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PubMed1991

Skeletal integrity in premenopausal and postmenopausal women receiving long-term L-thyroxine therapy.

PURPOSE: The impact of long-term L-thyroxine replacement therapy on skeletal integrity is a growing concern because of the large number of women receiving thyroid hormone therapy. The purpose of this study was to examine the hypothesis that long-term L-thyroxine therapy in which the free thyroxine index (FT4I) is maintained within a physiologic range has minimal impact on vertebral or femoral bone mineral density in both premenopausal and postmenopausal women. PATIENTS AND METHODS: We measured hip integral and spinal trabecular and integral bone densities in 28 premenopausal and 28 postmenopausal women who had been receiving L-thyroxine therapy for a median of 12 and 15 years, respectively, and in whom therapy was titrated to keep the FT4I within the normal range. The relationship between bone density parameters and thyroid hormone status was examined using univariate and multivariate statistical methods. RESULTS: Seventy-nine percent of the premenopausal women and 86% of the postmenopausal women had FT4I values in the normal range at the time of bone density determination. Moreover, throughout the study's duration, the majority of annually measured values were in the normal range for more than 80% of subjects. Premenopausal women had slightly lower bone density than would be expected for age: -6.7% (z = -0.39 +/- 0.74 [mean +/- SD], p less than 0.01), -3.1% (z = -0.22 +/- 0.78, p = 0.15), and -5.1% (z = -0.36 +/- 0.74, p less than 0.02) for spinal trabecular, spinal integral, and hip integral bone density, respectively. Postmenopausal women likewise had slightly lower bone density values that were significant only at the hip: -0.2% (z = -0.01 +/- 1.01, p = 0.95), -1.0% (z = -0.05 +/- 1.11, p = 0.80), and -6.2% (z = -0.39 +/- 0.80, p less than 0.02) for spinal trabecular, spinal integral, and hip integral bone density, respectively. When patients with previously treated Graves' disease (n = 4 in each group) were eliminated, the differences in bone density at the hip were no longer seen. Correlation analysis revealed only weak and generally nonsignificant relationships between parameters of thyroid hormone status and bone density at any site in either subgroup. Results of multiple regression analysis among the pooled data of all subjects showed that age provided a consistently significant contribution (R2 = 0.18 to 0.66) to the variability in bone density at the spine and the hip, but parameters of thyroid hormone status did not. CONCLUSION: These data provide the first supportive evidence that long-term L-thyroxine therapy that maintains the FT4I in the physiologic range is associated with a statistically significant, but clinically minimal, decrement in spinal and hip bone density in both premenopausal and postmenopausal women. The decrement at the hip was entirely due to the inclusion of patients with treated Graves' diseases. Thus, the changes in bone density in women receiving long-term L-thyroxine therapy are minimal at most and should not be a contraindication to therapy.

Adult↗
PubMed1981

Premenopausal hysterectomy and cardiovascular disease.

A premenopausal simple hysterectomy is associated with a threefold increase in the subsequent incidence and prevalence of coronary heart disease during the remaining premenopausal years. During the 10 years following a premenopausal hysterectomy, there is an approximately 4% probability of developing coronary heart disease and a 0.4% probability of dying from it. For every 28 uterine cancer deaths prevented by hysterectomy in 30-year-old women, there is an operative death. To be assured that premenopausal hysterectomies do not cause more deaths from cardiovascular disease than they save by prevention of uterine cancer requires a prospective study of 20,000 women observed until death. Pending further elucidation of this phenomenon, gynecologists should consider advising premenopausal women considering hysterectomy on the risks of coronary heart disease following the procedure.

Adult↗
PubMed1992

Behavioral stress responses in premenopausal and postmenopausal women and the effects of estrogen.

