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PubMed1977

[DNA concentration in the nuclei of endometrial gland epithelium in the presence of dyshormonal hyperplasias of the climacteric period].

The DNA content in the nuclei of the glandular epithelium of the endometrium was studied by microspectrophotometry in 6 women of fertile age and 10 with the climacteric dyshormonal adenocystic hyperplasia. In normal uterine mucosa the DNA quantity remained unchanged at various phases of the menstrual cycle. As compared to the normal, in dyshormonal endometrial hyperplasia the DNA content was almost doubled; there was also a moderate increase of polyploidy.

Cell Nucleus↗
PubMed1996

[Diagnosis and evaluation of climacteric symptoms. The "Menopause Rating Scale" MRS helps in diagnosis and evaluation of therapeutic effectiveness].

For the evaluation of climacteric symptoms, Kupperman and his collaborators worked out guidelines as long ago as 1953. As time passed, however, their validity was increasingly called into question. In the nineteen-seventies, on the basis of large epidemiological studies, the conclusion was drawn that merely the symptoms hot flushes and vaginal atrophy were specific to the menopause, while other, largely psychological, complaints represented a "domino effect", so to speak. In contrast to this, the scale (Menopause Rating Scale [MRS]) presented here also permits the identification of emotional complaints. In addition, urinary tract problems, joint and muscle pain, and sexual disorders are also rated. For each of the ten symptom groups, a graphical rating scale ranging from 0.0 (no symptoms) to 1.0 (severe symptoms) is available that permits a synoptic individual complaints profile of the patient to be established.

Attitude to Health↗
PubMed1996

[Incidence of climacteric syndrome].

A retrospective study on 300 women who attended the menopausal out-patient clinic of Physiopathology of Human Reproduction at Bari University Hospital from 1994 to 1995, was carried out to evaluate the incidence of climacteric syndrome in premenopause together with its correlations with the social and cultural environment. The results don't show differences between spontaneous and surgical menopause, and minor differences with premenopause. No relationship has been discovered between the onset of the menarche and the onset of spontaneous menopause. The hot flushes are more frequent in women with low level of learning.

Climacteric↗
PubMed1997

[A new rating scale for the climacteric syndrome (Menopause Rating Scale (MRS)].

Since 1952 the Kupperman index has served as an indicator for climacteric symptoms. This index, original at that time, has been widely criticized in recent years. After worldwide criticism it was finally reduced to two true symptoms, namely hot flushes and genital atrophy. The so-called psychosomatic symptoms which are essential for the quality of life, insomnia, nervousness and depression, were largely disregarded. In 1994, an expert group of German, Austrian and Swiss members published a new score (Menopause Rating Scale [MRS]) selectively adopting most of the symptoms of the Kupperman index and adding the missing symptoms such as alteration of libido, urological complaints and vaginal dryness. In contrast to the Kupperman index, the Menopause Rating Scale (MRS) presented here registers every single symptom individually in a numerical and graphic way without any multiplication factor. Thus, an individual profile of each patient can be established. This new score may be completed by the physician or by the patient. An improvement in therapy can be rapidly recognized by means of the score as well as by the graphic presentation.

Climacteric↗
PubMed1976

[The neurovegatative reaction-situation in climacteric. Modification of blood pressure regulation by estrogens].

48 women complaining of climacteric disorders were treated with an estrogen preparation for 1 year. Before an intervalls of 2 month during the treatment period studies of the Kupperman index, the vaginal karyopcnotic index and 3 neurovegatative (hemodynamic) tests were carried out: The orthostase-test according to Schellong, the cold-pressor-test according to Hines and Brown, the Pholedrin (Veritol-)test. During estrogen substitution the following alterations could be stated: A significant decrease of systolic and diastolic blood pressure values, a tendency of adjusting the systolic blood pressure values after standing up to the values in rest (Schellong-test I), a shortening of the interval needed to establish stable values of blood pressure and heart frequency, a tendency to reduce the increase of blood pressure in the cold pressor test, and a significant amplification of the increase of blood pressure and blood pressure amplitude in the Pholedrin test. These results are believed to indicate an alteration of vegetative reactivity in the parasympathicomimetic direction. Estrogens seem to exert a favourable influence on the mechanism of blood pressure regulation.

