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[Psychometric aspects of estrogen therapy in the climacteric. Quantification of the psychotropic effect of hormones in 122 women (author's transl)].

The psychosocial aspects of estrogen substitution for deficiency symptoms in the climacteric were investigated in 122 women. In addition, psychometric tests were used before, after 6 weeks, after 3 months and after 6 months therapy. Results based on psychometric tests should be taken into consideration to a greater extent than formerly in discussing the cancer risks of estrogen administration in the climacteric.

Adult↗

Self-reported climacteric symptoms as a function of the relationships between marital adjustment and childrearing stage.

The relationship between reported climacteric complaints of 185 healthy middle-class women between 40 and 60 years of age and marital adjustment and stages of childrearing were studied. Women low on marital adjustment had significantly more frequent and severe symptoms than women high on marital adjustment, but no differences in climacteric symptoms were reported for stage of childrearing or for the interaction between marital adjustment and stage of childrearing. Physical and psychosocial factors that may be related to the symptoms should be assessed before intervention strategies for midlife complaints are begun.

Adaptation, Psychological↗

Vulnerability and resilience in climacteric women.

Two groups of climacteric women, 38 with symptoms and 39 without, were compared by means of a detailed analysis of their life history, personality, roles and psychosomatic reaction tendency. The results indicate that climacteric women may be classified into physical and psychosomatic reactors with different degrees of vulnerability and resilience. The characteristics of each group are described and the necessity for different treatment is outlined.

Adult↗

[Epidemiology of the climacteric period in a large city].

Epidemiological screening of 1,939 females working in Moscow showed the incidence of the climacteric syndrome to be as high as 42.4%. The mean age at the onset of the pre-menopause was 48 +/- 0.4, its duration 12 to 17 months, mean age at menopause onset 49 +/- 0.5. A close correlation between the development of the climacteric syndrome and arterial hypertension was detected.

Adolescent↗

[Splenopeptides for climacteric complaints. Comparison of ovarian stimulation with transdermal estradiol substitution].

256 women aged 45 to 60 years with climacteric complaints participated in an open randomized clinical study comparing spleno-peptides (SPS 1187, Solcosplen) with transdermal estrogen (CAS 50-28-2, E2) substitution (4 mg) in respect of efficacy and tolerability. The primary criterion, defined as the Kupperman Index, and the safety parameter of the drugs were estimated prior to and after 1, 4 and 8 weeks of therapy. In the pre-, peri- and early postmenopause the results of treatment with the spleno-peptides were comparable to those with transdermal E2 substitution (4 mg). Pretreatment with estrogens impaired the results of treatment significantly. Although the menopausal status (in most cases < 3 years) did not influence the results essentially, the efficacy of SPS 1187 is expected to decrease 2 to 3 years postmenopause. Therefore SPS 1187 should be used in pre-, peri- and early postmenopause only. The tolerance of SPS 1187 was found to be significantly better than that of the E2 patch. With respect to the claimed indication, i.e. climacteric complaints in the pre-, peri- and early postmenopause, SPS 1187 having an equivalent efficacy compared to that of the E2 patch shows a better tolerability (total collectives) and better benefit/risk ratio.

Administration, Cutaneous↗

[Evaluation of the peripheral skin sympathetic function by cooling thermography in women with climacteric complaints].

To evaluate the peripheral skin sympathetic function, cooling thermography was performed on women with climacteric complaints (CG) and without them (NG). Both hands were immersed into 4 degree C water for 1 minute ant the nail temperature of the right second finger was measured before and after the stress every 1 minute for 7 minutes. And the recovery rate was calculated. By dividing the CG groups by the 5 minute recovery rate minus the 2SD of the NG groups, there was seen to be a significant difference between the recovery patterns. One is a good recovery group (GR, N = 26) and the other is a poor recovery group (PR, N = 28). The significant difference between GR and PR groups was only recognized in the pre-cooling nail temperature. No significant difference was seen in age, Body Mass Index, Kupperman Index, symptoms, serum estradiol or serum testosterone levels. These results indicate that in about half of women with climacteric symptoms, peripheral skin sympathetic nerve function is continuously hypertensioned and the response to cooling stress is decreased. Although the reason for these results is not clear, sympathetic nerve dysfunction is supposed to be the main cause. This test is useful for evaluating peripheral skin sympathetic function.

Adult↗

[Factors associated with the use of gynecology services by climacteric women: a case-control study].

