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Report about the metabolism of estrogens in the postmenopausal period and the hormone replacement therapy. The indications and contraindications for the estrogen- and estrogen-progesterone-therapy were discussed. Osteoporosis in the aging women constitutes a major public health and socio-economic importance than the climacteric syndrome.
The authors share their experience in the importance of climacteric cardiopathy among the dyshormonal cardiopathies under out-patient department conditions. The observation is based on 20 cases of women, aged from 42 to 49. The subjective complaints of the patients were followed as well as the objective findings, some biochemical indices, arterial pressure and the electrocardiographic image within the course of two years. The results from the electrocardiographic records are of particular importance, giving the changes in T-wave of precordial leads, the necessity of differentiation from those in ischemic heart disease and the effectiveness of the treatment applied.
21 women with menopausal disorders were given veralipride, which is a benzamide derivative having a central anti-dopaminergic action. The LH, FSH and PRL plasma levels were controlled before and after treatment. Treatment, using veralipride at a daily dose of 100 mg for 20 days, improved the climacteric syndrome, and, in particular, the sudden hot flushes. The FSH plasma levels remained unchanged, the LH levels were reduced, although they remained high, and the PRL levels increased during the course of the treatment.
The author observed three groups of women during their receiving hormonal therapy for the climacteric syndrome. They underwent clinical investigation, mammography and thermography. The first group (n = 31) received 10 mg estradiolmonobenzoate every 6 weeks, the second group (n = 33) 2.5 mg estradiolmonobenzoate and 50 mg testosteroneisobutyrate every 6 weeks. The control group (n = 50) received no hormonal therapy. According to the results obtained, no statistically significant changes were observed following the hormonal therapy.
In 176 women hexestrol was substituted during 12 month or longer after ovarectomy and hysterectomy. Changes of the breast were watched by mammography and plate-thermography during hexestrol treatment. Also blood cagulation was examined. No differencies were found between these women and 179 women of a control group. In the authors opinion the substitution of hexestrol is justified further on in climacteric periods.
Twenty-three cases of the climacteric syndrome were analysed in a double-blind study comparing the effect of conjugated equine oestrogen (Premarin) and medrogestone (Colpro) with clonidine (Dixarit) on various clinical parameters. The treatment lasted 20 weeks. Statistical analysis of the results indictaed that opposed oestrogen therapy was effective in reducing hot flushes (P < 0,05) whereas clonidine was not. The other variables tested did not attain statistical significance.
The natural aging process affects a woman greatly during the climacteric; hormonal patterns, metabolic parameters, reproductive target organs and bone are involved. In every instance one can compare these changes with the effects of hormone-replacement therapy (HRT) on these same parameters. Therapy should reverse the negative trends imposed by the aging process and preserve the status quo. The approach must be holistic, and consideration must be given to the effects of HRT on all the parameters and not just to the uterus as the sole end point. Ideally the smallest amount of hormone should be used that will effectively treat symptoms and favorably affect metabolic parameters, the reproductive target organs and bone. Since recent clinical evidence has emphasized the protective nature of estrogen-plus-progestagen therapy in the prevention of endometrial and breast cancer and of osteoporosis, combination therapy is an essential feature of treatment. The shortfalls in our knowledge of the ideal therapy are undeniable. However, it is crucial to provide hormonal support with the available therapy to the woman suffering from estrogen-deficiency symptoms, particularly in view of the high mortality rates associated with postmenopausal osteoporosis, a preventable disease.
Laboratory tests of blood coagulation and platelet activity were undertaken in fifty-two climacteric patients who received cyclical oestrogen regimens for six consecutive months, following which they were given cyclical sequential oestrogen/progestogen regimens for periods ranging from fifteen months to twenty-seven months. The cyclical sequential regimen employed was determined by the dosage of oestrogen prescribed during the initial six-month period: norethisterone (2.5 mg or 5.0 mg) on days sixteen to twenty-one of cyclical treatment with oestrone piperazine sulphate or conjugated equine oestrogens, and DL-norgestrel (0.5 mg daily) from day twelve to day twenty-one of cyclical oestradiol valerate treatment. The results suggest that the addition of a progestogen to the cyclical oestrogen treatment does not modify blood coagulation factors or platelet aggregation.
