Selección de Resúmenes
de Menopausia
Semana del 1al 7 de Julio de
2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad
de Chile
Menopause. 2009 Jul
1. [Epub ahead of print]
Vaginal symptoms in
postmenopausal women: self-reported severity, natural history, and risk
factors.
Huang AJ, Moore EE, Boyko EJ, Scholes D, Lin F, Vittinghoff
E, Fihn SD.
From the
1Department of Medicine,
OBJECTIVE:: This
study aimed to examine factors other than estrogen deficiency influencing the
development and persistence of vaginal dryness, itching, and painful sexual
intercourse after menopause. METHODS:: We analyzed data from a 2-year,
population-based cohort of 1,017 postmenopausal women aged 55 to 75 years.
Vaginal symptoms were assessed by interviewer-administered questionnaire, and
vaginal swabs were performed to assess vaginal pH and microbial flora at
baseline, 12 months, and 24 months. Generalized estimating equations were used
to identify characteristics associated with symptoms. RESULTS:: Half of the
women (n = 471) reported problematic vaginal dryness, a third (n = 316)
reported itching, and 40% of sexually active women (n = 166) reported painful
intercourse at baseline. Of women not taking estrogen, half of those reporting
baseline symptoms were symptomatic after 24 months. Vaginal dryness was
associated with younger age (odds ratio [OR], 0.81; 95% CI, 0.69-0.94, per 5-y
increase), nonwhite race (ie, African American, Hispanic, Asian or Pacific
Islander, or American Indian [OR, 1.53; 95% CI, 1.04-2.27]), diabetes (OR,
1.51; 95% CI, 1.07-2.12), lower 36-item Short-Form Health Survey physical
functioning scores (OR, 0.90; 95% CI, 0.85-0.97, per 10-point increase), lower
body mass index (OR, 0.81; 95% CI, 0.71-0.93, per 5 kg/m increase), recent
sexual activity (OR, 1.14; 95% CI, 1.08-1.21), and vaginal colonization with
enterococci (OR, 1.25; 95% CI, 1.04-1.51). Vaginal itching was also associated
with lower physical functioning scores (OR, 0.86; 95% CI, 0.80-0.92, per
10-point increase). Risk factors for painful intercourse included younger age
(OR, 0.72; 95% CI, 0.56-0.93, per 5-y increase), diabetes (OR, 3.48; 95% CI,
1.93-6.27), lower body mass index (OR, 0.76; 95% CI, 0.61-0.95, per 5 kg/m
increase), and higher vaginal pH (OR, 1.10; 95% CI, 1.00-1.21, per 0.5 units).
CONCLUSIONS:: Vaginal symptoms affect a large proportion of postmenopausal
women, particularly those with diabetes and those with lower body mass index,
but may resolve for up to half of women without estrogen therapy.
Atherosclerosis. 2009 Jun
6. [Epub ahead of print]
Coronary heart
disease and menopause management: The swinging pendulum of HRT.
Stevenson
JC, Hodis HN, Pickar JH, Lobo RA.
National Heart
& Lung Institute,
The Women's Health
Initiative comprised a randomized placebo-controlled clinical trial of
therapeutic and dietary interventions influencing postmenopausal women's
health. One arm evaluated hormone replacement therapy and its effects on major
health outcomes. Initial publication of the preliminary results suggested
overall harm from hormone replacement therapy, leading to a dramatic worldwide
decrease in its use, and concerns from clinicians and regulatory authorities.
Subsequent publications with more detailed analyses appear to have
countermanded these initial concerns. Analyses of the studies have not been
adherent to those specified in the original published protocol. Nominal
confidence intervals should have been used only for the primary outcome, which
was coronary heart disease. Initially reported as showing a significant
increase in events with hormone replacement therapy, in a subsequent analysis
of the full data the increase was no longer significant. Adjusted confidence
intervals showed no significant increase for breast cancer, the primary adverse
outcome. A major difference in the effects of hormones between younger and
older women has emerged but this important finding has been minimized. For
women under age 60 years or within 10 years of menopause, the final findings
for all outcomes closely resemble those from observational cohorts. The raw
data must be made available for independent assessment to obtain valid
conclusions which may again change clinical practice.
J Appl Physiol. 2009 Jul
2. [Epub ahead of print]
Hormone replacement
therapy attenuates exercise-induced skeletal muscle damage in postmenopausal
women.
Dieli-Conwright
CM, Spektor TM, Rice JC, Schroeder
ET.
Hormone
replacement therapy (HRT) is a potential treatment to relieve symptoms of
menopause and prevent the onset of disease such as osteoporosis in
postmenopausal women. We evaluated changes in markers of exercise-induced
skeletal muscle damage and inflammation (serum CK, serum LDH, and mRNA
expression of IL-6, IL-8, IL-15, and TNF-alpha) in postmenopausal women following
a high-intensity resistance exercise bout. Fourteen postmenopausal women were
divided into two groups: Control, women not using HRT (n=6, 59+/-4 yr, 63+/-17
kg), or HRT, women using traditional HRT (n=8, 59+/-4 yr, 89+/-24 kg). Both
groups performed 10 sets of 10 maximal eccentric repetitions of single-leg
extension on the Cybex dynamometer at 60 degrees /s with 20 second rest periods
between sets. Muscle biopsies of the vastus lateralis were obtained from the
exercised leg at baseline and 4 hours after the exercise bout. Gene expression
was determined using RT-PCR for IL-6, IL-8, IL-15, and TNF-alpha. Blood draws
were performed at baseline and 3 days post-exercise to measure CK and LDH.
Independent t-tests were performed to test group differences (Control vs HRT).
A probability level of p</=0.05 was used to determine statistical
significance. We observed significantly greater changes in mRNA expression of
IL-6, IL-8, IL-15, TNF-alpha (p</=0.01) in the Control group compared to the
HRT group following the exercise bout. CK and LDH levels were significantly
greater post-exercise (p</=0.01) in the Control group. Postmenopausal women
not using HRT experienced greater muscle damage after maximal eccentric
exercise indicating a possible protective effect of HRT against
exercise-induced skeletal muscle damage.
Neuropsychiatr. 2009;23(2):71-83.
Antipsychotics and
hyperpolactinaemia: Pathophysiology, clinical relevance, diagnosis and therapy.
Riecher-Rössler
A, Schmid C, Bleuer S, Birkhäuser M. Psychiatrische Poliklinik, Universitätsspital
Basel.
Hyperprolactinaemia
is a frequent but often neglected side effect of typical, but also of many
atypical antipsychotics such as amisulpiride, risperidone or ziprasidone.
