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Biomedical subjects

L Dennerstein

Publications and source records attributed to L Dennerstein.

At least 73 records · Page 4Linked to original sources
PubMed1996

Bone turnover markers and bone density across the menopausal transition.

We measured lunbar spine and femoral neck bone mineral density (BMD); urine markers of bone resorption; serum markers of bone formation; and serum gonadotrophin, estradiol and inhibin concentrations in a population-based cohort of 281 women aged 45-57 yr. Women were classified into pre-, peri-, and postmenopausal groups, depending on menstrual bleeding patterns. Compared with premenopausal women, BMD was lower only in postmenopausal women but not in women currently using hormone replacement therapy (HRT). BMD decreased with age in the perimenopausal group. Compared with premenopausal women, perimenopausal women had 20% greater urine N-telopeptide excretion (P < 0.05) and a doubling of gonadotrophin levels (P < 0.01), whereas serum estradiol and bone formation marker concentrations were no different. Postmenopausal Women had greater levels of bone turnover markers (P < 0.0001), except free deoxypyridinoline and type I procollagen propeptide. Among postmenopausal women, bone resorption markers were lower in those using HRT. Levels of nearly all bone turnover markers were positively related to serum FSH concentrations (P < 0.0001). Overall, the major independent predictors of BMD were age, urine N-telopeptide, serum bone alkaline phosphatase, and serum, FSH, whereas urine free deoxypyridinoline was positively related to BMD in pre- and perimenopausal women. In conclusion, the perimenopause is associated with elevated bone resorption rates and declining BMD, and factors in addition to estrogen deficiency may also contribute to the pathogenesis of postmenopausal osteoporosis.

Aging↗
PubMed1996

Psychological morbidity in obstetric-gynaecology patients: testing the need for expanded psychiatry services in obstetric-gynaecology facilities.

OBJECTIVE: The present study set out to determine general levels of distress, anxiety and depression in an obstetric-gynaecology inpatient population and to ascertain levels of patient satisfaction with services. METHOD: 200 English-speaking consecutive admissions to the hospital filled out a package of questionnaires consisting of a demographic data form, the 30-item General Health Questionnaire, the Speilberger State-Trait Anxiety Inventory, the Inventory to Diagnose Depression and a Patient Satisfaction with Services Questionnaire. 134 packages were fully completed. RESULTS: The most significant findings were: first, that high levels of anxiety prevailed, with approximately 1/3 of patients at or above the 75th percentile for anxiety levels; and second, that those patients born in non-English speaking countries were significantly more dissatisfied with their care. CONCLUSIONS: The results of this study suggest that there is a need for increased awareness of and further research into the psychological needs of obstetric-gynaecology patients.

Adult↗
PubMed1996

Progress and evaluation of a consultation-liaison psychiatry service to an obstetric-gynaecology hospital.

OBJECTIVE: Recently we described the establishment and first 6 months of a psychiatric consultation-liaison service to a Melbourne obstetric-gynaecology teaching hospital. The follow-up report evaluates the service in two ways: first, it compares referral data for the 12 months of 1992 with that of the first 6 months of operation in 1990; and second, it reports on results of a survey of referrer and patient satisfaction with the service. METHOD: Referral data were collected for the data comparison from the consultation-liaison referral book and patients' files. Referrer and patient satisfaction was evaluated by questionnaires sent to 45 medical staff, 7 charge nurses, and 100 consecutive patients. RESULT: A fairly constant referral rate for inpatients has emerged at 0.8%, this very low referral rate being some cause for concern. An internal shift in the type of referrals over time has developed, with an increase in obstetric and a decrease in gynaecology referrals. High referrer satisfaction, with 86% of the doctors finding the consultation(s) "very" or "quite" helpful, and high patient satisfaction, with 83% of respondents having found the consultation(s) "very" or "quite" helpful, was found. CONCLUSIONS: Despite high referrer and consumer satisfaction, and objective evidence of need, this pioneering consultation-liaison service in obstetric-gynaecology continues to be grossly under-utilised. Increasing the referral rate will be one of the greatest challenges in the future of this service.

