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PubMedDate not supplied

Relation between climacteric symptoms and ovarian hypofunction in middle-aged and older Japanese women.

OBJECTIVE: To gain insight into the characteristics and current status of climacteric symptoms reported by middle-aged and older women in Japan, we surveyed women presenting at our menopause clinic. DESIGN: The participants included 1,069 women, ranging in age from 40 to less than 60 years (mean age, 50.2 y). Climacteric (indefinite) symptoms were objectively assessed with the use of the Keio questionnaire, which grades the severity of 40 types of symptoms classified into 20 subgroups. The total scores obtained for the 40 symptoms were used to calculate symptom prevalence and severity. To evaluate ovarian function, concentrations of estradiol and follicle-stimulating hormone (FSH) in sera were measured. RESULTS: The most frequent symptom was general fatigue, reported by 88.2% of the women. Shoulder stiffness was the symptom rated to be severe by the highest percentage of women (38.1%). The prevalence and severity of hot flushes (and sweats) were slightly higher in perimenopausal and early postmenopausal women than in premenopausal and late postmenopausal women. The prevalence and severity of hot flushes and sweats were higher in women with estradiol < 25 pg/mL and FSH > 40 mIU/mL than in those with estradiol > or = 25 pg/mL and FSH < or = 40 mIU/mL. CONCLUSION: General fatigue and shoulder stiffness, symptoms with low hormone dependence, are the two most frequent climacteric symptoms in our clinic. Hot flushes and sweats, symptoms with high hormone dependence, are also common symptoms.

Adult↗
PubMedDate not supplied

Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study.

OBJECTIVE: To investigate the recurrence and severity of climacteric symptoms after two methods of discontinuation of prolonged hormone therapy. DESIGN: Postmenopausal women treated with hormone therapy for more than 3 years and opting to discontinue therapy were randomly assigned to two treatment groups. Hormone therapy was discontinued either abruptly (group 1) or gradually (group 2). Symptoms in both groups were monitored with the Greene climacteric scale at 1, 3, 6, 9, and 12 months. RESULTS: Ninety-one women aged 48 to 73 years (mean age 56.8 +/- 4.2 years) participated in the study. The mean therapy duration was 8.8 +/- 3.8 years. No differences were noted between the two groups regarding age at menopause, body mass index, reasons to start therapy, hormone therapy duration, type of regimen, and reasons cited for hormone treatment discontinuation. After cessation of therapy, a similar percentage of patients in each group resumed hormone therapy. Climacteric syndromes, specifically vasomotor dysfunction, were more severe in group 1 than in group 2 during the first 3 months after hormone therapy withdrawal. However, by 6 months vasomotor symptoms were worse in group 2. By 9 to 12 months, no difference was noted between groups. No differences were observed in the percentage of weight gain, vaginal bleeding, and atrophy after discontinuation of therapy by either method. CONCLUSIONS: Our specific regimen of gradual discontinuation of hormone therapy merely postponed, and neither prevented nor minimized, the reappearance of vasomotor symptoms, mood deterioration, and sexual dysfunction, and the resulting discomfort.

Aged↗
PubMed2002

Molecular and genetic characterization of a non-climacteric phenotype in melon reveals two loci conferring altered ethylene response in fruit.

Fruit ripening and abscission are associated with an ethylene burst in several melon (Cucumis melo) genotypes. In cantaloupe as in other climacteric fruit, exogenous ethylene can prematurely induce abscission, ethylene production, and ripening. Melon genotypes without fruit abscission or without ethylene burst also exist and are, therefore, non-climacteric. In the nonabscising melon fruit PI 161375, exogenous ethylene failed to stimulate abscission, loss of firmness, ethylene production, and expression of all target genes tested. However, the PI 161375 etiolated seedlings displayed the usual ethylene-induced triple response. Genetic analysis on a population of recombinant cantaloupe Charentais x PI 161375 inbred lines in segregation for fruit abscission and ethylene production indicated that both characters are controlled by two independent loci, abscission layer (Al)-3 and Al-4. The non-climacteric phenotype in fruit tissues is attributable to ethylene insensitivity conferred by the recessive allelic forms from PI 161375. Five candidate genes (two ACO, two ACS, and ERS) that were localized on the melon genetic map did not exhibit colocalization with Al-3 or Al-4.

Alkenes↗
PubMed1967

Phosphorylation in avocado fruit slices in relation to the respiratory climacteric.

