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PubMed1991

[Estrogen substitution therapy in climacteric: should progesterone be omitted in hysterectomized women?].

The replacement therapy in postmenopausal women is seen to be for transformation of the oestrogen-stimulated endometrium only, which does not apply to hysterectomised women. Because of the influence of estrane on lipids, one often advises against a replacement therapy with progestogens in hysterectomised women. With increasing knowledge of encountered extragenital functions of sexual steroids, the latter is questionable, if natural progesterone is given, which is (said to be) lipid-neutral, performing the function of the progestogens, which is quite more than reproduction only, more efficiently than estrane or gonane. Due to the competitive blocking of aldosterone the effect of progesterone is sodium-diuretic and diuretic, being as important as the therapy of climacteric complaints, as well as the consequence, which is the result of the physiological connection between progesterone and encephalics. Moreover, the effect of the progestogens is to tonicise the vascular system and is linked to a number of intestinal hormones in order to adjust their function. Therefore, progesterone seems to perform a great variety of extragenital functions. Menopausal women should not be deprived of the benefits of these functions within the framework of a replacement therapy.

Climacteric↗
PubMed1979

Sexuality during the climacteric.

Menopause is a time of psychologic adjustment as well as of physical change. Its effects are closely related to sexuality, a neglected aspect. Sexual desire may increase, decrease, or remain the same, but the general pattern is one of declining sexual interest and activity with increasing age. The male climacteric is considered a time of decreasing sexual activity and capability, lowered self-esteem, and declining energy. Physical symptoms are milder than in women, and the process if more gradual. Health care professionals involved with menopausal patients should provide factual information and give supportive guidance which will permit women to continue to develop their full sexual potential.

Aged↗
PubMed2006

Effect of climacteric transition and hormone replacement therapy on body weight and body fat distribution.

In the present study we evaluated the effects of climacteric modifications on body weight and fat distribution. From women attending a menopause clinic we selected 2175 untreated, normal healthy women who were divided into three groups: premenopausal (n = 540), perimenopausal (n = 750) and postmenopausal (n = 885), and compared them with 354 postmenopausal women receiving different forms of hormone replacement therapy (HRT). The total body fat tissue mass and distribution were analyzed using dual-energy X-ray absorptiometry. Body weight and body mass index (BMI) were significantly higher in perimenopausal and postmenopausal than in premenopausal women. Mean total body fat and fat as a percentage of soft tissue were significantly (p < 0.05) higher in the perimenopausal and postmenopausal groups than in the premenopausal group. Fat tissue and regional fat tissue as a percentage of total fat tissue were higher in the trunk (p < 0.0001) and arms (p < 0.0001) in perimenopausal and postmenopausal than in premenopausal women. In postmenopausal women, leg fat tissue was significantly (p < 0.05) lower than in premenopausal and perimenopausal groups. Total body and leg lean tissue were significantly lower (p < 0.05) in postmenopausal than in premenopausal and perimenopausal women. In age-matched women with similar BMI, total body fat as a percentage of soft tissue was significantly (p < 0.001) higher in the perimenopausal and postmenopausal groups than in the premenopausal group. As for body fat distribution, fat as a percentage of total fat tissue was significantly higher in the trunk (p < 0.0001) region in perimenopausal and postmenopausal women compared with the premenopausal group. In the legs, fat as a percentage of total fat tissue was significantly higher (p < 0.05) in the premenopausal than in the postmenopausal group. In the arms a slight but not significant (p < 0.18) difference was shown in fat distribution between the three untreated groups. In age-matched HRT-treated postmenopausal women, the fat tissue was similar to that in the premenopausal group. The present results confirm that endocrine changes during the menopausal transition, rather than the aging process, are related to changes in body weight and fat distribution. Perimenopausal and postmenopausal women show a shift to a central, android fat distribution that can be counteracted by HRT.

Adult↗
PubMedDate not supplied

Climacteric complaints, female identity, and sexual dysfunctions.

Forty early menopausal women seeking relief from sexual symptoms within a long-term marital relationship and 40 matched women seeking relief of climacteric complaints completed questionnaires concerning three subject: vasomotor and psychosocial symptoms, sexual dysfunctions, and female identity. Results showed that women with sexual dysfunctions were more likely to suffer from vasomotor and psychosocial complaints and their feminine identity was based mainly on ideals of motherhood and beauty. In addition, sexual desire disorders were present significantly in those women with higher psychosocial symptoms, while sexual arousal disorders were particularly evident in women suffering more vasomotor symptoms.

Climacteric↗
PubMed1991

Alcohol and other dietary factors in relation to serum hormone concentrations in women at climacteric.

