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PubMed2006

[Age-related and menopause-related changes of urinary excretion of C- and N-terminal cross-linked telopeptides of type I collagen and the relationships thereof with menopause-related bone loss].

OBJECTIVE: To study the age-related and menopause-related changes of urinary excretion of C- and N-terminal cross-linked telopeptides of type I collagen (uCTX/Cr and uNTX/Cr) and the relationships thereof with menopause state, years after menopause, bone mineral density (BMD), and menopause-related bone loss in healthy women. METHODS: ELISA was used to examine the uCTX/Cr and uNTX/Cr of 659 female volunteers aged 20 - 80 in Changsha. Dual energy X-ray absorptiometry (DXA) was used to measure the BMD of various skeletal sites, including the lumbar vertebrae (L1 - L4) at anteroposterior (AP) position, L(2) - L(4) at lateral (LAT) position, hip, and forearm. 339 postmenopausal women among the 659 subjects were divided into 3 groups, osteoporotic, osteopenic, and normal groups according to the WHO criteria of osteoporosis diagnosis. RESULTS: (1) Both the curves of uCTX/Cr and uNTX/Cr with age were fit the best by regression analysis of cubic equation. The coefficients of determination (R(2)) were 0.139 for uCTX/Cr and 0.149 for uNTX/Cr. The levels of uCTX/Cr and uNTX/Cr of the women aged > 35 increased with age. (2) The values of uCTX/Cr and uNTX/Cr were 253 mg/mol +/- 101 mg/mol Cr and 63 nmol +/- 34 nmol BCE/mmol Cr respectively in the postmenopausal women, remarkably higher than those of the premenopausal women (149 mg/mol +/- 80 mg/mol Cr and 33 nmol +/- 17 nmol BCE/mmol Cr respectively), increased by 69.5% and 93.4% respectively. The annual change rates of uCTX/Cr and uNTX/Cr were the highest within the first 5 years after menopause, and these increases were in agreement with the significant decrease of BMD at most skeletal sites by 10.8% approximately 27.6%. (3) After controlled for age and body weight, both uCTX/Cr and uNTX/Cr showed significant negative correlation with BMD (r = -0.078 to -0.283, P < 0.05 or 0.01), and there was a significant positive correlation between uCTX/Cr and uNTX/Cr. (4) The elevation of the levels of uCTX/Cr and uNTX/Cr in the osteoporotic and osteopenic postmenopausal subgroups were significantly higher than those in the postmenopausal women with normal BMD (P < 0.05 or 0.01). For example, the uCTX/Cr levels of the osteoporotic, osteopenic, and normal BMD subgroups according to the DXA results at the anteroposterior lumbar spine were 189 +/- 87, 272 +/- 108, and 366 +/- 135 mg/mol Cr respectively, while the uNTX/Cr levels were 52 +/- 22, 68 +/- 34 and 108 +/- 41 nmol BCE/mmol Cr respectively. CONCLUSION: uCTX/Cr and uNTX/Cr can be used as sensitive markers to determine the bone turnover status, which is changeable with age and menopausal status in women. They present a significantly negative correlation with BMD, and increase significantly in the postmenopausal women with osteopenia or osteoporosis, which indicates that measuring uCTX/Cr and uNTX/Cr can predict age-related and menopause-related bone loss in women.

Adult↗
PubMed1994

[Echographic monitoring of the endometrium with a transvaginal probe in the menopause. A clinical study of 185 women in the menopause].

The aim of our study was to verify the efficacy of transvaginal ultrasound scanning as an indicator of the endometrial status in healthy menopausal women. One hundred eighty five healthy women in natural menopause were examined by vaginal sonography; the endometrial patterns were analyzed and the influence on it of body weight, menopausal age, and hormonal therapy was considered. The presence of irregular and the endometrial histology were related to the ultrasound findings. 38% of the women assumed estrogen plus progestin replacement treatment since one-two years, for menopausal complaints. 17% of all patients reported irregular bleeding during the last month. The majority of women (90%), regardless of the hormone assumption, presented en endometrial thickness less than 10 mm. 10% of untreated and treated women had an endometrial thickness between 10 and 20 mm. Among the subjects with elevated menopausal age is more frequent the imaging of endometrial layer minor than 5 mm in comparison with women in early menopause. 4% of untreated and 10% of treated women without irregular bleeding had an endometrial thickness higher than 10 mm, while 67% of women with irregular bleeding presented an endometrial layer higher than 10 mm. In treated group all women with endometrial thickness greater than 10 mm had amenorrhoea. 86% of patients had endometrial atrophy detected by biopsy; hyperplastic endometrium or endometrial cancer was not demonstrated. In conclusion, vaginal sonography is a simple and reliable method in the study of the endometrial pattern in healthy menopausal women.