The rate of uptake of inorganic phosphate by tissue discs from both preclimacteric and climacteric peak avocados is linear for at least 60 minutes. The loss of (32)P upon excessive washing was much greater from peak than from preclimacteric tissue. Short incubation periods and, most important, rapid washing procedures are essential for meaningful comparisons.Phosphate esterification proceeded at a much greater rate in climacteric than in preclimacteric tissue. The phosphorylation was sensitive to 2,4-dinitrophenol (DNP). The ADP to ATP ratio decreased materially with the advance of ripening. It was concluded that neither uncoupling nor acceptor control can account for the onset of the respiratory rise. Changes in permeability appear to play an important role in fruit metabolism during the climacteric.

Journal Article↗
PubMed1979

Polygalacturonase and Cellulase Enzymes in the Normal Rutgers and Mutant rin Tomato Fruits and Their Relationship to the Respiratory Climacteric.

Cell wall enzymes at different stages of fruit development were compared between the normal Rutgers and the isogenic nonripening rin tomato. In Rutgers, a detectable increase in polygalacturonase (PG) activity was observed 6 days prior to the respiratory climacteric (43 days postanthesis). The maximum increase in PG activity occurred after C(2)H(2) and CO(2) production reached their peak. However, in the rin tomato, no change in PG activity was noted up to 100 days postanthesis. Cellulase activity increased in Rutgers fruits prior to the respiratory climacteric and continued to increase thereafter. Similar changes in cellulase activity were also observed in the nonclimacteric rin fruits. Short term ethylene treatment (2 days) of 36-day-old rin fruits increased cellulase activity, but had no effect on PG activity. Detectable changes in other parameters of ripening, such as chlorophyll loss and softening, also occurred prior to the respiratory climacteric. These results suggest that the failure of rin fruits to ripen is related to their low PG activity during maturity as compared with normal fruits.

Journal Article↗
PubMed1988

Fructose 2,6-bisphosphate and the climacteric in bananas.

This work was done to test the view that there is a marked rise in the content of fructose 2,6-bisphosphate during the climacteric of the fruit of banana (Musa cavendishii Lamb ex. Paxton). Bananas were ripened in the dark in a continuous stream of air in the absence of exogenous ethylene. CO2 production and the contents of fructose 2,6-bisphosphate and sucrose were monitored over a 15-day period. A range of extraction procedures for fructose 2,6-bisphosphate were compared. Recovery of fructose 2,6-bisphosphate added to samples of unripe fruit varied from poor to unmeasurable. Recoveries from samples of ripe fruit were high. It is argued that this differential recovery of fructose 2,6-bisphosphate undermines claims that the amount of this compound increases at the climacteric. When recoveries are taken into account, our data suggest that there is no major change in fructose 2,6-bisphosphate content during the onset of the climacteric in bananas.

Carbon Dioxide↗
PubMed2003

Treatment of climacteric symptoms with herbal formulas of traditional Chinese medicine.

Hormone replacement therapy (HRT) is not successful or is contraindicated for the treatment of climacteric symptoms in some patients. To investigate whether certain herbal formulas of traditional Chinese medicine (Kampo in Japanese) could be used as an alternative treatment, a longitudinal 'before and after' comparative study was carried out in 18 Japanese women, and the results were compared with those of 16 women who underwent HRT. Kampo improved all the climacteric symptoms. In contrast, improvement of cold limbs, sleeping disorders, shoulder stiffness/lumbago, and fatigue in the HRT group was either not significant or of limited extent. In addition, the serum level of estradiol in postmenopausal women was raised by the combined use of two Kampo formulas. These results suggest that Kampo may be considered an alternative to HRT for the treatment of climacteric symptoms, but vigorous monitoring for potential side effects of increased estrogen levels in some postmenopausal patients is needed.

Drugs, Chinese Herbal↗
PubMed2000

Economic impact of tibolone compared with continuous-combined hormone replacement therapy. In the management of postmenopausal women with climacteric symptoms in the UK.