The relationships between concentrations of endogenous hormones in serum and dietary intakes of alcohol, fats, fiber, and caffeine were examined in 325 healthy Massachusetts women aged 50-60 y who reported having a normal menstrual period within the previous 12 mo. Diet was assessed by a semiquantitative food frequency questionnaire. Hormones assayed were estrone, estradiol, percent free estradiol, sex-hormone-binding globulin (SHBG), cortisol, and gonadotropins. Alcohol intake was not associated with concentrations of estrogens or gonadotropins. Neither total fat intake nor the fat composition of the diet influenced hormone concentrations. Fiber intake was positively correlated with SHBG; no associations with estrogens were seen. Caffeine intake was inversely correlated with free estradiol and positively correlated with SHBG. These data suggest that fat, fiber, and alcohol intakes of US women at climacteric are not determinants of variations in estrone and either total or percent free estradiol.

Alcohol Drinking↗
PubMed1985

Climacteric flushing in a patient with carcinoid tumour.

A 70-year-old man had frequent flushing attacks and a carcinoid tumour was verified histologically. The characteristics of his flushing reaction were typical of climacteric flushing and he had undergone orchiectomy for adenocarcinoma of the prostate 2 years ago. Laboratory studies indicated a normal production of serotonin and excretion of 5-hydroxyindoleacetic acid. A rapid and complete remission of the flushing attacks was obtained with oral diethylstilbesterol therapy. Thus, although the patient had a carcinoid tumour, he was having post-orchiectomy climateric flushing reactions.

Aged↗
PubMed1991

Desogestrel in hormone replacement therapy: long-term effects on bone, calcium and lipid metabolism, climacteric symptoms, and bleeding.

Seventy-three healthy, postmenopausal women, aged 45-54 years, were randomly assigned to one of three groups for 2 years of treatment: 17 beta-oestradiol 1.5 mg on days 1-12 and 17 beta-oestradiol 1.5 mg + desogestrel 150 micrograms on days 13-24 (E2/DG) or oestradiol valerate 2 mg on days 1-11 and oestradiol valerate 2 mg + medroxyprogesterone acetate 10 mg on days 12-21 (E2V/MPA) or placebo. Fifty-seven women (78%) completed the study. Bone mineral content of the distal regions of the forearms (measured by single photon absorptiometry, SPA) and bone mineral density of the spine (measured by dual energy X-ray absorptiometry, DXA) showed increases of 0.5-1% and 4-5%, respectively, in the hormone groups over 2 years. The placebo group exhibited a decrease in spinal bone density of 2% per year, and in the forearm of 2.5-3.5% per year. Biochemical estimates of bone turnover (serum alkaline phosphatase and fasting urinary calcium) decreased significantly to premenopausal levels in the hormone groups but remained unchanged in the placebo group. In both hormone groups total cholesterol decreased by about 9% (P less than 0.001), whereas low density lipoprotein cholesterol decreased by 16% in the E2/DG group and 20% in the E2V/MPA group (P less than 0.001). High density lipoprotein cholesterol showed only minor, insignificant changes in the hormone groups. The placebo group had virtually unchanged values. Climacteric symptoms, including hot flushes, were significantly reduced in both hormone groups. Bleeding occurred regularly in about 80% of the women.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1981

Climacteric flushing: clinical and endocrine response to infusion of naloxone.

Six postmenopausal women with frequent attacks of flushing were studied by measuring plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin and noradrenaline concentrations at regular and frequent intervals and at the time of each of 82 flushes. The hormone measurements were made on a control day and on the second day during infusion of either naloxone (22 micrograms/min) or saline. The perception of a flush was associated with a significant increase of plasma LH concentrations. There were no significant changes in plasma FSH, prolactin or noradrenaline concentrations. Naloxone infusion resulted in a highly significant reduction in the frequency of flushes and in the number of LH pulses. We conclude that flushing and its neuro-endocrine correlates are related to activation of opiate receptors. Naloxone may provide the basis for a non-steroidal treatment of climacteric flushing attacks.

Adult↗
PubMed1982

Effects of the climacteric and sequential mestranol and norethisterone on the cervix and genital tract.

The effects of the climacteric and sequential mestranol and norethisterone on the epithelium of the cervix and genital tract were determined in 12 postmenopausal women. Before treatment the squamocolumnar junction was visible in only six of the 12 women, but after treatment with sequential mestranol and norethisterone the squamocolumnar junction became visible due to a minor degree of eversion. Mucus, which was always absent before therapy, was always seen afterwards and any atrophic effects were reversed by therapy within 3 months. The effects of oestrogen and progestogen deficiency were more easily seen by scanning electron microscopy (SEM) than with conventional histology. Before treatment six of the nine women studied by SEM had a cervix covered by mature squamous epithelium, but after therapy all the women had mature squamous epithelium. The pretreatment lateral vaginal wall and urinary sediment smears showed mainly immature squamous cells; this correlated poorly with the histology and SEM of the cervix. There was a good correlation between urinary sediment and lateral vaginal wall smears both before and after treatment.