Adult↗
PubMed1999

Elevated levels of sE-selectin in post-menopausal females are decreased by hormone replacement therapy to levels observed in pre-menopausal females.

Observational epidemiological studies have shown that mortality from coronary heart disease is reduced in post-menopausal women by hormone replacement therapy (HRT). The aim of this study was to measure sE-selectin levels in post-menopausal females before and after HRT and to compare these with pre-menopausal females and aged matched males. Post-menopausal females (n = 70) were given HRT or no treatment to act as a control group. sE-selectin levels were significantly lower in the pre-menopausal (n = 36) when compared with the post-menopausal females (n = 70) (p = 0.027), whereas no difference between two age matched male groups was found (n = 40). Oral and transdermal HRT significantly decreased sE-selectin levels (p<0.0001 and p = 0.0005 respectively) with no change in the control group. The reduction in the levels of this marker of endothelial activation after HRT, may reflect a decrease in leucocyte/endothelial interaction which may reduce atherosclerotic risk in post-menopausal females.

Adult↗
PubMed1990

Serum placental protein 14 in pre-menopausal and post-menopausal women--dependency on oestrogen/progestogen status.

In view of the increasing use of oestrogen-progestogen therapy in post-menopausal women the availability of possible biochemical marker of endometrial response to progestogen would be highly desirable. Placental protein 14 (PP14) has recently been shown to be excreted from the endometrium during the secretory phase of the menstrual cycle. In the present study we examined the concentration of serum PP14 (S-PP14) in 15 pre-menopausal women during the menstrual cycle and in 30 early post-menopausal women receiving three different doses of 17 beta-oestradiol (E2), cyclically combined with norethisterone acetate (NETA). S-PP14 levels peaked on day 1 following the onset of menstrual bleeding and on day 7 during NETA administration. It was possible to estimate the area under the S-PP14 curve reliably from one or two blood samples taken at optimal times. In the post-menopausal women, S-PP14 varied in a highly significant dose-dependent manner, i.e., the higher the E2 dose (in relation to the fixed NETA dose) the higher the S-PP14 response was found to be. We suggest that S-PP14 measurements might reflect the quantitative development of the endometrium in the secretory phase in both pre-menopausal and post-menopausal women.

Adult↗
PubMed1996

Cross-talk about the menopause: enhancing provider-patient interactions about the menopause and hormone therapy.

Although many women make the menopause transition without problematic symptoms, the current tendency to prescribe hormone replacement therapy (HRT)2 as a preventive measure against potential life-threatening conditions for postmenopausal women has made menopause a medical issue for all women. Informing the millions of women due to experience menopause over the next decades of the possible long-term risks and benefits of HRT presents a major challenge to primary care. Recent research suggests that women are dissatisfied with their interactions with their health-care providers regarding menopause and the options for menopause management. We identify barriers to effective communication between providers and patients about these issues, and make recommendations for both research and practice to facilitate more effective provider-patient interactions concerning menopause and its management.

Communication↗
PubMed2001

Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women.

