Selección de Resúmenes de Menopausia

                                     Semana del 25 de Noviembre al 1 de Diciembre de 2009

                        Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile

 

   

Menopause. 2009 Nov 24. [Epub ahead of print]

Dysregulation of subcutaneous adipose tissue blood flow in overweight postmenopausal women.

Andersson J, Sjöström LG, Karlsson M, Wiklund U, Hultin M, Karpe F, Olsson T.

From the Departments of 1Public Health and Clinical Medicine, 2Biomedical Engineering and Informatics, and 3Surgical and Perioperative Sciences, Anesthesiology and Intensive Care, Umeĺ University Hospital, Umeĺ, Sweden; and 4NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.

OBJECTIVE:: A putative link between abdominal obesity and metabolic-vascular complications after menopause may be due to a decreased adipose tissue blood flow (ATBF). The present work aimed to analyze possible changes in ATBF with being overweight and menopausal and its putative link to endothelial dysfunction and autonomic nervous system balance. METHODS:: Forty-three healthy women were classified into four groups according to weight and menopause status. The ATBF was measured by xenon washout while fasting and after oral glucose intake. The nitric oxide synthase inhibitor asymmetric dimethylarginine was used as a marker of endothelial function and heart rate variability-estimated autonomic nervous system activity. RESULTS:: Fasting ATBF was decreased in both overweight groups (P = 0.044 and P = 0.048) versus normal-weight premenopausal women. Normal-weight and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight premenopausal women (P = 0.015 and P = 0.001, respectively), and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight postmenopausal women (P = 0.003). A negative correlation was found between fasting ATBF and asymmetric dimethylarginine (P = 0.015), whereas maximum ATBF was negatively associated with sympathetic-parasympathetic nervous system balance (ratio of the power of the low frequency to the power of the high frequency; P = 0.002). CONCLUSIONS:: Loss of ATBF flexibility in overweight postmenopausal women may contribute to the metabolic dysfunction seen in this group of women.

 

 

Fertil Steril. 2009 Nov 23. [Epub ahead of print]

Racial and ethnic differences in reproductive potential across the life cycle.

Butts SF, Seifer DB.

Division of Infertility and Reproductive Endocrinology, University of Pennsylvania Medical School, Philadelphia, Pennsylvania.

OBJECTIVE: To review variations in specific reproductive health outcomes by race and ethnicity. A growing number of reports have explored potential gaps in the quality of reproductive health and healthcare across racial and ethnic groups. Diverse results from numerous investigations have made it challenging for practitioners to confirm the significance of these disparities. METHOD(S): Three specific areas of the reproductive life cycle were examined: pubertal onset, outcomes from treatment with assisted reproductive technologies (ART), and the menopausal transition. These areas were selected as they encompass a continuum of events across the reproductive life span of women. Outcomes were compared in black, white, Asian, and Hispanic women. Medline searches querying on keywords puberty, IVF, ART, menopause, menopausal symptoms, racial disparity, race, Asian, Japanese, Chinese, African American, black, Hispanic, and Latino were performed to isolate relevant publications for review. RESULT(S): Differences across race and ethnicity were noted in each clinical endpoint. The most notable findings included earlier puberty in blacks and Hispanics compared with whites, significantly lower live birth rates after ART in all racial and ethnic groups compared with whites, and differences in perimenopausal symptomatology and possibly timing in various racial/ethnic groups compared with whites. Additional research is needed to completely unravel the full significance and basic underpinnings of these disparities. Some of the limitations of the current state of the literature in drawing conclusions about the independent effect of race/ethnicity on reproductive disparities include small samples sizes in some studies, inconsistencies in the characterization of racial/ethnic groups, and incomplete control of potential confounding. CONCLUSION(S): Race and ethnicity appear to be important correlates of outcomes from the initiation of reproduction functioning through to its conclusion. The ultimate goal of identifying racial disparities in reproduction is to isolate the basic determinants of disparities and formulate strategies to improve outcomes for women at risk. The differences demonstrated in this review of the literature could represent environmental, sociocultural, and/or genetic correlates of race that influence these important milestones.

 

 

Obstet Gynecol. 2009 Dec;114(6):1197-204.

Endometrial cancer in postmenopausal women using estradiol-progestin therapy.

Jaakkola S, Lyytinen H, Pukkala E, Ylikorkala O.

From the 1Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki; 2Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki; and 3Tempere School of Public Health, University of Tempere, Tempere, Finland.

OBJECTIVE:: To estimate the risk of endometrial cancer in all Finnish postmenopausal women using various forms of estradiol-progestin therapy. METHODS:: All Finnish women (aged more than 50 years) who had used estradiol-progestin therapy in 1994-2006 for at least 6 months (n=224,015) were identified from the national medical Reimbursement Registry and linked to the Finnish Cancer Registry. A total of 1,364 type I and 38 type II endometrial cancers were recorded by the end of 2006. The incidence of endometrial cancer in estradiol-progestin therapy users was compared with that in the general population in this cohort study. RESULTS:: The use of a continuous estradiol-progestin therapy regimen for 3 years or more was associated with a 76% reduction of the risk for type 1 cancer (95% confidence interval [CI] 6-60%). In contrast, the use of a sequential estradiol-progestin therapy regimen for at least 5 years was accompanied with a 69% elevation (95% CI 43-96%) if the progestin was added monthly, and with a significantly higher, 276% risk elevation (95% CI 190-379%) if progestin was added at 3-month intervals. Sequential regimens containing norethisterone acetate, medroxyprogesterone acetate or dydrogesterone administered orally showed no significant differences in the endometrial safety. Oral and transdermal norethisterone acetate were associated with similar risk elevations. Women using a monthly sequential estradiol-progestin regimen tended to be diagnosed with endometrial cancer in an earlier stage than the background population. CONCLUSION:: Use of a continuous rather than a sequential estradiol-progestin regimen decreases the risk of endometrial cancer, whereas the route of administration or type of progestin does not differ in terms of endometrial cancer risk. LEVEL OF EVIDENCE:: II.

 

 

BJOG. 2009 Dec;116(13):1706-14.

Pelvic floor function is independently associated with pelvic organ prolapse.

Braekken IH, Majida M, Ellström Engh M, Holme IM, Bř K.

Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway. ingeborg.brekken@nih.no

OBJECTIVE: To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function. DESIGN: One-to-one age- and parity-matched case-control study. SETTING: Akershus university hospital and one outpatient physiotherapy clinic in Norway. POPULATION: Forty-nine women with POP (POP quantification, stage>or=II) and 49 controls (stages 0 and I) were recruited from community gynaecologists and advertisements in newspapers. METHODS: Validated questionnaires, interview and clinical examination, including Beighton's scoring system (joint hypermobility) and vaginal pressure transducer measurements (PFM function), were used. Univariate and multivariate conditional logistic regression analyses for one-to-one matched case-control studies were used, and odds ratios with 95% CIs are reported. MAIN OUTCOME MEASURES: Pelvic floor muscle function (strength, endurance and resting pressure), socioeconomic status, body mass index, heavy occupational work, physical activity, family history, obstetric factors and markers of connective tissue weakness (striae, varicose veins, bruising, diastasis recti abdominis, joint hypermobility). RESULTS: No significant differences were found between groups with regard to postmenopausal status, current smoking, current low-intensity exercise, type of birth (caesarean, forceps, vacuum), birth weight, presence of striae, diastasis recti abdominis and joint hypermobility. Body mass index (OR 5.0; 95% CI 1.1-23.0), socioeconomic status (OR 10.5; 95% CI 2.2-50.1), heavy occupational work (OR 9.6; 95% CI 1.3-70.3), anal sphincter lacerations (OR 4.5; 95% CI 1.0-20.0), PFM strength (OR 7.5; 95% CI 1.5-36.4) and endurance (OR 11.5; 95% CI 2.0-66.9) were independently related to POP. CONCLUSIONS: Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP, whereas joint mobility and physical activity were not.

 

 

J Clin Endocrinol Metab. 2009 Nov 24. [Epub ahead of print]

Extremes of Endogenous Testosterone Are Associated with Increased Risk of Incident Coronary Events in Older Women.

Laughlin GA, Goodell V, Barrett-Connor E.

Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093.

Context: Few studies have examined whether endogenous testosterone is associated with the development of coronary heart disease (CHD) in women. Objective: This study tested the association of total testosterone (total T) and bioavailable T (BioT) levels with risk of incident coronary events among older community-dwelling women. Design, Setting, and Participants: This was a prospective, population-based study of 639 postmenopausal women, aged 50-91 (mean, 73.8) yr who had serum testosterone measurements at baseline (1984-87) and who were followed for incident CHD events through 2004. Main Outcome Measures: A total of 134 incident CHD events occurred during follow-up [45 nonfatal myocardial infarctions, 79 fatal myocardial infarctions, and 10 coronary revascularizations]. Results: The median follow-up was 12.3 yr. Age-adjusted CHD risk estimates were similar for the four highest total T quintiles relative to the lowest, suggesting a low threshold. In age-adjusted analyses, the lowest total T quintile (</=80 pg/ml) was associated with a 1.62-fold increased risk of incident CHD [95% confidence interval (CI), 1.10-2.39] compared to higher levels. BioT showed a U-shaped association with incident CHD. Age-adjusted risk for the lowest and highest BioT quintiles relative to the third were 1.79 (95% CI, 1.03-3.16) and 1.96 (95% CI, 1.13-3.41), respectively. Additional adjustment for lifestyle, adiposity, estradiol, and ovarian status, or for CHD risk factor covariates, had minimal influence on results. Conclusions: An optimal range of testosterone may exist for cardiovascular health in women, with increased risk of CHD events at low levels of testosterone overall and at high levels of the bioavailable fraction of testosterone.

 

 

Neurology. 2009 Nov 24;73(21):1729-37.

Characteristics of hormone therapy, cognitive function, and dementia: The prospective 3C Study.

Ryan J, Carričre I, Scali J, Dartigues JF, Tzourio C, Poncet M, Ritchie K, Ancelin ML.

INSERM U888, Nervous System Pathologies: Epidemiological and Clinical Research, Hôpital La Colombičre, 39 Avenue Charles Flahault, BP 34493, 34093 Montpellier Cedex 5, France joanne.ryan@inserm.fr.

OBJECTIVES: To examine the association between hormone therapy (HT) and cognitive performance or dementia, focusing on the duration and type of treatment used, as well as the timing of initiation of HT in relation to the menopause. METHODS: Women 65 years and older were recruited in France as part of the Three City Study. At baseline and 2- and 4-year follow-up, women were administered a short cognitive test battery and a clinical diagnosis of dementia was made. Detailed information was also gathered relating to current and past HT use. Analysis was adjusted for a number of sociodemographic, behavioral, physical, and mental health variables, as well as APOE epsilon4. RESULTS: Among 3,130 naturally postmenopausal women, current HT users performed significantly better than never users on verbal fluency, working memory, and psychomotor speed. These associations varied according to the type of treatment and a longer duration of HT appeared to be more beneficial. However, initiation of HT close to the menopause was not associated with better cognition. HT did not significantly reduce dementia risk over 4 years but current treatment diminished the negative effect associated with APOE epsilon4. CONCLUSIONS: Current hormone therapy (HT) was associated with better performance in certain cognitive domains but these associations are dependent on the duration and type of treatment used. We found no evidence that HT needs to be initiated close to the menopause to have a beneficial effect on cognitive function in later life. Current HT may decrease the risk of dementia associated with the APOE epsilon4 allele.

 

 

  

 Semana del 18 al 24 de Noviembre de 2009

 

Gynecol Endocrinol. 2009 Nov 9. [Epub ahead of print]

Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints.

Chedraui P, Pérez-López FR, Blümel JE, Hidalgo L, Barriga J.

Facultad de Ciencias Médicas, Institute of Biomedicine, Universidad Católica de Guayaquil, Guayaquil, Ecuador.

Background. Postmenopausal metabolic changes increase cardiovascular risk and impair quality of life (QoL). Despite this, few reports have addressed the association of these changes with female sexuality. Objective. To determine the association between the metabolic syndrome (METS), and its components, and female sexuality. Methods. Data of sexually active postmenopausal women who participated in a METS screening program who filled out the menopause-specific quality of life questionnaire (MENQOL) were assessed. Specifically the sexual domain of the MENQOL was analyzed in regard to mean total and item scores (decreased libido, vaginal dryness, and sexual avoidance). Criteria of the Third Adult Treatment Panel (ATP III) were used to identify women with the METS. Results. Two hundred six women fulfilled inclusion criteria. Mean age of participants was 54 +/- 6.9 years (median: 54 years). Prevalence of the METS in this sexually active postmenopausal series was 39.8%. About 52.9% of them presented abdominal obesity, 35.4% hypertension, 55.8% high triglycerides, 17.5% hyperglycemia, and 59.7% decreased high density lipoprotein cholesterol (HDL-C). Women with the METS as compared with those without the syndrome displayed no significant differences in MENQOL sexual scorings (total or of its composing items). Equally there were also no score differences among those presenting any of the five components of the METS, except women with hyperglycemia who significantly displayed a higher total sexual domain score (5.6 +/- 2.1 vs. 4.8 +/- 2.3, p < 0.05) in association to a higher mean score in the decreased libido item (6.0 +/- 2.3 vs. 4.8 +/- 2.6, p < 0.01). After controlling for several confounding factors, logistic regression confirmed that women with hyperglycemia were significantly at higher risk for presenting decreased libido (higher item score, OR 2.4, CI 95%: 1.0-5.7, p < 0.05) and more impaired sexuality (higher total MENQOL sexual domain score: OR, 2.5, CI 95%: 1.1-5.4, p < 0.05). Conclusion. Despite the limitations of this study, as assessed with the MENQOL, hyperglycemia in postmenopausal women screened for the METS was associated to a negative impact in sexuality. More research is warranted in this regard.

