.48; 95% CI, 0.05-0.91). Five studies
reported a reduced frequency of hot flashes within groups; however, none found
a significant difference between groups. An analysis of the outcomes of the
trials that compared acupuncture with hormone therapy or oryzanol for reducing
vasomotor symptoms showed that acupuncture was superior. Three RCTs reported
minimal acupuncture-related adverse events. CONCLUSIONS:: There is no evidence
from RCTs that acupuncture is an effective treatment in comparison to sham
acupuncture for reducing menopausal hot flashes. Some studies have shown that
acupuncture therapies are better than hormone therapy for reducing vasomotor
symptoms. However, the number of RCTs compared with a nonpenetrating placebo
control needle or hormone therapy was too small, and the methodological quality
of some of the RCTs was poor. Further evaluation of the effects of acupuncture
on vasomotor menopausal symptoms based on a well-controlled placebo trial is
therefore warranted.
Curr Opin Rheumatol. 2009 May
6. [Epub ahead of print]
Denosumab update.
New Mexico Clinical Research & Osteoporosis Center,
Albuquerque, New Mexico, USA.
PURPOSE OF REVIEW:
Denosumab is an investigational fully human monoclonal antibody to receptor
activator of nuclear factor kappaB ligand, an essential mediator of
osteoclastic bone resorption. Receptor activator of nuclear factor kappaB ligand
plays a major role in the pathogenesis of postmenopausal osteoporosis,
structural damage in rheumatoid arthritis, and bone loss associated with other
skeletal disorders. This is a review of recent clinical data on the efficacy
and safety of denosumab for the treatment of postmenopausal osteoporosis and
rheumatoid arthritis. RECENT FINDINGS: Denosumab reduces bone turnover markers
and increases bone mineral density in postmenopausal women with low bone
mineral density, reduces fracture risk in women with postmenopausal
osteoporosis, and inhibits structural damage in patients with rheumatoid
arthritis when added to ongoing methotrexate treatment. In postmenopausal women
with low bone mineral density, denosumab is associated with a greater increase
in bone mineral density and greater reduction in bone turnover markers compared
with alendronate; when women treated with alendronate are switched to
denosumab, there is an increase in bone mineral density that is greater than in
those continuing alendronate. Adverse events and serious adverse events,
including infections and malignancy, are generally similar in patients treated
with denosumab compared with those receiving placebo or alendronate. SUMMARY:
Denosumab is a promising therapeutic agent for the management of postmenopausal
osteoporosis and rheumatoid arthritis.
Menopause. 2009
May-Jun;16(3):559-65
Effect of microdose
transdermal 17beta-estradiol compared with raloxifene in the prevention of bone
loss in healthy postmenopausal women: a 2-year, randomized, double-blind trial.
Schaefers
M, Muysers C, Alexandersen P, Christiansen C.
Bayer Schering
Pharma AG, Berlin, Germany; and Center for Clinical and Basic Research, Byvej,
Denmark.
OBJECTIVE::
Declining estrogen levels after menopause result in bone loss and increased
fracture risk. This study investigated whether transdermal microdose 17beta-estradiol
(E2) has efficacy and safety comparable to those of raloxifene, a selective
estrogen-receptor modulator approved for the prevention and treatment of
postmenopausal osteoporosis. METHODS:: This study involved a multicenter,
randomized, double-blind, active-controlled, noninferiority trial in 500
osteopenic postmenopausal women comparing transdermal microdose E2 (0.014 mg/d)
versus oral raloxifene (60 mg/d), administered for 2 years. Percent change from
baseline in bone mineral density at the lumbar spine was measured after 2 years
of treatment. Secondary endpoints included proportion of women with no loss of
bone mineral density in lumbar spine, change in bone mineral density at hip,
biochemical markers of bone turnover, and safety parameters. RESULTS:: In the
per protocol set, lumbar spine bone mineral density increased by 2.4% (95% CI,
1.9-2.9) with microdose E2 versus 3.0% (95% CI, 2.5-3.5) with raloxifene after
2 years; 77.3% of E2 recipients and 80.5% of those taking raloxifene had no bone
loss in the lumbar spine. Both treatments were well tolerated. Most women (99%
in the E2 group and 100% in the raloxifene group) showed no histological
evidence of endometrial stimulation after 2 years. Mean dense area in breast
mammograms was 19.8% in the E2 group versus 19.0% in the raloxifene group after
2 years. CONCLUSIONS:: Transdermal microdose E2 was similarly effective as
raloxifene in preventing bone loss at the lumbar spine. Both treatments were
well tolerated, with no clinically significant effect on endometrium or breast
density.
Prescrire Int. 2008
Dec;17(98):243
Progestagen-only
treatment before menopause: increased risk of breast cancer.
[No authors
listed]
(1) A prospective
cohort study (E3N) conducted in
Menopause. 2009 May
5. [Epub ahead of print]
Vasomotor symptoms
and mortality: the Rancho Bernardo Study.
Svartberg J, von Mühlen D, Kritz-Silverstein D, Barrett-Connor E.
Department of
Medicine, University Hospital of North Norway, Tromsø, Norwayla; Rancho
Bernardo, CA.
OBJECTIVE:: The
purpose of this study was to examine the associations of vasomotor symptoms
with risk of all-cause, cardiovascular disease (CVD), and coronary heart
disease (CHD) mortality in community-dwelling older women, with a mean age of
69 years. METHODS:: This prospective population-based study included 867
postmenopausal women who provided lifestyle and menopause-related history at
the 1984 to 1987 visit of the Rancho Bernardo Study and answered a 1989 mailed
questionnaire on menopause and vasomotor symptoms. Ninety-eight percent were
followed for vital status through July 2004. RESULTS:: Overall, 73% reported
hot flashes, of whom 39% also reported night sweats. During the 11.5-year average
follow-up, there were 405 deaths, of which 194 were attributed to CVD and 71 to
CHD. Hot flashes alone were not associated with all-cause mortality, but women
who, in addition to hot flashes, also had night sweats had an almost 30%
(hazard ratio [HR], 0.72; 95% CI, 0.55-0.94) lower all-cause mortality risk
compared with women without this symptom, independent of body mass index, past
or current use of estrogen or progestin, physical exercise, and smoking habit.
There was a similar lower risk of CVD and CHD mortality in women with night
sweats when adjusted for past or current use of estrogen or progestin (HR,
0.62; 95% CI, 0.42-0.92 and HR, 0.51; 95% CI, 0.26-0.99, respectively). These
associations were independent of hormone use but were no longer significant
after adjusting for body mass index, physical exercise, and smoking.