OBJECTIVES: Many women seek alternatives to hormonal therapies for the management of menopausal symptoms. Among the treatments currently popular are extracts of wild yam (Dioscorea villosa), which are applied topically in the form of a cream. These preparations are known to contain steroidal saponins, including diosgenin, which has been claimed to influence endogenous steroidogenesis. However, there have been no studies of the safety or efficacy of these preparations in the management of menopausal symptoms. METHODS: We therefore conducted a double-blind, placebo-controlled, cross-over study of the effects of a wild yam cream in 23 healthy women suffering from troublesome symptoms of the menopause. After a 4-week baseline period, each woman was given active cream and matching placebo for 3 months in random order. Diaries were completed over the baseline period and for 1 week each month thereafter, and blood and saliva samples were collected at baseline and at 3 and 6 months, for measurement of lipids and hormones. RESULTS: The average age of the subjects was 53.3 +/- 1.1 (SEM) years and average time since last period 4.3 +/- 0.9 years. At baseline, the average body mass index was 27.3 +/- 0.8, cholesterol level 5.7 +/- 0.2 mmol/l and follicle stimulating hormone (FSH) level 74.2 +/- 5.1 IU/l; estradiol levels were undetectable in the majority of cases. After 3 months of treatment, no significant side-effects were reported with either active treatment or placebo, and there were no changes in weight, systolic or diastolic blood pressure, or levels of total serum cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, FSH, glucose, estradiol, or serum or salivary progesterone. Symptom scores showed a minor effect of both placebo and active treatment on diurnal flushing number and severity and total non-flushing symptom scores, and on nocturnal sweating after placebo, but no statistical difference between placebo and active creams. CONCLUSIONS: This study suggests that short-term treatment with topical wild yam extract in women suffering from menopausal symptoms is free of side-effects, but appears to have little effect on menopausal symptoms. It emphasizes the importance of careful study of treatments for menopausal symptoms if women are to be adequately informed about the choices available to them.

Administration, Cutaneous↗
PubMed2003

Awareness of personal healthcare and menopause in menopausal women in Israel.

BACKGROUND: Menopause affects women's health and well-being, but their knowledge of proper care and maintenance is uncertain. OBJECTIVE: To assess the attitude and approach of the healthy, low risk, postmenopausal population in Israel to personal healthcare and menopause. METHODS: The study population comprised 500 menopausal women attending community outpatient primary care clinics. All women completed a 20-item questionnaire covering personal healthcare habits, lifestyle, knowledge about menopause, and attitude and approach to menopause and use of hormone replacement therapy. RESULTS: The patients' mean body mass index was 25.8 +/- 4.1 kg/m2; more than half the women were overweight, 28% engaged in regular sports activity, and 11.2% smoked; 74% had a positive attitude towards their age; 60% underwent yearly screening mammography; 74% had had Pap smear, and 86% had lipid profile measurements during the last year; self-examination of the breast was regularly performed by only 49%. HRT is currently being used by 27% and had been used in the past by another 16%. The primary reasons for stopping therapy were irregular bleeding in 38% and apparent ineffectiveness in 35%. There was a positive significant correlation between level of education and both undergoing regular medical screening and engaging in regular sports activity. HRT current utilization was negatively associated with age and being a housewife. CONCLUSIONS: A relatively high percentage of the study population safeguards its health and regularly uses HRT. We believe that stronger efforts are needed in Israel to promote good healthcare habits and positive attitudes toward menopause and HRT use.

Body Weight↗
PubMed2004

Hormones and menopausal status as predictors of depression in women in transition to menopause.

BACKGROUND: Associations between depressed mood and hormonal changes during transition to menopause are controversial. To our knowledge, there has been no prospective study of these associations in women commencing when they are premenopausal. OBJECTIVE: To longitudinally study the associations among reproductive hormones, menopausal status, and other predictors of depressed mood in midlife women. DESIGN: Cohort study with 6 assessment periods during a 4-year interval. Blood samples were collected 12 times during the follicular phase (days 2-6). SETTING: Philadelphia County, Pennsylvania. PARTICIPANTS: A randomly identified, population-based, stratified sample of African American (n = 218) and white (n = 218) women aged 35 to 47 years with regular menstrual cycles, no hormonal or psychotropic medication use, and no serious physical or mental health problems at enrollment. MAIN OUTCOME MEASURES: Center for Epidemiologic Studies Depression Scale score and history of depression via the Primary Care Evaluation of Mental Disorders. RESULTS: There was an increased likelihood of depressive symptoms during transition to menopause and a decreased likelihood after menopause after adjustment for other predictors of depression, including history of depression, severe premenstrual syndrome, poor sleep, age, race, and employment status (P =.03). The likelihood of depressive symptoms decreased for individuals with a rapidly increasing follicle-stimulating hormone profile (P< or =.001) and also decreased with age compared with premenopausal women (P =.02). Participant aggregate profiles with increasing estradiol levels were significantly associated with depressive symptoms in bivariate analysis (P =.053). CONCLUSIONS: Depressive symptoms as assessed herein increased during transition to menopause and decreased in postmenopausal women. Hormone associations provided corroborating evidence that the changing hormonal milieu contributes to dysphoric mood during transition to menopause.