Besides galactorrhoea, potential consequences are suppression of the
hypothalamic-pituitary-gonadal axis with hypogonadism, sexual dysfunction,
infertility and in women also irregularities of the menstrual cycle and
amenorrhoea. Potential long term consequences are mainly osteopenia and
osteoporosis with an enhanced risk of fractures. Hyperprolactinaemia, if not
clearly caused by a prolactin inducing antipsychotic, should always be
thoroughly investigated. Ideally, prolactin should be measured before starting
a patient on a new antipsychotic. Furthermore, before neuroleptic treatment is
begun, and also in regular intervals after that, patients should be asked about
potential clinical signs of hyperprolactinaemia. Hyperprolactinaemia which is
clearly due to antipsychotics but without clinical symptoms only requires
regular controls of bone mineral density. However, if clinical symptoms occur,
switching to a prolactin sparing antipsychotic may be necessary. In these cases
fertility is often regained and the women concerned have to be informed about
the enhanced risk of pregnancy and counselled regarding contraception. If
switching is not possible, estradiol has to be substituted in women. Also in
men with hypogonadism hormonesubstitution (with testosterone) is usually
indicated. Hyperprolactinaemia in
psychiatric patients should be taken more seriously in the future.
Int J Cancer. 2009 Jun
30. [Epub ahead of print]
The association of
plasma androgen levels with breast, ovarian, and endometrial cancer risk
factors among postmenopausal women.
Danforth
KN, Eliassen
AH, Tworoger
SS, Missmer SA, Barbieri
RL, Rosner BA, Colditz GA, Hankinson
SE
Channing
Laboratory, Department of Medicine,
Although androgens
may play an etiologic role in breast, ovarian, and endometrial cancers, little
is known about factors that influence circulating androgen levels. We conducted
a cross-sectional analysis among 646 postmenopausal women in the Nurses' Health
Study to examine associations between adult risk factors for cancer, including
the Rosner/Colditz breast cancer risk score, and plasma levels of testosterone,
free testosterone, androstenedione, dehydroepiandrosterone (DHEA), and DHEA
sulfate (DHEAS). All analyses were adjusted for age, laboratory batch, and
other cancer risk factors. Free testosterone levels were 79% higher among women
with a BMI of >/=30 vs. <22 kg/m(2) (p-trend<0.01) and 25% higher
among women with a waist circumference of >89 vs. </=74 cm
(p-trend=0.02). Consuming >30 grams of alcohol a day vs. none was associated
with a 31% increase in DHEA and 59% increase in DHEAS levels (p-trend=0.01 and
<0.01, respectively). Smokers of >/=25 cigarettes per day had 35% higher
androstenedione and 44% higher testosterone levels than never smokers (p-value,
F-test=0.03 and 0.01, respectively). No significant associations were observed
for height or time since menopause with any androgen. Testosterone and free
testosterone levels were approximately 30% lower among women with a
hysterectomy vs. without (both p-values<0.01). Overall breast cancer risk
was not associated with any of the androgens. Thus, several risk factors,
including body size, alcohol intake, smoking, and hysterectomy, were related to
androgen levels among postmenopausal women, while others, including height and
time since menopause, were not. Future studies are needed to clarify further
which lifestyle factors modulate androgen levels.
Osteoporos Int. 2009 Jul
2. [Epub ahead of print]
Bisphosphonates and
osteoporotic fractures: a cross-design synthesis of results among compliant/persistent
postmenopausal women in clinical practice versus randomized controlled trials.
Wilkes MM, Navickis
RJ, Chan WW, Lewiecki
EM.
Hygeia Associates,
INTRODUCTION: The
purpose of the study was to determine whether clinical fracture risk reduction
by bisphosphonate treatment in women with postmenopausal osteoporosis differs
between randomized controlled trials and routine practice. METHODS: Randomized
trials comparing bisphosphonate with placebo and observational studies
comparing highly compliant/persistent with less compliant/persistent patients
were sought by electronic searches and ancillary methods. Clinical fracture
data were extracted from the study reports and quantitatively combined by
random effects metaanalysis. RESULTS: The odds ratio (OR) for all clinical
fractures in randomized trials of 0.762, with a 95% confidence interval (CI) of
0.680-0.855, was closely similar to that in the observational studies (OR,
0.797; CI, 0.748-0.850). Pooled clinical fracture reduction across both study
designs was 22%. Nonvertebral, vertebral, and hip fractures were also
significantly reduced by bisphosphonate treatment in both randomized trials and
observational studies. CONCLUSIONS: Compliant/persistent patients in the
"real-world" setting benefit from bisphosphonate treatment to a
similar extent as patients in randomized trials.
Maturitas. 2009 Jun
29. [Epub ahead of print]
Lifetime endogenous
estrogen exposure and electrocardiographic frontal T axis changes in
postmenopausal women.
Atsma F, van der
Schouw YT, Grobbee DE, Kors JA, Bartelink
ML.
Objetive: The
protective effect of endogenous estrogens in cardiovascular disease may in part
originate from effects of circulating estrogens on the electrophysiological
properties of the myocardium. The aim of this study was to investigate the
relation between reproductive factors and the electrocardiographic frontal T
axis in postmenopausal women. Design: Cohort study. SETTING: The study was
conducted at the University Medical Center Utrecht. Patients: In total, 998
postmenopausal women were included. Main outcomes: Information of women's
reproductive life was obtained by a questionnaire. Electrocardiographic frontal
T axes were categorized as normal (25-65 degrees ) or abnormal (-180 degrees to
24 degrees and 66-180 degrees ). Logistic regression analysis was used to
assess the relationship between reproductive factors and the frontal T axis.
Moreover, the effect of the lifetime cumulative number of menstrual cycles, a
composite measure of all reproductive factors, on the frontal T axis was
investigated. Results: The mean age was 66.0 (+/-5.6) years and 15.3% had
T-axes abnormalities. Later menopausal age decreased the risk on frontal T-axis
abnormalities; the multivariable adjusted odds ratio was 0.97 (95% CI:
0.94-0.99) per year increasing menopause. For the lifetime cumulative number of
menstrual cycles the age-adjusted odds ratio was 0.84 (95% CI: 0.75-0.99) per
100 menstrual cycles increase. Conclusions: Later age at menopause and
increasing lifetime cumulative number of menstrual cycles decreased the risk on
frontal T-axis changes. This supports the view that estrogens may protect
against ventricular repolarization disturbances
J Clin Endocrinol Metab. 2009 Jun 30. [Epub ahead of
print]
Effect of
once-yearly zoledronic acid 5 mg on fracture risk and change in femoral neck
bone mineral density.
Eastell R, Black DM, Boonen S, Adami S, Felsenberg
D, Lippuner K, Cummings
SR, Delmas PD, Palermo L, Mesenbrink
P, Cauley JA; for the
HORIZON Pivotal Fracture Trial.
