Selección de Resúmenes de Menopausia
Semana del 28 de Enero al 3 de Febrero de 2009
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad de Chile
Postgrad Med. 2009 Jan;121(1):73-85.
The bioidentical hormone debate: are bioidentical
hormones (estradiol, estriol, and progesterone) safer or more efficacious than
commonly used synthetic versions in hormone replacement therapy?
Holtorf Medical Group, Inc.,
Background: The use of bioidentical
hormones, including progesterone, estradiol, and estriol, in hormone
replacement therapy (HRT) has sparked intense debate. Of special concern is
their relative safety compared with traditional synthetic and animal-derived
versions, such as conjugated equine estrogens (CEE), medroxyprogesterone
acetate (MPA), and other synthetic progestins. Proponents for bioidentical
hormones claim that they are safer than comparable synthetic and nonhuman
versions of HRT. Yet according to the US Food and Drug Administration and The Endocrine
Society, there is little or no evidence to support claims that bioidentical
hormones are safer or more effective. Objective: This paper aimed to evaluate
the evidence comparing bioidentical hormones, including progesterone,
estradiol, and estriol, with the commonly used nonbioidentical versions of HRT
for clinical efficacy, physiologic actions on breast tissue, and risks for
breast cancer and cardiovascular disease. Methods: Published papers were
identified from PubMed/MEDLINE, Google Scholar, and Cochrane databases, which
included keywords associated with bioidentical hormones, synthetic hormones,
and HRT. Papers that compared the effects of bioidentical and synthetic
hormones, including clinical outcomes and in vitro results, were selected. Results:
Patients report greater satisfaction with HRTs that contain progesterone
compared with those that contain a synthetic progestin. Bioidentical hormones
have some distinctly different, potentially opposite, physiological effects
compared with their synthetic counterparts, which have different chemical
structures. Both physiological and clinical data have indicated that
progesterone is associated with a diminished risk for breast cancer, compared
with the increased risk associated with synthetic progestins. Estriol has some
unique physiological effects, which differentiate it from estradiol, estrone,
and CEE. Estriol would be expected to carry less risk for breast cancer,
although no randomized controlled trials have been documented. Synthetic
progestins have a variety of negative cardiovascular effects, which may be
avoided with progesterone. Conclusion: Physiological data and clinical outcomes
demonstrate that bioidentical hormones are associated with lower risks,
including the risk of breast cancer and cardiovascular disease, and are more
efficacious than their synthetic and animalderived counterparts. Until evidence
is found to the contrary, bioidentical hormones remain the preferred method of
HRT. Further randomized controlled trials are needed to delineate these
differences more clearly.
Gynecol
Endocrinol. 2008
Dec;24(12):718-23.
Effects of two estroprogestins containing
ethynilestradiol 30 microg and drospirenone 3 mg and ethynilestradiol 30 microg
and chlormadinone 2 mg on skin and hormonal hyperandrogenic manifestations.
Lello
S, Primavera
G, Colonna
L, Vittori
G, Guardianelli
F, Sorge
R, Raskovic
D.
Endocrinological Gynecology and
Pathophysiology of Menopause Unit, IRCCS-Istituto Dermopatico dell'Immacolata,
Hyperandrogenic manifestation in women,
such as seborrhea, acne and increased hair growth are common reasons of
psychological distress. Skin appearance is very important for young women. This
study evaluated the hormonal and skin effects of two estroprogestins (EPs) containing
ethinyl-estradiol (EE) 30 microg associated with drospirenone (DRSP) 3 mg or
chlormadinone acetate (CMA) 2 mg, respectively. Fifty-five women with signs and
symptoms of hyperandrogenism (seborrhea, acne and increased hair growth) were
enrolled in the study; randomly, 30 women were treated with EE 30 microg + DRSP
3 mg and 25 with EE 30 microg + CMA 2 mg. Follicle-stimulating hormone (FSH),
luteinising hormone (LH), 17-hydroxyprogesterone (17OHP), androstenedione (A),
testosterone (T), dehydroepiandrosterone sulfate (DHEAS), sex hormone binding
globulin (SHBG) and free androgen index (T x 100/SHBG, FAI) were assessed at
baseline, and after 3 and 6 months of treatment with EPs. Effects on seborrhea,
acne and increased hair growth (as Ferriman-Gallwey score) were also evaluated
at the same time points. Finally, skin hydration, transepidermal water loss
(TEWL) and skin homogeneity were studied with non-invasive technique during the
study. Treatment for 6 months with both EPs decreased significantly the circulating
androgen levels (A, T, DHEAS) and FAI, and increased SHBG levels; also skin
pattern was improved. EP containing EE and DRSP was better than EP containing
EE and CMA as for skin changes, as seborrhea, acne, increased hair, hydration,
homogeneity and overall quality of the skin; moreover, hormonal changes (as
FAI) under therapy were more pronounced with EE/DRSP than EE/CMA. These effects
may be considered in EP choice and could be important in improving patient's
compliance and quality of life in hyperandrogenic women.
Gynecol Endocrinol. 2008 Dec;24(12):696-700
Coronary heart disease and HRT in
Mares P, Chevallier T, Micheletti MC, Daures JP,
Postruznik D, De Reilhac P.
Service de Gynecologie Obstetrique, CHU
Hopital Caremeau, Nimes, France.
OBJECTIVE: To determine the morbidity incidence
associated with Hormone Replacement Therapy (HRTs) in postmenopausal women.
This paper presents the results concerning the incidence of coronary heart
disease (CHD). DESIGN:
Gynecol Endocrinol. 2008
Dec;24(12):691-5
Effect of androgens combined with hormone
therapy on quality of life in post-menopausal women with sexual dysfunction.
Blümel JE, Del Pino M, Aprikian D,
Vallejo S, Sarrá S, Castelo-Branco C.
Facultad Medicina, Departamento Medicina
Sur, Universidad de Chile, Santiago de Chile, Chile.
AIM: To evaluate with validated
instruments changes in quality of life and sexuality in women receiving
hormonal replacement therapy (AHT). DESIGN: Randomised, double-blind,
double-dummy study with two parallel treatment arms. PATIENTS AND METHODS:
Forty-seven healthy post-menopausal women, aged 45-64 years, were evaluated
using the Female Sexual Function Index (FSFI) and the menopause-specific
quality of life questionnaire (MENQOL). Of them, 40 diagnosed with sexual
dysfunction were randomised (1:1) to receive daily 0.625 mg of conjugated
estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised
progesterone or placebo. After 3 months follow-up, FSFI and MENQOL
questionnaires were administered for a second time. RESULTS: Quality of life
was unchanged in the placebo group whereas AHT significantly improved scores of
vasomotor, psychological, physical and sexual symptoms. As expected, FSFI was
not modified in the placebo group while in AHT group the FSFI score improved
significantly. In addition, at the end of the study, 68.7% of subjects of the
AHT group did not fit did not fit the criteria for sexual dysfunction as per
the FSFI (p < 0.0001). CONCLUSIONS: Adding methyl-testosterone to hormone
therapy improves quality of life and sexuality in post-menopausal women with
sexual dysfunction.
Arch Intern Med. 2009 Jan
26;169(2):132-40.
Loop diuretic use and fracture in
postmenopausal women: findings from the Women's Health Initiative.
Carbone LD, Johnson KC, Bush AJ, Robbins
J, Larson JC, Thomas A, LaCroix AZ.
Department of
BACKGROUND: The relationship of loop
diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal
women has not been established. METHODS: We examined whether loop diuretics are
associated with changes in BMD, falls, and fractures in women enrolled in the
Women's Health Initiative. We included the 133,855 women (3411 users and
130,444 nonusers of loop diuretics) who were enrolled in the WHI from
Appl Nurs Res. 2009 Feb;22(1):35-41.
Incidence of bone loss, falls, and
fractures after Roux-en-Y gastric bypass for morbid obesity.
Berarducci A, Haines K, Murr MM.
University of South Florida Colleges of
Medicine and Nursing,
The objectives of this study were to
determine the incidence of and associated risks for falls and fractures after
gastric bypass surgery for morbid obesity and to determine the clinical signs
of bone loss. The sample consisted of 167 individuals at a mean age of 47 years
(SD = 10). Ten participants (6%) reported a decrease in height since surgery,
and 33 (20%) reported a decrease in height since they were 20 years old. Eight
participants (5%) reported postoperative fractures. Twenty-three participants
(13.8%) reported falling once since surgery, and 34 (20.4%) reported falling
two or more times since surgery. Twelve participants reported a new diagnosis
of osteoporosis postoperatively, and 1 participant reported a new diagnosis of
osteopenia. Sixty-seven percent (n = 112) of the participants were never
advised to undergo a bone density test postoperatively. The findings from this
study suggest that bone loss is a critical issue in this patient population,
with 25% (n = 42) reporting a decrease in height, 8% (n = 13) reporting a new
diagnosis of osteoporosis or osteopenia, and 5% (n = 8) reporting fractures
during a mean postoperative interval of 2.4 years. In addition, risk for
skeletal fragility is profound in this cohort of individuals, with 34% (n = 57)
indicating a history of one or more falls postoperatively. The results from
this study clearly indicate a need for early recognition of bone loss in this
population so that timely interventions can be initiated to prevent further
loss and subsequent fractures.