CONCLUSIONS:: Reported night sweats at menopause are associated with reduced
risk of death over the following 20 years, independent of multiple risk factors
including past or current use of postmenopausal estrogen therapy.
J Bone Miner Res. 2009 May
6. [Epub ahead of print]
A 5-Year Cohort
Study of the Effects of High Protein Intake on Lean Mass and Bone Mineral
Content in Elderly Postmenopausal Women.
Meng
X, Zhu K, Devine A, Kerr DA, Binns CW, Prince RL.
Abstract Long term
effects of high dietary protein intake on muscle and bone structure in the
elderly are not clear. The aim of this study was to investigate the
relationship between baseline protein intake and lean mass and bone mineral
content (BMC) five years later in a cohort of elderly postmenopausal women. A
total of 862 community-dwelling women aged 75 +/- 3 years provided baseline data
including nutrient intake assessed by a food frequency questionnaire. At five
years upper arm muscle area (UAMA) and body composition using dual-energy X-ray
absorptiometry were measured. Baseline protein intake was 81 +/- 28 g/d (1.2
+/- 0.4 g/kg/d) contributing 19 +/- 3 % of the total energy intake. There were
positive correlations between baseline protein intake and whole body and
appendicular bone-free lean mass and BMC (r = 0.14-0.18, P < 0.001) and UAMA
(r = 0.08, P < 0.05). Compared to those in the lowest tertile of protein
intake (< 66 g/d), women in the top tertile (> 87 g/d) had 5.4-6.0 %
higher whole body and appendicular lean mass and UAMA and 5.3-6.0 % higher
whole body and appendicular BMC. These effects remained after adjusted for potential
confounders. However, the effect on BMC disappeared after further adjustment
for lean mass. This study demonstrates that a high protein intake is associated
with long term beneficial effects on muscle mass and size and bone mass in
elderly women. The protein effect on bone may be partly mediated via its
effects on muscle.
Climacteric. 2009 May
2:1-9. [Epub ahead of print
Effects of estrogen
therapy on age-related differences in gray matter concentration.
Robertson
D, Craig M, van Amelsvoort T, Daly E, Moore C, Simmons A, Whitehead M, Morris R.
Department of
Psychological Medicine, Institute of Psychiatry, King's College, London, UK.
Objective Previous
studies suggest that estrogen therapy (ET) either improves or has a neutral
effect on the structural integrity of neural tissue in postmenopausal women.
The inconsistency in the findings of previous studies is likely to be due to a
variety of methodological factors. In this study, we attempted to overcome many
of these factors. Method We used magnetic resonance imaging and voxel-based
morphometry to study the long-term effects of ET commenced immediately
postmenopause on age-related differences in (1) normalized lobar brain volumes
and (2) regional gray and white matter concentrations. We included 61 healthy
women: 23 young, 19 postmenopausal long-term ET users (who had started ET
around the time of menopause) and 19 postmenopausal ET never-users. Results We
report that ET users did not differ significantly from never-users in age,
duration of menopause, general intelligence, mnemonic function or
apolipoprotein E allele frequency. Compared to young women, both ET users and
never-users had significantly smaller normalized volumes of whole brain and
left and right frontal lobes, but ET users did not differ significantly from
never-users in bulk brain volumes. Compared to young women and ET users,
never-users had significantly lower gray matter concentration bilaterally in
orbitofrontal cortices and cerebellum, right inferior frontal and precentral
cortices, and left paracentral cortex. Conclusion These findings suggest that
initiation of ET around the time of menopause may modulate age-related
differences in regional gray matter concentration. The functional significance
of our findings remains unknown.
Eur J Obstet Gynecol Reprod Biol. 2009 May
2. [Epub ahead of print
Sleep in
post-menopausal women: Differences between early and late post-menopause.
Hachul
H, Bittencourt LR, Soares JM Jr, Tufik S, Baracat EC.
Department of
Gynaecology, Universidade Federal de São Paulo, Brazil; Department of
Psychobiology, Center for Sleep Medicine, Universidade Federal de São Paulo,
Escola Paulista de Medicina, Brazil.
OBJECTIVE: The aim
of this study was to evaluate the differences in sleep between women of early and
late post-menopause. STUDY DESIGN: Thirty post-menopausal women who came to the
climacteric service of their own volition were selected. Fourteen were in early
post-menopause (less than 5 years after menopause), and sixteen were in late
post-menopause (more than 5 years since menopause). None of the women were
suffering from any other clinical diseases. Participants had no previous
history of hormone therapy or hypnotic drug use. These patients were not
previously selected with regard to any sleep complaints. All participants
answered a sleep questionnaire and underwent a polysomnography recording.
RESULTS: Subjective complaints included body pain, bruxism, anxiety,
depression, lack of concentration, and sleepiness (measured by the Epworth
Sleepiness Scale). These complaints were more frequent in the late
post-menopause group. In contrast, complaints of memory impairment were more
frequent in the early post-menopause group (p</=0.05). Polysomnographic
findings revealed no differences between the early and late post-menopause
groups. CONCLUSIONS: Although early menopause is associated with several
symptoms, complaints related to sleep were higher in the late post-menopausal
group.
Semana del 13 al 26 de Mayo de 2009
Osteoporos Int. 2009 May
21. [Epub ahead of print
The effect of
calcium supplementation on bone loss in 32 controlled trials in postmenopausal
women.
Endocrine and
Metabolic Unit,
christopher.nordin@imvs.sa.gov.au.
In 32 controlled
trials of calcium supplementation (700-2000 mg) in 3,169 postmenopausal women,
mean bone loss in the controls was -1.07% p.a. and in the treated subjects
-0.27% p.a. (P for difference <0.001). The effect was similar at all
measured sites and at all doses of 700 mg or more but became weaker after 4
years. INTRODUCTION: We have reviewed 32 trials of calcium supplementation in
3,169 postmenopausal women. METHODS: We found 24 publications reporting 32
controlled trials lasting at least 1 year, which provided annual percentage
changes in bone mass or density at one or more sites in the calcium-treated and
control subjects. RESULTS: The median calcium supplement was 1,000 mg, median
duration of the trials 2 years and total number of sites measured 79. The
average of the mean rates of change in bone mass or density was -1.07% p.a. (P
< 0.001) in the controls and -0.27% p.a. (ns) in the treated subjects (P for
difference < 0.001). The effect of calcium was much the same at all measured
sites (forearm/hand, proximal femur, spine, and total body and others).