Academic Unit of
Bone Metabolism,
Context: In the
Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly -
Pivotal Fracture Trial (HORIZON-PFT), zoledronic acid (ZOL) 5 mg significantly
reduced fracture risk. Objective: To identify factors associated with greater
efficacy during ZOL 5 mg treatment. Design, Setting and Patients: Subgroup
analysis (preplanned and post hoc) of a multicenter, double-blind,
placebo-controlled, 36-month trial in 7765 women with postmenopausal
osteoporosis. Intervention: Single infusion of ZOL 5 mg or placebo at baseline,
12 and 24 months. Main Outcome Measures: Primary endpoints: new vertebral
fracture and hip fracture. Secondary endpoints: non-vertebral fracture, change
in femoral neck bone mineral density (BMD). Baseline risk factor subgroups:
age, BMD T-score and vertebral fracture status, total hip BMD, race, weight,
geographical region, smoking, height loss, history of falls, physical activity,
prior bisphosphonates, creatinine clearance, body mass index (BMI), concomitant
osteoporosis medications. Results: Greater ZOL induced effects on vertebral
fracture risk with younger age (treatment-by-subgroup interaction P=0.05),
normal creatinine clearance (P=0.04), and BMI >/=25 kg/m(2) (P=0.02). There
were no significant treatment-factor interactions for hip or non-vertebral
fracture or for change in BMD. Conclusions: ZOL appeared more effective in
preventing vertebral fracture in younger women, overweight/obese women and
women with normal renal function. ZOL had similar effects irrespective of
fracture risk factors or femoral neck BMD.
J Thromb Haemost. 2009 Jun
30. [Epub ahead of print]
Smoking and venous
thromboembolism: a Danish follow-up study.
Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjřnneland A, Overvad K.
Department of
Clinical Epidemiology,
Summary
Background: Large-scale prospective studies are needed to assess whether
smoking is associated with venous thromboembolism (VTE), i.e. deep venous
thrombosis and pulmonary embolism, independently of established risk factors.
Objective: To investigate the association between smoking and the risk of VTE
among middle-aged men and women. Methods: From 1993 to 1997, 27,178 men and
29,875 women, aged 50 to 64 year and born in
Gynecol Endocrinol. 2009 Jun
26:1-5. [Epub ahead of print]
Testosterone
addition to estrogen therapy - Effects on inflammatory markers for
cardiovascular disease.
Kocoska-Maras
L, Linden
Hirschberg A, Bystrom B, Schoultz
BV, Rĺdestad
AF.
Karolinska
Institutet and
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.
Selección de Resúmenes de Menopausia
Semana del 8 al 14 de Julio de
2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Climacteric. 2009 Jul 7:1-12.
[Epub ahead of print]
Dose effects of oral estradiol on bone
mineral density in Japanese women with osteoporosis.
Mizunuma H, Taketani Y, Ohta H, Honjo H, Gorai I, Itabashi A, Shiraki M.
Department
of Obstetrics and Gynecology,
Objectives
This 2-year study compared 0.5 and 1.0 mg oral estradiol (E(2)), with or
without levonorgestrel (LNG), for the treatment of postmenopausal osteoporosis
in Japanese women. Methods Japanese women with osteoporosis after natural
menopause or bilateral oophorectomy were randomized to receive E(2) 0.5 or 1.0
mg/day with LNG 40 mug as required, or placebo, for 52 weeks. Women treated
with E(2) in the first year continued therapy at the same doses in the second
year. Efficacy, safety and pharmacokinetics were assessed. Results There were
73 women randomized to E(2) 0.5 mg, 157 to E(2) 1.0 mg and 79 to placebo.
Lumbar bone mineral density at 52 weeks increased significantly more with E(2)
1.0 mg (p < 0.001) and 0.5 mg (p < 0.001) than with placebo (no change).
After 2 years, a 10% increase in bone mineral density with E(2) 1.0 mg was
significantly greater than with E(2) 0.5 mg (8%; p = 0.008]. E(2) was
associated with an acceptable safety and tolerability profile, with slightly
more adverse events with E(2) 1.0 than 0.5 mg. Serum E(2) concentration
increased in a dose-dependent manner. Conclusion This study showed that E(2),
at both 1.0 mg and 0.5 mg doses, was effective in increasing bone mineral
density with an acceptable safety and tolerability profile in Japanese
postmenopausal women with osteoporosis but that the bone mineral density
response was higher with the 1.0 mg dose.
Climacteric. 2009 Jul 8:1-8.
[Epub ahead of print]
Effect of non-oral estrogen on risk markers
for metabolic syndrome in early surgically menopausal women.
Kilic S, Yilmaz N, Erdogan G, Aydin M, Tasdemir N, Doganay M, Batioglu S.
Department
of Reproductive Endocrinology, Zekai Tahir Burak Women's
Objective
Postmenopausal women are at an increased risk of cardiovascular disease and
metabolic syndrome as many risk factors are aggravated by menopause. Elevated
levels of homocysteine, triglyceride and asymmetric dimethylarginine (ADMA)
have been recognized as risk factors for metabolic syndrome. The present study
aimed to investigate the effect of transdermal estrogen treatment on serum
levels of atherogenic amino acids, homocysteine, triglyceride, high density
lipoprotein (HDL) cholesterol and ADMA in women with surgical menopause.
Methods A prospective study was conducted in 85 surgically menopausal Turkish
women at the Department of Menopause of Dr Zekai Tahir Burak Women's Health
Research and Education Hospital between March 2007 and March 2008. Subjects
were divided into two groups: a treatment group (Group 1) and control (Group
2). Group 1 (n = 46) received transdermal estrogen while Group 2 (n = 39)
received no treatment. Body mass index (BMI) and levels of serum homocysteine,
ADMA, triglyceride and HDL cholesterol were analyzed postoperatively at the
first visit (baseline) and 6th months. Results The two groups did not differ in
age, baseline BMI and levels of ADMA, homocysteine and triglyceride. In Group
1, values of serum ADMA, homocysteine, triglyceride and HDL cholesterol levels
were not different at baseline and at the 6-month visit (p = 0.996, p = 0.564,
p = 0.113 and p = 0.173, respectively). On the other hand, the baseline and the
6th month measurements of serum ADMA, homocysteine and HDL cholesterol levels
were significantly different in Group 2 (p = 0.001, p = 0.001, and p = 0.023,
respectively). Conclusion Transdermal estrogen treatment has a protective
effect against the risk factors of metabolic syndrome (homocysteine, ADMA, HDL
cholesterol) in surgically menopausal patients who have undergone surgery in
the early premenopausal period.
Curr Opin
Oncol. 2009 Jul 7. [Epub ahead of print]
Managing menopausal symptoms after
gynecological cancer.
Gynecology,
PURPOSE
OF REVIEW: As the length of survival in patients with gynecological
malignancies increases due to advances in early diagnosis and therapy, quality
of life becomes a major issue for the survivors. These women frequently suffer
symptoms following an iatrogenically induced menopause. Many gynecologists
advise these patients against hormonal replacement therapy. This review
attempts to provide the clinician with information based on current evidence.