OBJECTIVE: To estimate the economic impact of using tibolone 2.5 mg compared with 17 beta-estradiol 2 mg/norethisterone acetate 1 mg (E2/NETA) in postmenopausal women with climacteric symptoms. DESIGN AND SETTING: This was a modelling study performed from the perspective of the UK's National Health Service (NHS). METHODS: The clinical outcomes from a previously reported trial were used as the clinical basis for the analysis, which showed that 48 weeks' treatment with tibolone and E2/NETA significantly alleviated the climacteric symptoms experienced by postmenopausal women. These data were combined with resource utilisation estimates derived from a panel of 10 GPs and 3 gynaecologists, enabling us to construct a Markov model depicting changes in the health status of postmenopausal women. The model was used to estimate the expected NHS costs and consequences after 48 weeks' treatment with tibolone and E2/NETA. MAIN OUTCOME MEASURES AND RESULTS: The mean expected direct healthcare cost of using tibolone and E2/NETA to manage postmenopausal women for 48 weeks was estimated to be 260 Pounds and 239 Pounds (1997/1998 prices) per patient, respectively. Starting hormone replacement therapy (HRT) with tibolone instead of E2/NETA was equally effective in alleviating climacteric symptoms (65.9 and 62.2%, respectively; p = 0.516) over 48 weeks and significantly reduced the incidence of vaginal bleeding by 36% (p < 0.0001) and breast tenderness by 57% (p < 0.0001) for a mean additional cost of 21 Pounds (ranging between -3 Pounds and 42 Pounds) per patient. The acquisition cost of HRT was the primary cost driver for tibolone-treated patients, whereas the cost of managing adverse events was the primary cost driver for E2/NETA-treated patients. CONCLUSIONS: The true cost of prescribing tibolone and E2/NETA is impacted on by a broad range of resources, not only drug acquisition costs. Although the acquisition cost of tibolone is higher than that of E2/NETA, the difference in the expected NHS cost of the first year of treatment between the 2 HRTs is negligible. This is because of the higher incidence of adverse events among E2/NETA-treated patients, which also results in a higher continuation rate among tibolone-treated patients. Factors such as patient preferences should also be taken into consideration so that treatment choices are not decided solely on the basis of acquisition costs.

Anabolic Agents↗
PubMed2006

Pilot study of hormone replacement therapy and menopausal symptoms, depression, and quality of life in Korean climacteric women.

This cross-sectional survey compared scores on the Menopausal Symptoms Index, Depression, and the Quality of Life for 65 Korean climacteric women receiving regular hormone replacement therapy (M age=52.8 yr., SD=6.3) and 70 Korean climacteric patients not receiving such therapy (M age =51.6 yr., SD=7.1). Depression scores were positively correlated with the Menopausal Symptoms Index in both groups (r = .58 in the Therapy group and r = .50 in the Control group) and negatively correlated with scores for Quality of Life (r = -.48 in the Therapy group and r = -.68 in the Control group). Scores on the Menopausal Symptoms Index were negatively correlated with ratings of Quality of Life in both groups (r = -.53 in the Therapy group and r = -.45 in the Control group). These results suggest that hormone replacement therapy is associated with reduced Depression scores and higher Quality of Life scores in this sample of Korean climacteric women.

Adult↗
PubMed2001

Vaginal symptoms in Japanese postmenopausal women: comparison with other climacteric symptoms.

OBJECTIVES: This study was designed to investigate the current status of vaginal symptoms in Japanese postmenopausal women, and to clarify the significance of vaginal symptoms by analyzing their relationship to other climacteric symptoms. METHODS: The complaints of 613 women attending a menopause clinic (mean age +/- standard deviation 53.5 +/- 7.2 years; time since menopause or bilateral oophorectomy 6.4 +/- 6.5 years) were evaluated according to the Keio modified menopause index. RESULTS: In total, 56.4% of subjects had at least one vaginal symptom. The most frequent vaginal symptom was dyspareunia, followed by vaginal dryness, discharge and itching, and the mean prevalence of the four symptoms was 31.7%. The peak intensity of vaginal symptoms occurred in the sixth decade, or 3-5 years after menopause or oophorectomy. Vaginal symptoms were usually associated with other climacteric symptoms, but some occurred independently. CONCLUSIONS: A moderate proportion of Japanese postmenopausal women experience vaginal symptoms, which can occur independently of other climacteric symptoms. Vaginal symptoms therefore warrant careful attention during the treatment of postmenopausal women.

Adult↗
PubMed2002

Pulsed estrogen therapy: relieving climacteric symptoms, preventing postmenopausal bone loss.

