Natural Menopause Relief Secrets
Coronary heart disease symptoms usually start around 10 years after the menopause, but the process of clogging of the arteries (atheroma) starts much earlier. It is thought to start in some people during childhood, particularly in those with an unhealthy lifestyle. It has been suggested that women are protected by the hormone estrogen while they still have periods. After the menopause, when women go through their change, the estrogen levels fall, and women become vulnerable to coronary heart disease. After the menopause, coronary heart disease can progress very rapidly, particularly in women with cardiovascular risk factors. After the menopause, the levels of cholesterol, the bad LDL cholesterol, triglycerides, glucose, and blood clotting factors (fibrinogen) increase. All the substances increase the fat
Postmenopausal hormone replacement therapy has been suggested to reduce cardiovascular morbidity by up to 56 in healthy women who take estrogen compared to women who have never taken hormone replacement medications (56) however, these observations from small clinical trials may overestimate the actual cardiovascular benefits derived from hormone replacement therapy (Fig. 6). Theoretically, estrogen supplementation may reduce coronary events by improving cholesterol profiles, promoting endothelium-derived vasodilation, and by serving as an antioxidant (12,57-59). Despite these potential therapeutic benefits, the HERS trial failed to demonstrate the therapeutic efficacy of estrogen replacement therapy compared to placebo with respect to coronary heart disease, nonfatal myocardial infarction, or mortality at 5 yr follow-up (60). In fact, hormone replacement therapy was associated with a three-fold increase in venous thromboembolic events, a 3- to 8-fold increase in lifetime risk of...
Menopause is the cessation of monthly menstrual cycles. This generally occurs between the ages of 45 and 55 years. Levels of reproductive hormones decline, and egg cells in the ovaries gradually degenerate. Some women experience unpleasant symptoms, such as hot flashes, headaches, insomnia, mood swings, and urinary problems. There is also some atrophy of the reproductive tract with vaginal dryness. Most importantly, decline in estrogen is associated with weakening of the bones (osteoporosis). Hormone replacement therapy (HRT), usually consisting of estrogen in combination with progestin, has been recommended to alleviate menopausal symptoms. Replacement hormones also seem to reduce loss of bone tissue associated with aging. Recent concerns about the safety of HRT, however, have caused reconsideration of this therapy beyond the early postmenopausal years. As always, exercise and a balanced diet with adequate calcium are important in maintaining health. Addition of soybeans to the diet,...
Identify all medications, both prescribed and self-administered, including herbal preparations. Patients will often forget about the oral contraceptive pill (OCP) and hormone replacement therapy (HRT) unless specifically asked. The incidence of use of medications rises with age and many of these drugs have important interactions with anaesthetics. A current British National Formulary (BNF), or the BNF website, should be consulted for lists of the more common and important ones. Allergies to drugs, topical preparations (e.g. iodine), adhesive dressings and foodstuffs should be noted.
Menopause The average weight gain after pregnancy is less than 1 kg although the range is wide. In many developing countries, consecutive pregnancies with short spacing often result in weight loss rather than weight gain. Menopausal women are particularly prone to rapid weight gain. This is primarily due to reductions in activity although loss of the menstrual cycle also affects food intake and reduces metabolic rate slightly.
Gout can present as polyarticular disease in the setting of long-established tophi. In men, there generally will be a history of previous, typical, acute oligoarticular attacks however, in postmenopausal women on thiazides, there is a well-described presentation of diffuse tophaceous, polyarticular disease without previous episodic disease. Virtually every joint can be involved, and significant fever and leukocytosis can be present. Diagnostic clues include palpable tophi in the olecranon bursa or along the pinna of the ear and characteristic erosions on radiographs of the hands or feet. Characteristic negatively birefringent crystals in the synovial fluid white blood cells and polyarticular or tophaceous disease make a septic process much less likely, but gout and joint sepsis can coexist. Similarly, gout and pseudogout crystals can be found in the same inflamed joint (see ,Ch.apte.r 37).
Genistein has been promoted as a possible preventive treatment or therapy for several diseases and conditions. There are claims that it reduces hot flashes associated with menopause, that it can prevent or delay the onset of osteoporosis in post-menopausal women, and that it can lower blood cholesterol levels. In each instance the potential effectiveness of genistein would be attributable to its acting as an estrogen replacement in older women, in whom the level of estradiol is naturally low. Genistein may also be effective in the treatment of certain breast cancers that require estrogen in order to grow. In this case it is theorized that the genistein, with weak estrogen activity, acts to reduce cancer growth by competing with the more potent estradiol for the estrogen receptor.
Carpal tunnel syndrome is produced by compression of the median nerve at the wrist. As the nerve passes through the unyielding carpal tunnel, it is at risk for compression by the transverse carpal ligament. In most patients, no specific etiology can be determined, but thickening and proliferation of the peritendinous synovium is seen. This condition is very common in RA, in diabetes, during or after pregnancy, and after wrist fracture. It is also seen in postmenopausal women and in patients with the myxedema of thyroid disease.
The majority of women in the focus groups believed heart attacks were a male problem. Older women (over age 65) did not link their health conditions to increased risk of a heart attack, especially after menopause. Men at higher risk due to the presence of one or more risk factors, discounted their personal risk if they were receiving regular health care for a chronic condition. Men were more likely than women to say that they were too young to experience a heart attack, perceiving it as a phenomenon of the elderly (53).
Sadly, in the modern era, when a young person presents with symptoms of autonomic dysfunction, the potential use of illicit drugs or alcohol should be considered. In women, symptoms may vary with the menstrual cycle, or an otherwise mild tendency toward autonomic dysfunction may be exacerbated by the onset of menopause.
There is a large body of evidence on the role of dietary lipids in cancer. It is based on epidemiolo-gical studies of various sorts in humans, and on feeding studies in animals. It should be stressed that the evidence is in all cases somewhat conflicting. In 1997-1998, two major reports on diet and cancer were published in which all existing evidence was reviewed (see Further Reading). The expert groups who compiled these reports assessed the literature and graded the evidence for associations between dietary components and specific cancers on a scale from 'convincing' to 'insufficient'. For dietary fat, no association was found to be convincing, and a few 'possible'. There was considered to be strong evidence, however, for a relationship between obesity (particularly central fat deposition) and risk of both endometrial cancer and breast cancer in post-menopausal women. As reviewed above, the evidence is strong for a link between adiposity and breast cancer and for endometrial cancer,...
Female cynomolgus monkeys have menstrual cycles that are similar to those of women in terms of length and cyclic hormone fluctuations (6,7). Following bilateral ovariectomy, extensive coronary artery atherosclerosis develops in females in amounts that are indistinguishable from those of males (8). CHD risk is also increased in oophorec-tomized and postmenopausal women (9). Subcutaneous replacement of estradiol, or estradiol and progesterone in physiological doses protects against atherosclerosis in female monkeys (10), and hormone replacement therapy (HRT) is associated with decreased CHD risk in postmenopausal women (11). Thus, ovarian function, and in particular estradiol, is implicated in the phenomenon of female protection, both in women and in female cynomolgus macaques.