Adult↗
PubMed1997

[Principles of hormone replacement therapy in climacteric].

With age-specific diminished and excluded ovarian function and estrogen deficiency, 60% of females may develop various systemic disorders (the menopausal syndrome, urogenital and cardiovascular diseases, osteoporosis). In the past 10-15 years, hormone replacement treatment regimens have been developed for climacteric females. Numerous epidemiological surveys have indicated that hormone replacement therapy shows a 50% reduction in the incidence of stroke, myocardial infarction, bone fractures. Therefore, post-menopausal hormone therapy is indicated both for therapeutical and prophylactic purposes, which may increase female longevity.

Aged↗
PubMed1997

Climacteric syndrome and body-weight.

A retrospective study on 181 women who attended the menopausal out-patient clinic of Physiopathology of Human Reproduction at Bari University Hospital throughout 1995, has been carried out to evaluate the relation between body-weight (valued as BMI) and the climacteric syndrome. From the data we have discovered that hot flushes and sweating are more common in women with greater body-weight. Also, women with BMI > 23.8 were found to have a lower level of education.

Body Mass Index↗
PubMed1998

Swedish gynecologists' and general practitioners' views on the climacteric period: knowledge, attitudes and management strategies.

AIMS: To investigate attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynecologists and general practitioners (GPs) in Sweden. MATERIAL AND METHODS: In 1996 a questionnaire was sent to all Swedish gynecologists (n=1323) and every third general practitioner (GP) (n=1397) regarding indications, contraindications, treatment regimens and their own (or their wives') use of estrogens. RESULTS: Answers were received from 53% of the GPs and from 80% of the gynecologists. Fifteen per cent of the GPs often considered it difficult to evaluate the advantages and disadvantages of hormone replacement therapy compared to 2% of the gynecologists (p<0.001). Almost 100% of the physicians considered hot flushes, night sweats and osteoporosis to be indications for HRT. Significantly more GPs compared to gynecologists (50% vs 24%) stated that estrogen increased the risk of developing a deep vein thrombosis. Significantly more GPs performed measurements of blood pressure, weight, lipoproteins and palpated the breasts before starting treatment and at the follow-up visits. Significantly more gynecologists performed pelvic examination, vaginal sonography, endometrial biopsy and mammography. Among the female doctors who were either postmenopausal or had climacteric symptoms 72% of the GPs and 88% of the gynecologists were current users of HRT (p<0.01). Corresponding figures for the wives were 68% vs 86% (p<0.001). CONCLUSION: As earlier contraindications to HRT nowadays have turned into indications it is reasonable that more GPs compared to gynecologists consider it difficult to evaluate advantages and disadvantages of HRT and more gynecologists than GPs took the first initiative to discuss HRT with their patients. The information that far more female doctors and doctors' wives, compared to the Swedish female population, were using HRT is important information when discussing HRT compliance with patients.

Adult↗
PubMed1995

Evidence for the involvement of ethylene in the expression of specific RNAs during maturation of the orange, a non-climacteric fruit.

Twelve cDNAs corresponding to mRNAs inducible by ethylene were isolated by differential screening of a cDNA library from ethylene-treated Citrus sinensis fruits. Northern analysis of RNA extracted from flavedo of ethylene-treated fruits and from fruits at different maturation stages showed that some of the mRNAs corresponding to these cDNAs were regulated both by ethylene treatment and during fruit maturation. The effect of exogenous ethylene on leaves and of endogenous ethylene on flowers showed that gene induction was not restricted to the flavedo tissue. The possible role of ethylene during maturation of the non-climacteric Citrus fruit is discussed.

