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R S Legro

Publications and source records attributed to R S Legro.

54 records · Page 3Linked to original sources
PubMed1995

The genetics of polycystic ovary syndrome.

Problems that confound the clinical characterization of polycystic ovary syndrome (PCOS) also complicate the search for its genetic cause. There is no consensus as to the nature of the clinical phenotype for PCOS, and there is even doubt whether polycystic ovaries are an indispensable part of the syndrome. Few ethnic studies on PCOS have been performed, although it has been reported in most major racial groups. Genetic studies of family clusters and relatives of affective probands have shown a high incidence of affected relatives. A dominant mode of inheritance, rather than a recessive one, seems more likely. Multiple genetic causes of adult-onset hyperandrogenism and chronic anovulation have been identified. Chromosomal studies of patients with PCOS have shown no consistent abnormality. Molecular genetic studies are now ongoing. Future genetic models should consider such problematic areas as the heterogeneity of the syndrome, phenotypes in males as well as in females in the nonreproductive years, the exclusion of secondary causes of hyperandrogenism, and the persistence of a syndrome that adversely affects fecundity.

Diabetes Mellitus, Type 2↗
PubMed1995

Recipient's age does not adversely affect pregnancy outcome after oocyte donation.

OBJECTIVE: Our purpose was to examine the effect of the recipient's age on pregnancy and miscarriage rates after oocyte donation. STUDY DESIGN: A retrospective analysis of 307 consecutively performed donor oocyte cycles was undertaken. Recipients were divided into two groups: younger group < or = 42 years old (165 cycles) versus older group > 42 years old (145 cycles). Pregnancy outcomes between groups were compared. Confounding variables such as donor and cycle characteristics, recipient characteristics, and male parameters were also examined. RESULTS: Both groups had the same incidence (6%) of failed fertilization cycles. At least one embryo was transferred in the remaining 286 cycles. Ongoing or delivered pregnancy rates per embryo transfer were similar for younger and older groups (30.2% vs 30.6%). Differences in miscarriage rates were not statistically significant (9.8% vs 16.3%). There were no differences in the cycle parameters related to donor age, number of oocytes aspirated, number of oocytes fertilized, and number of embryos transferred. Donor sperm was more frequently utilized in the older group (19 vs 4 cycles, p = 0.0002). In the remaining cycles male partners of older recipients were significantly older (37.9 +/- 0.5 years vs 43.9 +/- 0.6 years, p < 0.0001), but there were no differences in semen parameters or fertilization rates. Older recipients were more likely to be parous but also to have experienced a previous miscarriage. CONCLUSION: Recipient age does not adversely affect cycle outcome with donor oocytes. This implies that aging of the uterus is not of clinical significance to patients electing this method of infertility treatment.

Abortion, Spontaneous↗
PubMed1995

A dopamine D3 receptor genotype is associated with hyperandrogenic chronic anovulation and resistant to ovulation induction with clomiphene citrate in female Hispanics.

OBJECTIVE: To determine if dopamine (D3) receptor genotypes are associated with anovulation and response to ovulation induction with clomiphene citrate. DESIGN: Clinical and laboratory characteristics of anovulatory patients and ovulatory controls were compared with findings at the DNA level. SETTING: An outpatient clinic at an university medical center. PATIENTS: One hundred eighty human Hispanic female volunteers (130 of these with documented ovulatory status) were studied. INTERVENTIONS: Genomic DNAs were extracted from each patient. Polymerase chain reaction with subsequent restriction digest was performed to analyze the D3 receptor allele status (two possible alleles). MAIN OUTCOME MEASURES: Menstrual history, serum T, and midluteal serum Ps from spontaneous and clomiphene cycles were correlated with D3 receptor genotype. RESULTS: Hispanic females with the 22 genotype compared with the other genotypes (11 and 12) were more likely to have irregular menses, an elevated serum T (> or = 70 ng/dL [conversion factor to SI unit, 3.467]), and hyperandrogenic chronic anovulation. These patients tended to be resistant to ovulation induction requiring a significantly higher dose of clomiphene to achieve an ovulatory response (22 genotype [mean +/- SEM] [140.0 +/- 19.0 mg] versus 11 [77.1 +/- 17.5 mg] or 12 [69.2 +/- 13.1 mg]). This effect was independent of patient age, weight, or serum T level. CONCLUSIONS: Hyperandrogenic chronic anovulation may have a genetic component. Genetic analysis may be useful in predicting resistance to ovulation induction with clomiphene.

