Biomedical subjects

Lorraine Dennerstein

Publications and source records attributed to Lorraine Dennerstein.

10 recordsLinked to original sources

PubMed2003

Central abdominal fat and endogenous hormones during the menopausal transition.

OBJECTIVE: To investigate the effect of endogenous hormone levels on central abdominal fat during the menopausal transition in a population-based cohort of Australian-born women. DESIGN: Prospective observational study. SETTING: Population-based sample. Body composition was assessed in the Royal Melbourne Hospital, and interviews were conducted at the patient's home. SUBJECT(S): One hundred two women from the Melbourne Women's Midlife Health Project. Data, physical measures, and blood were obtained by interview when the longitudinal study commenced (baseline) and at the time of the total body scan approximately 5 years later. Body composition was measured using dual-energy X-ray absorptiometry. INTERVENTION(S): None. MAIN OUTCOME MEASURES: Total body fat and central abdominal fat. RESULT(S): The 102 women were either premenopausal or in the early menopausal transition at baseline. At the time of their dual-energy X-ray absorptiometry scan, 31 were in the early menopausal transition, 22 were in the late menopausal transition, and 49 were postmenopausal. Multiple regression analysis found that total percentage of body fat was associated with weight measures, whereas central abdominal fat was also positively associated with baseline free T index (FTI) and with the increase in FTI since baseline. CONCLUSION(S): The major hormonal change associated with central adiposity during the menopausal transition is the increase in the FTI. This effect is significant even after allowing for baseline and final weight.

Abdomen↗

PubMed2003

Predictors of declining self-rated health during the transition to menopause.

OBJECTIVE: To determine factors associated with declining self-rated health as measured annually for 8 years in a prospective population-based cohort of middle-aged Australian-born women. In particular, to investigate the potential role of the menopausal transition in changing self-rated health. METHODS: A total of 262 women from the Melbourne Women's Midlife Health Project were asked to rate their present health compared with other women about the same age as worse than, the same as or better than most. RESULTS: Women reporting their health to be "better than most" decreased from 51.2% at Year 1 to 41.3% at Year 8. In the year prior to the late menopausal transition, women reporting their health to be 'better than most' declined by 5%. Comparing women who experienced the menopausal transition with women whose menopausal status did not change, there was no significant difference in changes in self-rated health. Change in body mass index (OR = 1.53; 95% CI = 1.13 to 2.06) and change in feelings for partner (OR = 0.38; 95% CI = 0.17 to 0.86) predicted a change in self-rated health from a baseline status of 'better than most.' Having an operation or procedure in the last year (OR = 8.63; 95% CI = 1.84 to 40.4) and an increase in the number of symptoms (OR = 1.32; 95% CI = 1.01 to 1.72) predicted a decline in self-rated health from baseline status of 'same as others.' CONCLUSION: This prospective study found a small decline in self-rated health with age but no significant effect of the menopausal transition. Different factors relate to differing self-rated health groupings. Further studies involving other ethnic groups and larger sample sizes are needed.

Cohort Studies↗

PubMed2002

Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment.

OBJECTIVE: To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding definition, diagnosis, and assessment of androgen deficiency states in women. DESIGN: Evaluation of peer-review literature and consensus conference of international experts. SETTING: Multinational conference in the United States. PATIENT(S): Premenopausal and postmenopausal women with androgen deficiency. INTERVENTION(S): Evaluation of peer-review literature and development of consensus panel guidelines. RESULT(S): The term "female androgen insufficiency" was defined as consisting of a pattern of clinical symptoms in the presence of decreased bioavailable T and normal estrogen status. Currently available assays were found to be lacking in sensitivity and reliability at the lower ranges, and the need for an equilibrium dialysis measure was strongly emphasized. Causes of androgen insufficiency in women were classified as ovarian, adrenal, hypothalamic-pituitary, drug-related, and idiopathic. A simplified management algorithm and clinical guidelines were proposed to assist clinicians in diagnosis and assessment. Androgen replacement is currently available in several forms, although none has been approved for treatment of sexual dysfunction or other common symptoms of female androgen insufficiency. Potential risks associated with treatment were identified, and the need for informed consent and careful monitoring was noted. Finally, the panel identified key goals and priorities for future research. CONCLUSION(S): A new definition of androgen insufficiency in women has been proposed along with consensus-based guidelines for clinical assessment and diagnosis. A simplified management algorithm for women with low androgen in the presence of clinical symptoms and normal estrogen status has also been proposed.