OBJECTIVE: Our purpose was to determine the pattern of reactivity to stress in premenopausal and postmenopausal women and to assess the effects of estrogen. STUDY DESIGN: A behavioral stress test was given to premenopausal (n = 13) and postmenopausal women (n = 36). Biophysical and neuroendocrine responses were measured during and on completion of the stress test. The postmenopausal women were then randomized to placebo or transdermal estradiol treatment for 6 weeks, at which time another behavioral stress test was given. RESULTS: Stress reactivity to math and speech tasks elicited significantly greater systolic blood pressure responses in postmenopausal women compared with premenopausal women (p < 0.05). On retesting, significant biophysical responses that were present during the initial stress testing were still present (p < 0.05) in the placebo group but were blunted with estrogen treatment. Plasma corticotropin, cortisol, androstenedione, and norepinephrine increased during testing to a similar degree in premenopausal and postmenopausal women; this response was maintained after placebo treatment. Postmenopausal women treated with estrogen had blunted responses. CONCLUSION: Significant differences in responses to psychologic stress exist in premenopausal and postmenopausal women. The lack of adaptation may account in part for the increased risk of cardiovascular disease in postmenopausal women. Estrogen appears to blunt the stress-induced response.

Aged↗
PubMed1980

Testosterone and 17 beta-oestradiol secretion of the human ovary. I. normal young women, and premenopausal women with endometrial hyperplasia.

Testosterone and 17 beta-oestradiol were determined in blood obtained from the ovarian veins of 26 women, 16 of whom were young and regularly ovulating and menstruating, and 10 of whom were premenopausal with uterine bleedings and endometrial hyperplasia. The concentrations of these two hormones in the cubital veins of the premenopausal women were also determined. It was found that the concentrations of the two hormones were not significantly greater in the premenopausal women than in the control group of young normally ovulating and menstruating women in the periovulatory phase of the menstural cycle, but that the ovarian secretion rates of both hormones, particularly of testosterone, were considerably greater in the premenopausal women. In these women the concentrations of both hormones were significantly lower in the cubital veins than in the ovarian veins. The conclusion is that the augmented oestrogenic effect on the endometrium and on other target organs of premenopausal women with endometrial hyperplasia may be due not only to an increased ovarian secretion rate of estradiol, but also and more specifically to an increased ovarian secretion rate of testosterone, and to the rapid vonversion of this hormone into oestradiol in the periphery.

Adolescent↗
PubMed2005

Relationship between premenopausal dietary intake and postmenopausal subclinical atherosclerosis.

OBJECTIVES: This study examines the association of premenopausal dietary intake with postmenopausal subclinical atherosclerosis. DESIGN: A prospective population-based cohort of 401 premenopausal women from the Healthy Women Study. Baseline premenopausal dietary intake was determined with the use of single 24-h recall. Coronary and aortic calcium scores were measured by electron beam computed tomography 8 years after menopause, and carotid plaque index was measured by carotid ultrasound scan 5 years after menopause. RESULTS: Prevalence of coronary, aortic, and carotid subclinical atherosclerosis were 47.3%, 75.4%, and 52.1%, respectively. In unadjusted analysis, the relative risks (RR) of saturated fat intake for coronary calcification in second, third and highest quartile groups compared to the lowest were 1.82 (95% confidence interval, 1.00-3.30), 1.49 (0.82-2.70), and 1.99 (1.09-3.62), while those of carbohydrate intake were 0.48 (95% confidence interval, 0.26-0.88), 0.47 (0.26-0.86), and 0.35 (0.19-0.64), respectively. None of the dietary components were significantly associated with aortic calcification or carotid plaque. CONCLUSION: The association between premenopausal dietary intake and postmenopausal subclinical atherosclerosis supports the recommended premenopausal dietary intervention for the prevention of cardiovascular disease.

Adult↗
PubMed2006

[Do the premenopausal daughters of women with postmenopausal osteoporosis have lower peak bone mass?].