Alleles↗
PubMed1995

Metabolism of dihydrotestosterone to 5 alpha-androstane-3 alpha, 17 beta-diol glucuronide is greater in the peripheral compartment than in the splanchnic compartment.

OBJECTIVE: To compare the peripheral versus the splanchnic contribution to the formation of 3 alpha-diol G. DESIGN: Prospective study in various groups of women and men. SETTING: Reproductive Endocrine service of our University Medical Center. PATIENTS: Six normal ovulatory women, five hirsute women with polycystic ovary syndrome, and six normal men. INTERVENTIONS: All subjects received IV dihydrotestosterone (DHT) infusions as well as percutaneous administration of DHT. Serum was obtained at multiple time points before and after each administration of DHT. MAIN OUTCOME MEASURES: Comparison of serum levels of DHT, 3 alpha-androstanediol (3 alpha-diol), 3 alpha-diol G, and androsterone glucuronide in the three groups. RESULTS: Steady-state levels of DHT were similar in the three groups and were also similar after the two different routes of administration. However, ratios of 3 alpha-diol G to DHT were significantly greater after percutaneous gel than after IV administration in all three groups. This also was the case for the ratio of unconjugated serum 3 alpha-diol to DHT. Levels of androsterone glucuronide were similar with the different routes of administration. CONCLUSION: Using normal routes of administration and, in attempting to assess in vivo metabolism of DHT, our data confirm that the skin is the major site of unconjugated 3 alpha-diol and 3 alpha-diol G formation. Serum 3 alpha-diol G, therefore, appears largely to reflect skin DHT metabolism.

Administration, Cutaneous↗
PubMed1995

Altered responses to stress in women undergoing in-vitro fertilization and recipients of oocyte donation.

Clinical impressions suggest the presence of considerable anxiety and depression in infertile couples. We utilized a psychological stress test to assess adaptations to provoked stress to improve the psychological profile of infertile women. A psychological stress test was administered to four groups: normal menstruating females (controls, n = 13); oocyte donors (n = 13); recipients of oocyte donation (n = 7); and women undergoing standard in-vitro fertilization (IVF; mean age 38.0 years; n = 8). The psychological stress test consisted of three active coping tasks: (i) serial subtraction, (ii) Stroop colour test, (iii) speech task and (iv) one passive coping task, the cold-pressor test. Haemodynamic responses (HD) were monitored before, during and after the psychological stress test, and serum samples were drawn for catecholamines and cortisol. Baseline blood pressures were similar among groups. The psychological stress test elicited different biophysical responses in controls compared with the other groups (P < 0.001). Oocyte donors had different speech task responses from baseline, although these and the other parameters of the psychological stress test were not different from either the recipient or IVF groups. Blood pressure responses from baseline were blunted in both recipients and standard IVF patients following provoked stress. Baseline cortisol and norepinephrine were similar among all groups, yet provoked stress elicited a significant increase in controls (142.0 +/- 25.2%, P < 0.001) compared with oocyte donors (17.1 +/- 19.7%), recipients and standard IVF patients (mean -15.5 +/- 17.3% respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Multiple implantation after oocyte donation: a frequent but inefficient event.

OBJECTIVE: To evaluate the natural history of multiple implantation in a donor oocyte program. DESIGN: Retrospective review of clinical pregnancies resulting from donor oocytes with analysis of serial vaginal ultrasound examinations beginning 21 days after embryo transfer. SETTING: University of Southern California IVF program (USC-IVF). MAIN OUTCOME MEASURES: Number of implantation sites lost during gestation, furthest development of the gestation, and clinical symptoms of those experiencing loss. RESULTS: Sixty-two of 101 patients (61%) who became pregnant had multiple implantations, 41 (41%) with two sacs, 12 (12%) with three sacs, 6 (6%) with four sacs, and 3 (3%) with five sacs. Overall 28% of implantations sites were lost spontaneously. Rates of loss were similar for multiple implantations. The majority (62%) of these nonviable sacs did not develop beyond a gestational sac. All patients with three or more implantation sites had ongoing pregnancies through the first trimester. The probability of pregnancy loss after visualization of fetal heart motion was 5.7%. Few patients who underwent a natural self reduction of sacs were symptomatic. CONCLUSIONS: There is a significant self-reduction in multiple implantation sites in a donor oocyte program. This may obviate the need for a selective reduction procedure. Patients should be followed for up to 10 weeks after ET before committing to a selective reductive procedure.