Adult↗
PubMedDate not supplied

Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society.

OBJECTIVE: To create an evidence-based position statement regarding the treatment of vasomotor symptoms associated with menopause. DESIGN: The North American Menopause Society (NAMS) enlisted clinicians and researchers acknowledged to be experts in the field of menopause-associated vasomotor symptoms to review the evidence obtained from the medical literature and develop a document for final approval by the NAMS Board of Trustees. RESULTS: For mild hot flashes, lifestyle-related strategies such as keeping the core body temperature cool, participating in regular exercise, and using paced respiration have shown some efficacy without adverse effects. Among nonprescription remedies, clinical trial results are insufficient to either support or refute efficacy for soy foods and isoflavone supplements (from either soy or red clover), black cohosh, or vitamin E; however, no serious side effects have been associated with short-term use of these therapies. Single clinical trials have found no benefit for dong quai, evening primrose oil, ginseng, a Chinese herbal mixture, acupuncture, or magnet therapy. Few data support the efficacy of topical progesterone cream; safety concerns should be the same as for other progestogen preparations. No clinical trials have been conducted on the use of licorice for hot flashes. Among nonhormonal prescription options, the antidepressants venlafaxine, paroxetine, and fluoxetine and the anticonvulsant gabapentin have demonstrated some efficacy for treating hot flashes and were well tolerated. Two antihypertensive agents, clonidine and methyldopa, have shown modest efficacy but with a relatively high rate of adverse effects. For moderate to severe hot flashes, systemic estrogen therapy, either alone (ET) or combined with progestogen (EPT) or in the form of estrogen-progestin oral contraceptives, has been shown to significantly reduce hot flash frequency and severity. Clinical trials have associated ET/EPT with adverse effects, including breast cancer, stroke, and thromboembolism. Several progestogens (both oral and intramuscular formulations) have shown efficacy in treating hot flashes, including women with a history of breast cancer, although no definitive data are available on long-term safety in these women. CONCLUSIONS: In women who need relief for mild vasomotor symptoms, NAMS recommends first considering lifestyle changes, either alone or combined with a nonprescription remedy, such as dietary isoflavones, black cohosh, or vitamin E. Prescription systemic estrogen-containing products remain the therapeutic standard for moderate to severe menopause-related hot flashes. Recommended options for women with concerns or contraindications relating to estrogen-containing treatments include prescription progestogens, venlafaxine, paroxetine, fluoxetine, or gabapentin. Clinicians are advised to enlist women's participation in decision making when weighing the benefits, harms, and scientific uncertainties of therapeutic options. Regardless of the management strategy adopted, treatment should be periodically reassessed as menopause-related vasomotor symptoms will abate over time without any intervention in most women.

Body Temperature Regulation↗
PubMed1993

Menopause without symptoms: the endocrinology of menopause among rural Mayan Indians.

OBJECTIVE: Our purpose was to determine the characteristics of menopause among Mayan women who did not have menopausal symptoms. STUDY DESIGN: A cross-sectional study of Mayan women from Chichimila, Mexico, was performed. Demographic information, history and physical examination, hormone concentrations, and radial bone density measurement were obtained. RESULTS: Fifty-two postmenopausal women were compared with 26 premenopausal women. Menopause occurred at 44.3 +/- 4.4 years. None of the women admitted to hot flushes and did not recall significant menopausal symptoms. Hormone levels included elevated follicle-stimulating hormone (66.6 +/- 29 mlU/ml), low estradiol and estrone (9.4 +/- 8.3 and 13.3 +/- 7.8 pg/ml), estrone greater than estradiol levels, normal levels of testosterone and androstenedione (0.17 +/- 0.14 and 0.31 +/- 0.17 ng/ml). Bone mineral density declined with age, but height did not. Clinical evidence of osteoporosis was not detected. CONCLUSIONS: Lack of symptoms during the menopausal transition is not attributable to a difference in endocrinology. Postmenopausal Mayan women are estrogen deprived and experience age-related bone demineralization but do not have a high incidence of osteoporotic fractures.