 

 

Am J Public Health. 2009 Nov 12. [Epub ahead of print]

Correlates and Consequences of Venous Thromboembolism: The Iowa Women's Health Study.

Lutsey PL, Virnig BA, Durham SB, Steffen LM, Hirsch AT, Jacobs DR, Folsom AR.

University of Minnesota.

Objectives. We sought to document incidence, case-fatality, and recurrence rates of venous thromboembolism (VTE) in women and to explore the relationship of demographic, lifestyle, and anthropometric factors to VTE incidence.Methods. Data from participants aged 55 to 69 years in the Iowa Women's Health Study were linked to Medicare data for 1986 through 2004 (n=40377) to identify hospitalized VTE patients.Results. A total of 2137 women developed VTE, yielding an incidence rate of 4.04 per 1000 person-years. The 28-day case-fatality rate was 7.7%, and the 1-year recurrence rate was 3.4%. Educational attainment, physical activity, and age at menopause were inversely associated with VTE. Risk of secondary (particularly cancer-related) VTE was higher among smokers than among those who had never smoked. Body mass index, waist circumference, waist-to-hip ratio, height, and diabetes were positively associated with VTE risk. Hormone replacement therapy use was associated with increased risk of idiopathic VTE.Conclusions. VTE is a significant source of morbidity and mortality in older women. Risk was elevated among women who were smokers, physically inactive, overweight, and diabetic, indicating that lifestyle contributes to VTE risk.

 

 

J Clin Densitom. 2009 Nov 17. [Epub ahead of print]

Application of FRAX Model to Sri Lankan Postmenopausal Women.

Lekamwasam S.

Center for Metabolic Bone Diseases, Faculty of Medicine, Galle, Sri Lanka.

The FRAX software developed by the World Health Organization provides a method to estimate fracture probability of old men and women based on their bone mineral density (BMD) and clinical risk factors (CRFs). The validity of 4 selected ethnic-specific FRAX tools in determining prevalent fracture or treatment decisions in a group of postmenopausal women from Sri Lanka was examined. Women with a history of fragility fracture/s and those who were detected to have femoral neck T-score<2.5 were considered eligible for specific osteoporosis treatment. Ten-year all osteoporotic fracture (vertebral and nonvertebral) probability (10y-AOFP) of 481 postmenopausal women were estimated on US Caucasian, US Asian, Japanese, and Chinese FRAX tools, first using CRFs alone and then combining with femoral neck T-scores. At 20% 10y-AOFP, Chinese tool showed a very low sensitivity in detecting prevalent fracture or detecting women needing intervention (1.3%). Sensitivities observed with US Asian and Japanese tools ranged from 33% to 42%, showing their limitations in predicting prevalent fracture in this group of women. The US Caucasian tool, either with CRFs alone or with BMD incorporated, showed a relatively higher sensitivity in detecting fractures or identifying those needing interventions (71% and 76%, respectively). Furthermore, the US Caucasian tool showed a relatively high specificity (ranging from 70% to 87%). In conclusion, this analysis showed the limitations of the current FRAX tools in predicting fractures when applied to a different ethnic group. Until a separate FRAX tool is developed, the US Caucasian tool can be used to predict fractures in Sri Lankan postmenopausal women.

 

 

Exp Clin Endocrinol Diabetes. 2009 Nov;117(10):563-566. Epub 2009 Nov 18.

Obesity and Cancer.

Percik R, Stumvoll M.

Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel.

Epidemiological studies have suggested that obesity is associated with increased risk of several cancer types including colon, esophagus, breast (in postmenopausal women), endometrium, kidney, liver, gallbladder and pancreas. Suggested mechanisms include increased intake of potentially carcinogenic food ingredients along with excessive amount of calories, loss of cancer protective effects due to reduced physical activity, carcinogenic factors released from increased adipose tissue mass and "secondary" associations via "precursor" condition such as gallstones. The increased cancer risk in patients with obesity is a neglected topic which deserves more scientific attention. Because of its extreme chronicity and co-association with numerous other conditions true causality and underlying mechanisms are difficult to study. Nevertheless, a large body of literature is already available which provides concepts for future research. Š J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart ˇ New York.

 

 

Int J Obes (Lond). 2009 Nov 17. [Epub ahead of print]

Physical inactivity, abdominal obesity and risk of coronary heart disease in apparently healthy men and women.

Arsenault BJ, Rana JS, Lemieux I, Després JP, Kastelein JJ, Boekholdt SM, Wareham NJ, Khaw KT.

[1] Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada [2] Faculty of Medicine, Department of Anatomy and Physiology, Université Laval, Québec. Canada

Objective:To test the hypothesis that for any given body mass index (BMI) category, active individuals would have a smaller waist circumference than inactive individuals. Our second objective was to examine the respective contribution of waist circumference and physical inactivity on coronary heart disease (CHD) risk.Design:Prospective, population-based study with an 11.4-year follow-up.Subjects:A total of 21 729 men and women aged 45-79 years, residing in Norfolk, UK.Methods:During follow-up, 2191 CHD events were recorded. Physical activity was evaluated using a validated lifestyle questionnaire that takes into account both leisure-time and work-related physical activity. Waist circumference was measured and BMI was calculated for each participant.Results:For both men and women, we observed that within each BMI category (<25.0, 25-30 and >/=30.0 kg m(-2)), active participants had a lower waist circumference than inactive participants (P<0.001). In contrast, within each waist circumference tertile, BMI did not change across physical activity categories (except for women with an elevated waist circumference). Compared with active men with a low waist circumference, inactive men with an elevated waist circumference had a hazard ratio (HR) for future CHD of 1.74 (95% confidence interval (CI), 1.34-2.27) after adjusting for age, smoking, alcohol intake and parental history of CHD. In the same model and after further adjusting for hormone replacement therapy use, compared with active women with a low waist circumference, inactive women with an elevated waist circumference had an HR for future CHD of 4.00 (95% CI, 2.04-7.86).Conclusion:In any BMI category, inactive participants were characterized by an increased waist circumference, a marker of abdominal adiposity, compared with active individuals. Physical inactivity and abdominal obesity were both independently associated with an increased risk of future CHD.

 

Drug Des Devel Ther. 2009 Feb 6;2:193-202. Click here to read

Transdermal hormone therapy in postmenopausal women: A review of metabolic effects and drug delivery technologies.