OBJECTIVE: To determine whether premenopausal daughters of women with postmenopausal osteoporosis have lower peak bone mass than the daughters of normal women the same age, and to analyze the related risk factors affecting bone mass variation. METHODS: 126 pairs of mother with postmenopausal osteoporosis and her premenopausal daughter, and 136 pairs of normal postmenopausal mother and her premenopausal daughter selected for 410 core families including one healthy premenopausal daughter aged 20 - 40, all of Han ethnicity living in Shanghai recruited by advertisement and lectures. A questionnaire survey was conducted to investigate their dietary custom, Dual-energy X-ray absorptiometry at lumber spine 1 - 4 (L(1 - 4)) and proximal femur was conducted to measure the values of bone mineral density (BMD). RESULTS: The BMD values in L(1 - 4), femoral neck, and greater trochanter of the daughters of mothers with osteoporosis were 0.68 g/cm(2) +/- 0.07 g/cm(2), 0.59 g/cm(2) +/- 0.08 g/cm(2), and 0.47 g/cm(2) +/- 0.07 g/cm(2) respectively, all significantly lower than those of the daughters of normal mothers (0.86 g/cm(2) +/- 0.14 g/cm(2), 0.70 g/cm(2) +/- 0.11 g/cm(2), and 0.57 g/cm(2) +/- 0.10 g/cm(2) respectively, all P < 0.001). The average body weight of the daughters of mothers with osteoporosis was lighter then that of the daughters of normal mothers by 4.8% (P < 0.05). Multivariate regression analysis showed that age, body height, age of menarche, and milk intake were not influencing factors of BMD value, however, body weight was most significantly associated with BMD of the premenopausal daughters, contributing to the BMD variation at L(1 - 4), femoral neck, and greater trochanter by 9.4%, 16.5%, and 16.6% respectively. When body weight was excluded in the model, lower BMD of mother became the most important factors affecting the BMD variation, contributing to the BMD variation at L(1 - 4), femoral neck, and greater trochanter by 5.1%, 5.3%, and 4.2% respectively. CONCLUSION: The daughters of mothers with osteoporosis have reduced peak bone mass. It is likely due to the lower body weight of the daughter and the lower bone mass of the mother.

Adult↗
PubMed1983

Comparison of estrogen receptors in human premenopausal and postmenopausal uteri using isoelectric focusing.

Previous studies have suggested that the estrogen receptor in the postmenopausal uterus, although capable of binding estrogen, may be inactive, that is, incapable of translocating and binding to nuclear acceptor sites. The present study uses isoelectric focusing to characterize differences in the estrogen receptor between premenopausal and postmenopausal uterine tissue. Human myometrium (15 premenopausal and ten postmenopausal samples) was examined by isoelectric focusing in the presence and absence of diisopropylfluorophosphate (DFP) and molybdate, which inhibit proteolysis and stabilize the receptor. As demonstrated previously, receptor forms could be identified in two regions of the pH gradient, one in the pH 4 to 5 region and another at pH 6 to 7. When prepared without DFP and molybdate, the percentage of receptors focusing in the pH 4 to 5 range was significantly greater for premenopausal than postmenopausal tissue (P less than .01). The addition of DFP and molybdate significantly altered the focusing pattern of postmenopausal tissue (P less than .01), increasing the percentage of binding in the pH 4 to 5 range. In the presence of DFP and molybdate, the focusing patterns of receptor from premenopausal and postmenopausal tissue were not significantly different. These data suggest that endogenous proteases are more prevalent in postmenopausal tissue and can degrade the receptor to forms that focus at a higher pH. With the inhibition of these proteases, the focusing patterns of receptors in premenopausal and postmenopausal tissue become very similar, representing the undegraded and perhaps native form of the receptor.

Adult↗
PubMed2004

Clinical considerations in premenopausal osteoporosis.