RECENT FINDINGS: The most recent two prospective studies did not find an
increase in the recurrence rates in endometrial cancer patients who used
hormonal replacement therapy. To date, there are few studies on hormonal replacement
therapy in patients with ovarian cancer but the available data suggest that
there is no detriment to overall or disease-free survival. There are no data
showing an association between poorer outcome and hormonal replacement therapy
use in patients with cervical or vulvar cancers. SUMMARY: There is no evidence
showing hormones negatively influence survival after treatment for epithelial
ovarian, squamous cervical or vulvar cancer. Their use can be considered in
symptomatic patients with endometrial cancer, after weighing the benefits
against the risk of recurrence. Gynecologic cancer survivors suffering from
menopausal symptoms should be supported by advice about the alternatives to
hormonal replacement therapy and by giving them nonbiased information on the
present knowledge on the effects of hormonal use in women with a previous
cancer. It is reasonable to prescribe hormonal replacement therapy to
symptomatic, well informed patients.
Bull NYU Hosp Jt
Dis.
2009;67(2):226-9.
What Can We Learn from Design Faults in the
Women's Health Initiative Randomized Clinical Trial?
Design
faults resulted in the inability of the Women's Health Initiative (WHI)
randomized clinical trial to test the level of cardioprotection conferred by
timely hormone treatment of women seeking help for menopausal complaints.
Adopting a design constructed around the avoidance of symptomatic subjects and
recruitment of older subjects who were more likely to manifest cardiovascular
events during the life of the WHI resulted in recruitment of older, sicker
subjects than are normally treated for complaints around the time of menopause.
The lack of cardioprotection in subjects that began treatment a decade or more
after menopause diluted ardioprotection in subjects starting treatment close to
the menopausal transition. As a result, despite having the largest number of
subjects ever, there were not enough women in the WHI who were comparable to
those in the observational trials that showed cardioprotection. This led the
WHI to report that there was no cardioprotection in the trial, a position that
has been qualifed after further analysis. Misapprehension of the initial WHI
conclusions by the media, professionals, and regulatory agencies led to a major
shift away from menopausal hormone treatment. This remains problematic since
the evidence continues to favor cardioprotection and other benefts that are
denied under present regulations and guidelines. Regulatory agencies and
professional organizations need to better understand the faws in the WHI design
and results in order to properly consider its results and the sustainability of
their earlier conclusions and recommendations. Additionally, new trials are needed
to test the validity of menopausal hormone-related cardioprotection.
J Bone Miner
Res.
2009 Jul 6. [Epub ahead of print]
Mineralization Density Distribution of
Postmenopausal Osteoporotic Bone is Restored to
Roschger P, Lombardi A, Misof BM, Maier G, Fratzl-Zelman N, Fratzl P, Klaushofer K.
Abstract
Long term treatment studies showed that the therapeutic effects of alendronate
(ALN) were sustained over a 10 years treatment period. However, data on the
effects on intrinsic bone material properties by long term reduction of bone
turnover are still sparse. We analyzed transiliacal bone biopsies of a subgroup
of 30 FLEX-participants (n=6 were treated 10 years with ALN at dose of
10mg/day, n=10 10 years with ALN at dose of 5mg/day and n=14 were treated 5
years with ALN plus further 5 years with placebo) by quantitative backscattered
electron imaging (qBEI) and scanning small angle X-ray scattering (sSAXS) to
determine the bone mineralization density distribution (BMDD) and the mineral
particle thickness parameter T. BMDD data from these FLEX-participants were
compared to those from a previously published healthy population (n=52).
Compared to 5 years ALN plus 5 years placebo 10 years ALN treatment
(independent of the dose given) did not cause any difference in any of the
BMDD-parameters: The weighted mean (Ca(Mean)), the typical calcium concentration
(Ca(Peak)), the heterogeneity of mineralization (Ca(Width)), the percentage of
low mineralized bone areas (Ca(Low)) and the portion of highly mineralized
areas (Ca(High)) were not different for the patients who continued ALN from
those who stopped ALN after 5 years. Moreover, no significant differences for
any of the BMDD-parameters between the FLEX-participants and the healthy
population could be observed. In none of the investigated cases, abnormally
high mineralization or changes in mineral particle thickness were observed
(Ca(High) and T were both in the normal range). The findings of the present
study support the recommendation that antiresorptive treatment with ALN should
be maintained for 5 years. But even at longer treatment duration of up to 10
years no negative effects on the bone matrix mineralization were observed.
Rev Bras
Ginecol Obstet. 2009 Apr;31(4):196-202.
Quality of life in postmenopausal women,
users and non-users of hormone therapy
Martins MA, Nahas EA, Nahas-Neto J, Uemura G, Buttros Dde A, Traiman P.
Programa
de Pós-graduaçăo em Ginecologia, Obstetrícia e Mastologia da Faculdade de
Medicina de Botucatu da Universidade Estadual Paulista Júlio de Mesquita Filho
- Botucatu (SP), Brasil.
PURPOSE:
to evaluate the quality of life of post-menopause women, users and non-users of
hormonal therapy (HT), in a Healthcare Unit in Franca, Săo Paulo, Brazil.
METHODS: a clinical transversal study, carried out with 250 post-menopausal
women, with ages from 45 to 70 years old, attended to in Healthcare Units, from
September 2007 to August 2008. Participants were divided into two groups: HT
users (n=70) and non-users (n=180). Women making continuous HT use for at least
six months were considered as users. Sociodemographic and clinical
characteristics have been evaluated. Blatt-Kupperman's menopausal index has
been applied to assess climacteric symptoms, and the Women's Health
Questionnaire (WHQ), to assess their quality of life. Fisher's exact test or
chi2 and Mann-Whitney and Kruskal-Wallis's tests have been used for the
statistical analysis. RESULTS: no significant difference has been found in the
comparison of groups, concerning age, menarche, menopause, parity and body mass
index. It has been seen that 67.2% of the women were married, 83.2% had
attended primary school and 53.2% were housewives, with no difference between
the groups. HT users reported lower frequency of climacteric symptoms (BKMI)
with moderate and marked intensity, as compared to non-users (p<0.001). Even
though HT users presented lower average score in cognitive deficit
(p<0.001), vasomotor symptoms (p=0.04), sleeping problems (p<0.001),
attractiveness (p=0.02) from the WHQ, there has been no difference in the total
score, as compared to non-users. CONCLUSIONS: post-menopausal women, HT users
and non-users, admitted at Healthcare Units, have not presented differences in
global quality of life.
Am J
Cardiol. 2009 Jul 1;104(1):122-4. Epub 2009 May 4
Osteoporosis treatment and progression of
aortic stenosis.
Skolnick AH, Osranek M, Formica P, Kronzon I.