Obese women with PCOS are at increased risk for obstructive sleep apnea (OSA) (56). Based on the increased prevalence of OSA in men, and recent evidence that androgens may play a role in the male predominance, overnight polysomnog-raphy was performed in obese women with PCOS and age weight-matched controls (56). Women with PCOS had a significantly higher apnea-hypopnea index (AHI), and were more likely to suffer from symptomatic OSA syndrome. The AHI correlated with waist-hip ratio, as well as total and free testosterone levels. g Vgontzas et al. (57) also reported that sleep-disordered breathing (SDB) and ex-
Men with low testosterone, women after menopause and both men and women with growth hormone deficiency without involvement of HPA axis perturbations tend to have abdominal obesity (49). These hormones prevent accumulation of body fat in intra-abdominal depots, and deficiency would then be expected to be followed by enlargement of these depots. The mechanisms whereby this occurs have been largely elucidated, and substitution with the deficient hormone is followed by a specific decrease of visceral fat as well as improvement of the factors included in the metabolic syndrome (6). The prevalence of such conditions seem to be in the order of 10 in the middle-aged male population (56).
Hydroxyapatite crystal deposition disease may produce synovitis or tendinitis. Crystals may be seen with electron microscopy but not with routine polarizing microscopy. Therefore, the diagnosis must be made clinically. This disorder tends to develop in patients with calcifications of the shoulder area and patients on hemodialysis. In young, premenopausal women, goutlike inflammation of the first metatarsophalangeal joint, or pseudopodagra, may be caused by CPPD crystals.
In postmenopausal women, several studies (93,94) have also demonstrated that hormone replacement therapy if anything may lead to a small weight reduction. This effect is not fully understood, but increased lipid oxidation seems to be of importance, whereas circulating leptin is not affected (95,96). In contrast to these findings high to moderate doses of megestrol acetate have been shown to increase appetite and body weight in women with advanced cancer disease (97,98). Tamoxifen, a partial oestrogen receptor antagonist used in post-menopausal women with breast cancer, also promotes weight gain (99-101), but to a lesser extent when used as monotherapy (102).
Surgery remains the most appropriate treatment to relieve chiasmal and optic nerve compression and to reduce hormone hypersecretion. Patients with residual or recurrent NFPA may be offered conventional or high-precision external beam radiotherapy delivered in a fractionated manner using multiple fields to a dose of 45 Gy in 25 fractions. The most appropriate timing of radiotherapy after surgery is not defined. The morbidity of treatment is low, with the requirement for hormone replacement therapy the most frequent consequence. Persistent hormone elevation is successfully treated with radiotherapy, particularly in acromegaly and CD although the normalization of hormone levels occurs with delay. In the treatment of prolactinomas, radiotherapy is appropriate for patients who do not tolerate medical treatment and where dopamine agonists have failed. Patients with CD treated with bilateral adrenalectomy are at risk of developing Nelson's syndrome and prophylactic pituitary radiation...
From a scientific viewpoint, human senescence represents an evolutionary problem to be solved, while, medically, it represents a process to be avoided, halted, or delayed. To do either, senescence must be understood within the context of natural selection. This requires both a better understanding of the evolutionary biology of theories on senescence (reviewed in Chapter 2) and examination of the patterns of life history (changes through which an organism passes in its development from its primary stage of life (gametes) to its natural death) among humans, their closest relatives, and their immediate ancestors. Human life history includes copulation, fertilization, embryogenesis, fetal development, birth, infancy, childhood, adolescence, reproductive adulthood, menopause, post-reproductive survival of women and late-life survival of men, and senescence each of these is affected by numerous intrinsic (i.e., inborn, biological genetic) and extrinsic (i.e., not intrinsic) factors....
Because GH production is influenced by age and gender (GH secretion declines with increasing age), it is necessary to have the IGF-1 level measured in a laboratory that provides normal values in relation to age and gender. In patients with CD, the 24-h UFC concentration is the best measure of integrated cortisol production. A normal 24-h UFC is an excellent measure of excessive cortisol production but is not helpful to assess adrenal insufficiency. A single serum PRL measurement in a patient with a prolactinoma is sufficient to assess the response to Gamma Knife therapy. Gonadal function is assessed by a history of normal libido and erectile function and a normal serum testosterone in men. In premenopausal women, regular menses indicate normal ovarian function. Men should have serum testosterone measured regularly, and menstrual history and serum estradiol levels should be measured in premenopausal women. In patients with Nelson's syndrome (increased serum ACTH...
*Adjusted for age (continuous), energy intake (continuous), fat intake (continuous), body mass index (continuous), smoking status (never, current, former), alcohol status (non-drinker, former drinker, current drinkers consuming 1 drink week), nonsteroidal antiinflammatory use (yes, no), multivitamin use (yes, no), and hormone replacement therapy use (yes, no in women only). OR, odds ratio CI, confidence interval. Smith-Warner et al., 2002. *Adjusted for age (continuous), energy intake (continuous), fat intake (continuous), body mass index (continuous), smoking status (never, current, former), alcohol status (non-drinker, former drinker, current drinkers consuming 1 drink week), nonsteroidal antiinflammatory use (yes, no), multivitamin use (yes, no), and hormone replacement therapy use (yes, no in women only). OR, odds ratio CI, confidence interval. Smith-Warner et al., 2002.
Most women are concerned about their appearance and understand that being overweight is unhealthy. After the menopause, women become more vulnerable to coronary heart disease. They may feel less concerned about their weight and appearance. This is the time of their lives, however, when it is most important to be slim, active, fit, and supple.
Regular physical activity - at least half an hour every day to a level where we sweat and get breathless - reduces the risk of heart attack by at least 50 . The benefits of exercise depend on its frequency, intensity, and duration. The benefits of exercise apply equally to men and women, but the benefits may be greater in post-menopausal women, who are at greater cardiovascular risk, than in pre-menopausal women. Therefore, young women should start exercising regularly and continue to exercise throughout their lives.
There is a protein in the blood called C reactive protein. High levels are found in the blood in people with infection or inflammation. The levels ofC reactive protein increase with age and are higher in smokers. High levels may predict a future heart attack or episodes of angina. Levels are high in patients who have had attacks of angina. It is probable that the high levels reflect the general inflammatory process that occurs inside the heart arteries. Levels are also high in women after the menopause, but it is not known why. At this moment, we do not check this in the blood as a screening test.
Lymphocytic hypophysitis is a destructive inflammatory disorder of the anterior pituitary, presumed to be autoimmune in origin. Although the earliest descriptions of this condition stemmed from necropsy studies wherein the potentially lethal nature of the disorder was emphasized, improved recognition of the condition, coupled with hormone replacement therapy, has since rendered lym-phocytic hypophysitis an entirely treatable condition.
It is recommended for women with bad menopausal symptoms, including flushing. It may slightly reduce the risk of thin bones (osteoporosis). Generally, in women who do not have symptoms, HRT does not make women less depressed, sleep better, be more sexually satisfied, interested, or active, or help their brain work better. There are always examples of women who are very pleased with their HRT and feel that it improves their hair and their skin. It is sensible for women to consult their doctor about these matters. HRT should be started at a low dose and increased gradually until symptoms resolve. Patients should see their doctor regularly, with the goal of reducing the dose of HRT every six months to see whether it needs to be continued. HRT is not recommended for women who do not have menopausal symptoms.
Understand that they are as likely as men to get it and that their risk increases after the menopause. Women should therefore take at least as much interest in their hearts and arteries as their breasts and wombs All women should be as concerned about their cardiovascular health as men, and probably more so. 3. Get their cholesterol checked if they are post-menopausal or if they have a family history or another risk factor. The target total cholesterol is 5 mmol l and the LDL cholesterol (the bad cholesterol that causes the problem in the arteries) should be less than 3.0 mmol l. The LDL cholesterol should be less than 2.0 mmol l, and the total cholesterol to HDL cholesterol ratio should be 6.0, in patients with arterial disease, high blood pressure, and diabetes.