Supplements of less than 700 mg were not effective, but there was no
significant beneficial effect of higher doses. There was significantly faster
bone loss at total calcium intakes below 1,150 mg than on intakes over 1,350
mg. The effect of calcium appeared to be lost after 4 years of treatment.
CONCLUSION: Calcium supplementation of about 1,000 mg daily has a significant
preventive effect on bone loss in postmenopausal women for at least 4 years.
Osteoporos Int. 2009 May
21. [Epub ahead of print]
Adherence to
monthly and weekly oral bisphosphonates in women with osteoporosis.
Cotté FE, Fardellone P, Mercier F, Gaudin AF, Roux C.
CERMES, IFR69,
INSERM U750, National Institute of Health and Medical Research, Villejuif,
France.
This primary care
database survey evaluated whether osteoporotic women treated with
bisphosphonates were more adherent to monthly than to weekly treatment. Both
compliance (medication possession ratio [MPR]) and persistence (time to
discontinuation) were superior in the monthly ibandronate treatment group.
Better control of fracture risk may thus be achieved using monthly treatment
regimens. INTRODUCTION: Treatment adherence in osteoporosis is poor. The
objective of this study was to evaluate whether monthly bisphosphonate
treatment provided superior adherence than weekly treatment. METHODS: We
analysed medical claims from a national prescription database (Thales). All
women aged >45 years receiving a first prescription of monthly ibandronate
or weekly bisphosphonates in 2007 were included. Treatment adherence was
monitored from initial prescription until January 2008. Compliance was measured
by the MPR and persistence by the time from treatment initiation to
discontinuation. Multivariate analysis was used to identify variables
independently associated with adherence. RESULTS: Twelve-month persistence
rates were 47.5% for monthly ibandronate and 30.4% for weekly bisphosphonates.
Compliance was significantly higher in the monthly cohort (MPR = 84.5%) than in
the weekly cohort (MPR = 79.4%). After adjustment for potential confounding
variables, women with monthly regimens were 37% less likely to be
non-persistent (HR = 0.63 [0.56-0.72]) and presented a 5% higher mean MPR
(84.5% versus 79.3%, p < 0.001) than women with weekly regimens. Other major
factors associated with improved adherence were previous densitometry and
calcium or vitamin D supplementation (p < 0.01). CONCLUSIONS: Adherence to
bisphosphonates may be superior for monthly treatment than for weekly treatment
and may thus provide improved fracture protection.
Menopause. 2009 May
19. [Epub ahead of print
Sexual dysfunction
in middle-aged women: a multicenter Latin American study using the Female
Sexual Function Index.
Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, Espinoza MT, Flores D, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Vallejo S, Tserotas K; for the Collaborative Group for
Research of the Climacteric in Latin America (REDLINC). From
the Collaborative Group for Research for the Climacteric in Latin America
(REDLINC). OBJECTIVE:: The purpose of this study was to assess the prevalence
of sexual dysfunction (SD) and associated risk factors among middle-aged Latin
American women using one validated instrument. METHODS:: The Female Sexual
Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years
who were users of 19 healthcare systems from 11 Latin American countries. An
itemized questionnaire containing personal and partner sociodemographic data
was also filled out. RESULTS:: Mean +/- SD age of surveyed women was 49.0 +/-
5.7 years, with 11.6 years of schooling on average. There were 55.1% of women
who were married, 46.8% who were postmenopausal, 14.1% who used hormonal
therapy (HT), and 25.6% who were sexually inactive. Among those who were active
(n = 5,391), the mean +/- SD total FSFI score was 25.2 +/- 5.9 and 56.8% of
them presented SD (FSFI total score </=26.55), with a prevalence varying
from 21.0% to 98.5% depending on the center. Centers were grouped in terciles
(according to mean +/- SD prevalence). The tercile with higher SD prevalence
(86.4%) compared with that with lower SD prevalence (32.2%) had significantly
older women (49.5 +/- 5.3 vs 48.0 +/- 5.6 y) with a higher rate of vaginal
dryness (60.4% vs 40.8%) and older partners (53.0 +/- 6.9 vs 50.2 +/- 7.5 y).
Similarly, there was a significantly higher rate of married (68.5% vs 63.1%),
postmenopausal (49.7% vs 39.3%), and HT-using women (23% vs 9.2%). There were
no differences in regard to their health perception, history of oophorectomy,
rape, and partner SD rate (27% vs 26.2%). The total FSFI score was
significantly lower in the tercile with higher SD prevalence (22.0 +/- 5.0 vs
27.5 +/- 5.4). Logistic regression analysis was used to determine the odds ratios
(95% CIs) for the main risk factors associated with SD among those who were
sexually active: bad lubrication, 3.86 (3.37-4.43); use of alternative
menopausal therapies, 2.13 (1.60-2.84); partner SD, 1.89 (1.63-2.20); older
women (>48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use,
1.39 (1.15-1.68); negative perception of female health status, 1.31
(1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were
higher educational level (women), partner faithfulness, and access to private
healthcare. CONCLUSIONS:: The prevalence of SD in this middle-aged Latin
American series was found to be high, varying widely in different populations.
A decrease in vaginal lubrication was the most important associated risk
factor. Differences in the prevalence of risk factors among the studied groups,
several of which are modifiable, could explain the variation of SD prevalence
observed in this study.
Menopause. 2009 May
19. [Epub ahead of print]
Body mass index,
urinary incontinence, and female sexual dysfunction: how they affect female
postmenopausal health.
Pace G, Silvestri V, Gualá L, Vicentini C.
From the
Departments of 1Surgical Sciences and 2Health Sciences, University of L'Aquila,
L'Aquila; and 3Department of Urology, Mazzini Hospital, Teramo, Italy.