A
decrease in bone mineral density has been reported to be associated with
increased progression of aortic stenosis (AS). We hypothesized that
osteoporosis treatment (OT) is associated with decreased progression of AS. We
performed an observational study of patients with AS from our echocardiographic
database comparing 18 patients on OT (bisphosphonates, calcitonin, or estrogen
receptor modulators) with 37 patients not on OT. All patients had serial
echocardiograms. Patients with mitral stenosis, aortic valve replacement, renal
failure, calcium disorders, or left ventricular ejection fraction <40% were
excluded. Aortic valve area (AVA) was calculated using the continuity equation.
There was no significant difference in age, gender, renal function,
hypertension, statin use, diabetes, or calcium level between the 2 groups. Mean
baseline AVA was 1.33 cm(2) and not significantly different between groups.
After a mean of 2.4 +/- 1.0 years, mean annual changes in AVA were -0.22 +/-
0.22 cm(2) in those not on OT and -0.10 +/- 0.18 cm(2) in patients receiving OT
(p = 0.025). There was a graded association between AS progression rate and OT.
In a multivariable analysis including age, gender, and statin use, only OT was
associated with a change in AVA. In conclusion, OT is strongly and
independently associated with decreased progression of AS. This association warrants investigation in a larger,
prospective study.
Selección de
Resúmenes de Menopausia
Semana del 15 al 21 de Julio de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad
de Chile
Menopause. 2009 Jul
15.
Safety and efficacy
of black cohosh and red clover for the management of vasomotor symptoms: a
randomized controlled trial.
Geller SE, Shulman LP, van
Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, Farnsworth
NR.
From the
1Department of Obstetrics and Gynecology, Center for Research on Women and
Gender, College of Medicine, University of Illinois at Chicago, Chicago, IL;
2Department of Obstetrics and Gynecology, Northwestern University Feinberg
School of Medicine, Chicago, IL; 3University of Illinois at Chicago/National
Institutes of Health Center for Botanical Dietary Supplements Research, College
of Pharmacy, University of Illinois at Chicago, Chicago, IL; and 4Department of
Mathematics, Statistics and Computer Science, University of Illinois at
Chicago, Chicago, IL.
OBJECTIVE:: The
aim of this study was to evaluate the safety and efficacy of black cohosh and
red clover compared with placebo for the relief of menopausal vasomotor
symptoms. METHODS:: This study was a randomized, four-arm, double-blind
clinical trial of standardized black cohosh, red clover, placebo, and 0.625 mg
conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (CEE/MPA; n
= 89). Primary outcome measures were reduction in vasomotor symptoms (hot
flashes and night sweats) by black cohosh and red clover compared with placebo;
secondary outcomes included safety evaluation, reduction of somatic symptoms,
relief of sexual dysfunction, and overall improvement in quality of life. RESULTS::
Reductions in number of vasomotor symptoms after a 12-month intervention were
as follows: black cohosh (34%), red clover (57%), placebo (63%), and CEE/MPA
(94%), with only CEE/MPA differing significantly from placebo. Black cohosh and
red clover did not significantly reduce the frequency of vasomotor symptoms as
compared with placebo. Secondary measures indicated that both botanicals were
safe as administered. In general, there were no improvements in other
menopausal symptoms. CONCLUSIONS:: Compared with placebo, black cohosh and red
clover did not reduce the number of vasomotor symptoms. Safety monitoring
indicated that chemically and biologically standardized extracts of black
cohosh and red clover were safe during daily administration for 12 months.
Clin Pharmacol Ther. 2009 Jul
15. [Epub ahead of print]
No Evidence for
Variation in Colorectal Cancer Risk Associated With Different Types of
Postmenopausal Hormone Therapy.
Hoffmeister M, Raum E, Krtschil A, Chang-Claude J, Brenner H.
Division of
Clinical Epidemiology and Aging Research,
Little is known
about the effects of various types, modes, and routes of hormone replacement
therapy (HRT) on the risk of colorectal cancer (CRC) among postmenopausal
women. We conducted a population-based case-control study with validation of
self-reported hormone use and no upper age limit. In 1,456 postmenopausal women
aged 45-94 years (546 cases, 910 controls), the use of HRT was associated with
reduction in CRC risk among ever users (adjusted odds ratio (OR) 0.65, 95%
confidence interval 0.50-0.84), current users, and recent users. There was no
evidence that risk reduction among current users varies by age. Risk reduction
was seen both in estrogen-only therapy (0.42, 0.23-0.78) and in combination
therapy (0.60, 0.41-0.87), the latter regardless of the mode of therapy,
whether with hormone patches (0.40, 0.17-0.90) or with oral tablets (0.59,
0.39-0.90). In combination with estrogen, progestagens of the norethisterone
and levonorgestrel families were associated with strong reduction in CRC risk.
Menopause. 2009 Jul
13. [Epub ahead of print]
Biochemical markers
for cardiovascular disease in recently postmenopausal women with or without hot
flashes.
Tuomikoski
P,
Mikkola TS, Hämäläinen
E, Tikkanen
MJ, Turpeinen
U, Ylikorkala
O.
From the
Departments of 1Obstetrics and Gynecology, 2Clinical Chemistry, and 3Medicine,
OBJECTIVE::
Menopausal hot flashes may affect vascular function and perhaps explain conflicting
data on cardiovascular disease (CVD) between observational and randomized
hormone therapy (HT) studies. We prospectively assessed hot flash status in
recently postmenopausal women and related it to a number of biochemical
vascular surrogate markers for CVD. METHODS:: Healthy, nonsmoking women (n =
150) exhibiting a broad range (no, mild, moderate, severe) of hot flashes and
an onset of menopause within the previous 0.5 to 3 years were studied with
laboratory tests for lipids, lipoproteins, apolipoproteins, high-sensitivity
C-reactive protein, and sex hormone-binding globulin. RESULTS:: Apart from
marked differences in hot flashes, the groups showed comparable levels of
estrone, estradiol, or free estradiol index. The levels of total cholesterol (3.7-9.1
mmol/L) were similar between the groups (P = 0.744), and hypercholesterolemia
(>6.5 mmol/L) was encountered equally often (P = 0.699). No difference was
seen in high-, low-, or very low-density lipoproteins, triglycerides,
apolipoprotein A-1, apolipoprotein B (or their ratio), or lipoprotein(a)
between the groups. The levels of sex hormone-binding globulin and
high-sensitivity C-reactive protein correlated negatively with each other (r =
-0.204; P = 0.013) but showed no dependence on hot flashes (P = 0.531 and P =
0.215, respectively). CONCLUSIONS:: No baseline difference in lipid or nonlipid
CVD risk factors was observed between women with hot flashes (potential HT
users) and women with no or mild hot flashes (potential HT nonusers). This may
imply that hot flash status per se cannot explain the difference between
observational and randomized trials.
JAMA. 2009 Jul
15;302(3):298-305.
Hormone therapy and
ovarian cancer.