Cervix Uteri↗
PubMed1984

The symptomatology of the climacteric in relation to hormonal and cytological factors.

Climacteric symptomatology was investigated in a group of non-selected women aged between 54 and 56 years of age, Vasomotor complaints and dyspareunia, in particular, were noted and related to plasma hormone levels and vaginal cytology. Only 33% of those women who were within 5 years of the menopause had symptoms of a magnitude that might require hormone replacement therapy. Neither the vasomotor complaints nor dyspareunia correlated with the hormone levels or cytology findings to such an extent as to be helpful in planning treatment. Apparently only a minority of women in their middle 50s demonstrate a symptomatic need for hormone replacement therapy and laboratory investigations are of little use in their identification.

Cervix Uteri↗
PubMed1977

The climacteric disease.

Evidence is provided to show that the account of "The Climacteric Disease" given in 1813 by Sir Henry Halford, Physician to King George III, was his interpretation that the King's illness was due to aging as a disease. This laid foundations upon which are placed the unfavorable attitudes toward Geriatric Medicine today, and which may effect the provision of medical care for the elderly and aged tomorrow.

Aged↗
PubMed1979

Value of cytology for detecting endometrial abnormalities in climacteric women receiving hormone replacement therapy.

Over six months 113 endometrial specimens from 110 menopausal women receiving hormone replacement therapy were examined by two cytologists and two histopathologists. Specimens were obtained by aspiration with the Isaacs cell sampler immediately before Vabra suction curettage, both procedures being performed in the outpatient department without anaesthetic. The histologists agreed with each other on the classification of 85 specimens (75.2%) and the cytologists agreed on the classification of 44 (38.9%). In only 15 cases (13.3%) did all four observers agree. Of the three cases of cystic or adenomatous hyperplasia detected histologically, only one was diagnosed by cytology. Furthermore, both cases of adenocarcinoma escaped detection by cytology, though a third case--later confirmed-"was suspected by one cytologist alone. Use of the Isaacs endometrial cell sampler cannot be advocated for routine screening of women with climacteric symptoms receiving hormone replacement therapy. Efforts should be made to establish the correct dose and duration of treatment with an oestrogen-progestogen preparation in order to avoid over-stimulating the endometrium and the need for regular screening for endometrial abnormalities.

Adenocarcinoma↗
PubMed1980

Endometrial disease after treatment with oestrogens and progestogens in the climacteric.

A prospective study of 745 women receiving different regimens of hormone treatment for the climacteric for a total of 21 736 months was performed. There was a lower incidence of endometrial hyperplasia in biopsy specimens in the women receiving cyclical low-dose oestrogen by mouth than in those receiving cyclical high-dose oestrogen by mouth. The incidence of abnormalities in the women receiving sequential oestrogen and progestogen was lower than in either of these two groups. Among the women receiving subcutaneous oestrogen implants the incidence was higher still, but over half of the abnormal specimens were from women who had not taken their progestogen. The incidence of hyperplasia fell with longer courses of progestogen, and no hyperplasia was found in patients taking progestogen for over 10 days each month. The incidence of adenomatous and atypical hyperplasia is significantly reduced by a progestogen when taken for 10 or more days monthly. The absence of vaginal bleeding or of a regular bleeding response does not guarantee histologically normal endometrium in patients taking oestrogens without progestogen.

Climacteric↗
PubMed1992

[Treatment of climacteric syndrome using Estraderm TTS and premarin in a comparative study].

In an open-label, multicentric randomized trial the efficacy and tolerability of Estraderm TTS, a 17 beta-estradiol, and Premarin, consisting of conjugated estrogens, were compared in the treatment of the climacteric syndrome. 84 patients with manifest menopausal complaints were randomized into two groups of 42 women each. The duration of treatment was 11 weeks or 3 cycles, each with 3 weeks of estrogen treatment followed by a therapy-free week. Therapeutic efficacy was assessed with a questionnaire recording frequency and intensity of hot flushes and of sweating episodes during the night, changes in psychic well-being, frequency of micturition and dryness of the vagina. Systemic and local tolerability was also evaluated. Both substances proved almost equivalent in the treatment of menopausal complaints, although Estraderm TTS was markedly superior in suppressing vasomotor symptoms.

Administration, Cutaneous↗
PubMedDate not supplied

Mood, energy, cognition, and physical complaints: a mind/body approach to symptom management during the climacteric.