Adaptation, Psychological↗
PubMed1996

Effect of progesterone and its 5 alpha and 5 beta metabolites on symptoms of premenstrual syndrome according to route of administration.

Orally administered progesterone may have advantages over other routes of administration in the treatment of premenstrual syndrome (PMS) because of substantially higher levels of the anxiolytic metabolites 5 alpha and 5 beta pregnanolone. The only previous placebo-controlled trial which used oral progesterone reported beneficial effects in the treatment of PMS. The present study, a double-blind crossover trial, compared the administration of 300 mg daily oral progesterone with 200 mg daily vaginal progesterone and matched placebos for 10 days premenstrually. Although there was a significant treatment effect on symptoms, no difference between active treatments and placebo was found. The trial was terminated with 25 women completing treatment as it was evident that no clinically significant effect of either form of progesterone was likely to be detected even with twice the sample size. Serum levels of progesterone and metabolites showed that oral administration resulted in supraphysiological levels of 5 alpha and 5 beta metabolites and there was a negative correlation between 5 alpha pregnanolone levels and anxiety. However, this did not translate to overall reduction in premenstrual distress or anxiety beyond that achieved by placebo, as measured by validated questionnaires.

Administration, Intravaginal↗
PubMed1996

Psychological aspects of nipple pain in lactating women.

The aim of the study was to assess the psychological impact of nipple pain in lactating women. Forty-eight lactating women with nipple pain completed mood scales at their first visit and following resolution of their pain, and 65 lactating women without nipple pain completed one set of mood scales. At the first visit, the mean score on the Edinburgh Postnatal Depression Scale (EPDS) in the nipple pain group was 12.4 and the control group was 7.6 (p < 0.0001). Eighteen women (38%) scored above the threshold for depression (> 12), compared to nine in the control group (14%): p < 0.01. Following pain resolution, the mean score on the EPDS decreased to 7.3 (p < 0.001); and six women (16%) scored 13 or over on the EPDS, significantly less than initially (p < 0.05). Similarly, on the Profile of Mood States (POMS), the nipple pain group scored significantly higher than control group on all mood factors (Tension, Depression, Fatigue, Confusion, Vigor [lower]), except Anger which did not reach a level of significance. After pain resolution, POMS scores returned to similar levels as the control group. In conclusion, both the EPDS and POMS indicated women with nipple pain were experiencing high levels of emotional distress. However, once the pain had resolved their distress also resolved.

Adult↗
PubMed1996

Psychotropic drug use by women: could violence account for the gender difference?

Cross-national studies show that the female to male ratio of psychotropic drug use is approximately 2:1. Twenty per cent of female general practice patients are prescribed psychotropic drugs. The reasons behind this remain unclear but research points to the higher levels of psychopathology either experienced or reported by women. Recent studies have shown a strong association between the experience of domestic violence and sexual abuse and the development of mental ill health. It may be that women who use psychotropic drugs represent a group who are more likely to be victims of violence. If this is the case then doctors should be incorporating questioning about violence when thinking of prescribing such drugs. Further research is necessary to clarify whether or not a relationship exists between psychotropic drug use by women and a previous or current history of physical or sexual abuse.

Crime Victims↗
PubMed1996

Bone mineral density and hormone levels in menopausal Australian women.

To assess the relationships between bone mineral density (BMD) at the lumbar spine and femoral neck and menopausal status, age, physical variables, and lifestyle and gynecological factors. BMD and follicle-stimulating hormone (FSH), estradiol and inhibin levels were measured in 167 women born in Australia, aged 46-57 years, who had no record of receiving hormone replacement therapy. Using the premenopausal group as a baseline, the FSH level was higher in peri- and postmenopausal subjects (p < 0.0005), and estradiol and inhibin levels in the postmenopausal women were lower (p < 0.0005). Mean (+/- SE) lumbar spine and femoral neck BMD were 15 +/- 3% and 10 +/- 3% lower, respectively, in postmenopausal than in premenopausal women. Lumbar spine BMD decreased with increasing age in perimenopausal women only (p < 0.005), and femoral neck BMD decreased with increasing age in the pre-, peri-(p < 0.05) and postmenopausal women. The difference between femoral neck BMD in the pre- and postmenopausal women was explained by the difference in age between these groups, whereas for lumbar spine BMD the menopausal status was an additional determining factor. There was a negative effect of smoking on femoral neck BMD (p < 0.05) in postmenopausal women. In the perimenopausal decade the femoral neck BMD is primarily dependent on age, whereas lumbar spine BMD is dependent on both age and menopausal status.