J Sex Med. 2009 Jan;6(1):175-83
Clinically relevant changes in sexual
desire, satisfying sexual activity and personal distress as measured by the
profile of female sexual function, sexual activity log, and personal distress
scale in postmenopausal women with hypoactive sexual desire disorder.
DeRogatis LR, Graziottin A, Bitzer J,
Schmitt S, Koochaki PE, Rodenberg C.
INTRODUCTION: Transdermal testosterone
patch (TTP) treatment produced statistically significant improvements in a
satisfying sexual activity (SSA), sexual desire, and personal distress in
postmenopausal women suffering from hypoactive sexual desire disorder (HSDD),
but clinical significance of these changes was not determined. AIM: To quantify
the magnitude of change in three principal outcomes measures determined by HSDD
patients as associated with the perception of meaningful benefit with TTP
therapy. METHODS: The criteria for defining responders were determined using
anchoring methodology and receiver operating characteristics analysis to
establish minimum important differences (MIDs) in a representative subsample of
132 patients in two randomized, controlled trials in surgically menopausal
women with HSDD (N = 1,094). Perceived benefit was established based upon the
question "Overall, would you say that you experienced a meaningful benefit
from the study patches?". These data defined responders and established
MIDs for changes in sexual desire, SSA, and personal distress. The MIDs were
applied to the two trials to establish responder rates in each treatment group.
MAIN OUTCOME MEASURES: Changes in score that correspond to the MID for sexual
desire, SSA, and personal distress, and responder rates in each treatment group
based upon these values. RESULTS: Increases in frequency of SSA of greater than
1 activity/4 weeks, increases in sexual desire score of > or = 8.9, and
decreases in the personal distress score of > or = 20.0 were identified as
threshold improvements best able to differentiate responders and nonresponders.
The responder rate was significantly higher (P < 0.001) in the testosterone
group vs. placebo for all three outcomes measures (sexual desire, 50% vs. 34%;
SSA, 44% vs. 30%; personal distress, 51% vs. 39%). CONCLUSIONS: Changes in
sexual desire, SSA, and personal distress observed with TTP treatment in
surgically menopausal women with HSDD were clinically significant and were
associated with a meaningful treatment benefit.
J Sex Med. 2009 Jan;6(1):30-9
The effects of hypoestrogenism on the
vaginal wall: interference with the normal sexual response.
Lara LA, Useche B, Ferriani RA, Reis RM,
de Sá MF, de Freitas MM, Rosa e Silva JC, Rosa e Silva AC.
Ribeirão Preto School of Medicine,
University of São Paulo-Department of Gynaecology and Obstetrics, Ribeirão
Preto, Brazil. luciaalvess@yahoo.com.br
INTRODUCTION: The sexual response depends
on the adequate function of all systems related to the genital and
extra-genital organs. Physiological conditions such as menopause can interfere
with sexual expression because of central and peripheral changes. Genital
effects of estrogen include vaginal trophism, lubrication, and local pleasure
sensation in the sexual arousal phase. Hypoestrogenism causes changes in the
four layers of the vaginal wall that may result in dyspareunia and a loss in
the quality of the genital arousal response. AIM: The purpose of this review is
to highlight the changes in the vaginal wall caused by hypoestrogenism, its
possible relationship with dyspareunia, and its repercussions for genital
arousal. Treatments for hypoestrogenism are also discussed. METHODS: We
evaluated the data available in PubMed (1982-2008) and surveyed the reference
list for relevant studies. Two reviewers analyzed the data independently. A
study was considered to be of high quality if it had all three of the following
characteristics: (i) prospective design; (ii) valid data; and (iii) adequate
sample size. Reviews and experimental animal studies were also considered. MAIN
OUTCOME MEASURES:
J Sex Med. 2009 Jan;6(1):8-18; quiz 19-20
Testosterone replacement therapy in
naturally and surgically menopausal women.
Panzer C, Guay A.
Rose Medical Center-Department of
Endocrinology,
INTRODUCTION: Testosterone replacement
therapy in naturally and surgically menopausal women is a complex and currently
highly debated topic. Opposing guidelines for the use of testosterone exist,
which create a therapeutic dilemma for clinicians confronted by severely
distressed women who experience a decrease in sexual desire after surgical or
natural menopause. AIM: In this review, we will address the current knowledge
on androgen physiology, conditions associated with a low androgen state, and
risks and benefits of androgen therapy. METHODS: An English-language Medline
review was performed. MAIN OUTCOME MEASURE: Review of available literature.
RESULTS: A review of normal androgen physiology in women is summarized and a
brief review of prior use of androgens over the last six decades is included.
The data on the use of androgen replacement in pre- and postmenopausal women is
evaluated, especially its relationship to sexual functioning. Special concerns
about the effect of androgens on cardiovascular disease, breast, and
endometrial tissue are discussed. The balance of evidence seems to show that
androgens have more of a positive effect than a negative effect in women if
used properly. CONCLUSIONS: Testosterone replacement therapy for surgically and
naturally menopausal women with low sexual desire can be accomplished
physiologically and effectively after ruling out other medical conditions
leading to low sexual desire and after proper information of the patient that
testosterone therapy is not an FDA-approved medication in the
BMC Public Health. 2009 Jan 26;9(1):37.
[Epub ahead of print
Age-specific symptom prevalence in women
35-64 years old . A population-based study.
Bardel A, Wallander MA, Wedel H, Svardsudd
K.
ABSTRACT: BACKGROUND: Symptom prevalence
is generally believed to increase with age. The aim of this study was to
evaluate the age specific prevalence of 30 general symptoms among Swedish
middle-aged women. METHODS: A cross-sectional postal questionnaire study in
seven Swedish counties in a random sample of 4,200 women 35-64 years old, with
2,991 responders. Thirty general symptoms included in the Complaint Score
subscale of the Gothenburg Quality of Life Instrument were used. RESULTS: Four
groups of age specific prevalence patterns were identified after adjustment for
the influence of educational level, perceived health and mood, body mass index,
smoking habits, use of hormone replacement therapy, and use of other symptom
relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye
problems and impaired hearing) increased significantly with age. Eleven
symptoms (general fatigue, headache, irritability, melancholy, backache,
exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea)
decreased significantly with age. Two symptoms (sweating and impaired
concentration) had a biphasic course with a significant increase followed by a
significant decrease. The remaining twelve symptoms (difficulty in relaxing,
restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain,
constipation, nervousness, poor appetite, weight loss, and difficulty in
urinating) had stable prevalence with age. CONCLUSIONS: Symptoms did not
necessarily increase with age instead symptoms related to
stress-tension-depression decreased.
Menopause. 2009 Jan 23. [Epub ahead of
print]
Additive effect of depressed mood and
vasomotor symptoms on postmenopausal insomnia.
Zervas IM, Lambrinoudaki I, Spyropoulou
AC, Koundi KL, Voussoura E, Tzavara C, Verdeli H, Aravantinos L, Creatsa M,
Paparrigopoulos T.
From the 1Women's Mental Health Clinic;
2IPT Unit, First Department of Psychiatry, Eginition Hospital; and 3Menopause
Clinic, Second Department of Obstetrics and Gynecology, Aretaieion Hospital,
Athens University Medical School, Athens, Greece; 4Department of Counseling and
Clinical Psychology, Teachers College; and 5College of Physicians and Surgeons,
Columbia University, New York, NY; and 6Sleep Research Unit, First Department
of Psychiatry, Eginition Hospital, Athens University Medical School, Athens,
Greece.
OBJECTIVE:: The aim of this study was to
investigate the role of vasomotor and mood symptoms on insomnia in
postmenopausal women. METHODS:: One hundred sixty-three postmenopausal women,
not receiving hormone therapy, attending a menopause clinic at the University
of Athens, Greece, were included in this cross-sectional study. Climacteric
symptoms were assessed by Greene's scale, whereas psychological morbidity was
measured by Zung Self-Assessment Depression Scale, Symptom Checklist-90-R, and
Athens Insomnia Scale. RESULTS:: Vasomotor symptoms were significantly
associated with insomnia (P = 0.001). When depressive symptomatology was added
to the logistic regression analysis, the predictive ability of the model was
significantly improved as defined by the increase in the log likelihood (P <
0.001) and the increase in the area under the receiver operating characteristic
curve. CONCLUSIONS:: Insomnia in postmenopausal women attending a menopause
clinic is related both to the effects of vasomotor symptoms and depressive
symptomatology. Mood symptoms seem to affect sleep independently of vasomotor
symptoms, suggesting that depression should be carefully assessed and treated
in postmenopausal women with insomnia.