Recent studies suggest that energy and cognitive and physical complaints such as fatigue, disrupted sleep, concentration problems, and pain are more problematic than clinical depression during the climacteric and may contribute to depressed mood. Central nervous system pathways that mediate mood, cognition, and energy are influenced by fluctuations of circulating estrogen during perimenopause. Symptoms are also influenced by other factors, including psychosocial and environmental stresses and supports. Health care for women from perimenopause to postmenopause should include an accurate assessment of energy and cognitive, physical, and emotional symptoms. Multidisciplinary approaches that combine prevention, symptom management, and health promotion are most effective for women. A mind/body program for perimenopause and menopause is presented as an example of a comprehensive treatment approach for assessment and management of perimenopause and menopause. This 10-week group program combined information, self-education, relaxation training, group support, lifestyle modification, and psychological coping skills.

Affect↗
PubMed2002

Women, menopause, and (Ms.)information: communication about the climacteric.

This research utilizes a communication perspective to examine the dissemination of information about menopause in terms of women's attitudes, beliefs, and knowledge. Specifically, this study uses a grounded theory approach (Glaser & Strauss, 1967) to explore the communicative processes of misinformation concerning women's lived experiences in relation to the climacteric. Five emergent themes extracted from premenopausal, perimenopausal, and postmenopausal women's discourse are identified and described through qualitative data analysis. Findings suggest that due to a lack of consistent communication, women are generally either unknowledgeable or misinformed about menopause and its related issues. Inaccurate information concerning a health-related experience that all women undergo has negative implications for women, their practitioners, and society. Moreover, a clearer understanding of women's experiences concerning menopause may enhance communication in physician-patient interactions (PPIs).

Adult↗
PubMed1996

Effect of estrogen replacement therapy on hepatic triglyceride lipase, lipoprotein lipase and lipids including apolipoprotein E in climacteric and elderly women.

Estrogen provides beneficial effects on hyperlipidemia in climacteric and elderly women. In this study of 68 women (37 to 67 years old), hepatic triglyceride lipase (HTGL), lipoprotein lipase (LpL) serum lipids and apolipoproteins were analyzed to investigate the effects of estrogen replacement therapy (ERT). After menopause, LpL, total cholesterol, low-density lipoprotein (LDL)-cholesterol, and apolipoprotein B increased. But ERT suppressed total cholesterol, LDL-cholesterol, apolipoprotein B, and especially apolipoprotein E in menopausal women. The mechanism was thought that ERT significantly suppressed HTGL, but LpL was not affected. Estrogen also increases hepatic LDL receptors and accelerates transfer of serum LDL-C (and TC). It was said that HTGL accelerates conversion of intermediate-density lipoprotein (IDL) to LDL. The suppression of HTGL by the ERT may decrease conversion of IDL to LDL and lower LDL-C (and TC). These estrogen's beneficial effects on lipids, may prevent the atherosclerosis. In addition, apolipoprotein E increases senile plaques in senile dementia-Alzheimer's type. The decrease in apolipoprotein E with ERT may be related to cognitive functions of elderly women.

Adult↗
PubMed1983

Effects of various replacement oestrogens on hepatic transcortin synthesis in climacteric women.

The influence of peri-menopausal oestrogen replacement therapy upon protein synthesis in the liver was investigated. Changes in the cortisol-binding capacity of transcortin (TC-BC) were utilized as an indicator of hepatic oestrogen sensitivity. Forty-two climacteric women were studied before and after treatment with various drugs at different doses (patients receiving identical compounds served as their own controls for the evaluation of dosage effects; duration of medication: 14 days at each dose). Oral administration of oestriol (1 and 2 mg daily; n = 6), oestriol (1 and 2 mg daily) + oestradiol-17 beta (2 and 4 mg daily; n = 8), oestradiol valerate (1, 2, 4 and 6 mg daily; n = 6), conjugated equine oestrogens (0.3 and 0.6 mg daily; n = 6), sodium oestrone sulphate (0.8 and 1.6 mg daily) + sodium equilin sulphate (0.2 and 0.4 mg daily; n = 6) and quinoestrol (25 micrograms daily; n = 6) failed to alter TC-BC. However, ingestion of higher doses of conjugated equine oestrogens (0.9 and 1.25 mg daily; n = 5) and quinoestrol (50 micrograms daily; n = 6) caused a significant rise (P less than 0.01). Ethinyloestradiol was given orally as a reference substance and elicited an elevation of expected magnitude. Vaginal administration of dienoestrol cream (1 mg daily; n = 4) did not change TC-BC. These data indicate that the hepatotrophic effects of replacement oestrogens vary depending on the preparation and dosage selected for treatment.

Climacteric↗