Aerodiol with its new mode of action--pulsed estrogen therapy made possible by a unique pharmacokinetic profile and an innovative route of administration--acts on the full range of climacteric symptoms and on the long-term consequences of estrogen deprivation. Four well-designed, international studies investigating the efficacy of pulsed estrogen therapy on both the short- and long-term consequences of estrogen deprivation were conducted. Climacteric symptoms and their reduction were assessed individually and also using the Kupperman index, which is a weighted score. Aerodiol produced a significant reduction in the Kupperman index and in the occurrence of menopausal symptoms, such as hot flushes and night sweats. This reduction appeared to be significant as early as the second week of treatment. Moreover, Aerodiol remained effective even among highly symptomatic women with more than seven hot flushes per day, and also among smokers. Since it avoids hepatic first-pass metabolism, pulsed estrogen therapy also has a favorable action on the lipid profile, decreasing lipoprotein(a), apolipoprotein B, total cholesterol, and low-density lipoprotein cholesterol. Furthermore, Aerodiol is neutral with regard to clotting factors, angiotensinogen and insulin levels. The effect of pulsed estrogen therapy on bone has been assessed in both the short and the long term. Bone turnover, as measured by markers of resorption and formation, was normalized to premenopausal levels after 3 months of treatment at a dose of 300 microg/day. Aerodiol, again at the dose of 300 microg/day, is as effective as a 50-microg/day transdermal patch in increasing bone mineral density (p < 0.001 versus baseline) at the spine and hip after 56 weeks. Finally, data collected during the development of Aerodiol have shown that pulsed estrogen therapy is at least as effective as 2 mg of oral estrogen or 50 microg of transdermal estrogen in relieving climacteric symptoms and preventing postmenopausal bone loss.

Administration, Cutaneous↗
PubMed1949

Physiology and management of the climacteric.

Women in the climacteric should have a thorough medical investigation, reassurance, and endocrine therapy when indicated. Estrogens give prompt relief to the large number of women with sympathetic nervous system symptoms during the climacteric. Estrogens are most effective when given parenterally followed by short periods of oral administration. Estrogens should be given only for actual need and withdrawn after symptoms disappear. Androgens are useful in the immediate control of functional bleeding and also for alleviating symptoms in patients who respond poorly to estrogens or for whom estrogens are contraindicated. The addition of vitamin B to parenteral endocrine therapy apparently enhances the effect of the hormone.

Administration, Oral↗
PubMed2006

Development of active safety surveillance system for traditional Chinese medicine: an empirical study in treating climacteric women.

PURPOSE: Traditional Chinese medicines (TCM) prescribed by doctors are regularly reimbursed by the National Health Insurance (NHI) in Taiwan. The safety of TCM should undergo the same scrutiny that most western medicines do. This study was to monitor adverse events (AEs) associated with a new mixture of TCM, TMN-1, used to treat climacteric symptoms. METHODS: For this multi-center, prospective observational study, we recruited 134 women with climacteric symptoms. During this 12-week study, the subjects made nine visits, took TMN-1 three times a day, and received routine hematologic tests, biochemical tests, and tests for gynecologically relevant hormones at baseline and after 4 and 12 weeks of beginning medication. At every visit, the subjects were asked by questionnaire about any AEs. All AEs were examined through a process of causality assessment (CA) by a research team. RESULTS: In total, we recorded 203 AEs, in order of decreasing incidences--cough, pharyngitis, rhinitis, abdominal pain, abdominal fullness, diarrhea, and pruritus with incidence rates of 2.57, 2.47, 1.88, 1.78, 1.68, 1.58, and 1.58 per 10(3) person-days, respectively. Most AEs were tolerable. Five of the AEs were judged to be "probable" adverse drug reactions (ADRs): Two events of diarrhea and one event each of nausea, abdominal pain, and abdominal fullness. CONCLUSION: This study demonstrates the effectiveness using active safety surveillance to document safety of TCMs. This surveillance system could probably be useful to document the safety of other alternative or complementary medicines.

Adult↗
PubMed1995

The perception of the menopause and the climacteric among women in Hong Kong and southern China.

BACKGROUND: A lack of awareness of the long-term consequences of the menopause may be a major contributing factor to the low demand for hormone replacement therapy in Hong Kong and China. Most Chinese women suffer few acute menopausal symptoms, and it was our hypothesis that they had little knowledge of the risks of developing either osteoporosis or cardiovascular disease as a result of estrogen deficiency. METHODS: A prospective study was conducted among 200 Chinese women of all ages living in Hong Kong or southern China. A structured questionnaire was used to examine their perception of the menopause and the climacteric. RESULTS: While 96% of women from Hong Kong and 73% from southern China could define the menopause, none in either group were aware of the problems of either osteoporosis or cardiovascular disease in post-menopausal women. Only 8% of women from Hong Kong and 4% from southern China knew that hormone replacement therapy could be used to treat postmenopausal women. CONCLUSIONS: The results of this study confirm a relative lack of understanding of the climacteric in both groups of Chinese women. As menopausal symptoms are also infrequent in this population, most women will not have the need to consult a physician and will therefore not have the option of taking hormone replacement therapy to prevent the long-term effects of estrogen deficiency. Considering the sizes of the populations involved, the potential for reducing morbidity and mortality through improved education about the menopause is considerable.