BACKGROUND: The data and concepts described in the literature on menopausic women are based on observations and studies carried out in menopausic women attending medical or gynecological consultations and contrast greatly with the results obtained in women from a general population. METHODS: In a case-control study 505 women between 45-55 years of age, 142 having attended a gynecological consultation (cases) and 363 taken from a randomized sample of the general population (controls) were evaluated. Information concerning sociodemography, climacteric phase, psychic morbidity and psychosocial factors as stressing events, social support and adjustment and satisfaction with roles was collected in a personal interview. The odds ratio (OR) was used as the means of association and multiple regression analysis was performed to control possible confusing factors. RESULTS: The cases were fundamentally young women in a premenopausic phase of a high social class belonging principally to a group of widows, separated or divorcees and a group of married women with high levels of association (OR = 14.7; OR 12.14). The women attending a gynecological consultation were characterized by having greater risk of lacking social support (OR = 8.94), presenting a greater frequency of vital severely stressing events over the previous year (OR = 2.55), and demonstrating greater insatisfaction in social adjustment (OR = 2.42) particularly in their sexual and matrimonial relations. CONCLUSIONS: Women attending medical, specially gynecological, consultations during climacteric years are not representative of the population of women in these years as a whole. Purely pharmacologic management, principally substitutive hormonal therapy, was the most wide-spread treatment of preventive character should be reestablished in accordance with the results with the most manifold and multifactorial orientations and foci.

Case-Control Studies↗

[A clinical study on memory function in climacteric and periclimacteric women].

This study was designed to investigate memory function in climacteric and periclimacteric women who lived a normal, ordinary life. Two hundred women treated at the gynecological outpatient clinic of Koshigaya Hospital were divided into 7 groups: groups A(31-35 yr), B(36-40 yr), C(41-45 yr), D(46-50 yr), E(51-55 yr), F(56-60 yr) and G(61-65 yr). Each group consisted of 30 women except group G(n = 20). The memory function of each group was determined and the mean scores for 10 paired hard-associates after three trials of presentation were compared. The mean scores (+/- SD) for groups A and B were 8.0 +/- 2.0 and 8.2 +/- 1.7, respectively, which were not statistically different. The scores for both groups were significantly higher than those for the other groups (p < 0.01). The mean scores for groups C and D were 5.9 +/- 2.1 and 5.6 +/- 2.4, respectively, which were not statistically different. The score for group C was significantly higher than those for groups E(4.5 +/- 2.4), F(4.2 +/- 2.2), and G(3.3 +/- 1.6) (p < 0.05). The score for group D was significantly higher than those for groups F and G(p < 0.05). The score for group E was significantly higher than that for group G(p < 0.01). The decrease in memory function was the greatest in group C. In the climacterium, memory impairment was also observed in group E. The former corresponds to the climacteric commencement age group where cyclic changes in serum estrogen levels decrease or cease, and the latter corresponds to the age group for menopause.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Depression and climacteric. Clinical and neuroendocrinological aspects].

The clinical and neuroendocrine evidences that link depression with menopause are reviewed. Climacteric is associated with depressive symptoms, but these do not form a definite depressive entity. Depression would be due to the disregulation of brain noradrenergic and serotoninergic systems. Gonadal steroids modify the neurotransmission of these systems and may influence the mood regulations. Depression appearing in the climacteric period must be treated with antidepressants. The depressive symptoms associated to estrogen deficit may improve with hormonal substitution.

Antidepressive Agents↗

[Depression and nutrition in a group of women during climacteric].

Depression and eating disorders are often combined. Depression and weight changes are often observed in climacteric women. In our study the possibility of an association of depressive reactions and eating behavioral changes are assessed among 42 climacteric patients.

Adult↗

[Estradiol valerate/cyproterone acetate in the treatment of climacteric syndrome].

In a prospective study 40 perimenopausal women with climacteric complaints between 45 to 52 years of age were examined. Twenty three (100%) were assigned to treatment with hormonal replacement therapy (Climen fy Schering-estradiol valerate cyproteron acetate) for 6 months. The therapy had to be stopped in 5 women (22%) for side effects. The drug was contraindicated in 17 patients because of non-treated hypertension, varices, hepatopathy and uterine fibroids with repeated metrorrhagia. In 18 patients (78%) Climax score, ALT, AST, bilirubin, total cholesterol, HDL-Chol, LDL-Chol, triglycerides, haemogram, fibrinogen, APTT, Quick test, serum Ca2+ and P2+ and urine C2+ and P2+/24 hours, weight and arterial blood pressure before and after the treatment were examined. The results confirm the benefical effect of Climen on the Climax score (p < 0.0001), total cholesterol (p < 0.01), HDL-Chol (p < 0.05) and LDL-Chol (p < 0.0001). After administration of Climen a significant decrease of P2+ serum concentration was demonstrated. Climen is suitable for treatment of acute climacteric complaints and has benefical effects on lipid metabolism.