Mřrch LS, Lřkkegaard
E, Andreasen
AH, Krüger-Kjaer
S, Lidegaard
O.
Gynaecological Clinic, Rigshospitalet,
CONTEXT: Studies
have suggested an increased risk of ovarian cancer among women taking
postmenopausal hormone therapy. Data are sparse on the differential effects of
formulations, regimens, and routes of administration. OBJECTIVE: To assess risk
of ovarian cancer in perimenopausal and postmenopausal women receiving
different hormone therapies. DESIGN AND SETTING: Nationwide prospective cohort
study including all Danish women aged 50 through 79 years from 1995 through
2005 through individual linkage to Danish national registers. Redeemed prescription
data from the National Register of Medicinal Product Statistics provided
individually updated exposure information. The National Cancer Register and
Pathology Register provided ovarian cancer incidence data. Information on
confounding factors and effect modifiers was from other national registers.
Poisson regression analyses with 5-year age bands included hormone exposures as
time-dependent covariates. PARTICIPANTS: A total of 909,946 women without
hormone-sensitive cancer or bilateral oophorectomy. MAIN OUTCOME MEASURE:
Ovarian cancer. RESULTS: In an average of 8.0 years of follow-up (7.3 million
women-years), 3068 incident ovarian cancers, of which 2681 were epithelial
cancers, were detected. Compared with women who never took hormone therapy, current
users of hormones had incidence rate ratios for all ovarian cancers of 1.38
(95% confidence interval [CI], 1.26-1.51) and 1.44 (95% CI, 1.30-1.58) for
epithelial ovarian cancer. The risk declined with years since last use: 0 to 2
years, 1.22 (95% CI, 1.02-1.46); more than 2 to 4 years, 0.98 (95% CI,
0.75-1.28); more than 4 to 6 years, 0.72 (95% CI, 0.50-1.05), and more than 6
years, 0.63 (95% CI, 0.41-0.96). For current users the risk of ovarian cancer
did not differ significantly with different hormone therapies or duration of
use. The incidence rates in current and never users of hormones were 0.52 and
0.40 per 1000 years, respectively, ie, an absolute risk increase of 0.12 (95%
CI, 0.01-0.17) per 1000 years. This approximates 1 extra ovarian cancer for
roughly 8300 women taking hormone therapy each year. CONCLUSION: Regardless of
the duration of use, the formulation, estrogen dose, regimen, progestin type,
and route of administration, hormone therapy was associated with an increased
risk of ovarian cancer.
Breast Cancer Res Treat. 2009 Jul
14. [Epub ahead of print]
Oral contraceptives
and postmenopausal hormones and risk of contralateral breast cancer among BRCA1
and BRCA2 mutation carriers and noncarriers: the WECARE Study.
Figueiredo
JC, Haile RW, Bernstein
L, Malone KE, Largent J, Langholz B, Lynch CF, Bertelsen
L, Capanu M, Concannon
P, Borg A, Břrresen-Dale
AL, Diep A, Teraoka S, Torngren T, Xue S, Bernstein
JL.
Department of
Preventive Medicine, Keck School of Medicine, University of Southern
California, Harlyne J Norris Cancer Research Tower, 1450 Biggy Street, Los
Angeles, CA, 90033, USA, janefigu@usc.edu.
The potential effects
of oral contraceptive (OC) and postmenopausal hormone (PMH) use are not well
understood among BRCA1 or BRCA2 (BRCA1/2) deleterious mutation carriers with a
history of breast cancer. We investigated the association between OC and PMH
use and risk of contralateral breast cancer (CBC) in the WECARE (Women's
Environment, Cancer, and Radiation Epidemiology) Study. The WECARE Study is a
population-based case-control study of 705 women with asynchronous CBC and
1,398 women with unilateral breast cancer, including 181 BRCA1/2 mutation
carriers. Risk-factor information was assessed by telephone interview. Mutation
status was measured using denaturing high-performance liquid chromatography
followed by direct sequencing in all participants. Outcomes, treatment, and
tumor characteristics were abstracted from medical records. Ever use of OCs was
not associated with risk among noncarriers (RR = 0.87; 95% CI = 0.66-1.15) or
BRCA2 carriers (RR = 0.82; 95% CI = 0.21-3.13). BRCA1 carriers who used OCs had
a nonsignificant greater risk than nonusers (RR = 2.38; 95% CI = 0.72-7.83).
Total duration of OC use and at least 5 years of use before age 30 were
associated with a nonsignificant increased risk among mutation carriers but not
among noncarriers. Few women had ever used PMH and we found no significant
associations between lifetime use and CBC risk among carriers and noncarriers.
In conclusion, the association between OC/PMH use and risk of CBC does not
differ significantly between carriers and noncarriers; however, because
carriers have a higher baseline risk of second primaries, even a potential
small increase in risk as a result of OC use may be clinically relevant.
Menopause. 2009 Jul
8. [Epub ahead of print]
Menopausal symptoms
among breast cancer patients 6 months after diagnosis: a report from the
Dorjgochoo
T,
Gu K, Kallianpur
A, Zheng Y, Zheng W, Chen Z, Lu W, Shu XO.
From the
1Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram
Cancer Center, Vanderbilt University School of Medicine, Nashville, TN; and
2Shanghai Institute of Preventive Medicine,Shanghai, China.
OBJECTIVE:: The
aim of this study was to estimate the prevalence of menopausal symptoms in
relation to treatment modalities in Asian women treated for breast cancer.
METHODS:: A population-based cohort of 5,023 Chinese women aged 25 to 70 years
with primary stage 0 to III breast cancer was identified from a
population-based tumor registry and enrolled in the study approximately 6
months after diagnosis. Participants were asked about the occurrence of
specific menopausal symptoms. Associations between these symptoms and breast
cancer treatments were evaluated by stratified, multivariate logistic
regression. RESULTS:: Among women with a recent diagnosis of breast cancer,
67.2% of premenopausal women and 46.3% of postmenopausal women experienced at
least one menopausal symptom, namely, hot flashes, night sweats, and/or vaginal
dryness. Symptom prevalence among postmenopausal women decreased progressively
with age at diagnosis (63.3% for women aged 51-55 y, 51.5% for women aged 56-60
y, and 34.4% for women aged >65 y; P < 0.01). Overall, the highest
prevalence of most symptoms occurred in women aged 46 to 55 years (P <
0.01). Chemotherapy was positively associated with the occurrence of any symptom
and with each individual symptom, mainly in premenopausal women (adjusted odds
ratio [OR] range, 2.2-3.3; P < 0.05 for all). Tamoxifen use and
immunotherapy were associated with having any symptom and with each individual
symptom, regardless of menopause status (adjusted OR range, 1.5-1.8 and
1.3-1.5, respectively; P < 0.05 for all). Women treated before menopause
were at particularly high risk of experiencing two or more symptoms after
chemotherapy (OR, 1.77; 95% CI, 1.54-4.98; Pinteraction = 0.05) compared with
postmenopausal women. CONCLUSIONS:: Menopausal symptoms are prevalent among
Chinese women recently treated for primary breast cancer. These symptoms are
associated with age and menopause status at the time of diagnosis, as well as
with the type of treatment received.