OBJECTIVE:: The
aim of this study was to evaluate the relationship between body mass index
(BMI) and female sexual dysfunction (FSD) among perimenopausal and
postmenopausal women with urinary incontinence (UI). METHODS:: From 2005 to
2008, we enrolled 208 consecutive women affected by UI; all underwent a
comprehensive history including two validated questionnaires, physical
examination, and urodynamic evaluation. Based on BMI, participants were grouped
into normal weight, overweight, and obese. RESULTS:: A total of 158
participants completed both questionnaires (76% response rate); 41 (26%) were
normal weight, 73 (46%) were overweight, and 44 (28%) were obese. The
increasing Urogenital Distress Inventory score had a direct correlation with
age (P < 0.01), year of menopause onset (P < 0.05), and BMI (P <
0.01). FSD was diagnosed in 97 women (61%): 31 (32%) with hypoactive sexual
desire, 20 (21%) with sexual arousal disorder, 7 (7%) with orgasmic deficiency,
and 39 (40%) with sexual pain disorder. BMI greater than 30 kg/m was
independently associated with an increased risk of FSD (odds ratio [OR], 2.02)
and UI (OR, 2.03). With adjustment for BMI, the OR for FSD was 1.22 for
overweight women and 1.56 for obese women, with respect to healthy
participants. The total Female Sexual Function Index score correlated with BMI
(r = -0.82, P = 0.0001); in particular, arousal (r = -0.82), orgasm (r =
-0.72), lubrication (r = -0.61), and satisfaction (r = -0.63, all P < 0.001)
showed an inverse correlation with BMI, whereas desire and pain did not.
CONCLUSIONS:: Increased BMI early in menopause represents a risk both for UI
and for sexual dysfunction. Weight control has an essential role in
postmenopause and should be considered early in perimenopause to safeguard
female quality of life as well as to prevent or improve UI and female sexual
dysfunction symptoms.
Hum Reprod Update. 2009 May
20. [Epub ahead of print]
Female contraception
over 40.
The ESHRE Capri Workshop Group.
BACKGROUND The
majority of women 40-49 years of age need an effective method of contraception
because the decline in fertility with age is an insufficient protection against
unwanted pregnancy. Although pregnancy is less likely after the age of 40
years, the clinical and social consequences of an unexpected pregnancy are
potentially detrimental. No contraceptive method is contraindicated by advanced
reproductive age alone; thus there is a need to discuss the effectiveness,
risks and non-contraceptive benefits of all family planning methods for women
in this age group. METHODS MEDLINE searches were done by topic (epidemiology,
age and reproduction, sexual function, delayed childbearing and specific
contraceptive methods). The topic summaries were presented to the Workshop
Group and omissions or disagreements were resolved by discussion. RESULTS The
decline in fecundity in the fifth decade is insufficient for contraceptive
purposes. Thus a family planning method is needed. Sterilization is by far the
most common method in several countries. Copper intrauterine devices and
hormone intrauterine systems have similar effectiveness, with fewer than 1%
failures in the first year of typical use. Special considerations in this age
group include the frequency of menstrual irregularity, sexual problems and the
possibility of menopausal symptoms, all of which may respond to hormonal
methods of contraception. CONCLUSIONS Women should be advised to continue with
a contraceptive method until they have reached the menopause with its natural
state of sterility.
J Womens Health (Larchmt). 2009 May
20. [Epub ahead of print]
Association of Oxidative
Stress, Iron, and Centralized Fat Mass in Healthy Postmenopausal Women.
Crist BL, Alekel DL, Ritland LM, Hanson LN, Genschel U, Reddy MB.
1 Department of
Food Science and Human Nutrition,
Abstract
Objective: Centralized adiposity, insulin resistance, excess iron, and elevated
oxidative stress place postmenopausal women at risk for atherosclerotic
cardiovascular disease (CVD). The objective of this study was to determine the
relationship among excess iron, oxidative stress, and centralized fat mass in
healthy postmenopausal women. Methods: The parent project recruited healthy
women for a randomized, double-blind, clinical trial designed to examine the
effect of soy isoflavones on bone. At baseline (n = 122), we measured three
antioxidant enzymes, iron status indices (serum ferritin among others),
oxidative stress indices (oxidized low-density lipoprotein [oxLDL], urinary
isoprostanes [PGF(2alpha)], protein carbonyls, DNA damage), and waist, hip, and
thigh fat mass using dual-energy x-ray absorptiometry (DXA). We calculated
insulin resistance using the homeostasis model assessment (HOMA). Multiple
regression analysis was used to determine the CVD risk factors that contributed
to oxidative stress and centralized fat mass (waist + hip/thigh = AndGynFM
ratio). Results: Almost 14% (p < 0.0005) of the variability in oxLDL was
accounted for by AndGynFM ratio (6.1%, p < 0.0005), age (4.0%, p = 0.012),
and serum iron (2.8%, p = 0.053). Similarly, 16% (p < 0.0001) of the variability
in PGF(2alpha) was accounted for by the AndGynFM ratio (4.8%, p = 0.011), HOMA
(3.9%, p = 0.021), and serum iron (2.7%, p = 0.054). We accounted for 33% (p
</= 0.0001) of the variability in AndGynFM ratio by high-density lipoprotein
cholesterol (HDL-C) (4.3%, p = 0.008), ferritin (4.9%, p = 0.005), HOMA (4.5%,
p = 0.006), oxLDL (2.6%, p = 0.04), and PGF(2alpha) (3.0%, p = 0.025).
Conclusions: Our study suggests that reducing centralized fat mass and
maintaining a favorable lipid profile, antioxidant status, and iron status all
may be important in protecting postmenopausal women from atherosclerotic CVD.
Menopause. 2009 May
15. [Epub ahead of print]
Vasomotor symptoms usually
reappear after cessation of postmenopausal hormone therapy: a Swedish
population-based study.
Lindh-Åstrand L, Brynhildsen J, Hoffman M, Hammar M.
From the 1Division
of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine;
and 2Division of Drug Research, Department of Medical and Health Sciences,
Faculty of Health Sciences, Linköping University, Linköping, Sweden.
OBJECTIVE:: The
purpose of this study was to investigate the extent of reappearance of
vasomotor symptoms after cessation of postmenopausal hormone therapy (HT) in
women who started HT because of hot flashes. METHODS:: A cross-sectional postal
survey was conducted. A validated questionnaire was sent to all women 53 to 54
years old living in
Eur J Endocrinol. 2009 May
15. [Epub ahead of print]
Long term hormone
replacement therapy preserves bone mineral density in Turner syndrome.
Cleeman L, Hjerrild B, Lauridsen A, Heickendorff L, Christiansen J, Mosekilde L, Gravholt CH.
L Cleeman,
Pediatric Unit, Hilleroed Hospital, Hilleroed, Denmark.