Osteoporosis can occur at any age. In premenopausal osteoporosis, full achievement of peak bone mass may be curtailed, and accelerated bone loss may occur in young adulthood. Premenopausal osteoporosis may be associated with chronic glucocorticoid therapy, prolonged amenorrhea, anorexia nervosa, rheumatoid arthritis, and diseases that affect calcium and vitamin D metabolism. Lesser degrees of bone loss may be associated with common conditions such as dieting, low calcium intake, smoking, and oligomenorrhea. Owing to a paucity of prospective studies on screening and treatment in younger age groups, few practice recommendations exist to guide the management of osteoporosis in young adults. We review the most important clinical concerns in premenopausal osteoporosis, including measurement of bone mass, normal bone accrual, risk factors for premature bone loss, clinical outcomes, and management issues. We emphasize clinically relevant information for primary care physicians, who are usually the first to encounter premenopausal patients with risk factors for early bone loss.

Absorptiometry, Photon↗
PubMed2006

Premenopausal levels of circulating insulin-like growth factor I and the risk of postmenopausal breast cancer.

Increased levels of insulin-like growth factor I (IGF-I) may directly stimulate breast cell proliferation and promote growth and survival of transformed cells. Higher levels of IGF-I have been associated with increased risk of premenopausal breast cancer but not postmenopausal breast cancer. We investigated whether circulating levels of IGF-I prior to menopause are associated with breast cancer diagnosed after menopause in a population-based nested case-control study. Female cohort participants were enrolled in 1974 (n = 15,192) and 1989 (n = 18,724) and blood was drawn. Cases were women diagnosed with primary breast cancer at ages > or =50, of whom 152 were premenopausal at blood draw. One control was matched to each case on cohort participation, age, ethnic group, menopausal status and date of blood draw. Levels of IGF-I and IGF binding protein 3 (IGFBP-3) were measured using enzyme-linked immunoabsorbent assays. The association between IGF-I and breast cancer was determined using conditional logistic regression, adjusting for IGFBP-3. IGF-I levels decreased with age (p = 0.0001). Prior to age-stratification, IGF-I levels neither measured before nor after menopause were associated with postmenopausal breast cancer. After age-stratification, associations were suggested in the youngest premenopausal age group (upper vs. lowest third: odds ratio (OR) = 5.31, 95% confidence intervals (CI) = 0.85-33.13; p trend = 0.06) and oldest postmenopausal age group (upper vs. lowest third: OR = 3.41, 95% CI = 0.66-17.71; p trend = 0.13). The association between circulating levels of IGF-I and postmenopausal breast cancer risk may be modified by age. Increased levels of circulating IGF-I may be of particular interest in the younger premenopausal women and older postmenopausal women. Age-stratification should be undertaken in larger investigations of IGF-I levels as predictors of postmenopausal breast cancer.

Adult↗
PubMed2006

A prospective study of breast size and premenopausal breast cancer incidence.

Studies of the association between breast size, as a proxy for mammary gland mass, and breast cancer risk have given equivocal results. Most have been case-control studies with limited statistical power. We conducted a prospective analysis of the relation between breast size as measured by self-reported bra cup size and breast cancer risk among premenopausal women enrolled in the Nurses' Health Study II. Bra cup size at age 20 was assessed among 89,268 premenopausal women aged 29-47 in 1993. Subsequent incident cases of invasive breast cancer were assessed until 2001. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with a Cox proportional hazards model adjusting for potential confounders and risk factors for breast cancer. During 622,732 person-years of follow-up, 803 premenopausal women were newly diagnosed with invasive breast cancer. For women with a BMI below 25 kg/m2, those with a bra cup size of "D or larger" had a significantly higher incidence of breast cancer than women who reported "A or smaller" (covariate adjusted HR=1.80; 95% CI 1.13-2.88; ptrend=0.01). There was no significant association among women with a BMI of 25 kg/m2 or higher. Stratifying by BMI at age 18 at a cutoff point of 21 kg/m2 gave similar results. Larger bra cup size at a young age is associated with a higher incidence of premenopausal breast cancer, though this association is limited to leaner women.

Adult↗
PubMed2005

A specific haplotype in the 3' end of estrogen-receptor alpha gene is associated with low bone mineral density in premenopausal women and increased risk of postmenopausal osteoporosis.

