Natural Menopause Relief Secrets

Natural Cures For Menopause

Natural Cures For Menopause

Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?

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Surviving Perimenopause

To give you an even better idea of just what kind of useful and practical information youll find in Perimenopause: Have It, Live It, Love It!, heres a partial list of the topics covered extensively in this ebook: Learn about the 26 signs of perimenopause both common and not so common symptoms. Find out what your symptoms are Not telling you 18 perimenopause symptoms that are linked to other serious medical conditions. Learn how you can treat your symptoms Without the use of drugs and pills. Over 50 home remedies with recipes and instructions to help you cope with various perimenopause symptoms. What you need to prepare Before your visit to your doctor, including how to make sure your doctor listens to you and takes your symptoms seriously, and reaches the right diagnosis. Get tips and techniques to re-ignite your sex life. Its not too late to bring passion back to the bedroom. Perimenopause pregnancy? Get your facts straight whether you are trying to conceive or prevent a pregnancy. Make sense of the changes that are happening to your body and the ones that are happening inside your head. Learn techniques you can apply today to get better sleep and to overcome perimenopause insomnia. Discover what you can do now to prevent osteoporosis which attacks women after they hit menopause and is easily preventable only if you start now! Identify if you are estrogen deficient or estrogen dominant and find out which remedies work for each type. Determine whats actually causing your irregular periods, Pms and heavy bleeding. Learn how to tell when youll hit menopause. Understand medical jargon so you dont come out of a doctor consultation more confused than before you went in. Understand the link between hormonal changes in your body and your mood swings and depression. Find out what to expect when you have perimenopause the common and not-so-common transformations that can really affect the way you live. Get access to information that your doctor may not be telling you. Realize that you can do something about that weight youre putting on around your waist and thighs and why old dieting methods that worked for you in the past are next to useless now. Learn about the different kinds of tests your doctor may ask you to get and actually know what theyre for.

Surviving Perimenopause Overview


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Why Does Coronary Heart Disease Occur Later In Women And Develop So Rapidly After The Menopause

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

Hormone Replacement Therapy

Hormone Replacement Progress

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,...

Drug history and allergies

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.

Phytoestrogens in the Human Diet

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.

Perception of Heart Attack Risk

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).

Previous osteoporotic fracture

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.

Evaluation Of Patients

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.

Coronary Artery Atherosclerosis And Chd Risk

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.

Endocrine Deficiencies

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).

Estrogens And Other Hormone Derivatives

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).

Conclusions And Recommendations

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...

Introduction and background

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....

Indications For Gamma Knife Radiosurgery

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.

Restrict Inference to Disease Outcome That Can Be Ascertained Accurately

*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, 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, 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.

How Do Increased Stress And Time Pressures Lead To Less Exercise An Unhealthy Diet And Obesity

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.

What Is The Relationship Between Women And Obesity

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.

What Are Inflammatory Markers In The Blood

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.

Noninfectious Inflammatory Lesions of the Sellar Region

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.

So What Is Hrt Good

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.

So What Can And Should Women Do To Reduce Their Chances Of Getting A Heart Problem

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.

Female Sex Steroid Hormones

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 testosterone, is associated with visceral obesity (7,39). Menopause seems to be associated with increasing body fat and with an increasing proportion of abdominal body fat distribution (40). It may be conceivable that these changes in body fat and its distribution are related to the marked decrease in oestrogen and progesterone levels associated with menopause. Consequently, it may therefore be hy- TREATMENT HORMONES Table 32.3 The effects of hormone replacement therapy on body composition

Lipid Lowering Agents

Hormone replacement therapy and coronary artery disease. In women treated with estrogen or a combination of estrogen and medroxyprogestin (MPA), there was a reduction in LDL cholesterol and an increase in HDL cholesterol however, this improvement in lipid profile did not translate into a regression of coronary artery disease at angiography, nor did it lead to a significant reduction in clinical events. LDL, low-density lipoprotein cholesterol HDL, high-density lipoprotein cholesterol MI, myocardial infarction (60). Fig. 6. Hormone replacement therapy and coronary artery disease. In women treated with estrogen or a combination of estrogen and medroxyprogestin (MPA), there was a reduction in LDL cholesterol and an increase in HDL cholesterol however, this improvement in lipid profile did not translate into a regression of coronary artery disease at angiography, nor did it lead to a significant reduction in clinical events. LDL, low-density lipoprotein cholesterol HDL,...

Ongoing Assessment

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.

Gerontologic Alert

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.

Educating the Patient and Family

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

The Primordial Follicle Contains an Oocyte Arrested in Meiosis

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.