Kopper NW, Gudeman J, Thompson DJ.

KV Pharmaceutical, St. Louis, MO, USA.

Vasomotor symptoms (VMS) associated with menopause can cause significant discomfort and decrease the quality of life for women in the peri-menopausal and post-menopausal stages of life. Hormone therapy (HT) is the mainstay of treatment for menopausal symptoms and is currently the only therapy proven effective for VMS. Numerous HT options are available to treat VMS, including estrogen-only and estrogen-progestogen combination products to meet the needs of both hysterectomized and nonhysterectomized women. In addition to selecting an appropriate estrogen or estrogen-progestogen combination, consideration should be given to the route of administration to best suit the needs of the patient. Delivery systems for hormone therapy include oral tablets, transdermal patches, transdermal topical (nonpatch) products, and intravaginal preparations. Oral is currently the most commonly utilized route of administration in the United States. However, evidence suggests that oral delivery may lead to some undesirable physiologic effects caused by significant gut and hepatic metabolism. Transdermal drug delivery may mitigate some of these effects by avoiding gut and hepatic first-pass metabolism. Advantages of transdermal delivery include the ability to administer unmetabolized estradiol directly to the blood stream, administration of lower doses compared to oral products, and minimal stimulation of hepatic protein production. Several estradiol transdermal delivery technologies are available, including various types of patches, topical gels, and a transdermal spray.

 

 

J Steroid Biochem Mol Biol. 2009 Nov 12. [Epub ahead of print]

Gene Expression Profiling Studies of Three SERMs and Their Conjugated Estrogen Combinations in Human Breast Cancer Cells: Insights into the Unique Antagonistic Effects of Bazedoxifene on Conjugated Estrogens.

Chang KC, Wang Y, Bodine PV, Nagpal S, Komm BS.

Wyeth Research, Transcriptional Targets, Tissue Repair, 500 Arcola Road, Collegeville, Pennsylvania,

Bazedoxifene (BZA), a new selective estrogen receptor modulator (SERM) was recently approved in Europe for the prevention and treatment of postmenopausal osteoporosis. Combination therapy using BZA and conjugated estrogens (CE) is currently in late stage development representing a new paradigm for the treatment of menopausal symptoms and prevention of osteoporosis. A GeneChip microarray study was designed to compare gene expression profiles of BZA to that of other SERMs, raloxifene (RAL) and lasofoxifene (LAS). In addition, we compared the gene expression profiles of the three SERMs in combination with CE, a mixture of 10 most abundant estrogens present in Premarin. According to the hierarchical clustering heat map analysis, gene clusters that specifically responded to CE treatments or SERM treatments were identified and gene lists sorted based on a set of cutoff filters. A group of genes differentially regulated by CE were also identified to be antagonized by BZA when comparing CE with the BZA+CE treatment. All three SERMs showed significant antagonistic effect against CE-stimulated cell proliferation, based on the MCF-7 cell proliferation assay and GeneChip data, with the order of antagonist activity being BZA>RAL>LAS. These results indicate that SERMs in combination with CE exhibit differential pharmacology, and therefore, combinations of other SERMs and estrogen preparations may not yield the same effects that are observed in clinic by pairing BZA with CE.

 

 

J Intern Med. 2009 Aug 26. [Epub ahead of print]

Menopause impacts the relation of plasma adiponectin levels with the metabolic syndrome.

Henneman P, Janssens AC, Zillikens MC, Frolich M, Frants RR, Oostra BA, van Duijn CM, van Dijk KW.

From the Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract. Henneman P, Janssens ACJW, Carola Zillikens M, Frolich M, Frants RR, Oostra BA, van Duijn CM, van Dijk KW (Leiden University Medical Center, Leiden; Erasmus Medical Center, Rotterdam, The Netherlands). Menopause impacts the relation of plasma adiponectin levels with the metabolic syndrome. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02162.xObjective. Plasma adiponectin is negatively correlated with metabolic syndrome (MetS) components obesity and insulin sensitivity. Here, we set out to evaluate the effect of menopause on the association of plasma adiponectin with MetS. Design. Data on plasma adiponectin and MetS were available from 2256 individuals participating in the Erasmus Rucphen Family study. Odds ratios for MetS were calculated by logistic regression analysis using plasma adiponectin quartiles. The discriminative accuracy of plasma adiponectin for MetS was determined by calculating the area under the curve (AUC) of receiver operator. Analyses were performed in women and men, pre- and postmenopausal women and younger and older men. Results. Virtually all determinants of MetS differed significantly between groups. Low plasma adiponectin showed the highest risk for MetS in postmenopausal women (odds ratio = 18.6, 95% CI = 7.9-44.0). We observed a high discriminative accuracy of age and plasma adiponectin for MetS not only in postmenopausal women (AUC = 0.76) but also in other subgroups (AUC from 0.67 to 0.87). However, in all groups, the discriminative accuracy of age and body mass index (BMI) for MetS was similar to the discriminative accuracy of age and plasma adiponectin. Conclusions. Low plasma levels of adiponectin are associated with increased prevalence of MetS, especially in postmenopausal women. Age and BMI have similar discriminatory accuracies for presence of MetS when compared with age and plasma adiponectin. Thus, we conclude that the association of plasma adiponectin with MetS is significantly affected by menopause but challenge the additional value of adiponectin for the discriminatory accuracy for presence of MetS.

 

Semana del 11 al 17 de Noviembre de 2009

                         

 

Gynecol Endocrinol. 2009 Aug;25(8):491-7.

Quality of life impairment among postmenopausal women varies according to race.

Monterrosa A, Blumel JE, Chedraui P, Gomez B, Valdez C.

Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia.

Background. Few studies have addressed the impact of menopausal symptom severity over quality of life (QoL) in Latin American women with different ethnics. Objective. To assess menopausal symptom severity and the QoL among postmenopausal Colombian women with three different ethnicities. Method. Data of healthy naturally occurring postmenopausal Hispanic, indigenous and black women aged 40-59 years who participated in a cross-sectional study filling out the Menopause Rating Scale (MRS) and a general questionnaire was analysed. Results. A total of 579 women were included, 153 Hispanic, 295 indigenous and 131 Afro-descendent. Hispanic women had an average age of 55.3 +/- 3.3 years. Indigenous and black women were less educated than the Hispanic ones (2.2 +/- 1.8 and 4.6 +/- 4.4 vs. 6.4 +/- 3.5 years, p < 0.0001). Hispanic women displayed lower total MRS scores (better QoL) when compared to indigenous and black women. Urogenital scoring was worse among indigenous women compared to Hispanic and black women. Black women presented higher MRS psychological and somatic scorings than Hispanic and indigenous women. After adjusting for confounding factors, indigenous and black women continued to display a higher risk for impaired QoL, total MRS score >16 (OR: 3.11, 95% CI: 1.30-7.44 and OR: 5.29, 95% CI: 2.52-11.10, respectively), which was significantly higher among indigenous women due to urogenital symptoms (OR: 102.75, 95% CI: 38.33-275.47) and black women due to psychological (OR: 6.58, 95% CI: 3.27-13.27) and somatic symptoms (OR: 3.88, 95% CI: 1.83-8.22). Conclusion. In this postmenopausal Colombian series, menopausal symptoms in indigenous (urogenital) and black (somatic/psychological) women were more severe (impaired QoL) when compared to Hispanic ones.