70 women aged 47-66 years, menopausal between 3 and 14 years and suffering from climacteric deficiency symptoms, were treated with estriol succinate. After 5 weeks of treatment the subjective symptoms had greatly subsided. 50 patients had an atrophic vaginal smear prior to treatment. In all cases this improved during therapy. In 8 out of 11 patients no change in the endometrial picture was observed. After the period of treatment a therapy free interval of 4 weeks followed, during which complaints increased in all cases. Besides the morphologic symptoms specially the symptoms flush and sweating were improved by therapy. Psychological complaints were influenced to a lesser degree.
The peculiarities of the personality of 125 women in the climacteric period complicated by cardialgia of various intensity were studied. Psychopathological disorders of various severity were found in all women who were examined. With an increase in the intensity of cardialgia, the psychopathologic disorders became more severe.
Lumbago is considered to be an important clinical symptom of involutional osteoporosis, and is designated by the Ministry of Health and Welfare of Japan as one of the principal symptoms included in the criteria for the diagnosis of that condition. A study was designed to investigate the relationship between bone mineral density (BMD) and lumbago, as well as between BMD and vertebral compressive fractures in climacteric women. The study included a total of 400 outpatients (aged 49.2 +/- 0.4 years) visiting our department. The degree of lumbago was evaluated on the basis of an oral questionnaire. BMD was measured simultaneously by X-ray of the thoracic and lumbar vertebrae, the MD/MS and DXA. The presence or absence of vertebral fracture was judged on the X-ray image. As a result, there was seen to be no relation between lumbago and BMD. BMD was found to be significantly (p < 0.01) lower in 15 subjects with compressive fracture at thoracic and/or lumbar levels as judged on X-ray image than in subjects without fractures (n = 328). The above results suggested that, rather than considering lumbago as an important clinical symptom, the exact measurement of BMD and assessment of fracture in accordance with the definition of osteoporosis is the first step in diagnosing this disease. The upper limit of the fracture threshold determined from L2-4 BMD in these 15 subjects was 0.982 g/cm2. Of the subjects without fractures, 48.3% were found to have L2-4 BMD values at this level or lower, suggesting that they are at high risk of future fracture.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical and physiological examinations of 76 women in the postmenopause revealed in 64 of them the typical form of the climacteric syndrome, characterized by not only typical symptoms ("flushes", increased exudation, headaches, etc.), but also by various emotional vegetative disturbances detected at profound clinical neurological examination of the autonomic nervous system and the emotional sphere. Individual hormone therapy was associated with an appreciable alleviation of all psychovegetative disorders: "flushes", exudation, irritability, arterial hypertension, severity of vegetative dystonia, hysterical stigmata.
The incidence of climacteric symptoms was determined in 247 healthy premenopausal women in a community setting. These volunteers had been recruited to a longitudinal study of bone density. Of these subjects, 46 ceased to menstruate during the study, and in this subgroup symptoms were compared before and after cessation of menstruation. Only hot flushes increased after cessation of menstruation in the longitudinal study and showed age correlation in the cross-sectional study. Hot flushes thus emerged as a true menopausal symptom. Although evidence for this is weaker, cold sweats and suffocation seem likely to be genuinely menopausal. Breast discomfort and the four mood symptoms of irritability, excitability, depression and poor concentration improved after cessation of menstruation, and this study gives no support for their being part of the menopausal syndrome; it suggests that these symptoms are more likely to be related to menstruation than to the menopause.
Vasomotor symptoms are very common among perimenopausal women, but also among orchidectomized men. The cause of the symptoms is not the low steroid concentrations per se, but probably changes in central neuropeptide activity. Twenty-four healthy women with natural menopause, suffering from hot flushes, were included in the study and randomly assigned to either of two groups, one group received treatment with electrostimulated acupuncture (EA), the other with superficial needle position (SNP) acupuncture. Treatment was given for totally of eight weeks, twice a week during the first two weeks, and then once a week for the remaining six weeks. As recorded in logbooks kept by the participants, the frequency of flushes decreased significantly by more than 50 per cent in both groups, and remained decreased in the EA group, whereas in the SNP group it increased slightly again over the three months after treatment. Values for the Kupperman Index decreased in both groups during treatment, changes still evident at three-month follow-up, whereas the self-rated general climacteric symptoms (VAS) decreased significantly in the EA group only. The PGWB (Psychological General Well-Being) index did not change significantly in either group during treatment.