Context: Reduced
bone mineral density (BMD) and increased risk of fractures are present in many
women with TS. Objective: Examine longitudinal changes in BMD in TS and relate
changes to biochemical parameters. Design: Prospective, pragmatic,
observational study. Examinations at baseline and follow-up (5.9 +/- 0.7
years). Setting: Tertiary hospital. Participants: 54 women with TS (43.0 +/-
9.95 yr). Interventions: Hormone replacement therapy and calcium and vitamin D
supplementation. Main Outcome Measures: Bone mineral density (BMD; grams/
square centimetre) measured at lumbar spine, hip and the non-dominant forearm.
Bone formation and resorption markers, sex hormones, IGF-I and maximal oxygen
uptake. Results: At follow-up forearm BMD, radius ultradistal BMD and hip BMD
remained unchanged, radius 1/3 BMD declined (0.601+/-0.059 vs. 0.592+/-0.059,
p= 0.03), while spine BMD increased (0.972+/-0.139 vs. 1.010+/-0.144,
p<0.0005). Bone formation markers did not change over time in TS. Bone
resorption markers decreased over time in TS. Testosterone, IGF-I and maximal
oxygen uptake was significantly reduced in TS. Conclusion: Longitudinal changes
in BMD in TS were slight. BMD can be maintained at most sites in well-informed
women with TS, being encouraged to maintain a healthy life-style including HRT
and intake of calcium and vitamin D.
Ann Clin Psychiatry. 2009
Apr-Jun;21(2):70-6
Escitalopram
reduces hot flashes in nondepressed menopausal women: A pilot study.
Defronzo
Dobkin R, Menza
M, Allen
LA, Marin
H, Bienfait
KL, Tiu
J, Howarth
J.
Department of
Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA.
dobkinro@umdnj.edu
BACKGROUND: Hot
flashes are one of the most troubling manifestations of menopause, affecting
about 80% of women. Due to recent controversies about hormone replacement
therapy, many women seek alternative treatments. The use of antidepressants to
treat hot flashes and other menopausal symptoms has been an active area of
investigation. However, the majority of past research in this area has included
women with significant medical or psychiatric histories that may influence
treatment response. This was the first study to examine the impact of
escitalopram on hot flashes, mood, sleep, and quality of life in a sample of
healthy nondepressed menopausal women. METHODS: This study enrolled 25
menopausal women who had no significant psychiatric or medical history. All
women were treated with escitalopram (10 to 20 mg flexibly dosed) for 8 weeks.
The active treatment phase was preceded by a single-blind placebo lead-in
period. RESULTS: Over the course of the study, women reported significant
decreases in both hot flash frequency and severity as well as improvements in
dysphoria, anxiety, quality of life, and sleep. CONCLUSION: These preliminary
findings suggest that escitalopram may be a feasible and effective option for
treating hot flashes and other menopausal symptoms in healthy women who might
not ordinarily consider antidepressant treatment.
Menopause. 2009 May
19. [Epub ahead of print]
Microdose
transdermal estrogen therapy for relief of vulvovaginal symptoms in
postmenopausal women.
Bachmann GA, Schaefers M, Uddin A, Utian WH.
From the 1Robert
Wood Johnson Medical School, University of Medicine and Dentistry of New
Jersey, New Brunswick, NJ; 2Bayer Schering Pharma AG, Berlin, Germany; 3Bayer
HealthCare Pharmaceuticals, Inc., Montville, NJ; and 4Rapid Medical Research,
Cleveland, OH.
OBJECTIVE:: The
aim of this study was to investigate the effectiveness of microdose transdermal
17beta-estradiol (E2) therapy in postmenopausal women with moderate to severe
vulvovaginal symptoms. METHODS:: This report is based on a subset of 121 women
who reported most bothersome moderate or severe vulvovaginal symptoms at
baseline, from a previous randomized, double-blind, placebo-controlled,
multicenter study of 425 healthy, symptomatic, postmenopausal women. Recruits
had experienced at least 7 moderate or severe hot flushes daily for at least 1
week or at least 50 moderate or severe hot flushes per week for at least 1
week. Effects on coprimary efficacy variables have been reported previously.
Participants received low-dose transdermal E2 plus levonorgestrel (n = 43;
nominal delivery 0.023 mg/d E2/0.0075 mg/d levonorgestrel), microdose E2 (n =
42; nominal delivery 0.014 mg/d), or placebo (n = 36) for 12 weeks. Secondary
efficacy variables reported herein include mean change from baseline in vaginal
pH and vaginal maturation index, the proportion of women with symptoms of
vulvar and vaginal atrophy at baseline and week 12, and the proportion of women
with moderate-to-severe symptoms of vulvar and vaginal atrophy. RESULTS::
Microdose transdermal E2 treatment was associated with a consistent benefit
versus placebo in women with vulvovaginal atrophy. There was a statistically
significant difference between both E2 versus placebo for changes in vaginal pH
and vaginal maturation index. CONCLUSIONS:: Microdose transdermal E2 offers a
useful addition to the therapeutic armamentarium for postmenopausal women in
whom vulvovaginal symptoms are particularly troublesome.
Semana del 27 de Mayo al 2 de Junio de 2009
Climacteric. 2009 May 25:1-8. [Epub ahead of
print]
Micro-dose transdermal estradiol for relief of hot flushes in
postmenopausal Asian women: a randomized controlled trial.
Haines C, Yu SL,
Hiemeyer F, Schaefers
M.
Prince of Wales
Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong.
Objectives To
compare the effect of micro-dose transdermal estradiol and placebo on the
incidence and severity of menopausal symptoms and well-being in postmenopausal
Asian women with vasomotor symptoms. Design Multicenter, double-blind,
randomized, placebo-controlled study. Results Of 165 subjects randomized to
estradiol 0.014 mg/day or placebo for 12 weeks, 80 per group were included in
the analysis. Groups were comparable at baseline, although time since menopause
was slightly shorter in the estradiol group. There was a greater reduction in
mean weekly hot flushes at week 12 in the estradiol group (55%) than the
placebo group (40%; p < 0.01), which was evident by week 4. A similar
pattern was seen for moderate and severe hot flushes (-58% vs. -39%,
respectively). Reductions were statistically significant at weeks 4, 8, and 12.
Vaginal pH fell significantly in the estradiol group by week 4 and then
remained stable throughout the treatment period, but there were no significant
changes in the placebo group. Vaginal maturation value increased more in the
estradiol than the placebo group (p < 0.001). Few subjects had vaginal
bleeding or spotting. Quality of life improved similarly in both groups.