Blotting, Northern↗
PubMed1986

Dermal prostacyclin, thromboxane A2 and prostaglandin F2 alpha in climacteric women: effect of oestrogen replacement therapy.

The involvement of dermal prostanoids in menopausal flushing was studied in 8 women suffering from climacteric hot flushes and in 10 asymptomatic control subjects by inducing suction blisters on abdominal skin and assaying blister fluids for 6-keto-PGF1 alpha, a metabolite of the vasodilative prostacyclin (PGI2), thromboxane B2 (TxB2), a metabolite of the vasoconstrictive thromboxane A2 (TxA2), and 13,14-dihydro-15-keto-PGF2 alpha (M-PGF2 alpha), a metabolite of prostaglandin F2A (PGF2A). No marked differences were observed in the levels of these prostanoids in the two study groups. The women experiencing flushes then received conjugated oestrogens for 3 mth to abolish vascular instabilities. This decreased the blister fluid concentration of M-PGF2 alpha from 1720 +/- 476 pg/ml (mean +/- SE) to 1490 +/- pg/ml (P less than 0.05), but had no effect on the dermal levels of 6-keto-PGF1 alpha or TxB2. It was concluded that although certain dermal prostanoids may be affected by oestrogen treatment they are not of primary significance as regards menopausal flushing.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Non-invasive 24-hr monitoring of high blood pressure in climacteric outpatients.

Blood pressure (BP) monitoring was carried out over a period of 24 hr in 28 hypertensive women selected among the outpatients attending the Menopause Clinic at Bologna University. Seven (7) of the women (mean age 50 +/- 1 yr) were in the pre-menopause, 7 had undergone a natural menopause at 6 to 36 mth previously (mean age 52 +/- 4 yr) and a further 7 had had a natural menopause 37-120 months previously (mean age 56 +/- 5 yr). The control group was made up of 7 women in late fertile age (mean age 47 +/- 1 yr). It was found that: high blood pressure was not confirmed in all patients; there was a significant increase in systolic and diastolic BP values in natural post-menopause subjects (P less than 0.01) temporarily related to ovarian failure, but BP reached a steady state in elderly women when a new hormonal balance is established; 24-hr monitoring made it possible to identify a group of climacteric outpatients at higher cardiovascular risk whose suitability for antihypertensive treatment could thus be assessed.

Blood Pressure↗
PubMed2002

Sexuality in the climacteric years.

Menopause is a time of anatomic, physiological and psychological changes that often influence in the sexuality of aging female. Being sexual functioning an important aspect of health and well-being, doctors should have an holistic approach reassuring about the possibility of treating the various symptoms. The central nervous system is an important target for sex steroid hormone; estrogen, progestagens and androgens are able to modulate several brain functions, and receptors for gonadal steroids have been identified in several brain areas. Because there is no test that physicians can make to assess sexual function, taking a sexual history is probably the most important aspect in the diagnostic and treatment of sexual problems. Hormonal transition with decreasing levels of estrogen and testosterone produces clinical effects, so women need to make adjustments for this period of life. Testosterone is an important component of female sexuality, and alterations in its circulating levels play an important role in psychological and sexual changes that occur after menopause. This is the reason why the research in identifying women who have a decrease androgen active should be aimed. Treatment may include education about sexuality and medical management of symptoms or problems interfering with sexual activity. Also treatment implications and the diverse aspects that may influence on sexuality in the climacteric years are discussed.

Aging↗
PubMed1998

Methods of assessing the impact of climacteric complaints on quality of life.

Quality of life is an important outcome that reflects the way patients feel and function. Assessing the impact of a condition on quality of life is particularly relevant in symptomatic conditions such as the menopause. A range of measurement tools are available for monitoring how symptoms, typical of the climacteric period, affect patients with regard to their well-being, sleep disturbance, other somatic symptoms, cognitive function and sexual functioning. However, to gain a valid assessment of quality of life and the effects of treatment in the menopause, only standard and well-validated measurement tools should be used. The appropriateness of relying on the use of psychiatric rating scales to assess mood is questionable. Results obtained from an increasing number of controlled clinical studies indicate that treatment with oestrogen, in addition to alleviating vasomotor symptoms, can substantially improve patients' quality of life.