Climacteric↗

[Climacteric symptoms: intensity, incidence and need for treatment. A study of 716 women between 40 and 70 years of age].

Is treatment for climacteric complaints more often required because of the intensity or the frequency of problems? Which marked problems-according to the Menopause Rating Scale (MRS)-are considered to be worth treatment by the affected women? This was the topic of a study among more than 700 women aged 40 to 70 years. 1. Covering 10 items of complaint by the MRS there was a tendency towards higher incidence of frequency than incidence of intensity. With 24% respectively 15% severe joint- and muscle problems were mentioned in the first place followed by distinct lack of sexual desire with 16% respectively 10%. 2. The comparison of pre- and postmenopausal women showed differently experiences intensity respectively frequency for only some of the 10 items. 3. With time advancing after menopause (intervals of 5 years) only vaginal dryness was found to be an increasingly serious problem: 9%-15%-27%. 4. 3 out of 10 registered postmenopausal complaints were age-related: flushes/sweating, lack of sexual desire and vaginal dryness. 5. Relief of these complaints by estrogen substitution was exemplary experienced for distinct lack of sexual desire. Postmenopausal patients without estrogen-therapy complained of this problem almost twice as often as those receiving estrogen-therapy: 22% versus 12%. The results of this study facilitate special counselling on climacteric problems. The necessity of treatment for these complaints with regard to particular groups of symptoms is judged quite differently by the patients.

Adult↗

[Effects of estrogen supplementation on psychological variables in climacteric women].

BACKGROUND: The beneficial effects of estrogen supplementation in climacteric women are clear. However, their psychological effects are not well documented. AIM: To study the effects of estrogen supplementation on psychological variables in climacteric women. SUBJECTS AND METHODS: Forty postmenopausal women were divided in two groups to receive a daily dose of 2 mg oestradiol valerate and 2.5 mg medroxyprogesterone acetate or an identical placebo during six months. Initially and at the end of the treatment period, they were subjected to a psychiatric interview and the Graffar, Hamilton and Eysenk personality tests were applied. Also, an Analysis of Verbal Behavior was used, that results in hope and hopeless scores. RESULTS: There were no differences in the initial assessment between the two treatment groups. In women receiving hormonal supplementation, the Hamilton score decreased from 11.2 to 4.9 (p < 0.002) and in women receiving placebo from 8.1 to 5.3 (NS). No other significant changes in psychological tests were observed. CONCLUSIONS: Hormonal supplementation decreases the Hamilton depression score in postmenopausal women.

Climacteric↗

Role of pivagabine in the treatment of climacteric syndrome.

A multicenter, double-blind, controlled study of pivagabine (4-[(2,2-dimethyl-1-oxopropyl)amino]butanoic acid, CAS 69542-93-4, Tonerg) was conducted in 186 female patients (age: 33-79 years) suffering from climacteric syndrome. In these patients, climacteric syndrome was mainly constituted by symptoms of anxiety, often with mild symptoms of depression and sometimes with mild symptoms of cardiac somatization. The enrolled patients were randomized to two treatment groups: the first group was administered pivagabine, 900 mg/d, for 90 days in succession; the second group was administered placebo for the same period. The efficacy of the treatments was assessed by the Hamilton Depression Rating Scale (HDRS) and the Zung's Self-rating Anxiety Scale (SAS) before the start of treatment, after one month and at the end of treatment. At the end of the study, the physicians and the patients were also requested to evaluate the efficacy of the two treatments. Tolerability was evaluated by recording side effects and by assessing the course of arterial blood pressure, of heart rate and of selected laboratory parameters. The study showed that pivagabine was able to reduce symptoms of anxiety and depression. As a consequence, when asked to evaluate the efficacy, the physicians and the patients consistently stated that pivagabine was effective in controlling the symptoms of anxiety, often associated with mild symptoms of depression, that may arise during the climacterium. Furthermore, these results were obtained with a high safety margin, since the few side effects recorded were mild and transient and the laboratory results were normal as well as the physical examination findings.