Urogenital symptoms improved considerably from baseline in both treatment
groups, with no significant differences. Eight subjects experienced
treatment-related adverse events (seven in the estradiol group). Conclusions In
Asian women, micro-dose estradiol was significantly superior to placebo in
improving vasomotor symptoms. The bleeding profile was comparable with that of
placebo. Micro-dose estradiol was safe and well tolerated in Asian women.
Am J Primatol. 2009 May 27. [Epub ahead of
print]
Neuroprotective effects of estrogen therapy for cognitive and
neurobiological profiles of monkey models of menopause.
Voytko ML, Tinkler GP,
Browne C, Tobin JR.
Neurobiology and
Anatomy, Wake Forest University School of Medicine, Winston-Salem, North
Carolina.
Many
postmenopausal women question whether to start or continue hormone therapy
because of recent clinical trial negative results. However, evidence from other
studies of postmenopausal women, and from studies in menopausal monkeys, indicate
that estrogen has neurocognitive protective effects, particularly when therapy
is initiated close to the time of menopause before neural systems become
increasingly compromised with age. In this review, we present studies of
menopausal women and female monkeys that support the concept that estrogen
therapies protect both cognitive function and neurobiological processes.
Am J Clin Nutr. 2009 May 27. [Epub ahead of
print]
Soy proteins and isoflavones affect bone mineral density in older women:
a randomized controlled trial.
Kenny AM, Mangano KM,
Abourizk RH, Bruno RS, Anamani DE, Kleppinger A,
Walsh SJ, Prestwood KM, Kerstetter JE.
BACKGROUND: Soy
foods contain several components (isoflavones and amino acids) that potentially
affect bone. Few long-term, large clinical trials of soy as a means of
improving bone mineral density (BMD) in late postmenopausal women have been
conducted. OBJECTIVE: Our goal was to evaluate the long-term effect of dietary soy
protein and/or soy isoflavone consumption on skeletal health in late
postmenopausal women. DESIGN: We conducted a randomized, double-blind,
placebo-controlled clinical trial in 131 healthy ambulatory women aged >60
y. Ninety-seven women completed the trial. After a 1-mo baseline period,
subjects were randomly assigned into 1 of 4 intervention groups: soy protein
(18 g) + isoflavone tablets (105 mg isoflavone aglycone equivalents), soy
protein + placebo tablets, control protein + isoflavone tablets, and control
protein + placebo tablets. RESULTS: Consumption of protein powder and
isoflavone pills did not differ between groups, and compliance with the study
powder and pills was 80-90%. No significant differences in BMD were observed
between groups from baseline to 1 y after the intervention or in BMD change
between equol and non-equol producers. However, there were significant negative
correlations between total dietary protein (per kg) and markers of bone
turnover (P < 0.05). CONCLUSIONS: Because soy protein and isoflavones
(either alone or together) did not affect BMD, they should not be considered as
effective interventions for preserving skeletal health in older women. The
negative correlation between dietary protein and bone turnover suggests that
increasing protein intakes may suppress skeletal turnover.
Clin Endocrinol (Oxf). 2009 May 16. [Epub
ahead of print]
Distribution of plasma levels of adiponectin and leptin in an adult
Caucasian population.
Marques-Vidal P, Bochud
M, Paccaud F, Mooser V, Waeber G, Vollenweider P.
Centre for
Cardiovascular and Metabolic Research, University of Lausanne, Lausanne,
Switzerland.
Objective Little
is known regarding the distribution and the determinants of leptin and
adiponectin levels in the general population. Design Cross-sectional study.
Patients:ensp; 3,004 women and 2,552 men aged 35-74 living in Lausanne,
Switzerland. Measurements:ensp; Plasma levels of leptin and adiponectin (ELISA
measurement). Results Women had higher leptin and adiponectin levels than men.
In both genders, leptin and adiponectin levels increased with age. After
adjusting for fat mass, leptin levels were significantly and negatively
associated with age in women: 18.1+/-0.3, 17.1+/-0.3, 16.7+/-0.3 and 15.5+/-0.4
ng/mL (adjusted mean+/-standard error) for age groups [35-44], [45-54], [55-64]
and [65-75], respectively, p<0.001. A similar but non-significant trend was
also found in men. Conversely, the age-related increase of adiponectin was
unrelated to body fat in both genders. Post-menopausal women had higher leptin
and adiponectin levels than pre-menopausal women, independently of hormone
replacement therapy. Although body fat mass was associated with leptin and
adiponectin, the associations were stronger with BMI, waist and hip in both genders.
Finally, after adjusting for age and anthropometry, no relationships were found
between leptin or adiponectin levels with alcohol, caffeine consumption and
physical activity, whereas smoking and diabetes decreased leptin and
adiponectin levels in women only. Conclusions The age-related increase in
leptin levels is attributable to changes in fat mass in women and probably also
in men. Leptin and adiponectin levels are more related to BMI than to body fat
mass. The effects of smoking and diabetes appear to be gender-specific.
Neurology. 2009 May 26;72(21):1850-7.
Effects of the menopause transition and hormone use on cognitive
performance in midlife women.
Greendale GA, Huang MH,
Wight RG, Seeman T, Luetters C, Avis NE,
Johnston J, Karlamangla AS.
Division of
Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
BACKGROUND: There
is almost no longitudinal information about measured cognitive performance
during the menopause transition (MT). METHODS: We studied 2,362 participants
from the Study of Women's Health Across the Nation for 4 years. Major exposures
were time spent in MT stages, hormone use prior to the final menstrual period,
and postmenopausal current hormone use. Outcomes were longitudinal performance
in three domains: processing speed (Symbol Digit Modalities Test [SDMT]),
verbal memory (East Boston Memory Test [EBMT]), and working memory (Digit Span
Backward). RESULTS: Premenopausal, early perimenopausal, and postmenopausal
women scored higher with repeated SDMT administration (p < or = 0.0008), but
scores of late perimenopausal women did not improve over time (p = 0.2). EBMT
delayed recall scores climbed during premenopause and postmenopause (p < or
= 0.01), but did not increase during early or late perimenopause (p > or = 0.14).
