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PubMed1998

Two distinct two-step ranks of progesterone stimulation after three different levels of oestrogen priming. Effect on induction of luteinizing hormone surges in young and climacteric women.

Age and menopausal status were evaluated as potential modulators of the progesterone action in the initiation of the mid-cycle luteinizing hormone (LH) surge in women. Three distinct levels of oestradiol priming were used, in combination with two different two-step ranks of progesterone stimulation (10/25 mg and 25/50 mg i.m. injections of progesterone in oil, over 2 consecutive days) in two groups of women, ten premenopausals, aged between 18 and 25 years, and 14 postmenopausals, aged between 48 and 57 years. The low, moderate and high levels of oestradiol priming were defined in the premenopausal group by days 5 and 9 of the cycle, and 0.4 mg transdermal oestradiol applied in the early follicular phase respectively. The corresponding situation in the postmenopausal women was defined by the absence of treatment, 0.1 mg transdermal oestradiol, and 0.4 mg transdermal oestradiol respectively. The oestradiol patches were maintained for 5 days, and the first progesterone dose administered on day 3 of treatment. Unambiguous LH surges, detected in serum and urine, were restricted to the protocols using 0.4 mg oestradiol in both groups, with an onset soon after progesterone administration. The surge was higher in the postmenopausal group in serum and urine. The percentage LH increase above baseline, however, was higher in the premenopausal women. The dose of progesterone did not result in any changes in pituitary LH release. Therefore, the oestradiol threshold for the progesterone stimulatory effect on LH release was similar in both groups. The postmenopausal women did not yield defective LH surges when adequately primed with oestradiol and progesterone.

Adult↗
PubMed1977

Physiology of aging: metabolic changes during the climacteric and menopausal periods.

Endocrine regulation is altered with age. Changes in hormone secretory rates, patterns of secretion, and responses to physiologic and pharmacologic stimuli have been demonstrated. Target tissue sensitivity to hormones appears to be age related and to involve hormone receptor mechanisms, enzymatic responses, and carrier proteins. The aging process reflects changes in cellular structure and metabolism that decrease the function and efficiency of tissues. Structural changes occur with age and are characterized by a loss of elastic tissue, accumulation of highly crosslinked collagen, reduction in ground substance, and an increase in a cellular fluorescent pigment called lipofuscin. These changes decrease the pliability of tissues and alter membrane permeability. Modifications in protein synthesis and enzymatic systems may predispose the aged to autoimmune and neoplastic disease. Endocrine diseases are common in the aged and often may be atypical in their presentation. Cancer is common in the elderly and may be associated with endocrine manifestations because the tumor is producing hormones. Physicians must be aware of these syndromes so that a correct diagnosis can be established, treatment instituted, and the quality of life improved. Laboratory test results in the aged must be carefully interpreted because most aged patients are taking medications that interfere with endocrine tests and also the normal range for the elderly has not been clearly established. Abnormal laboratory diagnostic tests are common in the aged and do not always imply endocrine disease. No hormone can reverse the natural process of aging; however, hormones do regulate all metabolic functions and the neuroendocrine system plays a key role in all phases of growth, maturation, and aging.

Adrenal Gland Diseases↗
PubMed1985

Exercise, high-density lipoprotein-cholesterol, and cardiorespiratory function in climacteric women.

Fifty healthy women between the ages of 40 and 65 participated in a 12-week program of exercise, discussion sessions, or both. Levels of serum cholesterol, triglycerides, total high-density lipoprotein (HDL), HDL-cholesterol, and HDL-2b were monitored at baseline and at six and 12 weeks. Cardiorespiratory function was assessed at baseline and 12 weeks. Women participating in the exercise groups had smaller increases in serum cholesterol (P less than .05) and greater increases in maximal oxygen consumption, time spent on a treadmill, and time required to attain 90% of maximal oxygen consumption (P less than .01) than the nonexercising women. No statistically significant differences were observed in levels of serum triglycerides, total HDL, or HDL-cholesterol fractions between nonexercising and exercising groups at either six or 12 weeks.

Adult↗
PubMed1989

Comparison of the effects of oral and transdermal oestradiol administration on oestrogen metabolism, protein synthesis, gonadotrophin release, bone turnover and climacteric symptoms in postmenopausal women.