Adult↗
PubMed2004

Immune effects of surgical menopause and estrogen replacement therapy in peri-menopausal women.

The complex relationship between sex hormones and immune function suggests that sex hormone deficiency and estrogen replacement therapy (ERT) in post-menopausal women may have pleiotropic effects on immune function. For this reason, we aimed to investigate short-term effects of surgical menopause and ERT on immunity profile in peri-menopausal women. Seventeen healthy peri-menopausal women who were to undergo total abdominal hysterectomy and bilateral salpingo-oopherectomy (TAH + BSO) for uterine myoma were enrolled into this study. Three blood samples were collected from each patient: 1-day prior to surgery, 30 days after the operation (before ERT) and 30 days after transdermal ERT. The percentages of peripheral blood lymphocyte subpopulations, serum interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) concentrations were determined by flow-cytometry and ELISA, respectively. Following TAH + BSO, the percentage of CD8+ cells was increased ( P < 0.001 ) while the percentage of CD19+ cells, serum IL-4, and IFN-gamma concentration and the ratio of CD4+ to CD8+ cells were decreased ( P < 0.001, P < 0.001, P < 0.002, and P < 0.05 respectively). After ERT, this trend reversed and a decrease in the CD8+ cells ( P < 0.001 ), increase in the CD19+ cells percentages ( P < 0.02 ) and increase in serum IFN-gamma concentration ( P < 0.002 ) were observed. Although an increasing trend in the CD4+ to CD8+ ratio occurred by ERT, this was not significant. However, the decrease in the serum IL-4 concentration after TAH + BSO was not reversed by ERT. Hormone deficiency in post-menopausal women may cause an impaired immune response, and ERT can restore this phenomenon. Estrogen seems to have an important role in the regulation of immune function.

Enzyme-Linked Immunosorbent Assay↗
PubMed2001

'Menopausal symptoms': associations with menopausal status and psychosocial factors.

This study investigated the relative importance of psychosocial factors as opposed to menopausal status in relation to so-called 'menopausal symptoms' among a large sample of premenopausal, perimenopausal and (naturally and surgically) postmenopausal women (n = 4308) in The Netherlands. The incidence of psychological, somatic, vasomotor and sexual symptoms was assessed and related to menopausal status and to measures relating to coping behaviors, (body- and self-) esteem and quality of life. Among the findings were that vasomotor symptoms in particular, and loss of interest in sex to a lesser extent, were relatively strongly associated with menopausal status. Psychological and somatic symptoms, however, were found to be more closely associated with psychosocial factors (although perimenopausal women as a group were found to suffer them most). Findings are discussed and interpreted as further evidence that only vasomotor symptoms may rightly be called 'menopausal'.

Adult↗
PubMedDate not supplied

The role of isoflavones in menopausal health: consensus opinion of The North American Menopause Society.

OBJECTIVE: Given the increasing interest in the effect of isoflavones on menopause-related symptoms and diseases related to menopause/aging combined with the growing body of published literature on isoflavones, much of which presents conflicting data, The North American Menopause Society (NAMS) established a goal to develop an evidence-based consensus opinion on the role of isoflavones in menopausal health. DESIGN: NAMS appointed a panel of clinicians and researchers acknowledged to be experts in the field of isoflavones. Their advice was used to assist the NAMS Board of Trustees in developing this consensus opinion. RESULTS: Many animal and human studies have evaluated the health effects of isoflavones on menopause-related symptoms and diseases related to menopause/aging. However, data are inconclusive regarding whether the observed health effects in humans are attributable to isoflavones alone or to isoflavones plus other components in whole foods. The most convincing health effects have been attributed to the actions of isoflavones on lipids. Studies have associated isoflavones with statistically significant reductions in low-density lipoproteins and triglycerides as well as increases in high-density lipoproteins. Although some data seem to support the efficacy of isoflavones in reducing the incidence and severity of hot flashes, many studies have not found any difference between the isoflavone recipients and the controls. Inadequate data exist to evaluate the effect of isoflavones on breast and other female-related cancers, bone mass, and vaginal dryness. CONCLUSIONS: Although the observed health effects in humans cannot be clearly attributed to isoflavones alone, it is clear that foods or supplements that contain isoflavones have some physiologic effects. Clinicians may wish to recommend that menopausal women consume whole foods that contain isoflavones, especially for the cardiovascular benefits of these foods; however, a level of caution needs to be observed in making these recommendations. Additional clinical trials are needed before specific recommendations can be made regarding increased consumption of foods or supplements that contain high amounts of isoflavones.