Initial SDMT, EBMT-immediate, and EBMT-delayed tests were 4%-6% higher among
prior hormone users (p < or = 0.001). On the SDMT and EBMT, compared to the
premenopausal referent, postmenopausal current hormone users demonstrated
poorer cognitive performance (p < or = 0.05) but performance of
postmenopausal nonhormone users was indistinguishable from that of
premenopausal women. CONCLUSIONS: Consistent with transitioning women's
perceived memory difficulties, perimenopause was associated with a decrement in
cognitive performance, characterized by women not being able to learn as well
as they had during premenopause. Improvement rebounded to premenopausal levels
in postmenopause, suggesting that menopause transition-related cognitive
difficulties may be time-limited. Hormone initiation prior to the final
menstrual period had a beneficial effect whereas initiation after the final
menstrual period had a detrimental effect on cognitive performance.
Cancer Prev Res (Phila Pa). 2009 May 26.
[Epub ahead of print]
Association between Plasma 25-Hydroxyvitamin D and Breast Cancer Risk.
Crew KD, Gammon MD,
Steck SE, Hershman DL, Cremers S, Dworakowski E,
Shane E, Terry MB, Desai M, Teitelbaum SL, Neugut AI, Santella RM.
Department of
Medicine, Division of Hematology/Oncology, College of Physicians and Surgeons,
Arnold School of Public Health, Columbia, South Carolina.
Vitamin D has been
associated with decreased risk of several cancers. In experimental studies,
vitamin D has been shown to inhibit cell proliferation and induce
differentiation and apoptosis in normal and malignant breast cells. Using a
population-based case-control study on Long Island, New York, we examined the
association of breast cancer with plasma 25-hydroxyvitamin D (25-OHD) levels, a
measure of vitamin D body stores. In-person interviews and blood specimens were
obtained from 1,026 incident breast cancer cases diagnosed in 1996 to 1997 and
1,075 population-based controls. Plasma 25-OHD was measured in batched,
archived specimens by Diasorin RIA. The mean (SD) plasma 25-OHD concentration
was 27.1 (13.0) and 29.7 (15.1) ng/mL in the cases and controls, respectively
(P < 0.0001). Plasma 25-OHD was inversely associated with breast cancer risk
in a concentration-dependent fashion (P(trend) = 0.002). Compared with women
with vitamin D deficiency (25-OHD, <20 ng/mL), levels above 40 ng/mL were
associated with decreased breast cancer risk (odds ratio, 0.56; 95% confidence
interval, 0.41-0.78). The reduction in risk was greater among postmenopausal
women (odds ratio, 0.46; 95% confidence interval, 0.09-0.83), and the effect
did not vary according to tumor hormone receptor status. In summary, these
results add to a growing body of evidence that adequate vitamin D stores may
prevent breast cancer development. Whereas circulating 25-OHD levels of >32
ng/mL are associated with normal bone mineral metabolism, our data suggest that
the optimal level for breast cancer prevention is >/=40 ng/mL. Well-designed
clinical trials are urgently needed to determine whether vitamin D
supplementation is effective for breast cancer chemoprevention.
Menopause Int. 2009 Jun;15(2):82-6.
Hormonal management of migraine at menopause.
Nappi RE, Sances G, Detaddei S, Ornati A,
Chiovato L, Polatti F.
Research Center of
Reproductive Medicine, Unit of Gynecological Endocrinology and Menopause, IRCCS
Maugeri Foundation, University of Pavia, Via Ferrata 8, 27100 Pavia, Italy.
renappi@tin.it.
In this review, we
underline the importance of linking migraine to reproductive stages for optimal
management of such a common disease across the lifespan of women. Menopause has
a variable effect on migraine depending on individual vulnerability to
neuroendocrine changes induced by estrogen fluctuations and on the length of
menopausal transition. Indeed, an association between estrogen 'milieu' and
attacks of migraine is strongly supported by several lines of evidence. During
the perimenopause, it is likely to observe a worsening of migraine, and a
tailored hormonal replacement therapy (HRT) to minimize estrogen/progesterone
imbalance may be effective. In the natural menopause, women experience a more
favourable course of migraine in comparison with those who have surgical
menopause. When severe climacteric symptoms are present, postmenopausal women
may be treated with continuous HRT. Even tibolone may be useful when analgesic
overuse is documented. However, the transdermal route of oestradiol
administration in the lowest effective dose should be preferred to avoid
potential vascular risk.
Menopause Int. 2009 Jun;15(2):76-81
Depression and the menopause: why antidepressants are not enough?
Graziottin A, Serafini A.
Via Enrico Panzacchi 6, 20123 Milano,
Italy. a.graziottin@studiograziottin.it.
BACKGROUND: Gender
differences, related to varying sexual hormone levels and hormone secretion
patterns across the lifespan, contribute to women's vulnerability to mood
disorders and major depression. Women are more prone than men to depression,
from puberty onwards, with a specific exposure across the menopausal
transition. However, controversy still exists in considering fluctuation/loss
of estrogen as a specific aetiologic factor contributing to depression in
perimenopause and beyond. AIMS: To briefly review the interaction between
changes in menopausal hormone levels, mood disorders, associated
neuropsychological co-morbidities and ageing, and to evaluate the currently
available therapeutic options for perimenopausal mood disorders: (a) treatment
of light to moderate mood disorders with hormonal therapy (HT); (b) treatment
of major depression with antidepressants; (c) the synergistic effect between HT
and antidepressants in treating menopausal depression. RESULTS: Depression
across the menopause has a multifactorial aetiology. Predictive factors
include: previous depressive episodes such as premenstrual syndrome and/or
postpartum depression; co-morbidity with major menopausal symptoms, especially
hot flashes, nocturnal sweating, insomnia; menopause not treated with HT; major
existential stress; elevated body mass index; low socioeconomic level and
ethnicity. Postmenopausal depression is more severe, has a more insidious
course, is more resistant to conventional antidepressants in comparison with
premenopausal women and has better outcomes when antidepressants are combined
with HT. CONCLUSION: The current evidence contributes to a re-reading of the
relationship between menopause and depression. The combination of the
antidepressant with HT seems to offer the best therapeutic potential in terms
of efficacy, rapidity of improvement and consistency of remission in the
follow-up.
Menopause Int. 2009 Jun;15(2):55-7
Hormone replacement therapy and cardiovascular disease revisited.
Stevenson JC.
Royal Brompton
Hospital, Sydney Street, London SW3 6NP, UK. j.stevenson@imperial.ac.uk.