Adult↗
PubMed1992

Women with climacteric symptoms: a target group for prevention of rapid bone loss and osteoporosis.

The relations of vasomotor symptoms to the rate of bone loss and to the response of forearm bone mineral density (BMD) to hormone replacement therapy (HRT) were analyzed in a 2-year non-randomized study. Forty peri/postmenopausal women who were given HRT for climacteric symptoms were compared with untreated control women, individually matched for age and length of time since the last menstrual period. The women who received HRT gained, on average, about 2% in BMD, while the control women lost about 6% (mean group difference 8%; 95% confidence interval (CI) 5.7-10.2). Adjustment for potential confounders did not change the results. Sweating frequency was inversely correlated with serum estradiol levels (p = 0.05). Among untreated women the rate of bone loss was higher in those who had frequent sweating initially than in those with less frequent sweating (9% vs. 4%, mean difference 4.3%; 95% CI 0.7-7.8, p = 0.023). Among women who received HRT, those who had the highest frequency of sweating initially, compared with those with a lower frequency, showed a greater gain in bone density (mean difference 4%; 95% CI 1.2-6.8, p = 0.007). In multivariate analysis adjusting for covariates, sweating frequency remained an independent determinant of change in bone density in women both with and without HRT. When sweating frequency and serum estradiol levels were compared in a multivariate analysis, only sweating frequency showed an independent association with rate of bone loss. The findings indicate that women with severe climacteric symptoms may have an excessive rate of bone loss and should therefore be considered as a special target group for prevention of osteoporosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Short-term effects of ovariectomy: the opioid control of LH secretion in fertile climacteric and postmenopausal women.

The aim of this study was to evaluate the activity of opiate receptors involved in the regulation of LH secretion in relationship to ovariectomy. Menstruating fertile (n = 5) and climacteric (n = 7) patients and postmenopausal (n = 5) women who underwent therapeutical bilateral ovariectomy were studied in the first week postsurgery and LH plasma levels were evaluated after naloxone (4 mg in bolus plus 4 mg infusion/90 min), LHRH (10 micrograms + 10 micrograms iv) and saline administration. Two groups of fertile (n = 6) and postmenopausal (n = 6) subjects were studied as controls. Since the LH responsiveness to naloxone was impaired in climacteric patients after ovariectomy, the test was repeated in 5 of them after 1 and 6 months of estrogen-gestagen treatment (conjugated estradiol + noretisterone acetate), showing a significant increase in all patients in both cases. In four subjects treated with only gestagen, naloxone was still unable to significantly modify LH plasma levels. These results indicate that ovariectomy affects the activity of opiate receptors, resulting in the first week postsurgery LH rise inversely related to basal LH levels. Furthermore, these results indicate that one or six cycles of estrogen-gestagen treatment in ovariectomized patients similarly induces a restoration of the opiate receptors neuroendocrine activity.

Adult↗
PubMed1986

Cardiorespiratory fitness evaluation in climacteric women: comparison of two methods.

Middle-aged women are becoming increasingly interested in aerobic exercise. For exercise to be meaningful, training needs to be performed at 70% to 85% of VO2max for 20 minutes, three times weekly. The graded exercise test is the standard method used to determine maximum oxygen uptake, but this test is impractical for use in clinical practice. A cross-sectional study evaluated 163 women between 35 and 75 years of age by graded exercise test and compared the result with a matched group of 121 women tested by bicycle ergometer (predicted maximum oxygen uptake). Bicycle testing and the graded exercise test had a similar range of values; this was confirmed by 29 climacteric women performing both tests (r = 0.789). Menopausal status has no effect on cardiorespiratory fitness: the predicted maximum oxygen uptake of age-matched menstruating women was 27.4 +/- 6.3 ml/kg/min and that of nonmenstruating women was 25.3 +/- 4.2 ml/kg/min (p greater than 0.05). Bicycle ergometry can thus be used as a screen to determine the cardiorespiratory fitness status of climacteric women.

Adult↗