Animals↗
PubMed2000

Risk factors for genital prolapse in non-hysterectomized women around menopause. Results from a large cross-sectional study in menopausal clinics in Italy. Progetto Menopausa Italia Study Group.

OBJECTIVE: To analyze determinants/risk factors for uterine prolapse in a population of women around menopause. METHODS: Between 1997 and 1999, we conducted a large cross sectional study on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. Eligible for the study were women consecutively observed during the study period. All women underwent a gynecological examination. RESULTS: Considering the 21,449 non-hysterectomized women, uterine prolapse was diagnosed in 1182 cases (5.5%). Of those, 772 (65.3%) had prolapse degree I and 410 (34.7%) degree II or III. The frequency of uterine prolapse increases with age: In comparison with women aged < or = 51 years, the odds ratio OR of uterine prolapse was 1.3 and 1.7 respectively for women aged 52-55 and > or = 56 years. In comparison with women with none/primary education, the OR of uterine prolapse was 0.8 (95% confidential interval CI 0.7-0.9) and 0.8 (95% CI 0.6-0.9), respectively, for women with intermediate or high school/university degree. The risk of uterine prolapse increased with body mass index (BMI; kg/m(2)) value: In comparison with women with BMI<23.8, the OR was 1.4 (95% CI 1.2-1.7) and 1.6 (95% CI 1.3-1.9) for women with BMI 23.8-27.2 and >27.2. In comparison with nulliparae, the OR of uterine prolapse increased with number of births, being 3.0 (95% CI 2.1-4.3) in women reporting > or = 3 births. A history of caesarean section or of a delivery of a fetus weighing >4500 g were not associated with increased risk of uterine prolapse. When the analysis was conducted separately in strata of grade of uterine prolapse (I and > or = II), no marked differences emerged in the OR estimates. CONCLUSIONS: This study indicates that, in this population, the risk of uterovaginal prolapse increase with the number of vaginal births and was higher in overweight women, offering some quantitative estimates of the role of these factors on the risk of the condition.

Age Factors↗
PubMed1978

Effects of chronic alcoholism on the pituitary-gonadal function of women during menopausal transition and in the post menopausal period.

The hypothalamo-pituitary gonadal function was evaluated in eleven chronically alcoholic menopausal women by measurement of basal serum oestradiol, FSH, LH and prolactin, followed by LHRH-TRH test and administration of clomiphene citrate. All patients had hepatic damage, fibrosteatosis or cirrhosis. Two subgroups have been isolated according to urinary and serum estrogen levels: seven patients with urinary estrogen output less than 14 microgram per 24 h and plasma oestradiol less than 40 pg per ml were considered as post menopausal women: basal values of FSH and LH and their response to LHRH did not differ from that observed in normal menopausal women; clomiphene citrate induced a significant suppression of FSH and LH blood levels. Four women with urinary estrogen output greater than 14 microgram per 24 h and plasma oestradiol greater than 40 pg per ml were considered in menopausal transition. Their basal and post LHRH-FSH blood levels were lower than in the control group. These results suggest a normal hypothalamo-pituitary-gonadal axis at least in the post menopausal alcoholic women.

Aged↗
PubMedDate not supplied

[Acute and chronic treatment with sodium valproate on gonadotropin hormone levels before menopause and during menopause].