Preadministration Assessment

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.

Correlation between osteoporosis age and sex for hip fractures

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.

Herbal Alert Black Cohosh

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

Testing Ovarian Reserve

Chance Pregnancy Age And Fsh

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...

Female Infertility Is Caused by Endocrine Malfunction and Abnormalities in the Reproductive Tract

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.

F500 Anorexia nervosa

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.

Graafian Follicle Is the Final Stage of Follicle Development

Cell Layers Graafian Follicle

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.

Protocol For Treatment And Followup

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.

Uterus at Time of Implantation

First Week Human Development

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,

Menstrual and obstetric history

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. Age at cessation of menstruation (menopause) Use of contraceptive drugs or hormone replacement...

Metabolic Bone Diseases

Radiology Signs Bone Disease

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

Hormonal Regulation Plasma Calcium

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.

The Onset of Puberty Depends on Maturation of the Hypothalamic GnRH Pulse Generator

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.

Cardiovascular Diseases

Coronary Artery Disease Statistics

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.

On Life Longevity Problems

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

Calcium Intake and Bone Health

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 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

So What Should Girls And Young Women Do To Reduce Their Risk Of Heart Disease

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.

Clinical Focus Box 361

Bone Weight Strength Charts

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 that occurs at menopause. Low-dose estrogen supplementation of postmenopausal women is usually effective in retarding bone loss without causing adverse effects. This condition of increased bone loss in women after menopause is called postmenopausal osteoporosis (see Clinical Focus Box 36.2).

Coronary Heart Disease

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.


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.

Table E124

> 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.


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. Furthermore,...

Eggs and RNA

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...

Hormones In Mammals

Throughout the development of the organism, profound changes such as birth, puberty, menopause, aging, and death occur. Progressive changes in cell functions contribute to these sequential processes. Many of these developmental changes are controlled by hormones, chemical messengers that provide communication between cells located in different portions of the body via the bloodstream.

Human Data

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...

Metabolic disease

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.

Bone Turnover

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 onset of menopause and they had taken no hormone replacement therapy for the past year. Moreover, there was a strong positive correlation (p < 0.001) between bone resorption at baseline as measured by deoxypyridinoline cross links and increase in Mg (but...

Physical Development

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.

Risk factors

Back pain and fractures are the most characteristic presenting symptoms. Loss of height is a cardinal sign of vertebral OP. More than 60 of vertebral fractures are not symptomatic. Compression fractures are often multiple and most commonly occur in the T-11 to L-2 distribution. Fractures of the wrist (Colles' fracture), hip (femoral neck and intertrochanteric), and pelvis may be the first manifestation of OP. High-turnover OP results from increased bone resorption and occurs at the onset of menopause. Low-turnover OP is caused by decreased osteoblastic bone formation as a consequence of genetics, senility, and antimetabolites.

Shoulder pain

Adhesive capsulitis is an idiopathic inflammatory synovitis in the glenohumeral joint. It occurs three to seven times more frequently in women than in men. The cause is not well understood, but the clinical entity is frequently associated with other conditions, such as diabetes and menopause. Four distinct stages have been recognized, which reflect the degree of synovitis. The cornerstones of treatment include intraarticular steroid injection and a rehabilitation program to maintain strength and range of motion. Manipulation under anesthesia and arthroscopy may be required.

Endocrine disrupters

Endocrine-disrupting chemicals may be pesticides or metabolites of pesticides, as well as industrial and household chemicals. Oestrogen-active compounds are also found naturally in plants, and are called phytoestrogens. A well-known case of phytoestrogen action is the occurrence of isoflavonoids in Australian clover, Trifolium subterraneum (Leguminosae), which was identified as the cause of impaired sexual performance in sheep. Phytoestrogens from soybean (Glycine max, Leguminosae) are considered as an alternative to oestrogen therapy for menopausal symptoms. Why plants would produce compounds that affect the endocrine system of vertebrates is not clear. Maybe it is just a side effect, while the main function of these compounds lies elsewhere. For example, isoflavonoids are also implicated in signalling between plants and microorganisms in the rhizosphere. Still, it is often assumed that plants have evolved phytoestrogens as a defence strategy against herbivory. If this is the case,...