Previous works have clearly demonstrated that female sex hormones influence adipose tissue metabolism differently in various fat depots (37). The typical female adipose tissue in the femoral-gluteal region in premenopausal women tends to accumulate fat, particularly during pregnancy, which can then be mobilized efficiently during lactation. These findings suggest a specific female function for this depot, to provide a reserve of energy for lactation purpose. In contrast, lipolytic responsiveness and sensitivity are higher in subcutaneous abdominal adipocytes. The disappearance of this typical metabolic pattern with menopause and its reappearance with hormonal substitution indicate that sex steroid hormones exert an important influence here (38). The specific role of oestrogen and progesterone is, however, not fully clarified. Previous studies have demonstrated that increasing androgenicity in women, as reflected by low SHBG concentration, or an increase in the percentage of free...
It is well established that a decline in circulating levels of 17p-estradiol is a major contributing factor in the development of osteoporosis in postmenopausal women. Until recently, specific mechanisms by which estradiol might influence bone metabolism were largely unknown. Recent studies suggest that estradiol influences the production and or modulates the activity of several cytokines involved in regulating bone remodeling. When estradiol is present, as in a premenopausal state, it acts as a governor to reduce cytokine production and limit osteoclast activity. When estradiol levels are reduced, the governor is lost, secretion of these cytokines increases, and osteoclast formation and activity increase, resulting in increased bone resorption.
Liable than those obtained later in the day. In women, prolactin levels vary with time of menstrual cycle, with the peak at day 12 of the cycle and the nadir during the follicular phase. In addition, the number of live births plays a role in premenopausal women, with prolactin levels varying inversely with parity. In premenopausal women, high intake of saturated fats is associated with elevated prolactin levels (Wang et al. 1992 Wennbo and Tornell 2000). Primary hypothyroidism can also cause hyperprolactine-mia, but values seldom exceed 50 ng mL. The upper limit of normal prolactin levels is 23-25 ng mL in women (obtained at day 3 of the cycle in premenopausal women) and 20 ng mL in men.
In women with acute coronary syndromes, in whom symptoms stabilize or in whom the diagnosis of coronary artery disease is uncertain, noninvasive testing is usually performed. In general, noninvasive evaluation of coronary artery disease in women is less accurate than in men, owing primarily to the lower prevalence of disease in women. The most widely employed and best studied diagnostic modality is the exercise treadmill test (28), and it is predictably problematic in women due to a lower prevalence of coronary artery disease in premenopausal women, a higher prevalence of mitral valve prolapse and hyperventilation-induced ST-segment depression, a higher incidence of hypertensive heart disease, and limited ability to exercise to an adequate heart rate response. In contrast to what is observed in men, resting ST-T wave abnormalities on an electrocardiogram in women do not predict exercise stress test outcome independent of other clinical risk factors of coronary disease (Fig. 4) (29).
Although few studies addressed the efficacy of aspirin for primary prevention in women, a meta-analysis of randomized trials of aspirin therapy revealed a 25 reduction in the risk of subsequent cardiovascular events in both women and men with vascular disease (38). Further review revealed that only one-third of postmenopausal women with cardiovascular disease were taking daily aspirin, and, the majority of these women were doing so for primary prevention (39). In the Second National Registry of Myocardial Infarction (NRMI 2), women were less likely to receive aspirin both on hospital admission and at discharge than their male counterparts (40).
National Cholesterol Education Program (NCEP) guidelines recommend an LDL cholesterol goal of less than 100 mg dL for men and women with documented coronary heart disease, the Heart Estrogen Progestin Replacement Study (HERS) trial of postmenopausal women with atherosclerotic coronary artery disease revealed that only 47 of women were taking lipid-lowering medication, and LDL cholesterol was above target in 91 of the study group. In fact, only 33 of women with LDL cholesterol 160 mg dL were receiving lipid lowering therapy (51). To address this issue, the Women's Atorvastatin Trial on Cholesterol (WATCH) aggressively treated women and importantly demonstrated that 87 of women with 2 or more coronary artery disease risk factors and 80 of women with documented coronary heart disease treated with atorvastatin reached their LDL cholesterol goal (52). Fig. 6. Hormone replacement therapy and coronary artery disease. In women treated with estrogen or a combination of...
The full effects of thyroid hormone replacement therapy may not be apparent for several weeks or more, but early effects may be apparent in as little as 48 hours. During the ongoing assessment, the nurse monitors the vital signs daily or as ordered and observes the patient for signs of hyperthyroidism, which is a sign of excessive drug dosage. Signs of a therapeutic response include weight loss, mild diuresis, a sense of well-being, increased appetite, an increased pulse rate, an increase in mental activity, and decreased puffiness of the face, hands, and feet.
Older adults are more sensitive to thyroid hormone replacement therapy and are more likely to experience adverse reactions when taking the thyroid hormones. In addition, the elderly are at increased risk for adverse cardiovascular reactions when taking thyroid drugs. The initial dosage is smaller for an older adult, and increases, if necessary, are made in smaller increments during a period of about 8 weeks. Periodic thyroid function tests are necessary to monitor drug therapy. Dosage may need to be reduced with age. If the pulse rate is 100 bpm or more, the nurse notifies the primary health care provider before the drug is administered.
Thyroid hormones are usually given on an outpatient basis. The nurse emphasizes the importance of taking the drug exactly as directed and not stopping the drug even though symptoms have improved. The nurse provides the following information to the patient and family when thyroid hormone replacement therapy is prescribed
A graph of LH release throughout the female life span is shown in Figure 38.2. During the neonatal period, LH is released at low and steady rates without pulsatility,- this period coincides with lack of development of mature ovarian follicles and very low to no ovarian estradiol secretion. Pulsatile release begins with the onset of puberty and for several years is expressed only during sleep, this period coincides with increased but asynchronous follicular development and with increased secretion of ovarian estra-diol. Upon the establishment of regular functional menstrual cycles associated with regular ovulation, LH pulsatil-ity prevails throughout the 24-hour period, changing in a monthly cyclic manner. In postmenopausal women whose ovaries lack sustained follicular development and exhibit
Female germ cells develop in the embryonic yolk sac and migrate to the genital ridge where they participate in the development of the ovary (Table 38.1). Without germ cells, the ovary does not develop. The germs cells, called oogonia, actively divide by mitosis. Oogonia undergo mitosis only during the prenatal period. By birth, the ovaries contain a finite number of oocytes, estimated to be about 1 million. Most of them will die by a process called atresia. By puberty, only 200,000 oocytes remain,- by age 30, only 26,000 remain,- and by the time of menopause, the ovaries are essentially devoid of oocytes.
Before administering an estrogen or progestin, the nurse obtains a complete patient health history, including a menstrual history, which includes the menarche (age of onset of first menstruation), menstrual pattern, and any changes in the menstrual pattern (including a menopause history when applicable). In patients prescribed an estrogen (including oral contraceptives), the nurse obtains a history of thrombophlebitis or other vascular disorders, a smoking history, and a history of liver diseases. Blood pressure, pulse, and respiratory rate are taken and recorded. The primary health care provider usually performs a breast and pelvic examination and obtains a Pap smear before starting therapy. He or she may also order hepatic function tests.
