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PubMed1989

[Endocrinology of the climacteric].

The endocrinology of the menopause is determined by the decrease of estrogens. In 250 healthy patients there was an observed decrease of estrone to 35 pg/ml and of estradiol to 10 pg/ml serum between the 49th and 54th year of age. Thereafter no further decline occurred, because the androgen precursors of the estrogens were secreted by the adrenal cortex until advanced age. In a period of 30 years there was a decrease of the androgen levels of only 25%. In 200 patients with severe obesity we found no differences in peripheral steroid concentrations, but the SHBC concentrations were significantly lowered; therefore, the amount of free active estradiol and the effect on the target organ is higher in these patients.

Climacteric↗
PubMed1979

Physiological, psychological and situational stresses in depression during the climacteric.

The present study examined the characteristics and circumstances which distinguished between groups of depressed and non-depressed menopausal women: 20 women were studied overall. The Beck Depression Inventory (BDI) was used to assess depression levels, while the administration and content analysis of a semistructured interview provided information regarding the presence or absence of stress across a number of variables. While the depressed group were not found to differ significantly from the non-depressed group in terms of stress due to physical symptomatology, they did differ on a number of the psychological and social stress variables, and showed a significantly greater combination of stresses compared with the non-depressed group. Some recommendations concerning management are made.

Adaptation, Psychological↗
PubMed1982

Evaluation of a continuous oestrogen-progestogen regimen for climacteric complaints.

Subjective complaints, endometrial histopathology, vaginal cytology and bleeding patterns were recorded in 26 patients treated with a continuous oestrogen-progestogen regimen for 12 mth. A marked reduction of hot flushes and sweats were noted and the evaluation of endometrial specimens revealed that the mucosae were mostly inactive-atrophic. The karyopyknotic index proved to be a poor indicator of oestrogenic activity. The number of recorded bleedings in the peri-menopausal women differed markedly from the post-menopausal women during treatment; they were very slight in the latter group. Even in those cases where bleeding occurred, the endometrial samples were found to be atrophic. Vaginal bleeding seemed to be an unreliable indicator of endometrial histopathology. The present combination of hormones used in a continuous regimen is a good alternative for post-menopausal women in need of hormonal therapy.

Climacteric↗
PubMed1983

Opipramol in the climacteric syndrome. A double-blind, placebo-controlled trial.

In a double-blind trial, 48 women suffering from post-menopausal complaints were randomly allocated to an 8-wk course of treatment with opipramol (50 mg sugar-coated tablets) or an identical placebo. Autonomic nervous system instability (7 target symptoms) and depression (10 target symptoms) were scored at the beginning of the trial and after 1, 2, 4, 6 and 8 wk and a final assessment was made at the end of the trial. A daily record of hot flushes was kept by the patients. Opipramol brought about an approximately 50% reduction in the symptoms, but a considerable placebo effect was noticed also. It was found that opipramol treatment was significantly better than placebo treatment (P less than 0.01) in reducing hot flushes after 2 mth of therapy. The symptoms of depression were significantly reduced in the opipramol group, as compared with the placebo group. No significant reduction could be seen in the vasomotor symptoms. The final assessment at the end of the trial period showed a significant difference (P less than 0.05) in favour of opipramol.

Adult↗
PubMed1987

Climacteric symptoms after oral and percutaneous hormone replacement therapy.

One hundred and ten (110) healthy early post-menopausal women with mild subjective vasomotor symptoms (mean Kupperman index score 11) participated in a long-term, double-blind, placebo-controlled therapeutic trial. The effects of 2 hormone regimens were evaluated. Group I received percutaneous oestrogen therapy for 2 yr, opposed by oral micronized progesterone (200 mg) during the second year, while Group II received oral 17 beta-oestradiol valerate together with cyproterone acetate (CPA). The serum oestrogen concentrations differed markedly in the 2 treatment groups. In Group I the serum/oestrone/oestradiol ratio was 1 (comparable to the pre-menopausal value), but in group II the ratio was greater than 5. Despite the difference in the serum oestradiol and oestrone concentrations, the mean symptom scores were rapidly and similarly reduced in both treatment groups (P less than 0.001). They remained low throughout the study and were not significantly different from pre-menopausal values.

Administration, Cutaneous↗
PubMed1987

Long-term placebo-controlled efficacy and safety study of Org OD 14 in climacteric women.

In a randomized, double-blind, placebo-controlled efficacy and safety study of Org OD 14 [(7 alpha,17 alpha)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one] in 60 post-menopausal women, the effects of treatment on clinical parameters (hot flushes and associated complaints) and laboratory parameters (routine haematology and biochemistry) were evaluated. Assessments were made before treatment and after 1, 3, 6, 9 and 12 mth of therapy (in the case of the laboratory parameters after 6 and 12 mth only). In total, 17 patients dropped out, 6 of whom were on Org OD 14 and 11 on placebo. Clinical parameters were evaluated by means of the Yates test. Org OD 14 had a significantly better effect than placebo on hot flushes and sweating at all stages of assessment. A similar effect, albeit to a lesser extent, was seen on sleeplessness, fatigability, irritability and psychic instability. Serum levels of alkaline phosphatase, triglycerides, high-density lipoprotein cholesterol and phosphate decreased during Org OD 14 treatment. It was concluded that Org OD 14 provides a new, efficient and safe means of treating the post-menopausal syndrome.

Adult↗
PubMed1987

Endometrial effects of a continuous percutaneous oestrogen/low dose oral progestogen regimen for climacteric complaints.