We compared the effect of administering oestradiol via the transdermal or oral routes in six and eight postmenopausal women respectively. Although both treatments achieved similar plasma levels of oestradiol, oral administration led to much greater increases in plasma levels of oestrone and the sulphates and glucuronides of oestradiol, oestrone and oestriol than transdermal treatment (P less than 0.001). Both treatments reduced plasma FSH; from 42 +/- 10 (SE) IU/l to 30 +/- 2 IU/l with oral and from 46 +/- 7 IU/l to 28 +/- 6 IU/l with transdermal treatment. Urine calcium excretion fell from 0.41 +/- 0.06 (molar ratio to creatinine) to 0.17 +/- 0.02 with oral and from 0.25 +/- 0.06 to 0.13 +/- 0.02 with transdermal treatment. Patients' symptoms were improved by both treatments. These changes were related to the plasma oestradiol concentration but not to that of oestrone. Oral, but not transdermal, treatment stimulated hepatic protein synthesis as shown by increased plasma levels of both vitamin-D-binding globulin and sex-hormone-binding globulin. We conclude that although both oral and transdermal oestradiol reduce postmenopausal bone loss, gonadotrophin secretion and symptoms, oral treatment also leads to hepatic stimulation and extensive metabolism of oestradiol, both of which may increase side-effects without conferring additional benefit.

Administration, Oral↗
PubMed1989

A study of the experience of Glasgow women in the climacteric years.

Overall, 424 women between 40 and 60 years of age were interviewed with reference to their experience of the menopause; 179 (42%) expressed a 'need for treatment' which was more marked in those who had had a hysterectomy (57%) or oophorectomy (76%). Of those who sought help (174) a large majority (92%) had seen their general practitioner and 72% received some form of drug therapy, predominantly hormone replacement therapy (HRT) or psychotropic drugs. Twenty-eight women were currently having HRT (7%) and 39 (9%) had previously had HRT. Only 12 women (3%) had received greater than 3 years of HRT and nine of these had had an oophorectomy. Only 1% of other women were 'long-term' users of HRT. Of the 424 women 11% expressed dissatisfaction with their general practitioner's approach to this subject.

Adult↗
PubMed1999

Climacteric vasomotor symptoms do not imply autonomic dysfunction.

OBJECTIVE: To study whether oestrogen replacement therapy has an effect on autonomic haemodynamic control in postmenopausal women. DESIGN: A placebo-controlled, prospective, randomised, double-blind cross-over trial. POPULATION: Fourteen healthy postmenopausal women who had had a hysterectomy, of whom 12 were double-blind. METHODS: At the end of each treatment period we conducted autonomic nervous system tests: the Valsalva manoeuvre, the deep breathing test, study at rest and the active orthostatic test. Baroreflex sensitivity was evaluated non-invasively from the Valsalva manoeuvre. Heart rate variability was assessed in time and frequency domains during supine rest and standing. Serum oestradiol was also measured and the previous two weeks' symptoms were assessed. RESULTS: Autonomic nervous function was mostly normal for age and unchanged by oestrogen. Vasomotor symptoms were not associated with autonomic dysfunction. Baroreflex sensitivity was 13.3 ms/mmHg (SD 7.4 ms/mmHg) with placebo and 10.5 ms/mmHg (SD 5.4 ms/mmHg) with oestrogen (P = 0.052). This was mostly due to a fall in three of the highest indices. In the orthostatic test the 30 s blood pressure overshoot in two women exceeded the normal 90% confidence interval upper limit, making the mean response strong, especially in the symptomatic group (n = 7). Oestrogen attenuated this overshoot. CONCLUSIONS: Oestrogen did not have a consistent effect on the autonomic nervous system. Oestrogen attenuated a highly sensitive baroreflex and a strong 30 s blood pressure rise in the orthostatic test. This minor effect of oestrogen could be due to the fact that, in general, women with menopausal symptoms do not have impaired autonomic haemodynamic control. The effect of oestrogen in women with autonomic nervous system dysfunction remains to be studied.

Autonomic Nervous System↗
PubMed2006

Scientific evidence changes prescribing practice--a comparison of the management of the climacteric and use of hormone replacement therapy among Swedish gynaecologists in 1996 and 2003.

OBJECTIVES: To study changes in attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynaecologists in Sweden. DESIGN: Comparative questionnaire study. SETTING: National survey. POPULATION: Practising gynaecologists. METHODS: In 1996, gynaecologists in Sweden (n= 1323) were invited to return a postal questionnaire concerning their attitudes, knowledge and management strategies concerning HRT. They were also asked about their own use of HRT. In 2003, a similar questionnaire was sent to practising gynaecologists (n= 1320) in Sweden. MAIN OUTCOME MEASURES: Attitudes to and personal use of HRT. RESULTS: The response rate was 76% in 2003 when 11% of the gynaecologists thought that all women without contraindications should be offered HRT compared with 44% in 1996 and 89% found it difficult to evaluate pros and cons with HRT in a clinical situation (74% in 1996). More gynaecologists in 2003 believed that HRT increased the risk for breast cancer (95% vs 71%). Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT (60% in 1996). Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). In 2003, current use of HRT was reported by 71% of female menopausal gynaecologists (88% in 1996). CONCLUSIONS: Swedish gynaecologists were more cautious in their management strategies concerning HRT in 2003 compared with 1996, probably influenced by results from the Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies. Current use of HRT was still high among female gynaecologists, although it had decreased since 1996.

Adult↗