Menopause. 2009 Jan 21. [Epub ahead of
print
A prospective study of the association
between endogenous hormones and depressive symptoms in postmenopausal women.
Ryan J, Burger HG, Szoeke C, Lehert P,
Ancelin ML, Dennerstein L.
From 1The University of Melbourne,
Parkville, Victoria, Australia; 2Inserm U888, Montpellier, F-34093 France;
3University of Montpellier, Montpellier, F-34000 France; 4Prince Henry's
Institute of Medical Research, Clayton, Victoria, Australia; and 5University of
Mons, Belgium.
OBJECTIVE:: Across a woman's lifetime,
variations in hormone levels are known to influence mood and well-being.
Whether absolute or changes in hormone levels over time are associated with
depression among postmenopausal women remains unclear. METHODS:: The Melbourne
Women's Midlife Health Project is a longitudinal population-based study of
women who were followed through the menopausal transition. This analysis is
based on data collected from 138 postmenopausal women in years 11 and 13 of the
study, who were assessed for the presence of depressive symptoms using the
Center for Epidemiological Studies Depression Scale. Logistic regression models
were developed to determine whether absolute or changes in hormone levels were
associated with depression. RESULTS:: No significant associations were found
between depressive symptoms and the absolute levels of sex hormone-binding
globulin, testosterone, free androgen index, estradiol, free estradiol, or
follicle-stimulating hormone (FSH). On the other hand, women with a decline in
total serum estradiol over the 2-year period had a more than threefold
increased risk of depressive symptoms (odds ratio, 3.5; 95% CI, 1.2-9.9). A
large increase in FSH levels over this period was also associated with
depressive symptoms (odds ratio, 2.6; 95% CI, 1.0-6.7). These associations
remained even after adjustment for initial depression score, as well as a range
of potential confounding factors. CONCLUSIONS:: Changes in estradiol and, to a
lesser extent, in FSH levels are associated with an increased risk of
depressive symptoms in postmenopausal women. These results further support a
role for fluctuating rather than absolute hormone levels in depression in later
life.
Selección de Resúmenes de Menopausia
Semana del 4 al 10 de Febrero de 2009
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de
Chile
Arq
Bras Endocrinol Metabol. 2008 Dec;52(9):1439-47.
Risk of late-onset hypogonadism
(andropause) in Brazilian men over 50 years of age with osteoporosis:
usefulness of screening questionnaires.
Clapauch R, Braga DJ, Marinheiro LP, Buksman S, Schrank Y.
Division of Female Endocrinology and
Andrology, Endocrinology Sector, Hospital da Lagoa, Instituto Fernandes
Figueira, Fiocruz, Rio de Janeiro, RJ, Brazil.
OBJECTIVE: To analyze the relative risk of
late-onset hypogonadism in men with osteoporosis and the usefulness of
screening questionnaires. METHODS: We correlated the Aging Male's Symptoms
(AMS), Androgen Deficiency in Aging Male (ADAM) and International Index of
Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of
hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with
normal bone density, paired by age and ethnicity). RESULTS: Hypogonadism
presented in 25% of the osteoporotic and in 12.2 % of normal bone density men
(OR 2.08; IC95%: 1.14-3.79) and was associated with ADAM first question (low
libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score
above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels.
CONCLUSION: Hypogonadism was 2.08 times more prevalent in osteoporotic men. The
symptom that best correlated with late-onset hypogonadism was low libido (ADAM
1 positive).
Menopause. 2009 Feb 3. [Epub
ahead of print]
Is the immunological noise of abnormal
autoimmunity an independent risk factor for premature ovarian aging?
Gleicher N, Weghofer A, Oktay K, Barad DH.
OBJECTIVE:: The risk for premature ovarian
failure increases in association with two principal known etiologies: in the
presence of excessive triple CGG expansions on the FMR1 (fragile X) gene (genetic
etiology) and in association with a variety of autoimmune conditions
(autoimmune etiology). To what degree milder forms of premature ovarian aging
are also associated with these two etiologies is, however, unknown. METHODS::
We, therefore, investigated 119 consecutive, so identified, infertile women and
statistically correlated by linear and logistic regression analyses ovarian
function parameters to markers of a possible genetic etiology (number of CGG
triple repeats on the FMR1 gene) and to markers of possible abnormal immune
function (immune panel). RESULTS:: Sixty (50.4%) of 119 participants
demonstrated at least one immune abnormality. Both groups did not differ
statistically in age, mean follicle-stimulating hormone, estradiol, and
antimüllerian hormone levels, although antimüllerian hormone suggested a trend
toward higher levels in autoimmune participants (P = 0.19). Autoimmune
participants also demonstrated lower mean triple CGG expansion sizes (P <
0.05) and included fewer women with greater than or equal to 35 triple repeats
(relative risk, 4.0; 95% CI, 1.3-11.9; P < 0.01), previously reported to
demarcate increased risk for premature ovarian aging. CONCLUSIONS:: Even
minimal evidence of abnormal autoimmune function ("immunological noise")
seems to increase risk toward premature ovarian aging, often manifesting as
infertility. Evidence of abnormal autoimmune function, such as increased CGG
triple expansion sizes, in young women, therefore, warrants vigilance for
development of prematurely diminished ovarian reserve and infertility.
N Engl J Med. 2009 Feb
5;360(6):573-87.
Breast cancer after use of estrogen plus
progestin in postmenopausal women.
Chlebowski RT, Kuller LH, Prentice RL, Stefanick ML, Manson JE, Gass M, Aragaki AK, Ockene JK, Lane DS, Sarto GE, Rajkovic A, Schenken R, Hendrix SL, Ravdin PM, Rohan TE, Yasmeen S, Anderson G; WHI Investigators.
Los Angeles Biomedical Research Institute
at Harbor-UCLA Medical Center, Torrance, CA 90502, USA. rchlebowski@gmail.com
BACKGROUND: Following the release of the
2002 report of the Women's Health Initiative (WHI) trial of estrogen plus
progestin, the use of menopausal hormone therapy in the United States decreased
substantially. Subsequently, the incidence of breast cancer also dropped,
suggesting a cause-and-effect relation between hormone treatment and breast
cancer. However, the cause of this decrease remains controversial. METHODS: We
analyzed the results of the WHI randomized clinical trial--in which one study
group received 0.625 mg of conjugated equine estrogens plus 2.5 mg of
medroxyprogesterone acetate daily and another group received placebo--and
examined temporal trends in breast-cancer diagnoses in the WHI
observational-study cohort. Risk factors for breast cancer, frequency of
mammography, and time-specific incidence of breast cancer were assessed in
relation to combined hormone use. RESULTS: In the clinical trial, there were
fewer breast-cancer diagnoses in the group receiving estrogen plus progestin
than in the placebo group in the initial 2 years of the study, but the number
of diagnoses increased over the course of the 5.6-year intervention period. The
elevated risk decreased rapidly after both groups stopped taking the study
pills, despite a similar frequency of mammography. In the observational study,
the incidence of breast cancer was initially about two times as high in the
group receiving menopausal hormones as in the placebo group, but this
difference in incidence decreased rapidly in about 2 years, coinciding with
year-to-year reductions in combined hormone use. During this period,
differences in the frequency of mammography between the two groups were
unchanged. CONCLUSIONS: The increased risk of breast cancer associated with the
use of estrogen plus progestin declined markedly soon after discontinuation of
combined hormone therapy and was unrelated to changes in frequency of
mammography.
Menopause. 2009 Feb 3. [Epub
ahead of print]
Angeliq versus Activelle in normotensive
postmenopausal women: a prospective, randomized pilot study.
Battaglia C, Cianciosi A, Mancini F, Persico N, Sisti G, Facchinetti F, Busacchi P.
From the 1Department of Obstetrics and
Gynecology, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and
2Department of Obstetrics and Gynecology, University of Modena and Reggio
Emilia, Modena, Italy.
OBJECTIVE:: The aim of this study was to
compare, in normotensive postmenopausal women, the effects of
drospirenone/estradiol and norethisterone acetate/estradiol on blood pressure
and other surrogate markers of cerebrovascular and cardiovascular risk.
METHODS:: Thirty postmenopausal women were submitted to utero-ovarian
ultrasonography and to color Doppler evaluation of ophthalmic arteries.
