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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

[A histological and hormonal study of 399 women near the menopause or with confirmed menopause (author's transl)].

This work is concerned with 399 women who were either near the menopause or had had the menopause and on whom 476 hormone levels and 169 examinations of the endometrium had been carried out. It is possible to put the women into three groups. 13 p. 100 showed a diphasic cycle, with more or less normal ovarian function. Among the group of women whose cycle was not diphasic an appreciable number had normal oestrogenic activity, or were indeed hyperoestrogenic. The others were hypo-oestrogenic. Several facts can be derived from this study. Raised levels of E.2 can be found even when there is no cyclical activity and even in women who have raised levels of FSH. Normal ovarian function may be resumed several months after the menopause, although when the levels of FSH are raised the occurrence of the postmenopausal state would seem to be confirmed. The presence of hot flushes does not seem to correspond to a particular hormonal state. Marked differences seem to exist between the levels of the plasma hormones and the endometrial biopsy results. It is possible to have an atrophic endometrium with a raised level of oestradiol-17 beta, or on the other hand a polypoidal endometrium in women who are hypo-oestrogenic. The presence of levels of progesterone such as are found in a normal luteal phase does not indicate that the endometrium will necessarily be secretory. These contradictions cannot be resolved by studying the intra-cellular concentrations of the hormone receptors. The approach of the menopause is not always characterized by a progressive and continuous state of oestrogen deficiency or by hypophysial overactivity. This classical picture can be heavily shaded. All kinds of hormone profiles and responses by the receptor organs may be met and the clinician should be aware of these facts when he chooses therapy.

Adult

Menopause in the All of Us Research Program: a descriptive summary of electronic health record and survey response across sociodemographic characteristics.

OBJECTIVES: Menopause is a significant physiological transition with implications for health outcomes (eg, cardiometabolic disease), yet gaps remain in understanding this transition, including how menopause timing and type influence health outcomes. Large-scale cohort studies in midlife (age=40-60) females, including the All of Us Research Program (AoURP), provide opportunities to study menopause across diverse populations and data modalities. We characterized menopause-related data in AoURP, focusing on age distributions and concordance between electronic health record (EHR) diagnosis codes and survey responses. METHODS: We analyzed menopause-related surveys, EHR diagnostic codes, and genomic data among ~396,000 AoURP female participants. We summarized menopause-related variables across data sources, evaluated overlap between survey, EHR, and genomic data sets, and described age distributions overall and across sociodemographic characteristics. RESULTS: Among ~396,000 females, survey responses captured ~193,000 menopause observations, nearly seven times more than EHR diagnoses (~28,000), suggesting under-ascertainment in EHR data. Nearly all females (~99%) with an EHR menopause diagnosis reported menopause in the survey. Approximately 22,000 participants had overlapping menopause-related EHR, survey, and genomic data. Survey age patterns matched expectations, with participants predominantly <40 years reporting premenopausal status and those >60 years reporting postmenopausal status. A small subset with age >70 years (N&#x2248;1,700; 4%) reported no menopause, suggesting response or recall bias. EHR menopause codes were concentrated after age 45 years, with a notable spike at age 65. Modest differences in survey-based menopause age distributions were observed across sociodemographic characteristics (eg, race and ancestry). CONCLUSIONS: These findings inform sampling strategies, power calculations, phenotype definition, and study design for menopause research using AoURP data.

Age

Age at menopause and subjective cognitive symptoms predict digital cognitive outcomes at the gynecological Well-Woman visit.