Selección de Resúmenes
de Menopausia
Semana del 22 al 28 de Julio de
2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Diabetologia. 2009 Jul 23. [Epub ahead of print]
Menopausal hormone therapy and new-onset diabetes in the French Etude
Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale
(E3N) cohort.
de
Lauzon-Guillain B, Fournier A, Fabre A, Simon N, Mesrine S, Boutron-Ruault
MC, Balkau B, Clavel-Chapelon
F. INSERM, ERI 20, EA 4045, Villejuif cedex, France.
AIMS/HYPOTHESIS: Two US randomised trials
found a lower incidence of type 2 diabetes in women treated by menopausal
hormone therapy (MHT) with oral conjugated equine oestrogen combined with
medroxyprogesterone acetate. The purpose of this study was to evaluate
the influence of various MHTs, according to their formulation and route of
administration, on new-onset diabetes in a cohort of postmenopausal French
women. METHODS: The association between MHT use and new-onset diabetes was
investigated by Cox regression analysis in 63,624 postmenopausal women in the
prospective French cohort of the Etude Epidemiologique de Femmes de la Mutuelle
Générale de l'Education Nationale (E3N). Cases of diabetes were identified
through self-reporting or drug-reimbursement record linkage, and further
validated. RESULTS: 1,220 new-onset diabetes cases were validated. We observed
a lower risk of new-onset diabetes among women who had ever used MHT (HR 0.82
[95% CI 0.72-0.93]), compared with those who had never used MHT. Adjustment for
BMI during follow-up (rather than according to baseline BMI) did not
substantially modify this association. An oral route of oestrogen
administration was associated with a greater decrease in diabetes risk than a
cutaneous route (HR 0.68 [95% CI 0.55-0.85] vs 0.87 [95% CI 0.75-1.00], p for
homogeneity = 0.028). We were not able to show significant differences between
the progestagens used in combined MHT. CONCLUSIONS/INTERPRETATION: Use of MHT
appeared to be associated with a lower risk of new-onset diabetes. This
relationship was not mediated by changes in BMI. Further studies are needed to
confirm the stronger effect of oral administration of oestrogen compared with
cutaneous administration.
J Clin Pharmacol. 2009 Jul 23. [Epub
ahead of print]
Steady-State Pharmacokinetics Following Application of a Novel
Transdermal Estradiol Spray in Healthy Postmenopausal Women.
Morton TL, Gattermeir
DJ, Petersen
CA, Day WW, Schumacher
RJ.
KV Pharmaceutical Company.
This study was
designed to evaluate the steady-state pharmacokinetics (PK) of estradiol and
its metabolites, estrone and estrone sulfate, following application of a novel
estradiol transdermal spray to healthy postmenopausal women. Participants were
randomly assigned in parallel to receive 1-, 2-, or 3-spray doses (24
participants/dose level) of a 1.7% estradiol metered-dose transdermal spray
(1.53 mg/spray) once daily for 14 days. Blood was collected predose on days 1
to 14 and over 7 days after the last dose. Serum concentrations for all 3
analytes reached steady state by day 7 or 8 and were still slightly above
baseline on day 21. Estradiol, estrone, and estrone sulfate serum
concentrations generally increased with increasing dose. Mean estradiol and
estrone maximum serum concentration (Cmax) following 1, 2, or 3 sprays for 14
days were 36 and 50, 57 and 60, and 54 and 71 pg/mL, respectively. Estradiol
time when maximum concentration occurred (tmax) was 18 to 20 hours. The area
under the serum concentration-time curve over 24 hours following the last dose
of study drug (AUC0-24 h) on day 14 for the 1-, 2-, and 3-spray groups,
respectively, was 471, 736, and 742 pgh/mL for estradiol; 886, 1208, and 1367
pgh/mL for estrone; and 16 501, 26 515, and 27 971 pgh/mL for estrone sulfate.
The metered-dose estradiol transdermal spray delivers estradiol at therapeutic
levels and produces low serum estrone concentrations.
Menopause. 2009 Jul 21. [Epub
ahead of print]
Age-related pelvic floor modifications and prolapse risk factors in
postmenopausal women.
Tinelli A, Malvasi A, Rahimi S, Negro R, Vergara D, Martignago
R, Pellegrino
M, Cavallotti
C.
Department of
Obstetrics and Gynaecology, Vito Fazzi Hospital, Leece; Rome, Italy.
OBJECTIVE::
Genital prolapse is frequent in postmenopausal women; it describes the loss of
support to the pelvic organs, resulting in a herniation of these into the
vaginal channel. This problem affects 50% of parous women, and at least 50% of
all women develop a mild form of genital prolapse after pregnancy. METHODS:: An
extensive literature review from 1990 to 2008 was performed on prolapse
etiology and its risk factors; analyzing the data, we reviewed the genetic and
biological aspects, age-related prolapse, biological tissue modifications,
surgical problems, pelvic musculature modifications, and neuropathy. RESULTS::
Data suggested that aging, pelvic trauma, and surgery evoke tissue denervation
and devascularization, anatomic alterations, and increased degradation of
collagen; all of these may lead to a decrease in mechanical strength and
predispose an individual to prolapse. It has been demonstrated that there is a
reduction in protein content and estrogens in uterosacral ligaments, in the
vagina, and in the parametrium of women with prolapse. This is a possible
explanation for why many surgical procedures to correct prolapse fail and
recurrences after surgical correction are frequent. CONCLUSIONS:: Even if the
etiology of pelvic prolapse is poorly defined and multifactorial, aging risk
factors, such as biomechanical abnormalities in connective tissue composition,
hormonal deficiency, and irregular tissue metabolism, are nonmodifiable and
therefore largely stated in clinical practice. Regardless of future
developments, based on the reported findings, prolapse therapy will be more
influenced by genetics, biological pelvic changes, changes in tissue
homeostasis, and topical hormones, rather than general pelvic corrective
surgical anatomy.
Endocrinol Nutr. 2009
May;56(5):227-32. Epub 2009 Jul 1.
Lifestyle, socioeconomic status and morbidity in postmenopausal women
with grade II and III obesity.
Navarro
Rodríguez MC, Saavedra Santana
P, de Pablos
Velasco P, Sablón González
N, et al.
Universidad de
Las Palmas de Gran Canaria. Las Palmas. Espańa.