Eleven post-menopausal women were followed up during continuous replacement therapy with percutaneous 17 beta-oestradiol, 1.5 mg, opposed by oral levo-norgestrel, 30 micrograms, daily. Endometrial biopsies were taken before and after 3 months of treatment. Conventional histopathological analyses and morphometric analyses of glandular epithelial nuclei revealed only slight proliferative activity and no secretory changes. The results indicate that endometrial proliferation during post-menopausal oestrogen replacement therapy can probably be prevented by the continuous addition of a very low dose of progestogen.

Administration, Cutaneous↗
PubMed1988

Sequential use of conjugated estrogens and medroxyprogesterone in the climacteric syndrome: clinical and histological findings.

Seventy-four symptomatic postmenopausal women received conjugated equine estrogens, 0.625 mg daily, alternating 3 wk of treatment with 1 wk free. Medroxyprogesterone acetate, 10 mg daily, was added from day 12 to day 21 of the estrogen therapy. The length of treatment ranged between 36 and 50 mth (media 42.8). This sequential treatment appears to be an effective medication for menopausal women as 86.4% of patients showed a complete regression of symptoms. Its acceptability may be considered good since few side effects and low incidence of abandons (12.2%) were registered. Medroxyprogesterone seems to be a useful agent to counteract the possible cocarcinogenetic effect of conjugated estrogens on account of the high incidence of induced secretory endometrium obtained (92.2%), the reversal of six pretreatment endometrial hyperplasias and the absence of any premalignant endometrial lesion after at least 3 yr of this sequential treatment. The only case of endometrial cancer registered does not jeopardize this conclusion as was observed in a women who took medroxyprogesterone very irregularly.

Adult↗
PubMed1988

Comparison of two equine oestrogen-dydrogesterone regimens in the climacteric.

Menopausal women receiving 0.625 mg/day conjugated oestrogen continuously for 6 mth were also given either 10 mg/day dydrogesterone continuously or 20 mg/day for the first 12 days of each calendar month in order to evaluate both the efficacy and the tolerance of each regimen. The following parameters were assessed: subjective symptoms, bleeding patterns, lipid metabolism, glycaemia, weight and blood pressure. Of the 81 patients who entered the study, 60 opted for the continuous treatment and 21 for the cyclic treatment. Seven (7) patients dropped out, 6 for administrative reasons and 1 because of nausea. The two groups were comparable with regard to all parameters, with the exception of the duration of pretreatment amenorrhoea, which was longer in the continuous-treatment group (40.6 vs. 19.1 mth), and the initial lipid profile levels, which were higher in the same group. The subjective symptoms were influenced rapidly and positively by both treatments. The other parameters remained unchanged, except for a clinically insignificant rise in triglycerides in both groups. Both treatments were quite satisfactorily accepted by the patients, in spite of a 70% rate of withdrawal bleeding in the cyclic group and a 40% rate of spotting in the continuous-treatment group. Sixty-two (62) patients remained free of side effects, while mastodynia was reported in 9 cases.

Climacteric↗
PubMed1991

Efficacy of sustained-release vaginal oestriol in alleviating urogenital and systemic climacteric complaints.

In a double-blind, placebo-controlled study, 109 patients suffering from local and vasomotor postmenopausal complaints were randomly assigned to treatment with either depot vaginal suppositories containing 3.5 mg oestriol (E3) or a placebo. The treatment schedule comprised one vaginal suppository twice weekly for 3 weeks initially, followed by maintenance therapy with one vaginal suppository weekly for the 6-month study period. The effectiveness of the therapy was assessed on the basis of questionnaires (Kupperman index for vasomotor complaints and an original urogenital index for local complaints) and gynaecological examinations which included assessments of vaginal cytology, vaginal pH and Döderlein bacilli. To rule out induced endometrial proliferation, endometrial biopsies were performed in 50 women before and after the study. The vaginal depot (E3) formulation showed highly significant superiority over the placebo with respect to therapeutic effect on local urogenital complaints and alleviation of vasomotor complaints, including hot flushes. Analysis of the endometrial biopsies indicated that the monotherapy used caused no endometrial stimulation. Taking into account the minimal rate of adverse effects, the 3.5 mg E3 depot formulation studied represents a useful variant in the range of preparations available for the treatment of post-menopausal complaints.

Administration, Intravaginal↗
PubMed1993

The menopausal age and climacteric complaints in Thai women in Bangkok.

Age at menopause, associated factors and related clinical symptoms were recorded in a sample of Thai women living in the Bangkok area. Interviews by trained nurses were offered to a sample of 2375 women aged 45-59 years selected at random in 19 of the 54 Bangkok Metropolis Administration health centers. Full reports were obtained from 2354 women. Fifty-six percent of the study population were classified as postmenopausal, i.e. having no vaginal bleeding during the last 12 months, 12% were perimenopausal, i.e. having irregular vaginal bleeding during the last 12 months and 31% were premenopausal, i.e. having regular vaginal bleeding during the last 12 months. The average age at menopause was 49.5 +/- 3.6 years and was not related to body weight, height, age at menarche, level of education, smoking or use of oral contraceptives. However, high parity was significantly correlated to delayed menopause. Clinical symptoms of oestrogen deficiency were reported at a significantly higher rate in the perimenopause group, but the premenopause and postmenopause groups did not differ in their complaints about any symptom, including hot flushes. The most striking effect of menopause was a dramatic loss of sexual desire in 86.9% of postmenopausal women. However, the situation did not induce any specific complaint or any request for medical support.

Adult↗