Female↗
PubMed2005

A study of the control of climacteric symptoms in postmenopausal women following sequential regimens of 1 mg 17beta-estradiol and trimegestone compared with a regimen containing 1 mg estradiol valerate and norethisterone over a two-year period.

OBJECTIVE: To compare the efficacy of two sequential 17beta-estradiol (17beta-E2)/trimegestone (TMG) combinations with the sequential estradiol valerate (E2V)/norethisterone (NET) regimen in relieving climacteric symptoms. STUDY DESIGN: This was a double-blind, randomized, multicenter study conducted among 1218 Caucasian (99%) postmenopausal women with an intact uterus in seven European countries and Israel, over 13 cycles (each of 28 days). Study duration was extended further for 13 cycles, with 531 women receiving treatment for up to 26 cycles. Treatments consisted of 1 mg 17beta-E2 on days 1-14 and 1 mg 17beta-E2/0.125 mg TMG or 0.25 mg TMG on days 15-28, and 1 mg E2V on days 1-16 and 1 mg E2V/1 mg NET on days 17-28. RESULTS: Rapid and significant reductions in the mean daily number and severity of hot flushes and in the mean daily number of nocturnal sweats were established in most women with 1 mg 17beta-E2/0.25 mg TMG and E2V/NET. These treatments also induced a significant improvement in the quality-of-life assessments. CONCLUSION: The 1 mg 17beta-E2/0.25 mg TMG regimen provides rapid and effective relief of menopausal symptoms, with a reduction in the number of hot flushes "at least as good as" that of the E2V/NET comparator.

Administration, Oral↗
PubMed2005

Efficacy on climacteric symptoms of a continuous combined regimen of 1 mg 17beta-estradiol and trimegestone versus two regimens combining 1 or 2 mg 17beta-estradiol and norethisterone acetate.

OBJECTIVES: To compare the efficacy of a continuous combined regimen of 1mg 17beta-estradiol (17beta-E2) and 0.125 mg trimegestone (TMG) with two continuous combined 17beta-E2/norethisterone acetate (NETA) combinations in the relief of climacteric symptoms in postmenopausal women. STUDY DESIGN: This was a randomized, double-blind, multicenter study conducted in 13 countries over a 2-year period. Healthy postmenopausal women with an intact uterus were treated with 1 mg 17beta-E2/0.125 mg TMG, 2 mg 17beta-E2/1 mg NETA or 1 mg 17beta-E2/0.5 mg NETA for up to 26 cycles, each of 28 days. RESULTS: The 1 mg 17beta-E2/0.125 mg TMG combination was effective in significantly reducing the mean daily number and severity of hot flushes and in reducing the number of night sweats from cycle 1 onward. No overall significant differences between this regimen and the comparators were detected. Other efficacy variables, including the Kupperman index, psychofunctional disorders and quality-of-life sub-scales, experienced a similar improvement from baseline with all treatments. CONCLUSION: Continuous combined 1 mg 17beta-E2/0.125 mg TMG provides relief of menopausal symptoms that is non-inferior to both 17beta-E2/NETA combinations. Furthermore, trimegestone appeared to provide a better improvement of depressive mood than 0.5 mg NETA when combined with 1 mg 17beta-estradiol.

Administration, Oral↗
PubMed2006

Climacteric obesity: from genesis to clinic.