It is well established that the development of postmenopausal osteoporosis is under genetic influence. We have recently identified a synonymous single nucleotide polymorphism (SNP) in exon 8 of estrogen receptor-alpha (ERalpha) gene in the vicinity of the stop codon (G2014A) that is associated with an increased risk of postmenopausal osteoporosis. In the present study, we attempted to locate SNPs in the 3'-unstranslated region (3'UTR) of the ERalpha gene that are in linkage disequilibrium with the exon 8 SNP and assessed their utilization in the risk assessment of postmenopausal osteoporosis in 352 Thai postmenopausal women. The association with bone mineral density (BMD) in premenopausal women was also investigated in 202 premenopausal women. A C to A SNP 1,748 nucleotides distal to the end of the stop codon (C3768A) was identified. The C3768A SNP was not overrepresented in subjects with osteoporosis. However, the presence of the A-C haplotype allele based on the A2014 and C3768 alleles was significantly related to the risk of osteoporosis independently of age, body weight, the G2014A and C3768A SNPs (odds ratio 2.36, 95% CI 1.42-3.91). Moreover, the presence of the A-C haplotype allele was associated with lower femoral neck BMD in premenopausal women ( P =0.05). We concluded that a specific haplotype in the 3' end of the ERalpha gene is associated with lower BMD in premenopausal women and is associated with a higher risk of osteoporosis in postmenopausal women. It is likely that the haplotype allele exerts its influence on bone as early as during young adulthood to increase the risk of osteoporosis later in life.

3' Untranslated Regions↗
PubMed2004

Effect of age, weight and lifestyle factors on calcaneal quantitative ultrasound in premenopausal women: the ESOPO study.

The objective of this study was to identify the determinants of bone mass as measured by quantitative ultrasound (QUS) in premenopausal women. The study population is part of the "Epidemiological Study On the Prevalence of Osteoporosis" (ESOPO) on risk of the general population of Italy. We report the data on 2727 premenopausal women aged 40-50 years who are still regularly menstruating. Bone stiffness (called simplicity stiffness), which is derived from the values of broadband ultrasound attenuation (BUA) and speed of sound (SoS), was measured by a heel QUS device (Achilles Apparatus, Lunar, Co. USA). The most commonly recognized determinants of bone mass were modelled with stiffness by multiple regression analysis or analysis of variance (ANOVA). Bone stiffness was negatively related to age and number of cigarettes and positively to body weight, body weight at 25 years, height and estimated daily calcium intake. By multiple regression analysis, independent, positive, predictors of bone stiffness were age, weight at 25 years and daily calcium intake. Bone stiffness adjusted for age and body weight at 25 years was positively associated with outdoor activity score and negatively with number of pregnancies, chronic use of any drug, smoking and subjective health status. Bone stiffness was also somewhat (p < 0.015) negatively related to history of prolonged bedrest and thyroxin use. In conclusion, our results indicate that risk factors usually associated in other studies with DXA-BMD in elderly women are also associated with calcaneal bone stiffness, as measured by QUS in premenopausal women. These findings should help to identify premenopausal women at risk and to design an early strategy for osteoporosis prevention based on eliminating modifiable risks.

Adult↗
PubMed2006

Trends in endocrine therapy and chemotherapy for early breast cancer: a focus on the premenopausal patient.