Candidates for in vitro fertilization (IVF) are women with disease of the oviducts, unexplained infertility, or endometriosis (occurrence of endometrial tissue outside the endometrial cavity, a condition that reduces fertility), and those whose male partners are infertile (e.g., low sperm count). Follicular development is induced with one or a combination of GnRH analogs, clomiphene, recombinant FSH, and menopausal gonadotropins (a combination of LH and FSH). Follicular growth is monitored by measuring serum estradiol concentration and by ultrasound imaging of the developing follicles. When the leading follicle is 16 to 17 mm in diameter and or the estradiol level is greater than 300 pg mL, hCG is injected to mimic an LH surge and induce final follicular maturation, including maturation of the oocyte. Approximately, 34 to 36 hours later, oocytes are retrieved from the larger follicles by aspiration using laparoscopy or a
Osteoporosis becomes an ever-increasing health problem world wide. It leads in older persons, starting in women already with the menopause, to an increased incidence of fractures. We are dealing with metabolic changes that involve all elements of bone tissue. Primarily we are facing a decrease of cancellous bone affecting its microarchitecture. Bone cannot resist even minor forces, to a point where fractures can occur spontaneously. Two main kinds must be distinguished the primary and the secondary (accompanying other diseases) osteoporosis. The primary kind predominates in hip fractures of elderly patients. It can be subdivided into two types type I is the post-menopausal osteoporosis and type II the senile osteoporosis (Riggs and Melton, 1992 Demster and Lindsay, 1993). Different risk factors play an eminent role in the development of osteoporosis. They may aggravate an existing osteoporosis or they themselves may induce bone loss as in alcoholics, after a prolonged immobilization...
Black cohosh, a herb reported to be beneficial in managing symptoms of menopause, is generally regarded as safe when used as directed. Black cohosh is a member of the buttercup flower family. The dosage of standardized extract is 2 tablets twice a day, or 40 drops of standardized tincture twice a day or one 500- to 600-mg tablet or capsule three times daily. Black cohosh tea is not considered as effective as other forms. Boiling of the root releases only a portion of the therapeutic constituents. Reduction in physical symptoms of menopause hot flushes, night sweats, headaches, heart palpitations, dizziness, vaginal atrophy, and tinnitus (ringing in the ears) Decrease in psychological symptoms of menopause insomnia, nervousness, irritability, and depression
A successful ICSI program depends on ovarian stimulation, which is essentially similar to methods used for conventional IVF. Current ovarian stimulation regimens use a combination of gonadotropin-releasing hormone (GnRH) agonists or antagonists, human menopausal gonadotropin (hMG), or recombinant follicle-stimulating hormone (recFSH), and human cho-rionic gonadotropin (hCG), which allows the retrieval of a high number of cumulus-oocyte complexes (43,44). Administration of GnRH agonists
Excludes postmenopausal bleeding ( N95.0 ) Regular intermenstrual bleeding N92.4 Excessive bleeding in the premenopausal period menopausal premenopausal Menopausal and other perimenopausal disorders Excludes excessive bleeding in the premenopausal period ( N92.4 ) postmenopausal premature menopause NOS ( E28.3 )
Ovaries contain all the eggs they will ever have before birth. Depletion of this supply begins before birth, and continues until menopause, when the endowment is gone (Fig. 1). The rate of this depletion is fairly constant over a woman's life span, but accelerates at around 37 years of age on average. At the beginning of every menstrual cycle, a fixed proportion of all remaining eggs acquires gonadotropin sensitivity. In natural cycles, all but one of these recruitable eggs undergo atresia, but the size of the recruitable cohort correlates with the woman's age. Given that the overall number of eggs in younger women is higher than in later years, the size of the cohort of recruit-able eggs in younger women is much larger. Figure 1 At birth, a women has all the eggs she will ever have, and steadily looses them thereafter, until none remain at menopause. As her age increases and the supply diminishes, fertility declines. This fall in fertility is often signaled by a rise in basal FSH...
Menopausal women only when calcium intakes exceed 1 g day. Because exercise may also improve gait, balance, coordination, proprioception, and reaction time, even in older and frail persons, the risk of falls and osteoporosis are reduced by chronic activity. In fact, the incidence of hip fracture is reduced nearly 50 when older adults are involved in regular physical activity. However, even when activity is optimal, it is apparent that genetic contributions to bone mass are greater than exercise. Perhaps 75 of the population variance is genetic, and 25 is due to different levels of activity. In addition, the predominant contribution of estrogen to homeostasis of bone in young women is apparent when amenorrhea occurs secondary to chronic heavy exercise. These exceptionally active women are typically very thin and exhibit low levels of circulating estrogens, low trabecular bone mass, and a high fracture risk (Fig. 30.5).
The diagnosis and treatment of amenorrhea present a challenging problem. The amenorrhea must first be classified as primary or secondary, and menopause, pregnancy, and lactation must be excluded. The next step is to determine whether the disorder originates in one of the following areas the hypothalamus and central nervous system, the anterior pituitary, the ovary, and or the reproductive tract.
A disorder characterized by deliberate weight loss, induced and sustained by the patient. It occurs most commonly in adolescent girls and young women, but adolescent boys and young men may also be affected, as may children approaching puberty and older women up to the menopause. The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and the patients impose a low weight threshold on themselves. There is usually undernutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics.
The plasma concentration of estradiol in normal adult men is 20-40 pg mL, and its production rate in blood is 25-40 g 24 h both of these values are higher than in postmenopausal women. Mean serum estrone and estradiol levels are elevated in obese men (29,37), and urinary estrone and estradiol production rates were positively correlated to percent above ideal body weight (37). Moreover, FSH, LH, and testosterone levels rose normally when obese men were treated with the antiestrogen clomiphene for 5 d (37). However, in the aforementioned study showing reduced LH pulse amplitude in massive obesity, estradiol levels were comparable in men with mild and moderate obesity (38).
Gonadotropin therapy is generally effective in achieving fertility in cases of pituitary insufficiency or GnRH resistance but is also an option for patients with hypothalamic disorders. Since the 1960s, hCG and human menopausal gonadotropin (hMG) that are purified from the urine of pregnant and menopausal women, respectively, have proven to be an effective treatment for spermatogenesis stimulation (5,7,19-21). hCG is used as the source of LH activity, because both hormones have structurally similar subunits and activate the same Leydig cell receptor. hMG has been used as the source of FSH, but it also contains LH activity. However, the LH activity is too low to maintain Leydig cell function, so a combination of hMG with hCG is required to achieve fertility (12). In the early 1980s, a purified preparation of urinary FSH (uFSH) and a highly purified preparation of urinary FSH (uFSH-HP), both from the urine of menopausal women, which are practically devoid of LH activity, were produced....
Premenopausal women, most of whom have microprolactinomas, usually have oligomenorrhea or amenorrhea (90 ) and or galactorrhea (up to 80 ). Anovulatory infertility is common. Excluding pregnancy, hyperprolactinemia accounts for 10-20 of cases of secondary amenorrhea. In passing, it is worth remembering that most women with galactorrhea do not have menstrual disturbance, hyperprolactinemia, or a pituitary tumor. Postmenopausal women are, by definition, already hypogonadal and markedly hypoestrogenemic. Hyperprolactinemia in this age group does not, therefore, present with classic symptoms and may be recognized only when a large pituitary adenoma produces headache and or visual disturbance.