INTRODUCTION: Women are at increased risk for Alzheimer's Disease (AD). Growing evidence suggests that the menopausal transition may represent a vulnerable window for development of AD-related pathology. Yet, women are diagnosed with AD later than men. Conducting routine cognitive screenings and integrating information about both cognitive symptoms and age at menopause may help address sex-based disparities in detection and prevention. This study investigated whether subjective cognitive symptoms, in combination with age at menopause, were associated with performance on a digital cognitive task in postmenopausal women. METHODS: 183 postmenopausal women (mean age&#x2009;=&#x2009;63.8, range&#x2009;=&#x2009;45-85) were recruited after their Well-Woman visit. Participants completed the Screener for Cognitive Problems in Everyday Life (SCoPE) to assess subjective cognitive symptoms, followed by a sensitive measure of objective cognition: the Linus Health Digital Clock and Recall (DCR&#x2122;). Information was also collected on age at menopause. We examined associations of subjective cognitive symptoms and age at menopause with digital cognitive performance, adjusting for age, education and depression. Model fit was evaluated using adjusted R2, AIC, and BIC. RESULTS: 48.1% of women reported one or more cognitive symptoms on the SCoPE. On objective testing, 73.2% scored in the normal range, 20.8% in the borderline range, and 6.0% in the impaired range. SCoPE total score was negatively associated with objective cognitive performance in adjusted models (B&#x2009;=&#x2009;-.12, p&#x2009;=&#x2009;.03). Age at menopause showed a significant quadratic association with cognitive performance (B&#x2009;=&#x2009;-0.006, p<.001). SCoPE total was not associated with DCR subtests, while age at menopause predicted both Delayed Recall and Clock Drawing. CONCLUSION: Subjective cognitive symptoms and age at menopause were associated with lower performance on a sensitive, objective cognitive test. Findings support routine cognitive screening and suggest that subjective cognitive symptoms as well as age at menopause are associated with cognitive function.

Humans

Changes in hypophysio-ovarian endocrinological function of post-menopausal and castrated women.

The serum levels of estradiol, progesterone, LH and FSH were determined by radioimmunoassay in post-menopausal and castrated women and the data obtained at the same periods after menopause and castration were compared. The serum levels of estradiol and progesterone in post-menopausal women within 1 year after menopause were higher than those of castrated women. The result suggested that ovarian function was indeed depressed in the post-menopausal women but was still preserved for 1 to 2 years after menopause. In the post-menopausal women, the levels of serum LH and FSH rose gradually to reach a peak at 1 to 3 years after menopause, when the production of ovarian sex steroid hormones presumably ceased. On the contrary, the serum LH and FSH levels of castrated women began to decrease gradually 4 to 9 years after castration. It is highly suggestive from these findings that a negative feedback mechanism is elicited by ageing.

Aging

Age at the menopause and onset of the climacteric in women of Martin District, Czechoslovkia. Statistical survey and some biological and social correlations.

In this study, 6877 women were analysed whose ages ranged between 38 and 58 (born between 1909 and 1929) and who had had no artificial menopause. This is 88.04% of the total female population in this actual period of life, living in Martin District in 1967. The mean age at the menopause was found, by status quo method, to be 51.21 years (standard deviation 4.4), and by the method of weighted arithmetical means, 48.81 years, (standard deviation 3.9). The mean age at the onset of the climacteric, calculated by the same methods, was 47.55 years, or 46.74 years, respectively. The mean age at menarche was 14.6 years. The average birth-rate was 2.8. The mean period of fertility for the series as a whole was 36.6 years. Women with menstrual disturbances had their menopause about 1 year earlier. We have noted a similar tendency in nulliparas and primiparas. We could find no great difference in the age at menopause between those who had had an early or a late menarche. Menstrual disturbances also influenced the onset of the climacteric. It was at least one year earlier than with regular menstruation. Age at menarche and parity had no effect on the age at the onset of climacteric. Women working in agriculture and housewives had their menopause a little later than mean age of the series, whereas manual workers and those in other occupational categories had their menopause and onset of the climacteric about 1 year earlier. Furthermore, single women had their menopause about one year earlier than the married ones. Widows had their menopause twice so often as the married women and they got it very soon after the husbands's death.

Adult

Menopausal age in relation to smoking.