Aging↗
PubMed1995

Psychotropic drug use by women: current prevalence and associations.

OBJECTIVE: To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables. DESIGN: A cross-sectional, questionnaire-based survey. SETTING: Metropolitan Melbourne between November 1993 and February 1994. SUBJECTS: Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation. OUTCOME MEASURES: Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics. RESULTS: The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension. CONCLUSIONS: Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.

Adult↗
PubMed1995

Influence of route of administration on progesterone metabolism.

While inducing similar progesterone levels, the ratio of 5 alpha- and 5 beta-pregnanolone/progesterone plasma concentrations has been dramatically increased after oral as opposed to vaginal administration, in a cross-over study. The known psychotropic effects of 5 alpha- and 5 beta-pregnanolone lead to different indications and precautions for oral and vaginal administration of progesterone.

20-alpha-Dihydroprogesterone↗
PubMed1995

Use of hormone replacement therapy by Melbourne women.

Hormone replacement therapy (HRT) is used for relief of symptoms related to the menopause and for the prevention of postmenopausal osteoporosis and cardiovascular disease. Patterns of use of HRT are thought to be changing rapidly, but little is known about who is using the therapy, for what purpose or for what period of time. Telephone interviews were conducted in May 1991 with a randomly selected sample of 2001 Australian-born women aged 45 to 55 years living in Melbourne, as part of the Melbourne Women's Midlife Health Project. Questions related to use of HRT, health status, use of health services, sexual functioning, attitudes to menopause and aging, and sociodemographic characteristics. Twenty-one per cent of the sample were using HRT. Use was more prevalent among women 50 years and over (28 per cent) than those under 50 (15 per cent). Seventeen per cent of nonhysterectomised women, 31 per cent of hysterectomised women and 49 per cent of women who had undergone hysterectomy and bilateral oophorectomy were current users. Almost 60 per cent had been using the therapy for two years or less, and 34 per cent for one year or less. Just over half reported control of hot flushes as a benefit, and 10 per cent mentioned prevention of bone loss as a benefit. Logistic regression analysis identified differences between users and nonusers in experience of hot flushes, health status, use of preventive and treatment services, sexual functioning, wellbeing, attitudes to menopause and aging, and sociodemographic characteristics. These differences may relate to risk of later cardiovascular disease.

Age Factors↗
PubMed1995

Oxytocin and female sexuality.

A search of the literature has been prepared to determine how oxytocin may affect sexual and reproductive in women. Many animal studies suggest that oxytocin induces a variety of reproductive behaviors, including grooming, sexual arousal, orgasm, gamete transport, nesting, birthing, and specific maternal behaviors such as breast-feeding and bonding between mother and infant. These actions are apparently facilitated by the 'priming' effect on certain cells by sex and steroid hormones - as the brief case report would also suggest. However, no adequate double-blind trial has confirmed the observations from this report in women. Only animal studies have been performed, albeit over a wide range of species. A variety of other causes and effects of sexual interest and arousal relating to oxytocin are considered, including some of those in males. More research is needed to clarify the role of oxytocin in human reproductive behaviors, including its potential 'aphrodisiac' or prosexual effect in women in the presence of the sex-steroid hormones.

Female↗
PubMed1995

The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample.