Data on the prevalence of supraventricular tachyarrhythmias are extremely scarce. Electrocardiographic (ECG) screening studies of large populations (13,14) suggest a prevalence of the WPW pattern on ECG of 1 to 2 per 1000, but not all of these patients have clinical arrhythmia. In a study of the 50,000 residents of the Marshfield Epidemiologic Study Area (MESA) in Wisconsin, the prevalence of symptomatic PSVT was 2.25 per 1000, with an incidence of 35 per 100,000 person-years (15). In this study, PSVT occurred more frequently in women than in men, which is also reflected in series of patients undergoing catheter ablation. Interestingly, episodes of PSVT may occur more during the luteal than the follicular phase of the menstrual cycle in premenopausal women (16).
Other nonreproductive organs and systems are affected, directly or indirectly, by androgens, including the liver, kidneys, adipose tissue, and hematopoietic and immune systems. The kidneys are larger in males, and some renal enzymes (e.g., -glucuronidase and ornithine decarboxy-lase) are induced by androgens. HDL levels are lower and triglyceride concentrations higher in men, compared to premenopausal women, a fact that may explain the higher prevalence of atherosclerosis in men. Androgens increase red blood cell mass (and, hence, hemoglobin levels) by stimulating erythropoietin production and by increasing stem cell proliferation in the bone marrow.
Primordial follicles are generally considered the non-growing resting pool of follicles, which gets progressively depleted throughout life, by the time of menopause, the ovaries are essentially devoid of all follicles. Primordial follicles are located in the ovarian cortex (peripheral regions of the ovary) beneath the tunica albuginea.
Assessment of baseline pituitary function before Gamma Knife radiosurgery is mandatory to determine the need for any hormone replacement therapy. Because radiation therapy is expected to cause damage to the normal pituitary gland, patients should be evaluated at least every 6 mo for development of secondary hypothyroidism, secondary hypogonadism, secondary adrenal insufficiency, and GH deficiency. Radiation therapy does not usually cause diabetes insipidus (DI), but patients should be asked about excessive urination and thirst. Patients should be educated about the symptoms of hypothyroidism, adrenal insufficiency, and hypogonadism and instructed to return earlier should such symptoms develop.
The protein component of the bone matrix is digested by enzymes, primarily one called cathepsin K, released by the os-teoclasts. The osteoclast can then move to another site and begin the resorption process again, or be eliminated. Interestingly, there is evidence that estrogen, often given to treat osteoporosis in postmenopausal women, works in part by stimulating the apoptosis (cell suicide) of osteoclasts.
The wall of the uterus consists of three layers (a) endometrium or mucosa lining the inside wall (b) myometrium, a thick layer of smooth muscle and (c) perimetrium, the peritoneal covering lining the outside wall (Fig. 2.11). From puberty (11-13 years) until menopause (45-50 years), the endometrium undergoes changes in a cycle of approximately 28 days under hormonal control by the ovary. During this menstrual cycle, the uterine en-dometrium passes through three stages, the follicular or proliferative phase,
The menstrual history should include the age at onset of menstruation (menarche) and of cessation of menstruation (menopause) as appropriate. Details of the menstrual cycle should also include the date of the first day of the last menstrual period and the duration of menses (Table 5.23). The norma age of the menarche varies from the ages 10-15. Thereafter, patients who fail to menstruate at all, primary amenorrhoea, should be investigated for possihle gynaecological or endocrinological abnormalities. The normal age of the menopause varies considerably within the age range 45-55. Secondary amenorrhoea is commonly due to pregnancy. If this is not the case, organic causes such as severe systemic illness, hyper-prolactinaemia, androgen excess or hypopituitarism should be excluded before attributing it to a psychological disorder. Useful questions in the menstrual history arc shown in Table 5.23. The presence of a vaginal discharge requires to be assessed and note made of its colour,...
Menotropins (Pergonal) and urofollitropin (Metrodin) are purified preparations of the gonadotropins (FSH and LH) extracted from the urine of postmenopausal women. Menotropins are used to induce ovulation and pregnancy in anovulatory (failure to produce an ovum or failure to ovulate) women. Menotropins are also used with human chorionic gonadotropin in women to stimulate multiple follicles for in vitro fertilization. In men, menotropins are used to induce the production of sperm (spermatogenesis). Urofollitropin is used to induce ovulation in women with polycystic ovarian disease and to stimulate multiple follicular development in ovulatory women for in vitro fertilization. See the Summary Drug Table Anterior and Posterior Pituitary Hormones for additional information on the gonadotropins.
Osteoporosis is a loss of bone mass that results in weakening of the bones (Fig. 19-8). A decrease in estrogens after menopause makes women over age 50 most susceptible to the effects of this disorder. Efforts to prevent osteoporosis include adequate intake of calcium and engaging in weight-bearing exercise. Because of safety concerns, hormone replacement therapy (HRT) is currently being re-evaluated for use in prevention of osteoporosis. Some drugs are available for reducing bone resorption and increasing bone density. Osteoporosis can be diagnosed and monitored using a DEXA (dual-energy x-ray absorptiometry) scan, an imaging technique that measures bone mineral density (BMD).
Hormonal Mechanisms Provide High Capacity Long Term Regulation of Plasma Calcium and Phosphate Concentrations
The Actions of Parathyroid Hormone, Calcitonin, and 1,25-Dihydroxycholecalciferol. Most hormones generally improve the quality of life and the chance for survival when an animal is placed in a physiologically challenging situation. However, PTH is essential for life. The complete absence of PTH causes death from hypocalcemic tetany within just a few days. The condition can be avoided with hormone replacement therapy.
Cardiovascular events due to hypertension differ between men and women. Moreover, the prevalence of hypertension is twice higher in postmenopausal women than in premenopausal women. Increased sodium reabsorption by the kidney has been suggested to be a factor in this. Tominaga et al. 32 reported that decreases in sex hormones and increases in sodium sensitivity are important factors in the genesis of post-menopausal hypertension. Otsuka and Sasaki 33-35 investigated the effect of ovariectomy on pressure natriuresis in DS rats. The impaired pressure-natriuresis response of DS rats was further blunted by ovariectomy and that of DR rats was 32 Tominaga T, Suzuki H, Ogata Y, Matsukawa S, Saruta T The role of sex hormones and sodium intake in postmenopausal hypertension. J Hum Hypertens 1991 5 495-500.
Figure 3 Gonadotropin-releasing hormone antagonist multiple- and single-dose protocols. Fixed day regimens. Abbreviations FSH, follicle-stimulating hormone hCG, human chorionic gonadotropin hMG, human menopausal gonadotropin. Figure 3 Gonadotropin-releasing hormone antagonist multiple- and single-dose protocols. Fixed day regimens. Abbreviations FSH, follicle-stimulating hormone hCG, human chorionic gonadotropin hMG, human menopausal gonadotropin.
Centration of 25-hydroxyvitamin D (25-OH-D(2) -D(3)) in human plasma. A deuterated standard is used and the tandem spectrometer is in the multiple-reaction-monitoring mode. Intra- and interassay variations 2-6 recoveries 104-99 . Potential applications are the evaluation of the vitamin D status in postmenopausal women and elderly subjects, the diagnosis of vitamin D insufficiency deficiency, as well as for the treatment and prevention of osteoporosis. tration of vitamin K and related compounds (phylloquinone (PK), menaquinone-4 (MK-4), and menaquinone-7 (MK-7)) in human plasma. The internal standard is an isotope-labeled compound (O18) detection is by MS-MS using multiple reaction monitoring. Intra and interassay variations
A urine culture growing 105 colony-forming units (CFU mL) of one or more organisms on two consecutive specimens is required to diagnose asymptomatic urinary infection. A single urine culture with 105 CFU mL is adequate for bacteriologic diagnosis in subjects with acute symptoms referable to the genitourinary tract. With a clinical presentation consistent with acute pyelonephritis 104 CFU mL is sufficient. In younger women, quantitative counts of Enterobacteriaceae of 102 CFU mL are isolated from 30 of episodes in women with acute cystitis. Whether this is also the case for postmenopausal women presenting with a similar clinical syndrome has not been studied. However, for older women with symptoms consistent with acute cystitis, the lower quantitative count of organisms may be relevant.
Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality in premenopausal women, and insulin resistance and compensatory hyperinsuli-nemia play a fundamental role in the etiology of this syndrome. This is another example of an organ, in this case the ovary, responding normally to hyperinsuli-nemia by increasing testosterone secretion in the face of muscle and adipose tissue insulin resistance. Indeed, in this instance, the ovary may be supersensitive to insulin stimulation. In any event, the primary clinical manifestations of PCOS (hirsutism, abnormal menstruation, and difficulty in conceiving) are secondary to increased insulin-stimulated testosterone secretion by the ovary. Women with PCOS are at increased risk to develop both type 2 diabetes and the dyslipidemia of syndrome X. Both of these changes suggest that insulin-resistant and hyperin-sulinemic women with PCOS will be at increased risk of CHD, and there is now evidence of enhanced atherogenesis in middle-aged...
Reduction in the effectiveness of intrinsic CNS inhibition over the GnRH pulse generator. The mechanisms underlying these changes are unclear but might involve endogenous opioids. As a result of disinhibition, the frequency and amplitude of GnRH pulses increase. Initially, pulsatility is most prominent at night, entrained by deep sleep,- later it becomes established throughout the 24-hour period. GnRH acts on the gonadotrophs of the anterior pituitary as a self-primer. It increases the number of GnRH receptors (up-regulation) and augments the synthesis, storage, and secretion of the gonadotropins. The increased responsiveness of FSH to GnRH in females occurs earlier than that of LH, accounting for a higher FSH LH ratio at the onset of puberty than during late puberty and adulthood. A reversal of the ratio is seen again after menopause.
There are two types of adipose tissue in the body, known as 'brown' and 'white'. White adipose tissue is the more abundant and is the main tissue involved in the storage of body fat. Brown adipose tissue has a more specialized function in energy metabolism (see below). White adipose tissue is widely distributed throughout the body. In human beings, a large proportion is located just beneath the skin (subcutaneous adipose tissue) and is the tissue that influences the contours of the body. It also provides an insulating and protective layer. Fat contributes a larger proportion of the body weight in women than in men and their subcutaneous adipose tissue is correspondingly more abundant. Four-fifths or more of the mammary gland in non-lactating premenopausal women, for example, may be adipose tissue. The contribution of subcutaneous adipose tissue to body mass is particularly noticeable in overweight or obese individuals (Section
Widdowson (1937), that iron balance in man is primarily determined by iron absorption. There is a reciprocal relationship between iron stores and iron absorption as stores decline, absorption increases. Similarly the rate of erythropoiesis (red cell development) is a major determinant of iron absorption enhanced erythropoietic activity is linked to increased iron absorption. The principal site of iron absorption is the upper part of the gastrointestinal tract (the duodenum). Both the amount and bioavailability of dietary iron, together with the pH and motility of the gut lumen and other factors, influence iron absorption. These different factors do not, however, regulate iron absorption this is thought to be carried out by the intestinal mucosa, which under normal circumstances adjusts the amount of dietary iron absorbed so that it just compensates for the iron that is lost by excretion. Since the human body lacks effective means of iron excretion, this means that only very small...
Examination of growth rates for individual follicles may be a useful characteristic with which to predict the number of follicles which may develop during ovarian stimulation protocols. This information is equally important when assessing the risks of ovarian hyperstimulation. In the past, follicular growth rates during induced cycles were observed to be faster than those of natural cycles (17). However, a mathematical equation developed to equate follicular growth rate to follicular age was used to conclude that the growth rates of individual follicles in spontaneous cycles were similar to those recruited by human menopausal gonadotrophin therapy (18). Reduced growth rates of follicles in cycles where a pregnancy was established led to the conclusion that growth rate was a more useful characteristic for prediction of ovulation than follicular diameter (19). Follow-up work does not appear to have been done. It will be logistically challenging to combine daily detailed ultrasound...
Post-menopausal woman aged 60 or older (23). Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue that leads to pronounced bone fragility and increased fracture risk. The compression fracture of the osteoporotic patient can reduce vertebral height and can also cause lateral displacement of the bone. The fracture may extend into the lateral masses and posterior arch. The compression fractures of the spine often produce wedging of the vertebral body, which may also be associated with retropulsion of bone fragments and posttraumatic disc herniation. Other fracture types include burst or vertical shear fractures. Anterior to posterior dislocations may result from disruption of the anterior or posterior longitudinal ligaments.
In an adult 70-kg male, total body water (42 kg) accounts for 60 of body weight and fat accounts for about 10 kg. In females, there is a greater percentage of total body water and, in the premenopausal, there arc often marked fluctuations in weight owing to premenstrual fluid retention. Body weight may fluctuate by several kilograms from year to year.
Evidence from the Framingham Study suggests that the presence of certain risk factors in women can attenuate their advantage in cardiovascular risk over that in men. The male-female gap in incidence closes with advancing age. After menopause, risk escalates two- to threefold, with more infarction and sudden death. A high total to HDL cholesterol ratio of 7.5 or greater virtually eliminates the female advantage. Diabetes has twice the relative impact on risk in women, almost canceling the female advantage. Electrocardiographic evidence of left ventricular hypertrophy has a greater relative impact on risk in women. The residual effect of triglycerides after consideration of HDL cholesterol appears to be greater in women than in men.
Among many factors, the human growth hormone, hGH, has a great deal to do with human longevity. After the age of 60, this hormone begins to shut down. The process is called hGH menopause. The certain procedures of injecting this hormone have resulted in not only stopping normal march toward aging, but also reversing certain biological functions. In conclusion, we would like to quote from Dr. Michael Jazwinski, Louisiana
During skeletal growth and maturation, i.e., until the early 20s in humans, Ca accumulates in the skeleton at an average rate of 150 mg d. During maturity, the body, and therefore the skeleton, is more or less in Ca equilibrium. From the age of about 50 in men and from menopause in women, bone balance becomes negative and bone is lost from all skeletal sites. This bone loss is associated with a marked 2. In premenopausal women 3. In postmenopausal women Increasing dietary Ca intake does not prevent bone loss but rather reduces the rate of bone loss to some extent. However, the effectiveness of Ca varies by skeletal site, by menopausal age, and with usual Ca intakes.7 For example, an increase in Ca intake for women during the first 5 years of menopause (the period of most rapid bone loss) does not retard bone loss from trabecular regions of the skeleton, including Women who are more than 5 years past menopause tend to be more responsive.37-40 But, and besides the number and the quality...
Hormones (premenopausal women) Postoperatively, loss of menses in a premenopausal woman is diagnostic of hypogonadism, and no further biochemical evaluation is needed. Young hypogonadal women require estrogen replacement therapy (oral contraceptives or equivalent therapy) to maintain well-being and bone mass. Postmenopausal women with pituitary adenomas do not need an evaluation for gonadal deficiency, and decisions regarding estrogen replacement therapy are independent of the presence of tumor.