Ultrasonographic and Doppler analysis of brachial artery flow-mediated
vasodilatation and 24-hour ambulatory blood pressure monitoring were performed.
Plasma concentrations of nitrites/nitrates were assayed. The participants were
randomly assigned to drospirenone 2 mg/estradiol 1 mg (group 1; n = 15) or
norethisterone acetate 0.5 mg/estradiol 1 mg (group 2; n = 15) treatment. The
duration of the study was 6 months. RESULTS:: The basal pulsatility index and
the back pressure of the ophthalmic artery were similar in groups 1 and 2.
After 6 months, no changes were observed. The nitrites/nitrates values were not
different between groups 1 and 2 both in basal conditions and after therapy.
The brachial artery flow-mediated vasodilatation and the pulsatility index of
the brachial artery did not show any difference in groups 1 and 2 both in basal
conditions and after the therapy. The 24-hour blood pressure monitoring showed
no significant differences in the 24-hour time, daytime, and nighttime values
either in basal conditions or after therapy. All participants were found to be
dippers normally (nocturnal reduction >/=10% in comparison with diurnal values).
The wake-up blood pressure values were similar in the studied participants.
CONCLUSIONS:: A 6-month hormone therapy with drospirenone/estradiol or
norethisterone acetate/estradiol is equally effective and does not seem to
alter the surrogate markers of cardiovascular and cerebrovascular risk.
Value Health. 2009 Jan 12.
[Epub ahead of print
Hypoactive Sexual Desire Disorder in
Postmenopausal Women: Quality of Life and Health Burden.
Biddle AK, West SL, D'Aloisio AA, Wheeler SB, Borisov NN, Thorp J.
Department of Health Policy and
Management, Gillings, School of Global Public Health, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA.
ABSTRACT Objectives: To describe the health-related
quality of life (HRQOL) implications of hypoactive sexual desire disorder
(HSDD) in a national sample of postmenopausal women ages 30-70. Methods: The
Nationwide Survey of Female Sexual Health, a random-digit telephone survey of
US households, collected information on female sexual function, demographic
characteristics, HRQOL, and the presence of specific medical disorders from
1189 naturally or surgically postmenopausal women in stable relationships of
>/=3 months duration. HSDD was defined as <40 on the Profile of Female
Sexual Function((c)) scale and <60 on the Personal Distress Scale((c)).
Short Form-12 Health Survey (SF-12) summary and domain scores, and EuroQol
(EQ-5D) index score and dimensions were compared with population-based norms for
healthy individuals and selected chronic conditions. Results: HSDD was
associated with significant HRQOL decrements, with the largest SF-12 score
differences in mental health (HSDD: 45.4 [standard error 1.9] vs. no HSDD: 51.0
[0.6], P < 0.01), vitality (HSDD: 47.7 [1.3] vs. no HSDD: 52.0 [0.7], P <
0.01), social function (HSDD: 47.3 [1.4] vs. no HSDD: 50.9 [0.7], P < 0.05),
and bodily pain (HSDD: 41.4 [2.2] vs. no HSDD: 46.7 [0.9], P < 0.05). EQ-5D
index was 0.08 points lower (HSDD: 0.76 [0.03] vs. no HSDD: 0.84 [0.02], P <
0.05) for those with HSDD compared with those without. HSDD was associated with
a 0.1-point decrement in naturally menopausal women (HSDD: 0.78 [0.03] vs. no
HSDD 0.88 [0.01], P < 0.01). Women with HSDD showed more HRQOL impairment than
healthy population norms but were similar to adults with other chronic
conditions such as diabetes and back pain. Conclusions: Women with HSDD showed
substantial impairment in HRQOL. Given a prevalence of 6.6% to 12.5% among US
women, HSDD represents an important burden on quality of life.
Menopause. 2009 Feb 2. [Epub
ahead of print]
Duration of vasomotor symptoms in
middle-aged women: a longitudinal study.
Col NF, Guthrie JR, Politi M, Dennerstein L.
From the 1Center for Outcomes Research and
Evaluation, Maine Medical Center, Portland, ME; 2Office for Gender and Health,
Department of Psychiatry, The University of Melbourne, Victoria, Australia; and
3Department of Behavioral and Preventive Medicine, Brown Medical School,
Providence, RI.
OBJECTIVE:: Vasomotor symptoms adversely
affect the quality of life and functional status of most women during the
menopausal transition, but little is known about how long these symptoms last.
The most effective treatment, hormone therapy (HT), carries risks and benefits
that depend on the timing and duration of use. In this study we sought to
estimate the duration of vasomotor symptoms in a longitudinal study. METHODS::
We reanalyzed primary data from 438 women in the longitudinal cohort of the
population-based Melbourne Women's Midlife Health Project. Two hundred and five
women who had completed 13 years of follow-up were included in the analyses.
The onset and cessation of vasomotor symptoms were reported, stratifying
analyses according to ever use of HT. Symptom duration was calculated as the
time between the first and last bothersome hot flush reported. RESULTS:: The
mean (SD) duration of bothersome menopausal symptoms for women who completed 13
years of follow-up and who never used HT was estimated to be 5.2 (3.8) years
(median, 4 years). If women who used HT were included, the mean (SD) duration
was 5.5 (4.0) years (median, 4 years). The estimated duration of symptoms
varied according to the duration of longitudinal follow-up, with a mean
estimate of 3.4 years (median, 3 years) when only 8 years of follow-up data
were analyzed. The only factor associated with duration of hot flushes was
regular exercise-more exercise was associated with shorter symptom duration.
CONCLUSIONS:: The average duration of vasomotor symptoms in this sample is more
than 5 years, substantially longer than had been previously reported.
Menopause. 2009 Feb 2. [Epub
ahead of print]
Temporal associations of hot flashes and
depression in the transition to menopause.
From the Departments of
1Obstetrics/Gynecology, 2Psychiatry, 3Center for Clinical Epidemiology and
Biostatistics, and 4Center for Research in Reproduction and Women's Health,
University of Pennsylvania School of Medicine, Philadelphia, PA.
OBJECTIVE:: The aim of this study was to
evaluate associations between hot flashes and depressed mood in the menopausal
transition and associations of these symptoms with reproductive hormone
changes. METHODS:: A 10-year follow-up in a population-based cohort of women
who had no experience of hot flashes or depressed mood at baseline was
conducted. RESULTS:: The incidence of hot flashes significantly increased
compared with the incidence of depressed mood in the 10-year follow-up (P <
0.001). Sixty-seven percent of the women reported hot flashes, 50% reported
depressed mood, and 41% reported both symptoms during the study interval.
Reporting of both hot flashes and depressed mood was greater than expected if
the processes operated independently (P < 0.001). Of the women who
experienced both symptoms, depressed mood was more likely to precede hot
flashes (relative risk = 2.1; 95% CI, 1.5-2.9). Within-woman increases in
follicle-stimulating hormone levels were associated with the onset of depressed
mood in unadjusted analysis (P = 0.05). Increased follicle-stimulating hormone
levels, decreased inhibin B levels, and the variability of estradiol were
significantly associated with hot flashes. Follicle-stimulating hormone and
inhibin B remained significantly associated with hot flashes in the final
multivariable models (P < 0.001). CONCLUSIONS:: Both hot flashes and
depressive symptoms occur early in the menopausal transition in women with no
previous experience of these symptoms. Depressive symptoms are more likely to
precede hot flashes in women who report both symptoms. The findings support the
concept that the changing hormonal milieu of the menopausal transition is one
of multiple factors associated with the onset of symptoms.
Bone. 2008 May 15. [Epub ahead of print]
Alendronate/vitamin D(3) 70 mg/2800 IU
with and without additional 2800 IU vitamin D(3) for osteoporosis: Results from
the 24-week extension of a 15-week randomized, controlled trial.
Binkley N, Ringe JD, Reed JI, Ljunggren O, Holick MF, Minne HW, Liu M, Lamotta A, West JA, Santora AC.
University of Wisconsin-Madison,
Osteoporosis Clinical Center and Research Program,
Although vitamin D supplementation is a
fundamental part of osteoporosis treatment, many patients do not regularly take
adequate amounts. A once-weekly (OW) alendronate (ALN) preparation that
includes 2800 IU of vitamin D(3) in a single combination tablet (ALN+D2800) is
available for treating patients and ensuring intake of vitamin D that is
consistent with existing guidelines. This randomized, double-blind study
extension was conducted to evaluate the safety and tolerability of ALN+D2800
and ALN+D2800 plus an additional 2800 IU vitamin D(3) single tablet supplement
(ALN+D5600) administered for 24 weeks in men and postmenopausal women with
osteoporosis previously treated OW for 15 weeks with either ALN or ALN+D2800.