In a study of the endocrinology of the perimenopausal years, levels of serum FSH, estradiol (E2), immunoreactive inhibin (INH), testosterone, and sex hormone-binding globulin were measured in a population-based sample of 380 women (mean age, 49.4 yr; range, 45.6-56.9 yr). Subjects were divided into women who reported continuing regular menstrual cycles (27%; group I), a change in menstrual flow without a change in frequency (23%; group II), a change in frequency but no change in flow (9%; group III), changes in both frequency and flow (28%; group IV), and at least 3 months since their last menstrual period (13%; group V). After adjusting for age and body mass index, the geometric mean FSH increased across menstrual groups and, compared with group I, was 53% higher in group IV (P < 0.0005) and 253% higher in group V (P < 0.0001). Age- and body mass index-adjusted geometric means for E2 and INH in group V were 54% and 53% of those in group 1, respectively (P < 0.005, P < 0.0001). Women in group V who did not have a menstrual period in the next year had higher FSH and lower E2 and INH levels than those who subsequently went on to have at least one more menstrual period (P < 0.05). FSH was negatively correlated with E2 (r = -0.30) and INH (r = -0.39), whereas INH was positively correlated with E2 (r = 0.45). We conclude that an increase in serum FSH and decreases in E2 and INH are the major endocrine changes associated cross-sectionally with the menopausal transition.

Androgens↗
PubMed1995

Mental health, work, and gender.

Women have significantly higher prevalence rates than men for many mental disorders, particularly affective disorders. Married women are more at risk for mental ill-health than single women or married men. The detrimental effects of marriage on mental health appear to relate to the contexts of role performances and the reduction in opportunities in paid employment. This review examines the influence of women's paid and unpaid domestic work and roles on mental health. Many studies show positive effects of paid employment on mental health, and multiple roles have been found to have beneficial rather than adverse effects on mental health. However, husbands' negative attitudes to women's paid employment, with resultant marital conflict, and husbands' lack of participation in child care may erode these potential beneficial effects.

Adult↗
PubMed1995

Premenstrual complaints: an idiosyncratic syndrome.

The two issues of premenstrual syndrome (PMS) symptom heterogeneity and symptom severity are addressed in an examination of the idiosyncratic nature of premenstrual complaints. Analyses of PMS symptoms reported during the first assessment month by a group of treatment-seeking women revealed that when presented with a prepared list of symptoms (Menstrual Distress Questionnaire), they select many more symptoms than when self-reporting their complaints in ranked order of severity. In this study of a sample of 98 women, most of the women reported only four rank-ordered symptoms. Symptom profiles from five symptom categories were constructed for each of the women and from a possible 86 different profiles 84 were discovered. Of these, psychological profiles dominated the total reports. These findings, together with results of previous research, lead to two conclusions. First, that PMS, though multidimensional, may be defined for each woman by a limited number of symptoms; and second, that PMS is highly idiosyncratic in nature.

Female↗
PubMed1994

Hysterectomy experience among mid-aged Australian women.

OBJECTIVES: To determine the rate of oophorectomy in, use of hormone replacement therapy by, and health, social and lifestyle factors of, mid-aged Australian women who have undergone hysterectomy. DESIGN AND PARTICIPANTS: A community-based cross-sectional survey by telephone interview of a random sample of 2001 Australian-born Melbourne women aged between 45 and 55 years. MAIN OUTCOME MEASURES: The health status, sociodemographic and lifestyle correlates of women who had undergone hysterectomy compared with women in the natural menopause transition. RESULTS: Twenty-two per cent of the women had undergone hysterectomy. Of these, 21% had had one ovary removed, and 20% both. Mean age at hysterectomy was 40.4 years. There was no trend in the bilateral oophorectomy rate over the last two decades. Current hormone replacement therapy use increased significantly with surgery, from 17% of non-hysterectomised women to 31% of hysterectomised women, and 49% for women who had undergone hysterectomy and bilateral oophorectomy. Hysterectomised women were significantly more likely to be of lower educational level, and to report a history of troublesome premenstrual complaints, more dilatation and curettage procedures and nongynaecological operations, and use of prescription medications. CONCLUSIONS: Social and pre-existing health problems influence hysterectomy rates. Many women undergo oophorectomy at hysterectomy despite limited evidence of benefit.

Australia↗