Abortion, Spontaneous↗
PubMed1995

Angiotensin-converting enzyme inhibition reverses luteal phase steroid production in oocyte donors.

OBJECTIVE: To determine whether angiotensin-converting enzyme (ACE) inhibition would affect ovarian steroid synthesis in the oocyte donors undergoing controlled ovarian hyperstimulation (COH). SETTING: The IVF program of the University of Southern California. DESIGN: Prospective matched clinical trial. PATIENTS: Twelve oocyte donors were studied in 28 hyperstimulation cycles. INTERVENTIONS: Donors underwent a standard COH protocol. Follicle aspiration was performed 34 hours after administration of hCG. After the procedure, seven donors were administered the ACE inhibitor, captopril, 6.25 mg orally twice daily for 4 days. The remaining patients served as controls. MAIN OUTCOME MEASURES: Serum E2, P, plasma prorenin, active renin, and angiotensin II (Ang II). RESULTS: Angiotensin II increased after aspiration in both groups but was significantly lower in those receiving captopril. Peak P in the captopril group was significantly lower than controls (81.8 +/- 27.8 versus 208.5 +/- 23.9 ng/mL [conversion factor to SI unit, 3.180]). Peak E2 was significantly higher (2,222.4 +/- 875.3 versus 425.6 +/- 490.4 pg/mL [conversion factor to SI unit, 3.671]). Active renin and Ang II correlated with P. CONCLUSIONS: In stimulated cycles, inhibition of Ang II production appears to raise serum E2 and lower P levels. Angiotensin II, therefore, may have a role in the regulation of ovarian steroid synthesis.

Adolescent↗
PubMed1995

First-trimester pancreatitis. Maternal and neonatal outcome.

OBJECTIVE: To determine the incidence and maternal-fetal outcome of first-trimester pancreatitis at one institution. STUDY DESIGN: A retrospective study of pancreatitis presenting during the first trimester of pregnancy over a 10-year period at Magee Womens Hospital. RESULTS: There were 11 cases, for an incidence of 0.1/1,000 live births. There was no maternal mortality. Three patients elected voluntary termination, and eight pregnancies proceeded to term. All delivered at > or = 35 weeks. The mean gestational age was 38.9 +/- 2.1 weeks (mean +/- SD), and mean birth weight was 3,103 +/- 641 g. There were no adverse neonatal outcomes, although one patient had a fetus with severe intrauterine growth retardation. Maternal morbidity and complications were due mainly to gallstone pancreatitis, which was the most commonly identified cause of pancreatitis, and three patients underwent cholecystectomy during pregnancy or the puerperium. No first-trimester pregnancy terminations were performed for medical indications. Pancreatitis tended to recur during the examined pregnancy (mean number of admissions, 2.27 +/- 2.1). CONCLUSION: Patients should be advised of the relapsing nature of pancreatitis that presents during the first trimester. However, there is a good prognosis for pregnancy outcome.

Adolescent↗
PubMed1995

Association of early beta-human chorionic gonadotrophin values with pregnancy wastage and multiple implantation in a donor oocyte programme.

An early marker predictive of a viable pregnancy would ease the anxiety associated with positive pregnancy tests after the use of donor oocytes. We examined the predictive value of an early serum quantitative human chorionic gonadotrophin (Q-HCG) concentration on pregnancy outcome following oocyte donation. Embryo transfers after oocyte donation resulting in a positive serum beta-HCG were examined beginning 9 days after embryo transfer from those samples assayed in our laboratory (n = 77). Q-HCG concentrations were measured in our laboratory by an immunoradiometric assay utilizing the first International Reference Preparation. Implantations were defined as the number of gestational sacs visualized by transvaginal ultrasound 21 days after embryo transfer. Biochemical pregnancies were those with transient elevations in beta-HCG concentration but without implantation sites. Spontaneous abortions were characterized by an implantation site with the eventual arrest of development. Ongoing/delivered pregnancies developed appropriately and proceeded beyond the first trimester. Day 9 Q-HCG concentrations did not differentiate between biochemical pregnancies/spontaneous abortions and ongoing/delivered pregnancies, although mean +/- SD concentrations for biochemical pregnancies were significantly lower than those for the other groups (P < 0.0001): biochemical pregnancies, n = 18, 5.8 +/- 8.9 mIU/ml, range 0-35; spontaneous abortions, n = 2, 46.0 +/- 10.0 mIU/ml, range 39-53; ongoing/delivered pregnancies, n = 57, 41.5 +/- 35.4 mIU/ml, range 0-214. In addition, day 9 Q-HCG concentrations did not differentiate between multiple implantations, although the implantation of four sacs had a significantly higher mean Q-HCG concentration compared with the implantation of fewer sacs (P < 0.0001): one sac, n = 22, 32.2 +/- 21.5 mIU/ml, range 3-78; two sacs, n = 25, 35.8 +/- 21.3, range 0-81; three sacs, n = 7, 47.1 +/- 37.1 mIU/ml, range 22-126; four sacs, n = 4, 122.3 +/- 62.4 mIU/ml, range 76-214. The positive predictive value of a Q-HCG > 10 mIU/ml was 0.91 (sensitivity 91%, specificity 75%). These initial data suggest that early day 9 serum Q-HCG determinations do not accurately identify viable pregnancies or multiple implantations. Even an early negative pregnancy test should be repeated because it can be associated with a normal pregnancy.