Androgens↗

PubMed2002

Hormones, mood, sexuality, and the menopausal transition.

OBJECTIVE: To determine the extent of changes in women's sexual functioning and well-being during the menopausal transition and the relationship to hormonal changes. DESIGN: Prospective observational study. SETTING: Population-based sample assessed at home. PATIENT(S): 438 Australian-born women 45-55 of years who were still menstruating at baseline. Of these, 226 were studied for effects of hormones on sexual functioning. MAIN OUTCOME MEASURE(S): Short Personal Experiences Questionnaire (SPEQ) and Affectometer 2 scores and annual blood sampling. RESULT(S): From the early to late menopausal transition, the percentage of women with SPEQ scores indicating sexual dysfunction increased from 42% to 88%. Mood scores did not change significantly. In the early menopausal transition, women with low total SPEQ scores had lower estradiol level but similar androgen levels to those with higher scores. Decreasing SPEQ scores correlated with decreasing estradiol level but not with androgen levels. Hormone levels were not related to mood scores. CONCLUSION(S): Female sexual functioning declines with the natural menopausal transition. This decline relates more to decreasing estradiol levels than to androgen levels.

Affect↗

PubMed2002

Time to the final menstrual period.

OBJECTIVE: To determine, for a woman aged >45 years, whether selected hormonal, health status, and demographic measures are related to the time to final menstrual period (FMP) from a point where 6 weeks separate the shortest and longest cycles experienced to date. DESIGN: Cohort study. SETTING: Volunteers in an academic research environment. PATIENT(S): Ninety-nine menstruating women aged 46 years to 55 years on entry completed menstrual diaries, gave annual blood samples, and were interviewed annually. They were observed for a mean period of 1.5 years. Seventy-seven reached FMP during observation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Time to reach FMP from the date of a marker event-the difference between the longest and shortest of recent cycles reaching 6 weeks. RESULT(S): Women self-rating as in the transition have a greater "hazard" or probability of FMP at any time after the marker event. Allowing for this and other covariates, the hazard is estimated to increase by 30% (confidence interval [CI]: 10%, 60%) for each year of age and 50% (CI: 7%, 118%) for each unit increase in log FSH, measured at the time of the marker event. CONCLUSION(S): For women aged >45 years, the time remaining in the menopausal transition from the day on which >or=6 weeks separate the longest and shortest recent cycles is related to self-rating of menopausal status and to serum FSH level. The median number of months remaining ranges from 11 for those with FSH of >20 IU/L and who see themselves as in transition to 21 months for those with lower FSH and who notice little evidence of being in transition.

Bone Density↗

PubMed2002

Menstrual diary data and menopausal transition: methodologic issues.

OBJECTIVES: To identify problems arising in the analysis of menstrual diary data in a longitudinal study of the menopausal transition, and to propose solutions. SUBJECTS AND METHODS: Menstrual diary information provided by 372 women over a period 7 years is the basis of the study. This paper considers the processes and decisions associated with transforming this information into a form suitable for answering research questions. RESULTS: We decided to use 'cycle' as the unit of analysis and to regard spotting-only episodes as nonmenstrual bleeding. Difficulties in distinguishing between long cycles and gaps because of recording lapses are shown to be related to both the design of the menstrual diary cards and the procedures used by fieldworkers. A new design that should minimize such difficulties is presented. Procedural changes are also proposed. CONCLUSIONS: It is important to minimize uncertainty about the meaning of gaps in menstrual diary data, especially in studies of the menopausal transition. Methodologic improvements that can help to achieve this aim include design of diary cards and fieldwork procedures to reduce uncertainty. The design of data entry interfaces to facilitate the checking of raw data and the use of graphs as a diagnostic tool are other important steps.

Australia↗

PubMed2002

Hormonal changes in the menopause transition.

The menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is heralded by the menopausal transition, a period when the endocrine, biological, and clinical features of approaching menopause begin. A common initial marker is the onset of menstrual irregularity. The biology underlying the transition to menopause includes central neuroendocrine changes as well as changes within the ovary, the most striking of which is a profound decline in follicle numbers. Follicle-stimulating hormone (FSH) is an established indirect marker of follicular activity. In studies of groups of women, its concentration, particularly in the early follicular phase of the menstrual cycle, begins to increase some years before there are any clinical indications of approaching menopause. The rise in FSH is the result of declining levels of inhibin B (INH-B), a dimeric protein that reflects the fall in ovarian follicle numbers, with or without any change in the ability of the lining granulosa cells to secrete INH-B. Estradiol levels remain relatively unchanged or tend to rise with age until the onset of the transition and are usually well preserved until the late perimenopause, presumably in response to the elevated FSH levels. During the transition, hormone levels frequently vary markedly - hence, measures of FSH and estradiol are unreliable guides to menopausal status. Concentrations of testosterone have been reported to fall by about 50% during reproductive life, between the ages of 20 and 40. They change little during the transition and, after menopause, may even rise. Dehydroepiandrosterone (DHEA) and DHEAS, its sulphate, on the other hand, decline with age, without any specific influence of the menopause. Symptoms of the menopause can be interpreted as resulting primarily from the profound fall in estradiol, occurring over a 3- to 4-year period around final menses, a fall that presumably contributes importantly to the beginning, in the late perimenopause, of loss of bone mineral density.

Adult↗

PubMed2002

The ageing female reproductive axis I.

The female reproductive axis includes the hypothalamo-pituitary unit, the ovaries and the uterus. While changes in the brain may contribute to reproductive ageing, the major focus of current research is on the ovary, where the progressive loss of follicles ultimately leads to absent follicular function and consequent permanent cessation of menstruation, the menopause. The pituitary gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone, stimulate ovarian secretion of oestradiol and the inhibins from follicular granulosa cells, and androgens from interstitial cells, including the theca. A primary event in the ageing of the reproductive axis appears to be a decline in the secretion of inhibin B as follicle numbers fall. This leads to a slow rise in FSH in women who continue to cycle regularly, particularly in the last decade of reproductive life. As the menopause approaches, decreasing concentrations of both oestradiol and inhibin B lead to more marked increases in the gonadotropins, which reach their postmenopausal peak 2-3 years after final menses. In contrast, total testosterone concentrations are maintained across the menopausal transition, with a fall in sex hormone binding globulin (SHBG) and hence a rise in free testosterone.

Aging↗

PubMedDate not supplied

Evaluation of a short scale to assess female sexual functioning.

This article provides information on the external and concurrent validity, test-retest reliability, and sensitivity to change of a short form of the Personal Experiences Questionnaire, which was adapted from the McCoy Female Sexuality Questionnaire. We drew participants from convenience samples of women attending three different clinic settings: family planning clinics, psychiatrists, and sex therapists. We chose the psychiatry and sex therapy clinics as samples likely to show poor sexual functioning in order to assist with external validity assessment and to establish a cut-off score indicating sexual dysfunction. Satisfactory external criterion validity, concurrent validity, reliability on re-test, and validation of the composite score were demonstrated. A cut-off score of 7 or below distinguishes with 79% specificity and sensitivity those with sexual dysfunction.

Adult↗

PubMedDate not supplied

Menstrual patterns leading to the final menstrual period.

OBJECTIVE: To characterize premenopausal menstrual regularity and the patterns of divergence from regularity associated with the approach of the final menstrual period. DESIGN: Two samples of individual cycle length sequences contributed by participants in a population-based longitudinal study of the menopausal transition were examined. The first sample, of "early" sequences, is used to characterize menstrual regularity. The second shows how cycle length patterns change as the final menstrual period (FMP) is approached. Regression slopes are used to measure trend in cycle length, and changes in cycle length variability are registered by a simply calculated measure, the "running range." RESULTS: Sequences in the early cycles sample rarely varied outside the 21-35 day range and did not show a rising or falling trend. In contrast, pre-FMP sequences generally became increasingly variable in length, while rising above 35 days in mean during the last 10 cycles. The variability measure remained below 40 days throughout the early sequences, but characteristically rose above 42 days during sequences including the last 20 pre-FMP cycles. In early sequences, but not in pre-FMP sequences, long and short cycles tended to alternate. CONCLUSIONS: Increased variability is the dominant feature of cycle length pattern for most women as their final menstrual period approaches. Underlying this is a steady trend toward mean cycle lengths above 35 days. An indicator of the approach of menopause is a rise in running range of cycle lengths to 42 days.

Female↗