The primary endpoint was the proportion of participants who developed
hypercalciuria (defined as a 24-hour urine calcium >300 mg in women or
>350 mg in men and an increase of >25% versus randomization baseline) at
week 39. The key secondary endpoint was the proportion of participants with vitamin
D insufficiency (serum 25(OH)D <15 ng/mL [37.4 nmol/L]) at the end of the
study. Hypercalciuria incidence (4.2% [ALN+D5600] vs. 2.8% [ALN+D2800]), did
not differ between groups (p = 0.354). No participants developed hypercalcemia.
Among the participants with vitamin D insufficiency at the week 0 baseline, the
prevalence of insufficiency at the end of the study was reduced by 92% in the
ALN+D5600 group and by 86% in the ALN+D2800 group. The incidences of clinical
adverse experiences, including drug-related adverse experiences, were similar
in both groups. In subjects previously treated with ALN+D2800 for 15 weeks, the
addition of 2800 IU D(3) for 24 weeks did not produce hypercalcemia nor
increase the risk of hypercalciuria.
Selección de Resúmenes
de Menopausia
Semana del 11 al 17 de Febrero de 2009
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad de Chile
Psychoneuroendocrinology. 2009 Feb 10. [Epub
ahead of print
Chronic estradiol replacement to aged female rats reduces anxiety-like
and depression-like behavior and enhances cognitive performance.
Department of
Decline in the
ovarian steroid, estradiol (E(2)), with the menopause transition may influence
cognitive and affective processing of older women and there is evidence that
hormone replacement therapies (HRTs) with E(2)-mimetics may provide benefit in
some, but not all, women. The parameters that play a role in determining
whether the response to HRTs is positive are of interest. It may be that the
likelihood for positive responses is related to the timing of E(2)-replacement
following E(2) decline. As such, in the present study an animal model was
utilized to investigate this. We investigated the effects of long- versus
short-term E(2)-replacement by examining cognitive (object placement task),
anxiety (open field, mirror maze, light-dark transition task), and depression
(forced swim task) behavior of female rats that were ovariectomized (OVX) at
middle-age (14 months) or older (19 months) and implanted with E(2)-filled
implants at the time of surgery or after a delay of 5 months, or OVX at 14
months of age and never replaced with E(2). Rats were tested at 20 months of
age. The hypothesis that was tested was that rats would have reduced anxiety
and depression behavior and improved cognitive performance with
E(2)-replacement at ovarian cessation, compared to a delay in E(2)-replacement.
Performance in the object placement task was improved in rats that were OVX and
then received continuous E(2)-replacement, compared to those that were OVX and continuously
administered placebo vehicle. In the open field and forced swim task, there was
an increase in anti-anxiety and anti-depression behavior, respectively, among
rats that were OVX and then received continuous E(2)-replacement, compared to
OVX rats administered vehicle or those that experienced a delay in
E(2)-replacement. In the mirror maze and light-dark transition task,
E(2)-replacement at OVX, or after a delay, reduced anxiety-like behavior. Thus,
E(2)-replacement reduced anxiety and depression behavior and improved cognitive
performance of aged female rats; however, delay in E(2) treatment influenced
whether there were favorable effects of E(2) in some tasks.
Menopause. 2009 Feb 10. [Epub ahead of print
Longitudinal changes in sexual functioning as women transition through
menopause: results from the Study of Women's Health Across the Nation.
Avis NE, Brockwell S, Randolph JF Jr, Shen S, Cain VS, Ory M, Greendale GA.
From the
1Department of Social Sciences and Health Policy, Wake Forest University School
of Medicine, Winston-Salem, NC; 2Epidemiology Data Center, University of
Pittsburgh, Pittsburgh, PA; 3Division of Reproductive Endocrinology, University
of Michigan Health System, Ann Arbor, MI; 4Centers for Disease Control, Washington,
DC; 5School of Rural Public Health, Texas A&M University System Health
Sciences Center, College Station, TX; and 6Geffen School of Medicine at
University of California Los Angeles, Los Angeles, CA.
OBJECTIVE:: Sexual
functioning is an important component of women's lives. The extent to which the
menopausal transition is associated with decreased sexual functioning remains
inconclusive. This study seeks to determine if advancing through the menopausal
transition is associated with changes in sexual functioning. METHODS:: This was
a prospective, longitudinal cohort study of women aged 42 to 52 years at
baseline recruited at seven US sites (N = 3,302) in the Study of Women's Health
Across the Nation (SWAN). Cohort-eligible women had an intact uterus, had at
least one ovary, were not currently using exogenous hormones, were either
premenopausal or early perimenopausal, and self-identified as one of the
study's designated racial/ethnic groups. Data from the baseline interview and
six annual follow-up visits are reported. Outcomes are self-reported ratings of
importance of sex; frequency of sexual desire, arousal, masturbation, sexual
intercourse, and pain during intercourse; and degree of emotional satisfaction
and physical pleasure. RESULTS:: With adjustment for baseline age,
chronological aging, and relevant social, health, and psychological parameters,
the odds of reporting vaginal or pelvic pain increased and desire decreased by
late perimenopause. Masturbation increased at early perimenopause but declined
during postmenopause. The menopausal transition was unrelated to other
outcomes. Health, psychological functioning, and importance of sex were related
to all sexual function outcomes. Age, race/ethnicity, marital status, change in
relationship, and vaginal dryness were also associated with sexual functioning.
CONCLUSIONS:: Pain during sexual intercourse increases and sexual desire
decreases over the menopausal transition. Masturbation increases during the
early transition, but then declines in postmenopause. With adjustment for other
factors, the menopausal transition was not independently associated with
reports of the importance of sex, sexual arousal, frequency of sexual
intercourse, emotional satisfaction with partner, or physical pleasure.
Clin Exp Rheumatol. 2008
Nov-Dec;26(6):986-91.
Idiopathic osteoporosis in premenopausal women. Clinical characteristics
and bone remodelling abnormalities.
Peris P, Ruiz-Esquide V, Monegal A, Alvarez L, Martínez de Osaba MJ, Martínez-Ferrer A, Reyes R, Guañabens N.
Services of
1Rheumatology, Hospital Clínic,
OBJECTIVE:
Osteoporosis is infrequent in young premenopausal women and is often associated
with secondary disorders. However, idiopathic osteoporosis may be found in this
setting and few data are known on this condition. Therefore, the aim of this
study was to analyse the clinical characteristics and bone remodelling
abnormalities in premenopausal women with idiopathic osteoporosis.METHODS:28
premenopausal women with idiopathic osteoporosis (aged 38.3+/-7.6 years) were
included. The patients had one or more fragility fractures and/or decreased
bone mass (z-score <-2 in the lumbar spine or femur). In all patients,
secondary causes of osteoporosis were excluded and previous skeletal fractures,
family history and risk factors for osteoporosis were recorded. In addition,
bone mineral density at the lumbar spine and hip, spinal x-rays, and laboratory
tests including PTH, 25-hydroxyvitamin D, 1,25 (OH)<inf>2</inf>
vitamin D and urinary calcium excretion were measured. Bone markers such as
serum bone alkaline phosphatase (bone AP) and P1NP, and urinary hydroxyproline
(HYP), NTx and CTx were measured and results were compared with those observed
in a control group of 28 healthy premenopausal women. RESULTS:46% of the
patients had previous fragility fractures, 53% had family history of
osteoporosis, 36% had associated hypercalciuria and 30% had a BMI <20
Kg/m<sup>2</sup>. Patients with idiopathic osteoporosis had
increased bone resorption markers (NTx and HYP) but normal bone formation
markers when compared with healthy controls. No significant differences in the
clinical and biochemical parameters were observed between patients with or
without hypercalciuria. CONCLUSION:Young women with idiopathic osteoporosis
have an increased bone resorption without changes in bone formation when
assessed by biochemical markers.
Arch Intern Med. 2009 Feb 9;169(3):294-304
Multivitamin use and risk of cancer and cardiovascular disease in the
Women's Health Initiative cohorts.
Neuhouser ML, Wassertheil-Smoller S, Thomson C, Aragaki A, Anderson GL, Manson JE, Patterson RE, Rohan TE, van Horn L, Shikany JM, Thomas A, LaCroix A, Prentice RL.