A population study of women revealed more smokers among 50-year-old postmenopausal women than among women of the same age who still menstruated. The difference was statistically significant. The postmenopausal smokers had on average smoked as long as or longer than the smokers who still menstruated. The higher number of smokers among postmenopausal women could thus not be explained by these women starting to smoke in connection with the menopause. Non-smoking women were on average heavier than smoking women. Previous studies indicate that an increased amount of adipose tissue might delay the menopausal age. It is therefore possible that the difference in menopausal age between smoking and non-smoking women might be explained either by a delayed menopause in non-smoking women due to an increased amount of adipose tissue in these women, or by a precocious menopause in smokers due to toxic effects from smoking. Probably both factors are of importance, but our results indicate that smoking per se is the main factor. The increased number of smokers among women with precocious menopause can probably explain part of the overrepresentation of women with precocious menopause among those who have myocardial infarction.

Adult

Is the menopausal age rapidly changing?

A population study of women in Goteborg, Sweden was carried out in 1968--1969. Altogether 1462 women participated (participation rate 90.1%). Five age strata were studied: 38, 46, 50, 54 and 60 (women born in 1930, 1922, 1918, 1914 and 1908, respectively). The same women were re-studied in 1974--1975. Information about menopausal state and, in postmenopausal women, about menopausal age was obtained on both occasions. The information given by the women in 1974--1975 agreed well with the information given in 1968--1969. Very few women started to menstruate again, if the interval since the last menstruation had been 6 mth or longer. The vast majority of the women had a spontaneous menopause. The medians of menopausal age were found to be between 49 yr 7 mth (in women born in 1908) and 50 yr 5 mth (in women born in 1918). There was a tendency towards a continuously increased menopausal age with time as judged from women born in 1908, 1914 and 1918, respectively, but women born in 1922 were found to have a median menopausal age which was more similar to that of the women born in 1908 than that of the women born in 1918. Our sstudy has, thus, not supported the view that the menopausal age in rapidly changing.

Aged

Patterns of menopause: a study of certain medical and physiological variables among Caucasian and Japanese women living in Hawaii.

Comparisons were made between menopausal women and nonmenopausal controls among Caucasians and Japanese living in Honolulu, to investigate the extent of physical changes and clinical symptoms associated with menopause. The analysis was conducted using the multiphasic screening records of 170 menopausal cases and 162 nonmenopausal controls in Caucasians, and of 159 menopausal women and 187 nonmenopausal controls in Japanese. Discriminant function analysis was employed with relevant anthropometric, medical, and physiological variables. After adjusting for the linear and non-linear effects of age, only surgery and medication were retained as significant discriminant variables. Discriminant functions for Caucasian and Japanese groups were not found to be significantly heterogeneous. With regard to the discrimination of the menopausal and nonmenopausal groups, the data suggested that, while no clinical conditions other than those attributable to the effects of aging were significantly associated with the menopausal state, medication and surgical procedures for female disorders were significantly related to menopause.

Adult

The prevention and management of post-menopausal osteoporosis.

In 6 groups of peri- and post-menopausal women, there was an inverse relation between the urinary sediment smear maturation value and the fasting urinary hydroxyproline/creatinine ratio. Administration of ethinyloestradiol and Progynova both reduced urinary hydroxyproline into the pre-menopausal range, the fall being proportional to the starting value. Oestrogen therapy also produced a significant fall in plasma ionised calcium. In a prospective trial, oestrogen therapy prevented post-menopausal bone loss but calcium therapy was less effective. It is suggested that a high fasting urinary hydroxyproline/creatinine ratio might be taken as an indication for oestrogen therapy in post-menopausal women. In established post-menopausal osteoporosis, pre-disposing risk factors appear to be low calcium intake, malabsorption of calcium and low oestrogen status. These patients appear to represent the fast bone-losers in the post-menopausal population. The accelerated bone loss can be wholly or partially corrected by hormone replacement therapy and by calcium supplements given to those with normal absorption only. These therapies also prevent loss of height due to further crush fractures. The malabsorption of calcium is very resistant to vitamin D therapy but responds to 1alpha-OHD3. Balance data suggest that the most effective therapy may be a combination of 1alpha-OHD3 with oestrogen.

Aged

[Coronary insufficiency in the female: possible effect of menopause].