Abortion, Spontaneous↗
PubMed1994

Alterations in androgen conjugate levels in women and men with alopecia.

OBJECTIVE: To assess levels of androgen metabolites thought to reflect, at least in part, peripheral androgen activity in women with androgenic alopecia and men with premature balding in an effort to determine if a common abnormality exists. DESIGN: Prospective study in various groups of women and men. SETTING: Reproductive Endocrine Clinic at our university medical center. PATIENTS: Ten normal ovulatory female controls and 50 hyperandrogenic women divided on the basis of hirsutism and alopecia as follows: [1] 8 hirsute women with androgenic alopecia; [2] 12 nonhirsute women with androgenic alopecia; [3] 18 hirsute women without androgenic alopecia; and [4] 12 nonhirsute women without androgenic alopecia. Ten normal men and 10 young premature balding men matched for age and weight also were compared. INTERVENTION: Blood was obtained from all subjects. MAIN OUTCOME MEASURE: Comparison of blood hormone levels in the various groups. RESULTS: Serum T, androstenedione, and DHEAS were similarly elevated in hyperandrogenic women with and without alopecia, compared with controls. The female groups were then divided on the basis of hirsutism. Hirsute groups with and without alopecia had similarly elevated levels of unconjugated 3 alpha-androstanediol, 3 alpha-androstanediol glucuronide, 3 alpha-androstanediol sulfate, androsterone glucuronide, and androsterone sulfate compared with controls. In the nonhirsute groups, androgenic alopecia patients were compared with hyperandrogenic females and cycling controls. The androgenic alopecia patients had elevated levels of 3 alpha androstanediol (0.75 +/- 0.12 versus 0.46 +/- 0.1 and 0.41 +/- 0.1 nmol/L), 3 alpha-androstanediol sulfate (200 +/- 31 versus 79.6 +/- 6 and 67.0 +/- 4.0 nmol/L), elevated ratios of 3 alpha-androstanediol sulfate:3 alpha-androstanediol (267 +/- 49 versus 170 +/- 20 and 164 +/- 49 nmol/L), elevated ratios of 3 alpha-androstanediol sulfate:3 alpha-androstanediol glucuronide (32.2 +/- 6 versus 10.8 +/- 1 and 10.0 +/- 1) and lower ratios of 3 alpha-androstanediol glucuronide:3 alpha-androstanediol glucuronide (8.3 +/- 1.8 versus 17 +/- 1.7 and 15.2 +/- 1.6 nmol/L). In men the premature balding group had lower levels of 3 alpha-androstanediol glucuronide compared with the male controls (29.8 +/- 4.4 versus 15.2 +/- 1.6 nmol/L). Also, the ratio of 3 alpha-androstanediol glucuronide:3 alpha-androstanediol was significantly decreased, whereas the ratio of 3 alpha-androstanediol sulfate:3 alpha-androstanediol glucuronide was elevated. CONCLUSIONS: These data provided evidence confirming that enhanced 5 alpha-reductase activity occurs in androgenic alopecia but also suggests that a disorder of androgen conjugation, favoring sulfurylation over glucuronidation, may be a characteristic feature of scalp hair loss.

Adolescent↗
PubMed1994

Association of dopamine D2 receptor gene haplotypes with anovulation and fecundity in female Hispanics.