Division of Public
Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N.,
Seattle, WA 98109-1024, USA. mneuhous@fhcrc.org
BACKGROUND:
Millions of postmenopausal women use multivitamins, often believing that
supplements prevent chronic diseases such as cancer and cardiovascular disease
(CVD). Therefore, we decided to examine associations between multivitamin use
and risk of cancer, CVD, and mortality in postmenopausal women. METHODS: The
study included 161 808 participants from the Women's Health Initiative clinical
trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary
modification, and calcium and vitamin D supplements) or an observational study
(N = 93 676). Detailed data were collected on multivitamin use at baseline and
follow-up time points. Study enrollment occurred between 1993 and 1998; the
women were followed up for a median of 8.0 years in the clinical trials and 7.9
years in the observational study. Disease end points were collected through
2005. We documented cancers of the breast (invasive), colon/rectum,
endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial
infarction, stroke, and venous thromboembolism); and total mortality. RESULTS:
A total of 41.5% of the participants used multivitamins. After a median of 8.0
years of follow-up in the clinical trial cohort and 7.9 years in the
observational study cohort, 9619 cases of breast, colorectal, endometrial,
renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865
deaths were reported. Multivariate-adjusted analyses revealed no association of
multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95%
confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI,
0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for
endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR,
1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI,
0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for
stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or
mortality (HR, 1.02, and 95% CI, 0.97-1.07). CONCLUSION: After a median
follow-up of 8.0 and 7.9 years in the clinical trial and observational study
cohorts, respectively, the Women's Health Initiative study provided convincing
evidence that multivitamin use has little or no influence on the risk of common
cancers, CVD, or total mortality in postmenopausal women.
Arch Intern Med. 2009 Feb 9;169(3):269-78
Exercise dose and quality of life: a randomized controlled trial.
Martin CK, Church TS, Thompson AM, Earnest CP, Blair SN.
Pennington
Biomedical Research Center, Louisiana State University System, 6400 Perkins
Road, Baton Rouge, LA 70808, USA. Martin@pbrc.edu
BACKGROUND:
Improved quality of life (QOL) is a purported benefit of exercise, but few
randomized controlled trials and no dose-response trials have been conducted to
examine this assertion. METHODS: The effect of 50%, 100%, and 150% of the
physical activity recommendation on QOL was examined in a 6-month randomized
controlled trial. Participants were 430 sedentary postmenopausal women (body
mass index range, 25.0-43.0 [calculated as weight in kilograms divided by
height in meters squared]) with elevated systolic blood pressure randomized to
a nonexercise control group (n = 92) or 1 of 3 exercise groups: exercise energy
expenditure of 4 (n = 147), 8 (n = 96), or 12 (n = 95) kilocalories per
kilogram of body weight per week. Eight aspects of physical and mental QOL were
measured at baseline and month 6 with the use of the Medical Outcomes Study
36-Item Short Form Health Survey. RESULTS: Change in all mental and physical
aspects of QOL, except bodily pain, was dose dependent (trend analyses were
significant, and exercise dose was a significant predictor of QOL change; P
< .05). Higher doses of exercise were associated with larger improvements in
mental and physical aspects of QOL. Controlling for weight change did not
attenuate the exercise-QOL association. CONCLUSION: Exercise-induced QOL
improvements were dose dependent and independent of weight change.
Selección de Resúmenes
de Menopausia
Semana del 18 al 24 de Febrero de 2009
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad de Chile
Maturitas. 2009 Feb 12. [Epub ahead of print
Is the Menopause Rating Scale accurate for diagnosing sexual dysfunction
among climacteric women?
Jara D, Fuenzalida A, Figueroa R, Del Prado M, Flores D, Blümel JE, Chedraui P.
Universidad Diego Portales, Santiago,
Chile.
BACKGROUND:
Although several tools have been designed to assess quality of life (QoL) among
middle-aged women their capacity to specifically assess sexual dysfunction (SD)
remains uncertain. Moreover, if SD impairs QoL within this population, then
sexual assessment becomes a key issue. OBJECTIVES: To evaluate the accuracy of
the Menopause Rating Scale (MRS) in diagnosing SD among climacteric women.
METHODS: In this cross-sectional study 370 women aged 40-59 years filled out
the MRS and the Female Sexual Functioning Index (FSFI) simultaneously. SD among
surveyed women was defined as those obtaining a total FSFI score of
</=26.55. A receiver-operator curve (ROC) was used to plot and measure the
diagnostic accuracy of one MRS item (item 8, assessing sexual problems) using
the FSFI total score as a gold standard. RESULTS: Mean age of surveyed women
was 49.3+/-5.8 years. A 56.5% of them were married, 44.3% were postmenopausal,
66.8% were sexually active and 57% had SD (FSFI total score </=26.55). ROC
curve determined a score >/=1 in the MRS item 8 as a cut-off value for discriminating
women with SD (78% sensitivity and 62% specificity with an area below the curve
of 0.70 Swett). CONCLUSIONS: The MRS was moderately accurate for diagnosing SD
among climacteric women. More research is warranted in this regard.
J Prev Med Public Health. 2009
Jan;42(1):29-34
C-reactive Protein and Carotid Intima-media Thickness in a Population of
Middle-aged Koreans.
Suh M, Lee JY, Ahn SV, Kim HC, Suh I.
Department of
Preventive Medicine,
OBJECTIVES: This
study was performed to evaluate the relationship between C-reactive protein
(CRP) and carotid intima-media thickness (carotid IMT) in a population of
middle-aged Koreans. METHODS: A total of 1,054 men and 1,595 women (aged 40-70
years) from
Clin Endocrinol (Oxf). 2009 Feb 18. [Epub
ahead of print
Lower bone mineral density is associated with higher coronary
calcification and coronary plaque burdens by multidetector row coronary
computed tomography in pre- and post-menopausal women.
Choi SH, An JH, Lim S, Koo BK, Park SE, Chang HJ, Choi SI, Park YJ, Park KS, Jang HC, Shin CS.
Department of
Internal Medicine (S.H.C., J.H.A., S.L., H.J.C., Y.J.P., K.S.P., H.C.J.,
C.S.S.),
SUMMARY
Objectives: There is growing evidence about the association between bone
mineral density (BMD) and vascular calcification, which is related to
cardiovascular disease. Coronary multidetector row computed tomography (MDCT)
is a non-invasive tool developed to precisely evaluate coronary status. We used
MDCT to evaluate this association. Design and patients: Eight hundred and
fifteen subjects received routine checkups. After excluding subjects with
factors affecting bone metabolism and cardiovascular disease, 467 subjects were
analysed. Measurements: Coronary calcification was measured with MDCT and BMD
was measured with dual X-ray absorptiometry. Results: The BMD of the femur and
the lumbar spine were negatively associated with the coronary calcium score
(CCS) after adjusting for age in women but not in men. This inverse correlation
was stronger in women with a greater time since menopause (r =-0.35 at femur,
post-menopausal women vs. r=-0.10 at femur, pre-menopausal women, P < 0.05),
and it was stronger at the femur than in the lumbar spine (r =-0.35 at femur
vs. r =-0.16 at lumbar spine, P < 0.01). The relationship was also stronger
in post-menopausal women with osteoporosis and osteopaenia than women with
normal BMD. The lower BMD associated with higher coronary plaque burdens and
multi-diseased coronary vessels in both men and women (P < 0.01)
Conclusions: Increased CCS and subclinical atherosclerosis of plaque burdens as
seen by MDCT was associated with a low BMD in all women, independent of
cardiovascular risk factors and age.
Br J Cancer. 2009 Feb 24;100(4):578-82
Circulating levels of leptin, adiposity and breast cancer risk.
Wu MH, Chou YC, Chou WY, Hsu GC, Chu CH, Yu CP, Yu JC, Sun CA.
Graduate Institute
of Life Sciences,
The present
case-control study was to investigate the relationships of plasma leptin level
and anthropometric measures of adiposity with the risk of breast cancer.
Questionnaire information, anthropometric measures and blood samples were taken
before treatment from 297 incident cases with breast cancer and 593 controls
admitted for health examination at the
J Gerontol A Biol Sci Med
Sci. 2009 Feb 16. [Epub ahead of print]
Calcium Plus Vitamin D Supplementation and Mortality in Postmenopausal
Women: The Women's Health Initiative Calcium-Vitamin D Randomized Controlled
Trial.
Lacroix AZ, Kotchen J, Anderson G, Brzyski R, Cauley JA, Cummings SR, Gass M, Johnson KC, Ko M, Larson J, Manson JE, Stefanick ML, Wactawski-Wende J.
WHI Clinical
Coordinating Center,
BACKGROUND:
Calcium and vitamin D (CaD) supplementation trials including the Women's Health
Initiative (WHI) trial of CaD have shown nonsignificant reductions in total
mortality. This report examines intervention effects on total and
cause-specific mortality by age and adherence. METHODS: The WHI CaD trial was a
randomized, double-blind, placebo-controlled trial that enrolled 36,282
postmenopausal women aged 51-82 years from 40
Med J Aust. 2009 Feb
16;190(4):S37-8
Oestrogen - a new treatment approach for schizophrenia?