Quantification and qualification of climacteric symptoms had been described by Kupperman et al in 1953. New findings and ideas in the following forty years needed a correction of Kupperman index. Two important groups reduced the essential symptoms only on two ones, vasomotoric hot flushes and genital atrophy. On the contrary, Menopause Rating Scale (MRS) presented here enables registration of so called psychic symptoms, too, essential for quality of life. Complaint from bladder and urethra, hints and muscles and sexual disorders are also registered. For each of the ten symptom groups there is a rating scale from 0.0 (no symptoms) to 1.0 (very strong symptoms), in a graphic, too. In this way an individual profile will be visible. Using MRC it is possible, to quantify a better or worst status during and after treatment and to depict it.
Climacteric symptoms were treated with Org OD14 in 30 women. Each patient received 2.5 mg/day orally, for 90 consecutive days in 6 cases and 120 consecutive days in 24 cases. The results demonstrated a good clinical effect with a significant difference in Kupperman's score is 26.67 +/- 9.97 t 5.06 +/- 3.95 before and after treatment. The fasting urinary calcium/creatinine and urinary hydroxyproline/creatinine ratios, blood triglyceride and cholesterol levels decreased, vaginal cytology showed estrogenic effects during therapy. In 2 of 20 patients the endometrium changed from atrophic before treatment to slightly proliferative phase after treatment. The clinical use of org OD14 for perimenopaused women was discussed.
To improve the quality of life among women during the three decades following the menopause, every effort should be made to prevent the adverse effects of ageing. Broad joint initiatives, involving various disciplines such as, cardiology, urology, oncology, orthopaedics and gynaecology, are needed to optimise medical care during the climacteric. Oestrogen-progesterone treatment is the most important means currently available for the prevention of postmenopausal problems. This form of hormone therapy also appears to provide protection against osteoporosis and cardiovascular disease.
PURPOSE: To discriminate patients with severe mental disorders from those complaining of menopausal symptoms, psychological tests were performed on patients who visited the menopausal clinic. The effectiveness of hormone replacement therapy (HRT) in patients with slight mental disorders was also evaluated. SUBJECTS AND METHODS: Patients with menopausal symptoms (n = 150, 41-59 yr. old) were interviewed by a psychiatrist (according to DSM-III-R) and classified as the climacteric syndrome group (C) and the mental disorder group (P). The patients were also evaluated by the Menopausal index (MI), Maudsley Personality Inventory (MPI) and Self-rating depression Scale (SDS). The patients with severe mental disorders were eliminated and the remaining patients with menopausal symptoms were treated with conjugated equine estrogen (0.625 mg/day) and medroxyprogesterone acetate (2.5mg/day) for 24 weeks. RESULTS: 1) Thirty six patients were diagnosed as P (24%) and seven of them were diagnosed as having major depression (4.7% of the all patients). 2) MPI-N (neurosis scale) in C was 16.2 +/- 10, and in P was 30.5 +/- 9.0, and SDS in C and P were 39.0 +/- 8.0, and 51.4 +/- 8.9, respectively. In both psychological test, P shows a significantly higher value than C (p < 0.01). 3) Ninety point six % of the patients responded. HRT was not effective in 63.2% of P, but when psychotropic drugs were combined, significant improvement (p < 0.05) was observed. CONCLUSION: One fourth of the patients were suspected of having mental disorders in the menopausal clinic, and 5% of the patients needed the care of the psychiatrist. And the application of MPI and SDS was useful in helping the gynecologist to differentiate and classify the mental disorders to some extent. The applicability and effectiveness of HRT for patients with mild mental disorders were suggested.