PURPOSE: The majority of breast cancers are diagnosed at an early stage, and treatment is focused on cure and prolonging disease-free survival. Local therapy (surgery and/or radiation treatment) is standard, along with systemic adjuvant therapy that may effectively prevent or delay relapse and death in early-stage disease. In premenopausal women, adjuvant therapeutic approaches include combination cytotoxic chemotherapy and endocrine therapy. Cyclophosphamide, methotrexate and 5-fluorouracil (CMF) was the established chemotherapy regimen; however, newer regimens have more recently been introduced that may offer some benefit over CMF including anthracycline-containing regimens [e.g. cyclophosphamide, epirubicin and 5-fluorouracil (CEF)], and taxane-containing regimens. For women with oestrogen receptor (ER)-positive disease, a second option is endocrine therapy that aims to suppress mitogenic oestrogen signalling. Until recently, 5 years of tamoxifen was regarded as the standard adjuvant endocrine treatment in ER-positive disease. Ovarian ablation is also effective in premenopausal women, and can be achieved by surgery, radiotherapy, or via the use of a luteinising hormone-releasing hormone analogue such as goserelin. Combining tamoxifen and goserelin treatment provides more effective oestrogen blockade than either drug alone. However, as the third-generation aromatase inhibitors (AIs) have demonstrated improved efficacy over tamoxifen in postmenopausal women with early and advanced disease, combination treatment with goserelin plus an AI may provide optimal oestrogen blockade in premenopausal patients. CONCLUSIONS: This review assesses the relative merits of chemotherapeutic and endocrine approaches for the treatment of early breast cancer, and summarises relevant ongoing clinical trials, with an emphasis on the premenopausal setting.

Antineoplastic Agents, Hormonal↗
PubMed2006

Bone mineral density evolution in young premenopausal women with idiopathic osteoporosis.

Idiopathic osteoporosis is a frequent cause of osteoporosis in young premenopausal women. However, there are no data about the treatment of these patients. The aim of this study was to analyse the evolution of bone mineral density (BMD) in premenopausal women with idiopathic osteoporosis treated with a conservative approach. Retrospective study of 16 premenopausal women with idiopathic osteoporosis (aged 35.7+/-7 years) with a mean follow-up period of 3 years (1-6 years). BMD measurements at the lumbar spine and femoral neck were obtained in all patients at baseline and yearly (patients had one or more fragility fractures and/or a Z score < -2 in the lumbar spine or femur). Secondary causes of osteoporosis were excluded in all patients. Patients were treated with calcium and vitamin D to achieve a calcium intake of up to 1,500 mg/day and were advised to increase physical activity. A significant increase in lumbar and femoral BMD was observed after 2 and 3 years of follow-up, respectively (1.9+/-1.9% mean increase in lumbar spine, p= 0.021, at 2 years) (5.6+/-4.5% mean increase in femur, p=0.04, at 3 years). The serum total alkaline phosphatase (TAP) values increased at 2 years (122+/-46 vs 140+/-36 U/l, p=0.054). In addition, a negative correlation between baseline TAP serum values and lumbar BMD evolution at 2 years was observed (r=-0.748, p=0.013). No patient developed new skeletal fractures during the follow-up period. In young premenopausal women with idiopathic osteoporosis the conservative treatment with supplements of calcium and vitamin D associated with an increase of physical activity is associated with an increase in BMD without evidence of further skeletal fractures after more than 3 years of follow-up.

Adult↗
PubMed2005

Treatment of low bone mass in premenopausal women: when may it be appropriate?

The diagnosis and treatment of osteoporosis in postmenopausal women has been well defined. Criteria for making a diagnosis using bone density testing has been established and widely disseminated. However, the definition established by the World Health Organization for osteoporosis cannot be used for other populations such as premenopausal women without further study. Measuring bone mass in premenopausal women should be done infrequently and only if specific and significant risk factors are present. Premenopausal women have a low risk for fracturing but women with low bone mass are at a greater risk for developing fractures before and after menopause. The major reason for low bone mass is the failure to reach peak bone mass because of genetic influences, although some environ-mental factors may also play a role. Hormonal therapy for hypogonadism, treatment of diseases such as hyperpara-thyroidism, and keeping medications with detrimental effects on bone to a minimum are important components of treatment. Pharmacologic treatment of low bone mass in premenopausal women has not been well studied although on rare occasions it may be appropriate in women with low bone mass, defined as a Z score of -2 or less, and the presence of other diseases or risk factors. Caution is urged because of the unknown effects of treatment in this population. Further study of the implications of low bone mass and the effects of treatment in this group of women is needed.