A population of 239 women suffering from chronic coronary disease was divided into two groups according to whether or not they had sustained a myocardial infarction. For the 226 post-menopausal women, the type of menopause (natural or artificial) and their age at its onset were determined, together with the age of onset of the infarction or angina, and possible correlations with other risk factors in atherosclerosis. Whilst the average age at the time of artificial menopause was markedly less than that of natural menopause, the age of onset of coronary complications was comparable regardless of the type of menopause, this applying to both groups. Contrary to a classically accepted opinion, early menopause would not appear to favourise the premature development of atherosclerotic coronary problems, and, in addition, would not appear to affect other coronary "risk factors".

Adult

Age at menarche and menopause of uterine cancer patients.

An investigation was undertaken of the ages at menarche and at menopause of cervical and endometrial cancer patients for the years 1950-55 and 1960-65. Analysis of the ages at menarche in relation to the year of birth did not show a difference between the uterine cancer groups, whereas the age at menopause did show such a difference. The menopause occurred later in the endometrial than in the cervical cancer group. There was an earlier mean age at menarche and a later mean age at menopause per decade. Therefore, the menopause seems a constitutional factor involved in the development of endometrial cancer and perhaps also cervical cancer.

Adolescent

Hormonal profiles after the menopause.

The endocrinological changes of the climacteric have been defined by studying the concentrations of follicle-stimulating hormone (FSH), luteinising hormone (LH), androstenedione, testosterone, oestrone, and oestradiol in 60 normal postmenopausal women of different menopausal ages. The women were studied in six groups, according to the number of years since their menopause. One year after the menopause androstenedione, oestrone, and oestradiol concentrations were reduced to about 20% of the values recorded during the early proliferative phase of the menstrual cycle. At the same time the mean concentration of FSH had risen by a factor of 13-4 and that of LH by a factor of 3-0. Concentrations of both gonadotrophins reached a peak of 18-4 and 3-4 times the proliferative phase value respectively after two to three years, and then gradually declined in the next three decades to values that were 40-50% of these maximal levels. Testosterone concentrations remained mostly in the normal range for premenopausal women but were depressed to 60% of these levels two to five years after the menopause, and the mean androstenedione levels showed a significant increase in the same group of women. The concentrations of both oestrone and oestradiol remained consistently low for 10 years after the menopause, but oestradiol concentrations inexplicably increased in the last two decades, with levels at the lower end of normal range for reproductive women in six patients.

Age Factors

Menopause and coronary heart disease. The Framingham Study.

A rise in coronary heart disease incidence after menopause and a dramatic increase in the severity of the presenting diseases are noted in a cohort of 2873 Framingham women who were followed up for 24 years. No premenopausal woman developed a myocardial infarction or died of coronary heart disease. Such events were common in postmenopausal women. Even in women under 55, 40% of the postmenopausal coronary heart disease presented in these more serious forms, whether menopause was natural or surgical. The contrast was especially marked in the age group 40 to 44 years. In the age groups 45 to 49 and 50 to 54 years, incidence rates in menopausal and postmenopausal intervals were more than double those in premenopausal intervals, whether menopause was natural or surgical. In surgical menopause there was excess incidence whether the ovaries were removed or not. Postmenopausal women on hormones had a doubled risk of coronary heart disease.

Adult

Probability of menopause with increasing duration of amenorrhea in middle-aged women.

The empirical percent probability that natural menopause has occurred after first presentation of amenorrhea of various durations in women greater than or equal to 45 years of age has been calculated using data from a cohort of subjects who prospectively recorded menstrual flow and related gynecologic events. The probability that menopause has occurred increases with the amenorrheal interval (duration), and for a given interval, the probability increases with age. After 180 days of amenorrhea, 45% to 72% of subjects were menopausal; after 360 days, 90%. These data may offer assistance in advising patients on the probability of menopause and the continuance of contraceptive practices, and in considering whether late genital bleeding after amenorrhea represents a physiologic or pathologic process.

Age Factors