 

 

Endocrinology. 2009 Nov 11. [Epub ahead of print]

Tissue-Selective Regulation of Aromatase Expression by Calcitriol: Implications for Breast Cancer Therapy.

Krishnan AV, Swami S, Peng L, Wang J, Moreno J, Feldman D.

Departments of Medicine, Division of Endocrinology, Stanford University School of Medicine, Ca. USA. Aromatase, the enzyme that catalyzes estrogen synthesis, is critical for the progression of estrogen receptor-positive breast cancer (BCa) in postmenopausal women. We show that calcitriol, the hormonally active form of vitamin D, regulates the expression of aromatase in a tissue-selective manner. Calcitriol significantly decreased aromatase expression in human BCa cells and adipocytes and caused substantial increases in human osteosarcoma cells (a bone cell model exhibiting osteoblast phenotype in culture) and modest increases in ovarian cancer cells. Calcitriol administration to immunocompromised mice bearing human BCa xenografts decreased aromatase mRNA levels in the tumors and the surrounding mammary adipose tissue but did not alter ovarian aromatase expression. In BCa cells, calcitriol also reduced the levels of prostaglandins (PGs), major stimulators of aromatase transcription, by suppressing the expression of cyclooxygenase-2 (which catalyzes PG synthesis) and increasing that of 15-hydroxyprostaglandin dehydrogenase (which catalyzes PG degradation). The mechanism of aromatase down-regulation by calcitriol in BCa cells is therefore 2-fold: a direct repression of aromatase transcription via promoter II through the vitamin D-response elements identified in this promoter and an indirect suppression by reducing the levels of PGs. Combinations of calcitriol with three different aromatase inhibitors (AIs) caused enhanced inhibition of BCa cell growth. The combination of calcitriol and an AI may have potential benefits for BCa therapy. In addition to augmenting the ability of AIs to inhibit BCa growth, calcitriol acting as a selective aromatase modulator that increases aromatase expression in bone would reduce the estrogen deprivation in bone caused by the AIs, thus ameliorating the AI-induced side effect of osteoporosis.

 

 

Am J Clin Nutr. 2009 Nov 11. [Epub ahead of print]

The Soy Isoflavones for Reducing Bone Loss (SIRBL) Study: a 3-y randomized controlled trial in postmenopausal women.

Alekel DL, Van Loan MD, Koehler KJ, Hanson LN, Stewart JW, Hanson KB, Kurzer MS, Peterson CT.

Nutrition and Wellness Research Center, Department of Food Science and Human Nutrition and the Department of Statistics, Iowa State University, Ames, IA.

BACKGROUND: Our previous study indicated that soy protein with isoflavones lessened lumbar spine bone loss in midlife women. OBJECTIVE: We examined the efficacy of isoflavones (extracted from soy protein) on bone mineral density (BMD) in nonosteoporotic postmenopausal women. We hypothesized that isoflavone tablets would spare BMD, with biological (age, body weight, serum 25-hydroxyvitamin D) and lifestyle (physical activity, dietary intake) factors modulating BMD loss. DESIGN: Our double-blind, randomized controlled trial (36 mo) included healthy postmenopausal women (aged 45.8-65.0 y) with intent-to-treat (n = 224) and compliant (n = 208) analyses. Treatment groups consisted of a placebo control group and 2 soy isoflavone groups (80 compared with 120 mg/d); women received 500 mg calcium and 600 IU vitamin D(3). Outcomes included lumbar spine, total proximal femur, femoral neck, and whole-body BMD. RESULTS: Analysis of variance for intent-to-treat and compliant (>/=80%) models, respectively, showed no treatment effect for spine (P = 0.46, P = 0.21), femur (P = 0.86, P = 0.46), neck (P = 0.17, P = 0.14), or whole-body (P = 0.86, P = 0.78) BMD. From baseline to 36 mo, BMD declined regardless of treatment. In intent-to-treat and compliant models, respectively, BMD decreases were as follows: spine (-2.08%, -1.99%), femur (-1.43%, -1.38%), neck (-2.56%, -2.51%), and whole body (-1.66%, -1.62%). Regression analysis (compliant model) indicated that age, whole-body fat mass, and bone resorption were common predictors of BMD change. After adjustment for these factors, 120 mg (compared with placebo) was protective (P = 0.024) for neck BMD. We observed no treatment effect on adverse events, endometrial thickness, or bone markers. Conclusion: Our results do not show a bone-sparing effect of extracted soy isoflavones, except for a modest effect at the femoral neck.

 

 

Ann N Y Acad Sci. 2009 Oct;1179:153-166.

Glucocorticoid Signaling in the Cell.

Chrousos GP, Kino T.

First Department of Pediatrics, Athens University Medical School, Athens, Greece.

Glucocorticoids contribute to the maintenance of basal and stress-related homeostasis in all higher organisms, and influence a large proportion of the expressed human genome, and their effects spare almost no organs or tissues. Glucocorticoids regulate many functions of the central nervous system, such as arousal, cognition, mood, sleep, the activity and direction of intermediary metabolism, the maintenance of a proper cardiovascular tone, the activity and quality of the immune and inflammatory reaction, including the manifestations of the sickness syndrome, and growth and reproduction. The numerous actions of glucocorticoids are mediated by a set of at least 16 glucocorticoid receptor (GR) isoforms forming homo- or hetero-dimers. The GRs consist of multifunctional domain proteins operating as ligand-dependent transcription factors that interact with many other cell signaling systems, including large and small G proteins. The presence of multiple GR monomers and homo- or hetero-dimers expressed in a cell-specific fashion at different quantities with quantitatively and qualitatively different transcriptional activities suggest that the glucocorticoid signaling system is highly stochastic. Glucocorticoids are heavily involved in human pathophysiology and influence life expectancy. Common behavioral and/or somatic complex disorders, such as anxiety, depression, insomnia, chronic pain and fatigue syndromes, obesity, the metabolic syndrome, essential hypertension, diabetes type 2, atherosclerosis with its cardiovascular sequelae, and osteoporosis, as well as autoimmune inflammatory and allergic disorders, all appear to have a glucocorticoid-regulated component.

 

 

Gynecol Endocrinol. 2009;25(12):823-7.