INTRODUCTION: Gamma-aminobutyric acid receptors are found in neurons secreting gonadotropin-releasing hormone and in pituitary gonadotrophs. AIM OF THE STUDY: the examination of 1. acute and chronic effects of sodium-valproate (agonist of gamma-aminobutyric acid) on gonadotropin secretion in women; 2. the role of valproate in negative feed back effects of oestradiol; 3. if the effects of Valproate are hypothalamic or hypophyseal. PATIENTS AND METHOD: Three groups of patients are examined (50 patients in each group): 1. group of menopausal women; 2. group of substituted menopausal women (Estroderm TTS 200 g); 3. group of women in luteal phase. The same tests were performed in each group: a) examination of one dose acute effects of Valproate and dose dependent effects (doses of 300, 600, 1200 mg, given to three subgroups; there were ten women in each subgroup); b) examination of one dose acute effects of Valproate on pulsatile secretion of luteinizing hormone (from ten women of each group blood samples for determination of luteinizing hormone pulsatility were taken in 10-min-intervals over the period of 6 h, except in luteal phase, and over the period of 8 h; c) examination of chronic effects of Valproate (10 women of each group used 1200 mg of sodium valproate for one month, except women in luteal phase who were given Valproate for 10 days). RESULTS: Menopausal women. The maximal fall of luteinizing hormone was similar in all three doses: 14-20%; effects were dose dependent in this group of patients-the higher dose, the longer duration of effect. Substituted menopausal women. There was no effect on gonadotropin secretion. Women in luteal phase. The similar fall in luteinizing hormone and follicle stimulating hormone was recorded with 300 mg and 600 mg of Valproate. The maximal fall in luteinizing hormone was about 80% and of follicle stimulating hormone about 50%; effects were not dose dependent. In all three groups we found that (1) with suppression of the concentration of luteinizing hormone, the frequency of pulses of luteinizing hormone was changed; (2) chronic effects of Valproate on gonadotropin secretion were not significant; (3) prolactin values were not significantly affected by Valproate. DISCUSSION: The three groups have different values of reproductive hormones. It is not possible to determine endogenous gamma-aminobutyric level by using gamma-aminobutyric acid antagonists because of their convulsive actions. In a steroid deprived state (such as menopause women), Valproate causes the statistically significant fall in luteinizing hormone level (20% fall). This fall is present with every dose used in this study, and is dose dependent. The influence of Valproate on gonadotropin secretion is the most evident in luteal phase. This can be explained by permissive effects of progesterone on gamma-aminobutyric acid neurotransmission. According to these results, the effects of Valproate are dependent on ovarian steroid hormone levels. The change in luteinizing hormone pulse frequency after Valproate points to a hypothalamic site of action of Valproate. These results suggest that an acute increase in tone of gamma-aminobutyric acid may inhibit gonadotropin secretion in the oestrogen-deprived state, as well as during the luteal phase of the menstrual cycle. It is possible that neuron pathways using gamma-aminobutyric acid as a neurotransmitter interact with opioids in the inhibitory modulation of gonadotropins in human females.

Estrogen Replacement Therapy↗
PubMed2004

Relationship between menopausal symptoms and menopausal status in Australian and Japanese women: preliminary analysis.

The main aim of the present study was to explore the midlife experience for women living in Australia and Japan. The specific objectives of the study included: (i) comparing menopausal symptoms between the two groups; and (ii) comparing the factor structure of symptoms and exploring their relationship to menopausal status. Postal questionnaires were distributed to two structured, random population based samples of midlife women aged 45-60 years; consisting of 712 women living in Australia and 1502 women living in Japan. Analysis showed significant differences in menopausal symptoms related to psychological symptoms (P < 0.001), including anxiety (P < 0.001) and depression (P < 0.001), somatic symptoms (P < 0.001), and vasomotor symptoms (P < 0.01). The analysis, which excluded hormone replacement therapy (HRT) users, found that there were significant differences seen across menopausal status in the following symptoms: difficulty in sleeping (P < 0.01), difficulty in concentrating (P < 0.01), feeling dizzy or faint (P < 0.001), loss of interest in most things (P < 0.01) and loss of feeling in hands or feet (P < 0.001). In the postmenopausal stage specifically, significant differences were seen in the areas of feeling tense or nervous (P < 0.01), feeling unhappy or depressed (P < 0.01), parts of body feeling numb or tingling (P < 0.05), headaches (P < 0.01), and sweating at night (P < 0.05). Our analysis revealed that the experience of menopause for women is different between Australian and Japanese women.

Australia↗