Controversy still
rages about whether hormone replacement therapy (HRT) confers cardiovascular
benefit or harm. There is a wealth of biological evidence that estrogen has a beneficial
effect, supporting a large body of epidemiological evidence demonstrating
reduction in coronary events with HRT. A large randomized placebo-controlled
clinical trial of preventive strategies for coronary heart disease (CHD) in
postmenopausal women, the Women's Health Initiative (WHI), included HRT arms.
The published preliminary findings of this trial showed a significant increase
in coronary events, stroke, venous thromboembolism and breast cancer with
estrogen-progestogen, leading to the conclusion that HRT was unsafe to use
other than for short-term relief of menopausal symptoms. But subsequent
publications of the more complete data from WHI have shown no significant
increase in CHD, and a tendency to a reduction in those initiating HRT below age
60 years. This is important because other therapeutic strategies for the
primary prevention of CHD, such as aspirin and statins, are not of proven
benefit in women, in contrast to men. Subsequent WHI findings have not shown a
clear increase in breast cancer, and any potential increase from HRT is similar
to that seen with many lifestyle factors and other commonly used medications.
The preliminary WHI results do not reflect accurately true benefits and risks,
and HRT should remain a potential preventive treatment for CHD.
Menopause Int. 2009 Jun;15(2):52-4.
Why are physicians reluctant to use estrogens for anything - or do they
prefer 'PROFOX'?
Studd J.
London PMS &
Menopause Clinic, 46 Wimpole Street, London W1G8SD, UK. harley@studd.co.uk.
The reluctance of
physicians to use estrogens in women with hormone responsive disorders is a
tragic result of the 2002 WHI study. Although their hostility to estrogen
therapy antedated these studies, the flawed data is now used as justification
for the denial of estrogens for treatment of low bone density and various types
of hormone responsive depression in women. Estrogens should be first choice
therapy for osteoporosis in women under the age of 60 years, but in practice
bisphosphonates, with its increasing number of long-term side-effects, has
become first-line therapy for physicians. These side-effects include
osteonecrosis of the jaw, mid-shaft femoral fractures and the need for proton
pump inhibitors, which further reduce bone density and add to the fracture risk.
Pyschiatrists fail to use transdermal estradiol for postnatal depression,
premenstrual depression and perimenopausal depression in spite of randomized
trials demonstrating their efficacy. Selective serotonin reuptake inhibitor
therapy for depression independently decreases bone density and is also
responsible for loss of libido, loss of mental acuity and dependence. Thus
postmenopausal women with vasomotor symptoms, depression, loss of libido,
vaginal dryness or low bone density are frequently denied effective estrogen
therapy and given a combination of low-cost generic prozac and fosamax, which
is in danger of becoming a post-WHI nightmare drug PROFOX (PROzacFOsamaX). This
can only be avoided if advisory bodies review the reassuring evidence
concerning estrogen therapy in women under the age of 60 years and advise
accordingly.
Joint Bone Spine. 2009 May 20. [Epub ahead
of print]
Antioxidant status in patients with osteoporosis: A controlled study.
Sendur OF, Turan Y, Tastaban E, Serter M.
Physical Medicine
Rehabilitation, Adnan Menderes University School of Medicine, Aydin, Turkey.
OBJECTIVE: We
aimed to investigate serum antioxidant enzymes and nitric oxide (NO) levels in
postmenopausal women with osteoporosis (OP) and in healthy controls; and to
determine the relationship between these enzymes, NO and clinical parameters in
this present study. METHODS: Forty-five postmenopausal women fulfilling OP
diagnostic criteria of World Health Organization (WHO) and 42 postmenopausal
healthy women without OP were enrolled. Patients in the study population were
selected among individuals that were not pre-diagnosed or pre-treated for OP.
Patients with metabolic bone diseases, fracture history, which were smokers,
alcohol users and taking antioxidant drug treatment, were excluded from the
study. Dual Energy X-ray Absorptiometry (DXA) results, body mass indices and
demographic data were recorded. Erythrocyte catalases (CAT), glutathione
reductase (GR) enzyme activities and erythrocyte glutathione (GSH) levels,
plasma malondialdehyde (MDA) levels were measured by spectrophotometer whereas
plasma nitrite+nitrate (NOx) levels were measured by ELISA microplate-reader.
RESULTS: Patients had significantly lower GR (P<0.01) enzyme activity and
higher levels of MDA (P<0.01) and NO (P<0.01) than non osteoporotic
healthy controls. There was no significant difference between both groups in
erythrocyte GSH levels and CAT activities. Total femoral BMD measurements
significantly correlated with MDA levels (P=0.001). There was no significant
relationship between other antioxidants and lumbar or femoral BMD. CONCLUSION:
Oxidative stress may play an important role in postmenopausal bone loss and
therefore it might be considered when pathogenesis of postmenopausal OP has
been investigated.
Maturitas. 2009 May 20. [Epub ahead of
print]
Menopause and sexuality: Prevalence of symptoms and impact on quality of
life.
Nappi RE, Lachowsky M.
Research Center
for Reproductive Medicine, Dept of Morphological, Eidological and Clinical
Sciences, Italy; Unit of Gynecological Endocrinology and Menopause, Dept of
Internal Medicine and Endocrinology, IRCCS "S Maugeri Foundation",
University of Pavia, Pavia, Italy.
OBJECTIVE: This
article aims to summarise the available knowledge on the prevalence of sexual
symptoms at the menopause and their impact on quality of life in elderly women.
Sexual changes are analysed in the context of the menopause transition and
beyond. METHODS: The medical literature was searched (1990-2008) with regard to
menopause and sexuality using several related terms. RESULTS: The prevalence of
sexual symptoms at the menopause differs across studies depending on several
factors such as sample size, design, hormonal status and country. The most
common sexual complaints are reduced sexual desire, vaginal dryness and
dyspareunia, poor arousal and orgasm and impaired sexual satisfaction. Age and
declining oestradiol levels have significant detrimental effects on sexual
functioning, desire and responsiveness (arousal, sexual pleasure and orgasm)
across the normal menopause transition, while reduced androgens levels played a
role in hypoactive sexual desire disorder (HSDD), a symptom frequently
diagnosed in surgically menopausal women. CONCLUSIONS: Women attending menopause
clinics are vulnerable to female sexual dysfunction (FSD) because of a complex
interplay of individual factors variably affecting well-being. Surgically
menopausal women may be more distressed by sexual symptoms. Giving women the
opportunity to talk about sexual problems is a fundamental part of health care
and may improve their quality of life.