Adult↗
PubMed1996

Urinary markers of estrogen metabolism 2- and 16 alpha-hydroxylation in premenopausal women.

There is considerable scientific interest in whether measurement of the major estrogen metabolites 2- and 16 alpha-hydroxyestrone will shed light on the role of estrogen in the risk of breast cancer. These have been difficult to measure in large numbers because of the need for radiolabeled tracers, but a new assay is able to utilize spot urine samples. The main objective of this study was to assess the reliability of a newly developed enzyme immunoassay (EIA) for the measurement of 2- and 16 alpha-hydroxyestrone in urine samples collected from a large group of healthy premenopausal women enrolled in a clinical trial A secondary objective was to assess the impact of several factors such as body weight on the urinary estrogen metabolite ratios. The study cohort included 174 women aged 44-50, who were enrolled in the Cardiovascular Risk Factors and Menopause Trial, also referred to as the Women's Healthy Lifestyle Project (WHLP), an ongoing 5-year clinical trial of 535 premenopausal women randomized either to an intensive dietary life-style intervention group or to an assessment-only control group. Measurements of 2- and 16 alpha-hydroxyestrone showed a high intraclass correlation for blind duplicate urine samples (R = 0.94 and R = 0.80), cross-sectionally and over time (R = 0.79 and R = 0.62), in this population of healthy premenopausal women. The intervention diet (of 25% of total calories from fat) did not appear to influence the estrogen metabolite ratio. This new estrogen metabolite EIA demonstrates good reliability and thus may be appropriate for use in large epidemiologic studies of estrogen-related diseases. There was no relation between dietary fat reduction, weight loss, and increased exercise and change in the ratio among premenopausal women in this study.

Adult↗
PubMed1996

The effect of surgical castration on lipid metabolism in premenopausal and postmenopausal women.

OBJECTIVE: To investigate the effect of endogenous estrogen on lipid and lipoprotein metabolism in premenopausal and postmenopausal women. DESIGN: Prospective randomized study. SETTING: Department of Obstetrics-Gynecology, Beilinson Medical Center and Tel-Aviv University Medical School, Israel. SUBJECTS: Twenty-seven women, 15 premenopausal and 12 postmenopausal, undergoing surgical castration (total abdominal hysterectomy and bilateral salpingo-oophorectomy). METHOD: Blood samples were drawn before the surgical intervention and after a 6-month interval. MAIN OUTCOME MEASURES: Assays were performed for estradiol, luteinising hormone and follicle-stimulating hormone, and triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol and total cholesterol/HDL as well as HDL/LDL ratio. RESULTS: No significant differences were found in both groups, before castration and after 6 months. A modest, but statistically significant, rise in triglycerides was observed in the premenopausal group. CONCLUSIONS: The serum lipid and lipoprotein profile encountered in premenopausal and postmenopausal women were unchanged 6 months after surgical castration. The clinical significance indicates that the effect of endogenous estrogen on lipid metabolism is doubtful and should be further investigated.

Adult↗
PubMed2005

Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women.

BACKGROUND: Screening mammography has led to earlier diagnosis of breast cancer; however, the increased tissue density of young women can complicate mammographic interpretation. We hypothesized that magnetic resonance imaging (MRI) has value in detection of mammographically occult breast cancers, particularly in premenopausal women for whom the sensitivity of mammography is compromised. METHODS: Data were available for 89 women with biopsy-proven breast cancer who had undergone both mammography and breast MRI. Variables evaluated included menopausal status and radiographic findings. Data were analyzed using Fisher's Exact test; P < .05 was considered significant. RESULTS: Of the 89 women in our study, 69 were perimenopausal or postmenopausal and 20 were premenopausal at the time of diagnosis. The malignant lesion was identified on mammography and MRI for a majority of patients. One third of premenopausal women had negative mammography but positive MRI findings. CONCLUSIONS: Our findings support a role for breast MRI in supplementing conventional mammography for early detection of breast cancer in premenopausal women.

Adult↗