The effects of oligofructose have been investigated in a wide variety of particular experimental protocols besides the normal healthy rats. Cecectomized rats as well as rats receiving Ca and Mg directly by stomach gavage or by cecal intubation have been used to test for the hypothesis that the effect of inulin-type fructans might be mediated through large bowel fermentation. Protocols in which rats were fed a Mg or a Fe-deficient diet were also used demonstrating that improving mineral absorption was an effective way to reduce the incidence of symptoms known to be associated with such deficiencies. With the same objective, gastrectomized rats, known to be at high risk of developing anemia were also used. Finally, adult virgin ova-riectomized female rats were also used because this well-recognized protocol mimics the physiological conditions prevailing in postmenopausal women. The conclusions of all these studies are that inulin-type fructans changes in the lower part of the intestine...
Young women should do everything they can to reduce their risk of getting coronary heart disease and make sure that they stop or do not start smoking that their blood pressure is normal that they do not have diabetes or high cholesterol that they are slim and fit. They should adopt good habits when they are young. After the menopause, women should be especially careful and have a healthy lifestyle.
What causes osteoporosis, and what can be done to prevent or treat the disease While it is known that a diet low in calcium or vitamin D, certain medications such as glucocorticoids and anticonvulsants, and excessive ingestion of aluminum-containing antacids can cause osteoporosis, in most cases, the exact cause is unknown. However, several identified risk factors associated with the disease are being a woman (especially a postmenopausal woman) being Caucasian or Asian being of advanced age having a family history of the disease having low testosterone levels (in men) having an inactive lifestyle cigarette smoking and an excessive use of alcohol. women. Maximum bone mass is attained between 30 and 40 years of age and then tends to decrease in both sexes. Initially this occurs at an approximately equivalent rate, but women begin to experience a more rapid bone mineral loss at the time of menopause (about age 45 to 50). This loss appears to result from the decline in estrogen secretion...
More angina occurs after MI than before. Only 20 percent of coronary attacks are preceded by longstanding angina the percentage is lower if the infarction is silent or unrecognized. In premenopausal women, serious manifestations of CHD such as infarction or sudden death are relatively rare. The incidence and severity of CHD increase with age in both sexes (see Table 1-3 and Table 1-4). There seems to be a more precipitous increase for women after menopause, with CHD rates in postmenopausal women two to three times those of women the same age who remain premenopausal.21 This applies whether the menopause is natural or surgical and, in the latter case, whether or not the ovaries are removed. The sex ratio in incidence narrows progressively with advancing age.
Inactivity, and use of hormone replacement therapy were verified, providing a general indication that the selection of subjects was successful and thereby increasing confidence that the patterns of association for uncertain risk factors is more likely to be valid as well.
It is also necessary to diagnose and treat promptly any new pituitary hormone deficiency or deficiencies resulting from radiation therapy. Thus, these patients require regular medical and endocrinologic monitoring to assess the effect of Gamma Knife therapy and the need for hormone replacement therapy.
The dosage should not exceed 5 mg kg of body weight the usual starting dose in RA is 2.5 mg kg of body weight daily. Renal function and arterial blood pressure should be monitored carefully. The serum creatinine should not be allowed to increase by more than 50 of baseline. Hypertension may be controlled with nifedipine or isradipine, but not with verapamil or diltiazem, both of which interfere with hepatic metabolism. Special caution should be taken with concomitant use of MTX, which can decrease the elimination of cyclosporin A. Additional medications to be avoided because of drug interactions include antifungal azole derivatives (ketoconazole, fluconazole, itraconazole), macrolide antibiotics (erythromycin, clarithromycin), and allopurinol, among many others. Grapefruit juice increases the bioavailability of the drug. Cyclosporin A is contraindicated in premenopausal women who do not practice effective contraception, during pregnancy, and in nursing mothers.
An unhealthy high fat, high salt, quick, convenience food diet leads to obesity and associated diabetes and high blood pressure. These important risk factors are more potent and dangerous in women and, particularly after the menopause, may lead to coronary heart disease. Coronary heart disease is increasing in women more than in men. Therefore, it is possible that in the future, coronary heart disease may become more common in women than in men. Angina and heart attacks may become more common in women than in men because risk factors are more risky to women, and women become more vulnerable after the menopause.
An increase in body weight and fat tissue is associated with several abnormalities of sex steroid balance in premenopausal women. They involve both androgens and estrogens and their main transport protein, sex hormone-binding globulin (SHBG). Changes in SHBG, which binds testosterone and dihydrotestosterone (DHT) with high affinity and estrogens with lower affinity, also lead to an alteration of androgen and estrogen delivery to target tissues. The concentrations of SHBG are regulated by a complex of factors, which include estrogens, iodothyronines and growth hormone (GH) as stimulating, and androgens and insulin as inhibiting factors (5). The net balance of this regulation is probably responsible for decreased SHBG con- Treatment with androgens increases visceral fat in postmenopausal women Obesity, hyperandrogenism and PCOS Half PCOS women are overweight or obese tion has been found in premenopausal women between lipid intake and SHBG levels (12). Moreover, experiments performed in...
Another mechanism by which a series of methodologically sound studies could yield inconsistent results is if the response to the agent in question truly differs across populations, i.e., there is effect measure modification. For example, in a series of studies of alcohol and breast cancer, one might find positive associations among premenopausal but not postmenopausal women, with both sets of findings consistent and valid. Some studies may include all or a preponderance of postmenopausal women and others predominantly premenopausal women. If the effect of alcohol varies by menopausal status, then the summary findings of those studies will differ as well. Whereas the understanding of breast cancer has evolved to the point that there is recognition of the potential for distinctive risk factors among premenopausal and postmenopausal women, for many other diseases the distinctiveness of risk factors in subgroups of the population is far less clear. Where sources of true heterogeneity are...
There are several pharmacological options for treating osteoporosis and, since its course varies in different patients and is not easily predictable, treatment of the bowel disease itself could be a kind of prophylaxis against bone disease, as inflammatory cytokines play an important role in altering bone metabolism 40 . Among treatment options for osteoporosis in IBD, hormone replacement therapy (HRT) has only been evaluated in an open study in postmenopausal women with CD. HRT has been shown to stop progression of bone loss in post-menopausal women and increase bone mass density in the long term although it does not seem to alter patients' fracture rate. HRT could be recommended in postmenopausal women with CD providing they have no contraindications, such as personal history or strong family history of breast cancer.
28 1043 775 Age at menopause (a) For each of the two factors (age at first live birth and age at menopause), choose the lowest level as the baseline and calculate the odds ratio associated with each other level. (b) For each of the two factors (age at first live birth and age at menopause), calculate the generalized odds and give your interpretation. How does this result compare with those in part (a)
Bergapten may cause photosensitivity in sensitive individuals. Excessive doses may interfere with anticoagulant and MAOI therapy. The documented estrogenic activity of anethole and its dimers may affect existing hormone therapy, including the oral contraceptive pill and hormone replacement therapy, if excessive doses are ingested. In view of the structural similarity reported between anethole and myristicin, consumption of large amounts of aniseed may cause neurological effects similar to those documented for nutmeg.