Adult↗

Changes in symptoms, blood pressure, glucose, hormones, and lipid levels according to weight and body fat distribution in climacteric women.

OBJECTIVE: To evaluate how symptoms, blood pressure, glucose, hormones and lipid levels are modified in climacteric women according to obesity and body fat distribution. METHODS: One hundred and thirteen women were studied and divided initially according to body mass index (BMI), and afterward to waist-hip ratio (WHR). Climacteric symptoms, blood pressure, fasting and post-breakfast glucose, hormone and lipid levels were analyzed. Statistical analysis was done by the chi square and Mann-Whitney U tests, and the relation of BMI and WHR with several variables was assessed by linear regression analysis. RESULTS: When dividing patients according to BMI, the only differences were found in age, number of diabetic and hypertensive patients, and values of systolic and diastolic blood pressure, which were greater in the obese group. When dividing according to WHR it was found that high-density lipoproteins were lower in those with upper segment body fat distribution. Subgroup analysis showed that chronic diseases are frequently found in obese women, while android body fat distribution has an additive effect on obesity in some of these variables. CONCLUSION: Chronic diseases are more frequently found in obese women, but most of the metabolic alterations are modified by body fat distribution in the upper segment.

Adult↗

Molecular and physiological evidence suggests the existence of a system II-like pathway of ethylene production in non-climacteric Citrus fruit.

Mature citrus fruits, which are classified as non-climacteric, evolve very low amounts of ethylene during ripening but respond to exogenous ethylene by ripening-related pigment changes and accelerated respiration. In the present study we show that young citrus fruitlets attached to the tree produce high levels of ethylene, which decrease dramatically towards maturation. Upon harvest, fruitlets exhibited a climacteric-like rise in ethylene production, preceded by induction of the genes for 1-aminocyclopropane-1-carboxylate (ACC) synthase 1 (CsACS1), ACC oxidase 1 (CsACO1) and the ethylene receptor CsERS1. This induction was advanced and augmented by exogenous ethylene or propylene, indicating an autocatalytic system II-like ethylene biosynthesis. In mature, detached fruit, very low rates of ethylene production were associated with constitutive expression of the ACC synthase 2 (CsACS2) and ethylene receptor CsETR1 genes (system I). CsACS1 gene expression was undetectable at this stage, even following ethylene or propylene treatment, and CsERS1 gene expression remained constant, indicating that no autocatalytic response had occurred. The transition from system II-like behavior of young fruitlets to system I behavior appears to be under developmental control.

Biological Evolution↗

Female sexual activity as a function of climacteric conditions and age.

By establishing a statistical profile of the average sexual behaviour of women during the climacteric period, an attempt was made to determine what influence the climacteric had on female sexual activity. With the advancement of age, the sexual activity of women tends to decline. The menopause itself tends to further reduce the retrogression of the sexual activity in women.

Adult↗

Climacteric medicine: European Menopause and Andropause Society (EMAS) statements on postmenopausal hormonal therapy.

Hormonal therapy (HT) is one of the most frequently prescribed drug regimens for women after the age of 50 years. HT has been developed progressively since the 1960s to provide estrogen to those women (a) who require relief of symptoms which have resulted from reduced circulating estrogen or (b) to act as an anti-resorptive agent to counteract the effect of the increased bone turnover which occurs with falling menopausal estrogen levels and which results in loss of bone mass leading to postmenopausal osteoporosis. However, a large number of women pass through the menopausal transition without experiencing distress as a result of the natural fall in estrogen hormone levels and since the introduction HT has been thought to be associated with a number of health benefits that have been tested in clinical trials but not substantiated. In women experiencing distressing climacteric symptoms double-blind randomised controlled clinical trials with a variety of HT regimens have shown that HT of any type provides symptom relief with no alternative treatment of similar effect. The dose and regimen of HT need to be individualised and in general the appropriate dose is dependent on the menopausal age. Women experiencing urogenital estrogen deficiency symptoms require long-term treatment which is most easily achieved with local estrogen. With the perspective provided by the most recent epidemiological findings not least from the estrogen only arm of the Women's Health Initiative Study (WHI) EMAS supports research activities generating HT with new compositions including lower doses and a wider range of progestins in order to positively affect the balance of clinical benefit and risk. Currently, however, individualized and appropriate prescription of the available HT products together with life-style management will sustain possibilities for beneficial effects on climacteric symptoms, quality of life and degenerative diseases after the menopause.

Estrogen Replacement Therapy↗