Testosterone addition to estrogen therapy - Effects on inflammatory markers for cardiovascular disease.

Kocoska-Maras L, Hirschberg AL, Byström B, Schoultz BV, Rĺdestad AF.

Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm.

Objective. To analyze the effects of testosterone addition to estrogen therapy in comparison with estrogen alone on cardiovascular risk factors in postmenopausal women. Methods. Fifty surgically postmenopausal women were included in this double-blind, placebo-controlled and randomized study to receive daily oral treatment with estradiol valerate 2 mg + placebo (E/P) or estradiol valerate 2 mg + testosterone undecanoate 40 mg (E/T) for 24 weeks and then switched to the other regimen for another 24 weeks. Sex hormones, High sensitivity CRP (hsCRP), Interleukin-6 (IL-6), Tissue necrosis factor (TNF)-alpha, Insulin-like growth factor binding globulin (IGFBP-1), vascular cell adhesion molecule (VCAM)- 1, and homocysteine were analyzed at baseline and after 6 and 12 months. Results. Estradiol and androgens increased as expected during the treatments. After 6 months of E/P, increases of hsCRP and IGFBP-1 and a decline of VCAM were recorded, whereas IL-6, TNF-alpha, and homocysteine were unchanged. When testosterone was added to estrogen, the increase of IGFBP-1 and decline in VCAM was similar as with estrogen treatment alone. However, testosterone addition counteracted the estrogen-induced rise in hsCRP but had no effects on IL-6, TNF-alpha, and homocysteine. Conclusion. Data suggest that testosterone addition to estrogen treatment in postmenopausal women has a modest influence on inflammatory markers and there were no apparent adverse effects. On the contrary, the estrogen-induced increase in hsCRP was suppressed.

 

 

J Clin Oncol. 2009 Nov 9. [Epub ahead of print]

Conjugated Equine Estrogen Influence on Mammographic Density in Postmenopausal Women in a Substudy of the Women's Health Initiative Randomized Trial.

McTiernan A, Chlebowski RT, Martin C, Peck JD, Aragaki A, Pisano ED, Wang CY, Johnson KC, et al.

Fred Hutchinson Cancer Research Center, Division of Public Health Sciences; University of Washington, Department of Epidemiology, School of Public Health and Community Medicine, and Department of Medicine, School of Medicine, Seattle, WA. USA

PURPOSE: Increased mammographic density is associated with increased breast cancer risk and reduced sensitivity of screening mammography and is related to hormone exposure. However, the effects of conjugated equine estrogens (CEEs) alone on mammographic density in diverse racial/ethnic populations are not established. We examined the effect of CEE alone on mammographic density in a subsample of the Women's Health Initiative (WHI) clinical trial participants. PATIENTS AND METHODS: In the WHI trial, women were randomly assigned to daily CEE 0.625 mg or placebo. The effect of CEE on mammographic percent density was determined over 1 and 2 years in a stratified random sample of 435 racially and ethnically diverse participants from 15 of 40 WHI clinics. RESULTS: Use of CEE resulted in mean increase in mammographic percent density of 1.6 percentage points (95% CI, 0.8 to 2.4) at year 1 compared with a mean decrease of 1.0 percentage point (95% CI, -1.7 to -0.4) in the placebo group (P < .001). The effect persisted for 2 years, with a mean increase of 1.7 percentage points (95% CI, 0.7 to 2.7) versus a mean decrease of 1.2 percentage points (95% CI, -1.8 to -0.5; P < .001) in the hormone and placebo groups, respectively. These effects were greater in women age 60 to 79 years (P = .03 for interaction across age). CONCLUSION: Use of CEE results in a modest but statistically significant increase in mammographic density that is sustained over at least a 2-year period. The clinical significance of the CEE effect on mammographic density remains to be determined.

 

 

Gynecol Endocrinol. 2009;25(12):807-15.

Progestagen component in combined hormone replacement therapy in postmenopausal women and breast cancer risk: A debated clinical issue.

Gadducci A, Biglia N, Cosio S, Sismondi P, Genazzani AR.

Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.

The relevance of the progestagen component in combined hormone replacement therapy (HRT) for breast cancer risk has been long debated. In vitro studies have shown that progestins exert both genomic transcriptional and non-genomic effects that can enhance the proliferation, invasiveness and spread of breast cancer cells. According to a novel hypothesis, progestins can still activate cancer stem cells in patients with pre-existing, clinically undetected breast cancer. However, some experimental and clinical data suggest that different progestins may have a different impact on the pathophysiology of malignant breast cells. In vitro studies on estrogen receptor (ER)+ breast cancer cells have shown that the addition of medroxyprogesterone acetate (MPA) to estradiol (E(2)) produces a significantly higher increase of the mRNA levels and activities of estrogen-activating enzymes aromatase, 17beta hydroxysteroid dehydrogenase type-1 and sulfatase when compared with progesterone plus E(2). In randomised trial performed on ovariectomised adult female monkeys, oral E(2) plus MPA have resulted in a significantly greater proliferation of breast lobular and ductal epithelium when compared with placebo, whereas E(2) plus micronised progesterone have not. In the same experimental model, oral E(2) plus MPA have been found to induce the expression of genes encoding epidermal growth factor receptor (EGFR) ligands and downstream targets, whereas E(2) alone or E(2) plus micronised progesterone had no or modest effects on EGFR-related genes. In last years, some clinical studies on HRT users have shown that androgenic progestin- or MPA-based formulations are associated with an increased breast cancer incidence, whereas micronised progesterone- or dydrogesterone-based formulations are not. Further basic and clinical investigations on this topic are strongly warranted to elucidate whether the choice of the progestagen component in combined HRT could be of clinical relevance as for breast cancer risk.

 

 

Climacteric. 2009 Dec;12(6):525-32.

Risk of hypoactive sexual desire disorder and associated factors in a cohort of oophorectomized women.

Castelo-Branco C, Palacios S, Combalia J, Ferrer M, Traveria G.

Hospital Clinic, Faculty of Medicine, University of Barcelona, Spain.

BACKGROUND: Women with surgical menopause are at high risk of developing hypoactive sexual desire disorder (HSDD), which may cause sexual and emotional discomfort. AIM: To determine the prevalence of HSDD and related risk factors in Spanish surgically postmenopausal women. DESIGN: Multicenter, cross-sectional study. Material and methods The Brief Profile of Female Sexual Function (B-PFSF) questionnaire was given to 1136 surgically postmenopausal women between 18 and 81 years old (mean 52.1 +/- 7.1 years) attending gynecological consultations in different urban and rural areas in Spain, covering the country widely. RESULTS: From the entire sample, 1083 subjects were finally included. The mean score on the B-PFSFwas 15.9 and a total of 74.4% of the patients presented total scores lower or equal to 20, indicating the risk of presenting with HSDD. The possibility to be at risk of HSDD increased with age from 65.9% in the age group <45 years old to 76.6% in the age group > or =55 years old. Non-users of hormone replacement therapy presented a higher risk of HSDD (odds ratio 2.1; 95% confidence interval 1.3-3.4); the risk was increased as well when the time elapsed since surgical menopause was <5 years (odds ratio 1.8; 95% confidence interval 1.0-3.0). CONCLUSION: Nearly three out of four women who had undergone bilateral oophorectomy were at risk of suffering HSDD; this risk was increased when less than 5 years since surgical menopause had elapsed. The use of hormone replacement therapy was associated with lower HSDD risk.