Dopamine is an important neurotransmitter in the hypothalamic control of gonadotrophin secretion. Neuron response is mediated through one of five different dopamine receptors. We explored the association of D2 receptor gene polymorphisms with disorders of ovulation. We utilized a multiplex allele specific polymerase chain reaction (PCR) to detect two bi-allelic polymorphisms (four potential haplotypes) in intron 5 and exon 6 of the D2 receptor gene. A second PCR/restriction endonuclease digest was utilized to verify this. Using these assays, 185 female Hispanics (51% with known ovulatory dysfunction and 49% with normal function) were haplotyped. One allele (3) was not present in the population and there were no significant differences in remaining allele distribution between ovulatory and anovulatory patients. However, significant associations were noted between alleles and gonadotrophins and fecundity. The 4 allele had a different reproductive profile compared to the 2 allele. The 4 allele was associated with significantly higher concentrations of luteinizing hormone (LH) (means +/- SE) (19.2 +/- 2.2 versus 12.3 +/- 1.3 mIU/ml, P < 0.02) and follicle stimulating hormone (FSH) (13.2 +/- 2.0 versus 10.0 +/- 0.6 mIU/ml, P < 0.05), significantly lower concentrations of prolactin (7.9 +/- 0.8 versus 14.9 +/- 3.5 ng/ml, P < 0.02) and higher parity (1.4 +/- 0.12 versus 0.92 +/- 0.13) and lower miscarriage rates (0.89 +/- 0.1 versus 1.33 +/- 0.24, P < 0.04). We conclude that D2 receptor alleles may be associated with reproductive success through altered gonadotrophin secretion and that this effect may be independent of ovulatory function.

Adult↗
PubMed1994

Size polymorphisms of the androgen receptor among female Hispanics and correlation with androgenic characteristics.

OBJECTIVE: To determine whether trinucleotide repeat polymorphisms of the androgen receptor gene correlate with androgenic measures in female Hispanics. METHODS: We studied 110 human volunteers from an endocrine and infertility clinic. Measures of androgenism including Ferriman Gallwey scores, waist-hip ratios, and body mass index (BMI) were correlated with the number of trinucleotide repeats of base sequence cytosine, adenine, and guanine in the androgen receptor gene. Serum testosterone was measured. Genomic DNA was obtained from leukocytes; amplification of the repeat region of the androgen receptor gene was performed and the products sized on an acrylamide gel. RESULTS: Trinucleotide repeats within our population ranged from 12-27, with a normal distribution. The number of repeats did not correlate with Ferriman Gallwey score or BMI, but correlated positively with waist-hip ratios (n = 54; r = 0.39, P = .028). Normoandrogenic patients with idiopathic hirsutism showed an inverse relation between Ferriman Gallwey score and repeat size (n = 16; r = -0.60, P = .014). CONCLUSION: Our findings suggest that androgenism may be mildly influenced by the molecular characteristics of the androgen receptor.

Adolescent↗
PubMed1994

Nonsurgical management of placenta percreta: a case report.

BACKGROUND: Although placenta percreta is rare, its sequelae include potentially lethal hemorrhage and loss of reproductive function. Therapy directed toward control of life-threatening hemorrhage frequently includes emergency hysterectomy. CASE: A woman with placenta percreta, suspected clinically and documented radiographically, was treated nonsurgically. Following delivery, the placenta was left in situ and methotrexate chemotherapy was initiated to aid destruction of the trophoblastic tissue. Eight months later, hysteroscopy showed a normal uterine cavity with only a small area of calcification at the presumed implantation site. Two years later, the patient had a normal pregnancy and vaginal delivery. CONCLUSION: Placenta percreta can be managed with preservation of the uterus, but careful follow-up may be required until the entire placenta has resorbed.

Adult↗
PubMed1993

Premature luteinization as detected by elevated serum progesterone is associated with a higher pregnancy rate in donor oocyte in-vitro fertilization.