The etiology of obesity is multifactorial and still unclear. Genetic factors play a significant role and include several gene candidates: polymorphisms of genes for ss(2)-adrenoreceptor, resistin, estrogen receptor-a and peroxisome proliferator-activated receptor-gamma. Moreover, peptides regulating hunger and satiety, e.g. leptin, galanin, cholecystokinin and neuropeptide Y, and altered nutritional patterns have been implicated. Also, factors associated with aging, e.g. decreased levels of growth hormone and dehydroepiandrosterone, and the activity of the sympathetic nervous system (resting metabolism and thermogenesis) cannot be disregarded. Participation of the sex steroids and inflammatory factors has also been postulated in the etiology of obesity. Three phenotypes of obesity are postulated; however, the visceral (abdominal) phenotype is typical of postmenopausal women and is characterized by several metabolic disorders with high risks of diabetes mellitus type 2 and cardiovascular disease. On the basis of personal experience and data from evidence-based medicine, diagnostic-therapeutic algorithms of climacteric obesity are presented.

Algorithms↗
PubMed2000

Sex differences in 'climacteric symptoms' with increasing age? A hypothesis-generating analysis of cross-sectional population surveys.

Are the established clinical symptoms of the female climacteric really specific for women? We were interested to compare the prevalence of these symptoms across age and sex. In the absence of longitudinal (cohort) studies, we tried to find cross-sectional, population-based studies with a broad age span to find a preliminary answer. We obtained six surveys that contained information for at least some of the symptoms. We re-analyzed these databases, which included over 8000 males and 8000 females, in a pooled fashion. Sixteen symptoms of predominantly somatic, psychological and urogenital origin were identified and the age-dependent increase of the relative frequencies was compared between genders. A general tendency for women to report more symptoms was confirmed; however, no significant differences were found between genders regarding the time trend of these symptoms. The analyses suggest that males experience a similar symptomatology in the same age span as women. One may thus be tempted to conclude that aging males experience similar phenomena to women during their menopausal transition. This should be confirmed in a specifically designed study.

Journal Article↗
PubMed2005

Finished herbal product as an alternative treatment for menopausal symptoms in climacteric women.

BACKGROUND: There is a paucity of scientific evidence supporting the efficacy of herbal medicines in treating menopausal symptoms. OBJECTIVE: The aim of this study was to evaluate safety and efficacy of the finished herbal product TMN-1 in the treatment of menopausal symptoms in climacteric women. DESIGN AND SETTING: A multicenter, prospective, observational follow-up study was conducted from July 2003 to December 2004 in four hospitals in Taiwan. PARTICIPANTS: Initially, 126 women were included who were between 45 and 55 years of age, were experiencing hot flashes, and were without hormone replacement therapy. Women were excluded if they had any signs of active cancer. Of the participants, 82% completed the study. The reasons for withdrawal included adverse effects (n = 7), failed to return (n = 7), lack of efficacy (n = 6), and from protocol deviation (n = 3). INTERVENTION: Every participant received TMN-1 treatment 4 g, 3 times per day, for 12 weeks. MAIN OUTCOME MEASURE: Primary measures were change in frequency of hot flashes and severity of menopausal symptoms measured by Kupperman Index (KI). Secondary outcomes included changes in quality of life and adverse events. RESULTS: Significant improvement in scores of hot flashes and KI were found at weeks 4 and 12 in the 50 peri- and 53 postmenopausal women who completed this study (p < 0.001). Logistic regression analyses showed that perimenopausal women with hot flashes had sevenfold (95% confidence interval [CI], 1.8-28.0) odds of improvement in favor of treatment, whereas that of the postmenopausal group was 1.5 (95% CI, 0.5 to 4.2). Further analyses showed that TMN-1 produced superior benefit in women with moderate and severe menopausal symptoms (KI > or = 21), compared to those with mild symptoms. It also improved symptoms of insomnia, nervousness, melancholia, and palpitation in perimenopausal women. Five (5) adverse drug reactions were detected: three single events of nausea, abdominal pain, and abdominal fullness; and two events of diarrhea. CONCLUSIONS: This study provides evidence that 12 weeks of TMN-1 therapy is a viable alternative treatment to consider in perimenopausal women with hot flashes, particularly in those with palpitations, emotional disturbance, and insomnia.

Drug Administration Schedule↗