Alfred Psychiatry
Research Centre,
The oestrogen
protection hypothesis proposes that oestrogen has a protective effect against
onset of schizophrenia. In support of this: Epidemiological studies have shown
that young women are less likely to develop schizophrenia than men of the same
age, and women are more likely to develop late-onset schizophrenia after
menopause. Clinical studies have shown higher psychotic symptoms in
perimenopausal women, and women at the low oestrogen phase of the menstrual
cycle. Animal studies provide further evidence in support of the oestrogen
protection hypothesis. Three randomised double-blind placebo-controlled trials
and an open-label study showed that adding oestradiol to women's usual
antipsychotic medications was associated with significant abatement of
schizophrenia symptoms. A small study of men with schizophrenia who received
oral oestradiol valerate also showed a significant abatement in psychotic
symptoms. Although oestrogen appears to be a useful treatment for
schizophrenia, further research is required to determine the correct dose and
duration of use of oestradiol. New types of oestrogen compounds may provide a
safer, non-feminising approach for the treatment of schizophrenia.
Selección de Resúmenes
de Menopausia
Semana del 25 de febrero al 3 de
Marzo de 2009
Juan Enrique Blümel. Departamento
Medicina Sur. Universidad de
Chile
Acta Ortop Mex. 2008
Sep-Oct;22(5):292-302.
Osteoporosis and
osteopenia in female health workers from Mexico City
Gómez-García F, Vázquez-Martínez JL, Lara-Rodríguez Mde L.
Hospital Angeles
Mocel, Delegación Miguel Hidalgo, DF México. sla@prodigy.net.mx
INTRODUCTION: The
prevalence of osteoporosis (OP) in Mexican population is not well known. This
disease constitutes a risk factor for fractures due to OP, which result in
disability, poor quality of life and increased mortality rates. OBJECTIVES: To
determine prevalence of OP and osteopenia in a group of female health workers
from Mexico City using central densitometry (Dual X Ray Absorptiometry-DXA); to
compare the Hispanic reference database from the LUNAR DPX L unit vs. the study
population; to determine the age at which the peak bone mass is reached and to
explore the relationship between some well known factors for osteoporosis and bone
mass. MATERIAL AND METHODS: In this prolective, cross-sectional observational
study 588 healthy females older than 18 years were selected at different stages
and a hip and spine densitometry (DXA) was undertaken with a LUNA DPX L unit.
To determine the prevalence of osteoporosis and osteopenia we used the criteria
of the Committee of Experts on Osteoporosis from the World Health Organization.
RESULTS: The mean age of our study population was 42.3 years +/- 9.6 (20-65);
the weight 66 kg +/- 12.1 (41-139) and height 153.9 cm +/- 5.7 (138-177). The
prevalence of osteoporosis on the lumbar spine was 13.5% (IC 95%: 10.5-16) and
osteopenia 27.7 (IC 95%: 24-31). On the femoral neck, the prevalence of
osteoporosis was 2% (IC 95%: 1.0-3) and osteopenia 26.1% (IC 95%: 22-29). The
peak bone mass on the femoral neck was found between 31 to 35 years and in the
lumbar spine between 26-30 years. In these groups, the bone mineral density
falls as age rises. When we compare our results to reference population from
the LUNAR densitometer database and to our same study group, there is an
overestimation of the prevalence of OP and osteopenia on the lumbar spine and
osteopenia on the femoral neck. We found a prevalence of overweight and obesity
higher to reported at the Mexican National Survey of Nutrition.
Am J Surg. 2009
Mar;197(3):403-7.
The effects of
hormone replacement therapy on postmenopausal breast cancer biology and
survival.
Sener SF,
Winchester DJ, Winchester DP, Du H, Barrera E, Bilimoria M, Krantz S, Rabbitt S.
Department of
Surgery and the Center on Outcomes Research and Education, NorthShore
University Health System, Evanston, and Northwestern University Feinberg School
of Medicine, Chicago, IL, USA.
BACKGROUND: The
goal of this study was to compare the characteristics of breast cancers and
survival rates in HRT users versus nonusers. METHODS: Data were analyzed for
1055 patients >/=50 years of age who had definitive therapy for breast
cancer from 1994 through 2002. RESULTS: There were 471 (45%) HRT users. The
median age at diagnosis was 61.0 years for HRT users and 68.0 years for HRT
nonusers (P < .001). HRT users more often had tumors that were <1 cm (P =
.007), node negative (P = .033), and grade I (P = .016). HRT users had a
decreased risk of death versus nonusers (hazard ratio = .438, 95% confidence
limit = .263 to .729, P = .002). CONCLUSIONS: HRT users developed breast cancer
at a younger age than nonusers; HRT use was associated with the development of
biologically more favorable cancers than those that developed in nonusers; and
overall and disease-free survival rates were higher in HRT users than nonusers.
Ultrasound Obstet Gynecol. 2009 Feb
26;33(3):344-348.
Value of
endometrial thickness measurement for diagnosing focal intrauterine pathology
in women without abnormal uterine bleeding.
Dreisler E, Sorensen SS, Ibsen PH, Lose G.
Department of
Obstetrics and Gynecology, Glostrup Hospital,
Glostrup, Denmark.
OBJECTIVE: To
assess the diagnostic value of transvaginal sonographic (TVS) measurement of
endometrial thickness for diagnosing focal intrauterine pathology in women
without abnormal uterine bleeding (AUB). METHODS: A random selection from the
Danish Civil Registration System was made: 1660 women aged 20-74 years were
invited to participate and 686 women were eligible and accepted inclusion (429
pre- and 257 postmenopausal). The women underwent TVS measurement of
endometrial thickness and saline contrast sonohysterography (SCSH).
Hysteroscopic resection with histopathology (gold standard) was performed when
focal intrauterine pathology was suspected at SCSH. We excluded women with AUB
(n = 237), failure of SCSH (n = 50), a scan that was not in the follicular
phase (n = 11), hysteroscopy contraindicated (n = 2), and users of sequential
hormone therapy (n = 9) or selective estrogen receptor modulators (n = 2).
Thus, 375 women without AUB were included (217 pre- and 158 postmenopausal).
Receiver-operating characteristics (ROC) curves for endometrial thickness and
focal lesion were analyzed. RESULTS: Focal intrauterine pathology was confirmed
in 41 women (35 with polyps, five with submucosal myomas and one with polypoidal
growing cancer). For premenopausal women, the area under the ROC curve (AUC)
was 0.79 (95% CI, 0.68-0.89) and for postmenopausal women it was 0.84 (95% CI,
0.76-0.92). For premenopausal women, the best negative likelihood ratio (LR- =
0.11) was obtained at an endometrial thickness of 5.2 mm, with a negative
predictive value (NPV) of 99% and a positive predictive value (PPV) of 10%. For
postmenopausal women the best LR- (0.08) was obtained at an endometrial
thickness of 2.8 mm, with a NPV of 99% and a PPV of 26%. CONCLUSIONS: In women
without AUB, TVS measurement of endometrial thickness is a poor diagnostic
test, but is apparently efficacious in excluding focal intrauterine pathology,
especially in postmenopausal women. The 4-5-mm threshold conventionally used to
exclude endometrial malignancy in women with postmenopausal bleeding is not
transferable to women without AUB for excluding focal intrauterine pathology.
Am J Clin Nutr. 2009 Feb
25. [Epub ahead of print]
Effects of beer,
wine, and liquor intakes on bone mineral density in older men and women.
Tucker KL, Jugdaohsingh R, Powell JJ, Qiao N, Hannan MT, Sripanyakorn S, Cupples LA, Kiel DP.
Jean Mayer US
Department of Agriculture Human Nutrition Research Centre on Aging, Tufts
University, Boston, MA.
BACKGROUND:
Moderate intake of alcohol has been reported to have beneficial effects on
bone. However, different classes of alcoholic beverages have not been
investigated. OBJECTIVE: Our aim was to determine the association between
intake of total alcohol or individual alcoholic beverages and bone mineral
density (BMD). DESIGN: Adjusting for potential confounding factors, we examined
alcohol intakes and BMD at 3 hip sites and the lumbar spine in 1182 men and in
1289 postmenopausal and 248 premenopausal women in the population-based
Framingham Offspring cohort (age: 29-86 y). RESULTS: Men were predominantly
beer drinkers, and women were predominantly wine drinkers. Compared with
nondrinkers, hip BMD was greater (3.4-4.5%) in men consuming 1-2 drinks/d of
total alcohol or beer, whereas hip and spine BMD were significantly greater
(5.0-8.3%) in postmenopausal women consuming >2 drinks/d of total alcohol or
wine. Intake of >2 drinks/d of liquor in men was associated with
significantly lower (3.0-5.2%) hip and spine BMD than was intake of 1-2
drinks/d of liquor in men. After adjustment for silicon intake, all intergroup
differences for beer were no longer significant; differences for other alcohol
sources remained significant. Power was low for premenopausal women, and the
associations were not significant. CONCLUSIONS: Moderate consumption of alcohol
may be beneficial to bone in men and postmenopausal women. However, in men,
high liquor intakes (>2 drinks/d) were associated with significantly lower
BMD. The tendency toward stronger associations between BMD and beer or wine,
relative to liquor, suggests that constituents other than ethanol may
contribute to bone health. Silicon appears to mediate the association of beer,
but not that of wine or liquor, with BMD. Other components need further
investigation.