Premature luteinization has been reported to be associated with decreased pregnancy rates in patients undergoing in-vitro fertilization. However, the detrimental effect created by a pre-aspiration rise in progesterone is difficult to assess since ovarian stimulation affects both oocyte quality and endometrial receptivity. Therefore, the relationship between premature luteinization and pregnancy rates remains uncertain. To achieve improved control for confounding variables, we studied premature luteinization in ovum donors of proven fertility. A total of 114 consecutive ovum donation cycles using pituitary suppression with a gonadotrophin-releasing hormone agonist followed by gonadotrophin stimulation were examined. Serum progesterone concentration on the day of administration of human chorionic gonadotrophin (HCG) was > 1.2 ng/ml in 29% of patients. Patients were divided into two groups based on this value. There was a significant increase in clinical pregnancy rates per embryo transfer in the group with higher progesterone concentrations (53 versus 25%, P = 0.012), as well as significantly more oocytes obtained at aspiration (19.6 +/- 10.4 versus 13.3 +/- 5.4, P < 0.001), and significantly higher peak serum oestradiol values (3903 +/- 1787 versus 2453 +/- 1232 pg/ml, P < 0.001). There were no significant differences between groups due to age, degree of stimulation or the number of embryos transferred. We conclude that premature luteinization as based on elevated serum progesterone concentration is a common occurrence in oocyte donors, reflects healthy follicular development, and is associated with increased pregnancy rates.

Adult↗
PubMed1992

Behavioral stress responses in premenopausal and postmenopausal women and the effects of estrogen.

OBJECTIVE: Our purpose was to determine the pattern of reactivity to stress in premenopausal and postmenopausal women and to assess the effects of estrogen. STUDY DESIGN: A behavioral stress test was given to premenopausal (n = 13) and postmenopausal women (n = 36). Biophysical and neuroendocrine responses were measured during and on completion of the stress test. The postmenopausal women were then randomized to placebo or transdermal estradiol treatment for 6 weeks, at which time another behavioral stress test was given. RESULTS: Stress reactivity to math and speech tasks elicited significantly greater systolic blood pressure responses in postmenopausal women compared with premenopausal women (p < 0.05). On retesting, significant biophysical responses that were present during the initial stress testing were still present (p < 0.05) in the placebo group but were blunted with estrogen treatment. Plasma corticotropin, cortisol, androstenedione, and norepinephrine increased during testing to a similar degree in premenopausal and postmenopausal women; this response was maintained after placebo treatment. Postmenopausal women treated with estrogen had blunted responses. CONCLUSION: Significant differences in responses to psychologic stress exist in premenopausal and postmenopausal women. The lack of adaptation may account in part for the increased risk of cardiovascular disease in postmenopausal women. Estrogen appears to blunt the stress-induced response.

Aged↗
PubMed1992

Chediak-Higashi syndrome in pregnancy.

We report the first known case of Chediak-Higashi syndrome in human pregnancy. This rare autosomal recessive disorder is characterized by partial oculocutaneous albinism, decreased leukocyte chemotaxis, susceptibility to infection, and death in childhood. Pathognomonic giant cytoplasmic granules are postulated to be dysfunctional fused lysosomes, which influence a wide range of physiologic processes. Pregnancy did not seem to exert any influence on the course of the disease. The pregnancy, labor, and delivery were not affected and the infant and placenta were normal.

Adult↗
PubMedDate not supplied

The effect of progestins on behavioral stress responses in postmenopausal women.

OBJECTIVE: We assessed the effects of progestin when added to estrogen on the adaptive patterns to provoked stress in postmenopausal women. METHODS: Fourteen postmenopausal women were randomized to receive either a transdermal estrogen patch (TE2) (n = 7) for 6 weeks or TE2 with added medroxyprogesterone acetate (10 mg) (TE2/MPA) (n = 7) for the last 10 days of the 6-week regimen. Behavioral stress tests were administered to each group, with measurements of biophysical and neuroendocrine responses. In a crossover fashion, after each group received the first treatment and testing, treatment was continued for another 6 weeks with the alternate regimen, at which time another stress test was administered. Responses to stress in the two treatment groups were compared to each other and to established placebo responses. RESULTS: Biophysical responses in the TE2 group were significantly blunted compared to both TE2/MPA and placebo responses (P < .05). Without MPA treatment, there were significantly blunted speech (P < .05) and cold pressor (P < .01) blood pressure responses. With added progestin, there was a greater systolic blood pressure response (P < .01) compared with estrogen alone. Both groups (TE2 and TE2/MPA) had blunted and nonsignificant responses of ACTH and cortisol upon testing, whereas the placebo group showed a significant response (P < .01). Plasma norepinephrine responses, however, were significantly blunted after TE2, compared with the increased responses observed with both TE2/MPA and placebo (P < .01). CONCLUSION: Although estrogen significantly reduces behaviorally induced stress reactivity in postmenopausal women, certain doses of progestin administration may blunt this effect.

Adaptation, Psychological↗