The extent to which prevention of urinary infection in elderly populations is feasible is unclear. The very high frequency of urinary infection is primarily due to associated comorbidity, and usually this cannot be modified. Adequate nutrition, optimal management of comorbidities, and maintenance of maximal function certainly seem reasonable recommendations, but the impact of these interventions in decreasing urinary infection is not known. For a small subset of elderly well women who are experiencing repeated episodes of acute cystitis, the use of prophylactic antibiotics, a strategy similar to younger female populations, may be effective. An alternate approach in selected postmenopausal women may be the use of topical estrogen therapy (24), although the relative efficacy of estrogen compared to antimicrobial prophylaxis remains to be determined. Studies of the impact of oral estrogen in reducing urinary infection have given conflicting results. Long-term antimicrobial prophylaxis...
Providers also need to explain that, in addition to chest discomfort, patients may experience a feeling of being short of breath sweating pain in the arms, back, neck, jaw, or stomach a feeling of being sick to your stomach or lightheaded. Providers should promote the notion of, when in doubt, check it out , acknowledging that it is normal to be uncertain about what is wrong or embarrassed or afraid about calling 9-1-1, leading to untoward delays in getting help. In addition, providers can stress that the only way to know for sure is to be evaluated in a hospital emergency department. It is important that they also emphasize that patients will be taken seriously and treated respectfully if they come to the emergency department with possible heart attack signs, even false alarms. Providers should actively address the benefits of artery-opening treatment and the importance of getting treatment quickly to stop a heart attack in its tracks....
Alendronate is administered orally each day or as a once-a-week dose. The nurse should check the physician's order to be certain of the dosage and the times of administration. When administering the drug for treatment of osteoporosis in postmenopausal women, the dosage is 70 mg once weekly or 10 mg daily. When administering the drug for prevention of osteoporosis, 5 mg of the drug is given daily or 35 mg once a week.
Menopausal estrogen use and osteoporosis, there might be no causal relation between screening history and that outcome. If there were an association between screening and use of estrogens, however, which is plausible, then the distortion due to random digit dialing would require adjustment in the analysis. The control sampling mechanism would have generated an association with disease status because of the overrepresentation of women who tend to have more health screening (and may well have a higher prevalence of estrogen use as well).
Oogenesis in the female has been the subject of intense investigation. At the beginning of each ovarian cycle, from puberty to menopause, one primary oocyte present in the female's ovaries is activated to continue the process of gamete formation. Release of GnRH from the hypothalamus at the beginning of each cycle stimulates the anterior portion of the pituitary gland to release FSH. FSH, in turn, affects the ovaries It stimulates a primary oocyte to mature to the point that it can be released from the ovary, as a secondary oocyte, and it causes certain cells (follicle cells) in the ovary to produce estrogens, female hormones. High estrogen levels will cause the pituitary to inhibit FSH release, a negative feedback mechanism, and stimulate LH release. These estrogen-mediated events occur at approximately the middle of the ovarian cycle. LH also affects the ovaries. LH, however, is responsible for ovulation (the release of the oocyte from the ovaries) and for the formation of a...
6.24 Postmenopausal women who develop endometrial cancer are on the whole heavier than women who do not develop the disease. One possible explanation is that heavy women are more exposed to endogenous estrogens, which are produced in postmenopausal women by conversion of steroid precursors to active estrogens in peripheral fat. In the face of varying levels of endogenous estrogen production, one might ask whether the carcinogenic potential of exogenous estrogens would be the peripheral fat. In the face of varying levels of endogenous estrogen production, one might ask whether the carcinogenic potential of exogenous estrogens would be the same in all women. A study has been conducted to examine the relation between weight, replacement estrogen therapy, and endometrial cancer in a case-control study (Table E6.24). Use the Mantel-Haenszel procedure to compare the cases versus the controls. State your null hypothesis and choice of test size.
Postmenopausal women with no hormone replacement therapy (n 11) were used to test for the effect of a diet supplemented with oligofructose (10 g) as compared to sucrose (placebo) for 5 weeks on net intestinal Mg absorption. A single stable isotope (25Mg) tracer methodology was used and the protocol was designed as randomized, double blind, and crossover (with a washout period of 3 weeks). During the last two weeks of the protocol, the volunteers received a controlled diet providing 250 mg Mg d. One week before the end, they were given a lunch In a more recent study (randomized, double blind, placebo controlled, crossover design) oligofructose-enriched inulin Synergy 1 (equivalent to 10 g d of inulin-type fructans) was shown to significantly (p 0.05) increase Mg absorption (+10 as measured by the dual stable isotope method using the ICP-mass spectrometry) in 15 postmenopausal women after 6 weeks of treatment. The volunteers included in that study were a minimum of 10 years past the...
Treatment of fractures in metabolically diseased bone is by conservative or operative means, aiming for early mobilization. The underlying disease should be investigated and treated as appropriate. Future preventative measures are essential to reduce the ever rising number of fractures, in particular femoral neck fractures, related to osteoporosis. Increasing awareness of HRT, which to be effective should be started within 6 years of the menopause, may be an essential preventative measure.
In postmenopausal women, in two separate studies in which Mg absorption was increased and Ca absorption was not increased, respectively, oligofructose did not modify bone turnover as assessed by measuring plasma osteocalcin and urinary deoxypyrinolidine.128,132 But in a more recent study (randomized, double blind, placebo-controlled, crossover design), oligofructose-enriched inulin Synergy 1 (equivalent to 10 g d of inulin-type fructans) was shown to significantly (p 0.05) increase both urinary excretion of deoxypyridinoline cross-links (+1.1 nmol mmol creatinine) and serum concentration of osteocalcin (+4.7 ng ml) in 15 postmenopausal women after 6 weeks of treatment. These effects were even more pronounced (+1.7 nmol mmol creatinine for deoxypyridinoline cross links and +6 ng ml for osteo-calcin) if analysis was limited to the volunteers who had an increased Ca and Mg absorption rate following inulin intake. The volunteers included in that study were a minimum of 10 years past the...
Certain physical markers denote significant changes. Puberty, the point at which the sexual organs mature, is thought to signify the start of adolescence. In the majority of cases, puberty does occur in the early teens, although its onset may occur as early as age 8 or 9 or in the late teens. Early adulthood is thought to be the period of peak physical performance. Menopause, the cessation of menstrual periods, marks the end of fertility for women. There is no comparable event for men, who can remain fertile and father children into later adulthood. Older age often is marked by a reduction in hearing, vision, or other sensory capabilities slower reaction times and loss of strength. Some diseases, such as the progressive brain disorder Alzheimer's disease, are experienced primarily in older age.
Increased bioavailability of an essential nutrient and especially of an essential mineral is recognized as a valid enhanced function claim (see Chapter 1). Supported by the results of a large number of animal studies and human nutrition intervention trials, the claim inulin-type fructans enhance Ca absorption is scientifically substantiated.169 Even though a majority of trials have involved adolescents, confirming evidence already exists in adults as well as in postmenopausal women. However, quantitative (in terms of effective daily dose) differences may exist between different inulins, the most active product being a mixture of oligofructose and long-chain inulin (inulin HP), the so-called oligofructose-enriched inulin Synergy 1 that is effective already at a daily dose of 8 g.
Generalized osteoarthritis was named by Moore in 1952. Generalized OA is defined by involvement of three or more joints or joint groups e.g., the distal interphalangeal (DIP) joints are counted as one group . By definition, conditions that are known to produce secondary generalized OA, such as ochronosis, are excluded. The DIP, proximal interphalangeal (PIP), first carpometacarpal (CMC), spine, knee, and hip joints are commonly involved. Other features of generalized OA include a predilection for postmenopausal women and episodic joint inflammation. A familial pattern, associated with Heberden's nodes, has been reported in a subset of generalized OA patients.
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