 

 

Endocr Relat Cancer. 2009 Nov 10. [Epub ahead of print]

Plasma sex hormone concentrations and breast cancer risk in an ethnically diverse population of postmenopausal women: the Multiethnic Cohort Study.

Woolcott C, Shvetsov Y, Stanczyk F, Wilkens L, White K, Caberto C, Henderson B, Le Marchand L, Kolonel L, Goodman M.

C Woolcott, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, United States.

To add to the existing evidence that comes mostly from White populations, we conducted a nested case-control study to examine the association between sex hormones and breast cancer risk within the Multiethnic Cohort that includes Japanese American, White, Native Hawaiian, African American, and Latina women. Of the postmenopausal women for whom we had a plasma sample, 132 developed breast cancer during follow-up. Two controls per case, matched on study area (Hawaii, Los Angeles), ethnicity/race, birth year, date and time of blood draw and time fasting, were randomly selected from the women who had not developed breast cancer. Levels of estradiol, estrone, androstenedione, dehydroepiandrosterone (DHEA) and testosterone were quantified by radioimmunoassay after organic extraction and Celite column partition chromatography. Estrone sulfate, dehydroepiandrosterone sulfate (DHEAS), and sex hormone binding globulin (SHBG) were quantified by direct immunoassays. Based on conditional logistic regression, the sex hormones were positively associated and SHBG was negatively associated with breast cancer risk. All associations, except those with DHEAS and testosterone showed a significant linear trend. The odds ratio associated with a doubling of estradiol levels was 2.26 (95% confidence interval (CI) 1.58-3.25) and the odds ratio associated with a doubling of testosterone levels was 1.34 (95% CI 0.98-1.82). The associations in Japanese American women, who constituted 54% of our sample, were similar to or nonsignificantly stronger than in the overall group. This study provides the best evidence to date that the association between sex hormones and breast cancer risk is generalizable to an ethnically diverse population.

 

 

Semana del 4 al 10 de Noviembre de 2009

                         

 

J Med Assoc Thai. 2009 Sep;92 Suppl5:S30-41.

Combination of alfacalcidol with calcium can improve quadriceps muscle strength in elderly ambulatory Thai women who have hypovitaminosis D: a randomized controlled trial.

Songpatanasilp T, Chailurkit LO, Nichachotsalid A, Chantarasorn M.

Department of Orthopedics, Phramongkutklao Army Hospital and College of Medicine, Bangkok, Thailand. thaweesps@yahoo.com

OBJECTIVE: The purpose of this study was to evaluate the efficacy of alfacalcidol and calcium on the improvement of muscle strength in ambulatory elderly Thai women in age group of 65 or more who have hypovitaminosis D. MATERIAL AND METHOD: Seventy-two postmenopausal women age 65 years or more were enrolled to this study. Blood was collected from all participants for measured of 25(OH)D3, intact PTH and vitamin D receptor (VDR) genotypes. After blood collection, the quadriceps muscle strength was measured using the isokinetic dynamometer device. There were 42 subjects who satisfy the eligible criteria and agreed to participate in the experimental randomized controlled study. These subjects were randomized into two groups, one received calcium 1500 g/day combined with alfacalcidol 0.5 mg/day. Another group received calcium 1500 g/day with placebo. RESULTS: After 12 weeks of intervention, 40 subjects had the second muscle strength measurement (2 dropped out). By ANCOVA analysis, there were significant improvement of muscle strength in the group that received alfacalcidol compared to placebo in both 30 degrees/sec (20.28 vs.16.29, p = 0.025) and 60 degrees/sec (20.32 vs. 15.05, p = 0.002) angular velocities. CONCLUSION: Daily doses of 0.5 mg alfacalcidol with calcium effectively improved muscle strength in elderly Thai women who had low level of 25(OH)D3 compared to calcium alone.

 

 

Breast Cancer Res Treat. 2009 Nov 6. [Epub ahead of print]

Reductions in use of hormone replacement therapy: effects on Swedish breast cancer incidence trends only seen after several years.

Lambe M, Wigertz A, Holmqvist M, Adolfsson J, Bardage C, Fornander T, Karlsson P, Odlind V, Persson I, Ahlgren J, Bergkvist L.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden, Mats.Lambe@ki.se.

Studies from Western countries have found evidence of a recent decline in breast cancer incidence rates in postmenopausal women, findings which have been hypothesized to reflect a reduced use of hormonal replacement therapy (HRT). We examined breast cancer incidence trends in Sweden between 1997 and 2007, a period characterized by a drop in the use of HRT. Incidence trends were assessed using data from three population-based Regional Clinical Registries on breast cancer covering 2/3 of the Swedish population. Information on HRT sales was obtained from national pharmacy data. The prevalence of HRT use in age group 50-59 years decreased from a peak of 36% in 1999 to 27% in 2002 and further to 9% in 2007. Incidence rates of breast cancer in women 50 years and older increased between 1997 and 2003. A significant decrease in incidence between 2003 and 2007 was confined to women 50-59 years of age, the group in which the prevalence of HRT use has been highest and the decrease in use most pronounced. As opposed to the immediate effects reported from the United States and other regions, there was a time lag between the drop in HRT use and clear reductions in breast cancer incidence. This may reflect between country differences with regard to types of HRT used, and the rate, magnitude and pattern of change in use. The present findings give further support to the notion that HRT use is a driver of breast cancer incidence trends on the population level.

 

 

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Oct;34(10):998-1002.

Association of serum testosterone with lean body mass, body fat content, and bone mineral density in postmenopausal females.

Zhang H, Liu W, Ye A, Zhao Q, Luo X, Liao E.

Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha 410011, China.