Fertil Steril. 2009 Feb
23. [Epub ahead of print
Short-term hormone
treatment modulates emotion response circuitry in postmenopausal women.
Love T,
Smith YR, Persad CC, Tkaczyk A, Zubieta JK.
Department of
Psychiatry, University of Michigan, Ann Arbor, Michigan; Molecular and
Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, Michigan.
OBJECTIVE: To
study the effects of combination hormone therapy (HT) on emotional processing
in postmenopausal women with use of functional neuroimaging. DESIGN: A
randomized, double-blind, placebo-controlled crossover study was performed.
SETTING: A tertiary care university medical center. PARTICIPANT(S): Ten healthy
postmenopausal women (mean age 56.9 years, SD = 1.4 years) were recruited.
INTERVENTION(S): Women were assigned randomly to the order they received
combined HT, 5 mug ethinyl E(2) and 1 mg norethindrone acetate, and placebo.
Volunteers received HT or placebo for 4 weeks, followed by a 1-month washout
period, and then received the other treatment for 4 weeks. Subjects
participated in a functional magnetic resonance imaging emotional processing
task, where they were asked to rate emotional pictures as positive, negative,
or neutral. MAIN OUTCOME MEASURE(S): Brain activation patterns were compared
between HT and placebo conditions within subjects. RESULT(S): During negative
emotional presentations, after subtracting the effect of neutral images, areas
of significant differences between HT and placebo conditions were identified in
the orbital, frontal, cingulate, and occipital cortices. During positive
emotional image presentation there were significant differences between placebo
and HT conditions within the medial frontal cortex. CONCLUSIONS: Short-term
menopausal treatment with combination HT affects regional brain activity within
areas implicated in emotional processing.
Menopause. 2009 Feb
20. [Epub ahead of print
The effect of
alendronate sodium on carotid artery intima-media thickness and lipid profile
in women with postmenopausal osteoporosis.
Celiloglu M, Aydin Y, Balci P, Kolamaz T.
Obstetrics and
Gynecology and 2Radiology, Dokuz Eylul University Medical Faculty, Izmir,
Turkey.
OBJECTIVE::
Observational and experimental studies support that osteoporosis and atherosclerosis
are two related phenomena. The aim of the present study was to investigate the
probable effect of alendronate sodium, which is used in the treatment of
osteoporosis, on carotid artery intima-media thickness (IMT), the lipid
profile, and apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) levels,
which are known to have a role in the atherosclerotic process. METHODS::
Carotid artery IMT was measured in 39 women in whom alendronate 70 mg/week was
started due to osteoporosis and in 33 control participants at the start and the
6th and 12th months of the study. Triglyceride, high-density lipoprotein,
low-density lipoprotein, ApoA-I, and ApoB levels were also measured at the same
time points, and ApoB/ApoA-I rates were calculated. RESULTS:: Among the basal
values, only the ApoA-I level was significantly lower in the alendronate group
(P < 0.01). IMT measurement results (mean [SE]) of the alendronate group
were 0.622 [0.015], 0.616 [0.014], and 0.597 [0.013] mm; those of the control
group were 0.600 [0.010], 0.611 [0.011], and 0.620 [0.011] mm, respectively. In
both groups, the difference between the start and 12-month values was
significant (P < 0.05). A significant difference was not determined in the
triglyceride and lipid measurement results between the groups and also within
groups. ApoA and ApoB levels at the start and the 12th month of the study were
as follows: 159.8 [3.6], 162.2 [3.4] (P > 0.05) and 96.2 [4.2], 101.5 [4.5]
(P > 0.05) in the control group and 145.1 [4.0], 173.7 [4.3] (P < 0.05)
and 98.7 [3.9], 84.6 [3.3] (P < 0.05) in the alendronate group,
respectively. The ratios of ApoB/ApoA-I were 0.611 [0.029] is to 0.636 [0.031]
(P > 0.05) in the control group and 0.703 [0.04] is to 0.498 [0.0] (P <
0.05) in the alendronate group. CONCLUSIONS:: We concluded that alendronate
sodium resulted in a significant decrease in IMT during a 1-year period
compared with matched controls. Also, alendronate was associated with a
positive effect on the ApoB/ApoA-I ratio.
Stroke. 2009 Feb
20. [Epub ahead of print
Age at Natural
Menopause and Risk of Ischemic Stroke. The Framingham Heart Study.
Lisabeth LD, Beiser AS, Brown DL, Murabito JM, Kelly-Hayes M, Wolf PA.
National Heart,
Lung and Blood Institute's Framingham Heart Study, Bethesda, Md.
BACKGROUND AND
PURPOSE: Women have increased lifetime stroke risk and more disabling strokes
compared with men. Insights into the association between menopause and stroke
could lead to new prevention strategies for women. The objective of this study
was to examine the association of age at natural menopause with ischemic stroke
risk in the Framingham Heart Study. METHODS: Participants included women who
survived stroke-free until age 60, experienced natural menopause, did not use
estrogen before menopause, and who had complete data (n=1430). Participants
were followed until first ischemic stroke, death, or end of follow-up (2006).
Age at natural menopause was self-reported. Cox proportional hazards models were
used to examine the association between age at natural menopause (<42, 42 to
54, >/=55) and ischemic stroke risk adjusted for age, systolic blood
pressure, atrial fibrillation, diabetes, current smoking, cardiovascular
disease and estrogen use. RESULTS: There were 234 ischemic strokes identified.
Average age at menopause was 49 years (SD=4). Women with menopause at ages 42
to 54 (hazard ratio=0.50; 95% CI: 0.29 to 0.89) and at ages >/=55 (hazard
ratio=0.31; 95% CI: 0.13 to 0.76) had lower stroke risk compared with those
with menopause <42 years adjusted for covariates. Women with menopause
before age 42 had twice the stroke risk compared to all other women (hazard
ratio=2.03; 95% CI: 1.16 to 3.56). CONCLUSIONS: In this prospective study, age
at natural menopause before age 42 was associated with increased ischemic
stroke risk. Future stroke studies with measures of endogenous hormones are
needed to inform the underlying mechanisms so that novel prevention strategies
for midlife women can be considered.
Menopause Int. 2009
Mar;15(1):19-25
Cost-effectiveness
of hormone replacement therapy for menopausal symptoms in the UK.
Lekander I, Borgström F, Ström O, Zethraeus N, Kanis JA.
i3 Innovus,
Klarabergsviadukten 90 Hus D, SE-111 64 Stockholm, Sweden.
ingrid.lekander@i3innovus.com.
OBJECTIVE: To
estimate the cost-effectiveness of five-year treatment of hormone replacement
therapy (HRT) compared with no treatment for women with menopausal symptoms in
the
Nutrition. 2009 Feb
19. [Epub ahead of print
Association of
total calcium and dietary protein intakes with fracture risk in postmenopausal
women: The 1999-2002 National Health and Nutrition Examination Survey (NHANES).
OBJECTIVE: We
examined the associations of total calcium intake (TCI) and dietary protein
intake (DPI) with risk of fracture. METHODS: A total of 2006 postmenopausal
women >/=50 y of age who were measured in the 1999-2002 National Health and
Nutrition Examination Survey were included in the study. Weighted mean TCI and
DPI and percentage of distributions of selected characteristics were estimated
by TCI category and fracture status. Multivariate logistic regression models
were used to assess the effect of TCI and DPI on risk of fracture. RESULTS:
Thirteen percent of participants reported a fracture history, of whom 17.8%
consumed a total of >/=1200 mg of calcium per day and 23.8% consumed <400
mg/d. TCI was not associated with fracture risk when controlling for all
selected covariates. In women who consumed <46 g/d of dietary protein, those
with a TCI >/=1200 mg/d had a significantly higher risk of fracture than those
with the lowest TCI (adjusted odds ratio 5.98, 95% confidence interval
1.15-31.13), whereas in women who consumed >70 g/d of dietary protein, those
with a TCI >/=1200 mg/d had an insignificant lower risk of fracture
(adjusted odds ratio 0.69, 95% confidence interval 0.20-2.39). CONCLUSION: TCI
is not associated with risk of fracture among postmenopausal women. Adequate
TCI in the presence of inadequate DPI may not be protective against fractures.
Optimal proportion of TCI and DPI warrants further investigation among older
women.