BACKGROUND:
Obesity has become a major public health problem in all western countries, and
its prevalence is increasing. This condition is associated with a higher
prevalence of diabetes mellitus, hypertension, and coronary heart disease;
furthermore, obesity is a risk factor for mortality. OBJECTIVE: To study the
association of some prevalent diseases (diabetes mellitus, thyroid disease,
obesity, hypertension, inflammatory rheumatic disease, urolithiasis), the
distribution of some lifestyle factors (tobacco, alcohol and caffeine
consumption and physical activity during leisure time) and the prevalence of
poverty in a population of postmenopausal women in the Canary Islands with
obesity class II or III (BMI>35). METHOD: A personal interview was performed
in all patients. A questionnaire was administered to assess their lifestyles
and current medication use. The women's medical records were reviewed to
confirm the existence of certain diseases. A complete physical examination was
performed in all patients. Weight and height were measured with the patient
dressed in light clothing. Blood samples were obtained with the patient in a
fasting state for subsequent analysis. Poverty was defined according to the
criteria of the Spanish National Institute of Statistics. RESULTS: Women with
obesity class II or III were older (56.8 +/- 11 vs 53.9 +/- 11.6 years,
p=0.02), shorter (153.7 +/- 6.3 vs 156.9 +/- 36.1 cm, p=0.001), heavier (89.6
+/- 9.3 vs 66.6 +/- 10.4 kg, p=0.001) and had a greater body surface than
controls (1.73 +/- 0.13 vs 1.54 +/- 0.13 m2, p=0.001). Alcohol and tobacco
consumption were lower in obese women than in controls. Obese women drank more
coffee and took less physical activity during leisure time than controls. The
prevalence of hypertension -36% vs 17.9%, p=0.001, odds ratio [OR] [95%
confidence interval (IC)]=2.57 (1.56-4.24)-, diabetes mellitus -24.4% vs 11.3%,
p=0.001, OR=2.52 (1.47-1.05)-and hypothyroidism -14.3% vs 8%, p=0.04; OR=1.91
(0.99-3.68)-was higher in obese women than in controls. More than half lived in
rural areas and were below the poverty threshold. CONCLUSIONS: More than half
of postmenopausal women with obesity class II or III were below the poverty
threshold and lived in a rural area. In these women there was a lower
consumption of alcohol and tobacco, lesser physical activity during leisure
time, and a higher prevalence of diabetes mellitus, hypertension and
hypothyroidism than in control postmenopausal women.
J Sex Med. 2009 Jul 13. [Epub
ahead of print]
Vaginal Dryness: A Comparison of Prevalence and Interventions in 11
Countries.
Leiblum SR, Hayes RD, Wanser RA, Nelson JS.
New Jersey Center
for Sexual Wellness, Bedminister, NJ, USA.
ABSTRACT
Introduction. There is limited research comparing cross-cultural differences in
women's experiences of vaginal dryness. Aim. To examine international
differences in the prevalence of vaginal dryness, the degree to which it is
experienced as problematic or bothersome, the use of lubricants to alleviate it,
and women's discussion of this problem with physicians. Main Outcome Measures.
Questionnaire measuring the level of vaginal dryness and degree to which it is
perceived as bothersome. Methods. The Global Survey of Sexual Attitudes and
Practices was administered to 6,725 women from 11 countries: UK, Germany,
Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand.
Results. Prevalence of self-reported vaginal dryness varied from a minimum of
5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with
self-reported vaginal dryness who found it very bothersome varied as well
(e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported
low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as
compared with younger women (18-34 years) reported significantly more vaginal
dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P
values <0.02). The majority of women under 50 attributed vaginal dryness to
inadequate sexual arousal while women over 50 believed it was because of aging
or menopause. Cross-culturally, women differed substantially in the likelihood
of discussing their sexual life/concerns with a physician. Conclusion. Women
from different countries differ substantially in their experiences, concerns,
and reports of vaginal dryness/sexual pain, as well as their familiarity with
personal lubricants as a treatment. Researchers should assess the prevalence
and degree of the bother of vaginal dryness in order to make international
comparisons of the burden of this condition.
Am J Clin Nutr. 2009 Jul 22. [Epub ahead of
print]
Dietary fiber intake and risk of breast cancer in postmenopausal women:
the National Institutes of Health-AARP Diet and Health Study.
Park Y, Brinton LA, Subar AF, Hollenbeck
A, Schatzkin
A.
National Cancer
Institute, Bethesda, MD, and the AARP, Washington, DC.
BACKGROUND:
Although dietary fiber has been hypothesized to lower risk of breast cancer by
modulating estrogen metabolism, the association between dietary fiber intake
and risk of breast cancer by hormone receptor status is unclear. OBJECTIVE: The
objective was to examine the relation of dietary fiber intake to breast cancer
by hormone receptor status and histologic type among postmenopausal women in
the National Institutes of Health-AARP Diet and Health Study (n = 185,598; mean
age: 62 y). DESIGN: Dietary intakes were assessed with a food-frequency
questionnaire. Incident breast cancer cases were identified through linkage
with state cancer registries. Cox proportional hazard models were used to
estimate relative risks (RRs) and 2-sided 95% CIs. RESULTS: During an average
of 7 y of follow-up, 5461 breast cancer cases were identified, of which 3341
cases had estrogen receptor (ER) and progesterone receptor (PR) status. Dietary
fiber intake was inversely associated with breast cancer risk [RR for the
highest quintile (Q5) compared with the lowest quintile (Q1): 0.87; 95% CI:
0.77, 0.98; P for trend: 0.02]. The inverse association appeared to be stronger
for ER(-)/PR(-) tumors (RR(Q5vsQ1): 0.56; 95% CI: 0.35, 0.90; P for trend:
0.008; 366 cases) than that for ER(+)/PR(+) tumors (RR(Q5vsQ1): 0.95; 95% CI:
0.76, 1.20; P for trend: 0.47; 1641 cases). The RR(Q5vsQ1) of lobular tumors
was 0.66 (95% CI: 0.44, 0.97; P for trend: 0.04) and 0.90 (95% CI: 0.77, 1.04;
P for trend: 0.10) for ductal tumors. Fiber from grains, fruit, vegetables, and
beans was not related to breast cancer. CONCLUSION: Our findings suggest that
dietary fiber can play a role in preventing breast cancer through nonestrogen
pathways among postmenopausal women.
Rev Med Chil. 2009 Mar;137(3):345-50. Epub 2009 Jun
15.
Prevalence
of sexual dysfunction among climacteric women
Figueroa J R, Jara A D, Fuenzalida P A, Del Prado A M, Flores D, Blumel JE.
Departamento de Gineco-obstetricia, Escuela
de Medicina, Universidad Diego Portales, Santiago, Chile. BACKGROUND:
The Female Sexual Function index (FSFI), is a scale designed to evaluate
sexuality and diagnose the presence of sexual dysfunction in women. AIM: To
apply the FSFI to climacteric women. PATIENTS AND METHODS: The FSFI was applied
to 370 healthy women aged between 40 and 59years old (49 +/- 6years) that
accompanied patients to public health services in