Objective To determine the relationship between serum testosterone level and lean body mass, body fat content, and bone mineral density (BMD).Methods The study involved 185 healthy females in Changsha, aged 45~81. Fasting serum testosterone was measured by radioimmunoassay. Hologic QDR 4500A fan beam X-ray bone densitometer was used to measure the BMD of anteroposterior lumber(AP, L(1~4)) and total hip,to measure the bone mineral content, BMD, body fat content and muscle tissue weight of head, trunk, ribs, pelvis, spine, upper limbs, lower limbs and the total body. Body weight, lean body mass and body fat percentage were calculated. SPSS11.0 software was used to conduct regression analysis.Results (1)Serum testosterone showed no correlation with lean body mass, body fat content, and body fat percentage. (2)Serum testosterone was positively related with the BMD of lumbar spine and hip, but showed no correlation with the BMD after adjustment of age and years since postmenopause. (3)Lean body mass showed significant positive correlation with the BMD of different sites. Total body fat content showed positive correlation with the BMD of total hip, while body fat percentage showed negative correlation with the BMD of the whole body. Conclusion Keeping lean body mass benefits postmenopausal women to maintain bone mineral content, and taking androgen should still be cautious.

 

 

Bone. 2009 Nov 2. [Epub ahead of print]

Serum Tsh Values And Risk Of Vertebral Fractures In Euthyroid Post-Menopausal Women With Low Bone Mineral Density.

Mazziotti G, Porcelli T, Patelli I, Vescovi PP, Giustina A.

Department of Medical and Surgical Sciences, University of Brescia, Italy; Department of Internal Medicine, Azienda Ospedaliera Carlo Poma, Mantova, Italy.

Introduction. There is evidence that variations of thyrotropin (TSH) even in its reference range may influence bone mineral density (BMD). In fact, low-normal TSH values have been associated with high prevalence of osteoporosis in post-menopausal women. However, data associating TSH and risk of fractures are scanty and limited to subjects with subclinical thyrotoxicosis. Materials and Methods. In this observational study, we investigated the correlation between serum TSH and prevalence of radiological vertebral fractures in a cohort of 130 post-menopausal women without biochemical and instrumental evidence of thyroid disease. Results. Osteoporosis was observed in 80 women (61.5%), whereas 49 women (37.7%) had osteopenia. Vertebral fractures were found in 49 women (37.7%), who were significantly older, with higher prevalence of osteoporosis and with lower serum TSH values as compared with women who did not fracture. Stratifying the patients according to serum TSH values, vertebral fractures were found to be significantly (p=0.004) more prevalent in first tertile (56.8%) of TSH values as compared with the second (23.3%) and third tertiles (32.6%). Multivariate logistic regression analysis demonstrated that low serum TSH maintained a significant correlation with vertebral fractures (odds ratio 2.8, C.I. 95% 1.20-6.79) even after correction for age, BMD, BMI and serum free-thyroxine values. Discussion. Low-normal TSH values are associated with high prevalence of vertebral fractures in women with post-menopausal osteoporosis or osteopenia, independently of thyroid hormones, age and BMD.

 

 

Climacteric. 2009 Nov 3. [Epub ahead of print]

Insomnia in Japanese peri- and postmenopausal women.

Terauchi M, Obayashi S, Akiyoshi M, Kato K, Matsushima E, Kubota T.

Department of Obstetrics and Gynecology.

Objective To determine the prevalence and to identify the correlates of insomnia in Japanese peri- and postmenopausal women. Method We retrospectively analyzed the records of 1451 peri- and postmenopausal women enrolled in the Systematic Health and Nutrition Education Program, conducted at the Menopause Clinic of the Tokyo Medical and Dental University Hospital, between 1995 and 2009. Results The prevalence of insomnia was 50.8%. The severity of insomnia correlated negatively with health-related quality of life (HR-QOL) scores on all the four domains assessed: physical health, mental health, life satisfaction and social involvement. With regard to other menopausal symptoms, insomnia correlated more strongly with depressed mood than with vasomotor symptoms, and one-third of insomniac women were seriously depressed. On categorizing the participants into four groups - not insomniac or depressed, N; insomniac but not depressed, I; not insomniac but depressed, D; insomniac and depressed, ID - the HR-QOL scores were observed to worsen in order N > I > D > ID. No significant difference was detected between groups I and ID with regard to their sleep quality measures. The number of heavy smokers was high in groups I and ID. With regard to the effect of the combination of medication and health/nutrition education, hormone therapy and nightly hypnotics significantly improved the insomnia symptoms, but hypnotics administered 'as needed' did not. Conclusions Insomnia in Japanese peri- and postmenopausal women correlates more strongly with depressed mood than with vasomotor symptoms. Cessation of smoking may improve the women's sleep quality, and hormone therapy and nightly hypnotics are both effective treatments.

 

 

Eur J Obstet Gynecol Reprod Biol. 2009 Oct 29. [Epub ahead of print]

Effects of menopausal hormone therapy on hemostatic parameters, blood pressure, and body weight: Open-label comparison of randomized treatment with estradiol plus drospirenone versus estradiol plus norethisterone acetate.

Junge W, El-Samalouti V, Gerlinger C, Schaefers M.

Laboratorium für Klinische Forschung GmbH, Raisdorf, Germany.

OBJECTIVES: Clinical studies have reported changes in hemostatic parameters in women taking menopausal hormone therapy (HT) and a small increased risk of venous thromboembolism. We compared the effects of two different HTs on hemostatic parameters in postmenopausal women. STUDY DESIGN: An open-label, randomized study conducted at two centers in Germany compared continuous 28-week combined HT with 17beta-estradiol 1mg plus drospirenone 2mg (E2/DRSP) daily versus E2 1mg plus norethisterone acetate 0.5mg (E2/NETA) daily in healthy postmenopausal women. Changes in D-dimer levels from baseline to the end of treatment, as well as effects on further parameters of coagulation, fibrinolysis, and global hemostasis, and effects on bleeding pattern, blood pressure, and body weight were evaluated. RESULTS: D-dimer levels increased by 9.1% (median change) with E2/DRSP (n=29) and by 15.1% with E2/NETA (n=30). Other hemostatic parameters showed <10% median change from baseline in both treatment groups, except for tissue plasminogen activator antigen (E2/DRSP, -1.9%; E2/NETA, -24.2%). Systolic blood pressure decreased from baseline by 6.4mmHg in the E2/DRSP group compared with 0.1mmHg in the E2/NETA group at final examination. Body weight remained stable in the E2/DRSP group (+0.18kg) compared with a slight increase (+1.00kg) in the E2/NETA group. In nonhysterectomized women, the mean number of bleeding/spotting days was 5.2 (2.0 bleeding/3.2 spotting) in the E2/DRSP and 8.2 (4.4 bleeding/3.8 spotting) in the E2/NETA group. Most nonhysterectomized women, however, remained amenorrheic during the study period (E2/DRSP, 68%; E2/NETA, 62%). CONCLUSION: Both E2/DRSP and E2/NETA were associated with a minor increase in fibrinolytic activity and a slight change in the concentration of some coagulation factors. Both HTs were well tolerated. The decrease in systolic blood pressure and stable body weight in the E2/DRSP group are consistent with DRSP's anti-aldosterone properties.