In the female patient, androgen therapy may be used as part of the treatment for inoperable metastatic breast carcinoma in women who are 1 to 5 years past menopause. In addition, some breast carcinomas in women are hormone-dependent tumors, that is, their growth and spread are influenced by the female hormone estrogen. Administration of an androgen to patients with this type of malignant breast tumor counteracts the effect of estrogen on these tumors. Androgens may also be administered to premenopausal women with metastatic breast carcinoma that is believed to be hormone dependent and whose tumor growth and spread have been slowed after an oophorec-tomy (removal of the ovaries). The uses of the andro-gens are listed in the Summary Drug Table Male Hormones.


Estrogen is most commonly used in combination with progesterones as contraceptives or as hormone replacement therapy in postmenopausal women. The estrogens are used to relieve moderate to severe vasomotor symptoms of menopause (flushing, sweating), female hypo-gonadism, atrophic vaginitis (orally and intravaginally), osteoporosis in women past menopause, palliative treatment for advanced prostatic carcinoma, and in selected cases of inoperable breast carcinoma. The estradiol transdermal system is used as estrogen replacement therapy (ERT) for moderate to severe vasomotor symptoms associated with menopause, female hypogonadism, after removal of the ovaries in premenopausal women (female castration), primary ovarian failure, and in the prevention of osteoporosis. Estrogen is given IM or intravenously (IV) to treat uterine bleeding caused by hormonal imbalance. When estrogen is used to treat menopausal symptoms in a woman with an intact uterus, concurrent use of progestin is recommended...

Ongoing Assessments

At the time of each office or clinic visit, the nurse obtains the blood pressure, pulse, respiratory rate, and weight. The nurse questions the patient regarding any adverse drug effects, as well as the result of drug therapy. For example, if the patient is receiving an estrogen for the symptoms of menopause, the nurse asks her to compare her original symptoms with the symptoms she is currently experiencing, if any. The nurse weighs the patient and reports a steady weight gain or loss. A periodic (usually annual) physical examination is performed by the primary health care provider and may include a pelvic examination, breast examination, Pap smear, and laboratory tests. The patient with a prostatic or breast carcinoma usually requires more frequent evaluations of response to drug therapy.


Estrogen (hormone replacement therapy). Consider strongly at menopause but beneficial at all postmenopausal ages. Increases bone mass and decreases fracture risk by 50 . Progesterone cyclically or in low doses continuously is required to prevent endometrial cancer. Improvement in bone mass and cardiovascular protection outweighs possible increased risk for breast cancer in many clinical situations. 5. Bisphosphonates (alendronate). Alendronate (10 mg daily) increases spine and bone mass and decreases the risk for fracture by 50 , a rate equal to that of hormone replacement therapy. Esophagitis is the main potential complication but can be eliminated by slow buildup of dosage and appropriate administration. Etidronate, at a dose of 400 mg orally d for two weeks every three months is an alternative.

Bone Disease in IBD

Fact, in prospective longitudinal studies, changes in BMD in patients with IBD were similar to those of the general population 88 . The most relevant clinical question is to determine whether alterations in BMD can affect the fracture risk. There have been four large population-based studies describing fracture risk in patients with IBD. A survey was mailed to members of the Danish Crohn's Colitis Association regarding fractures 89 . The authors concluded that patients with UC had similar overall fracture rates compared with control subjects. Crohn's disease patients had a relative risk of 1.7 for all fractures (RR for female patients 2.5, 2.9 among premenopausal females, 1.8 among postmenopausal women and 0.6 among men) compared to the control group. A family fracture history (RR 2.4) especially paternal (RR 3.6) increased the risk of fracture among patients with CD. Among UC patients, maternal fracture history (RR 2.4) and smoking (RR 3.8) were additional risk factors. There was no...

Empty Sella Syndrome

Relatively few patients with primary or secondary empty sella syndrome require surgical intervention. After establishing the diagnosis and excluding other intrasellar cystic pathologies, the management of these conditions rests primarily on the recognition and treatment of potential complications (endocrine, ophthalmologic, and CSF rhinorrhea). The endocrine status of the patient requires careful laboratory evaluation, both at the time of diagnosis and periodically thereafter. Hypopituitarism, if present, requires appropriate hormone replacement therapy. Except for the case of low-grade hyperprolactinemia, hormonal hypersecretion warrants the exclusion of a coexisting hypersecreting microadenoma with MRI. When radiologically occult GH, adrenocorticotrophic hormone (ACTH), or prolactin-secreting microadenomas are suspected, transsphenoidal exploration may be necessary. Low-grade hyperprolactinemia (of stalk compression origin), because of its long-term adverse effects, should be...

The Male Life Span

Human testicular function is maintained through old age. However, mean testosterone levels and spermatogenesis decline with aging (25). This phenomenon of andropause and the effect of testosterone replacement therapy, have recently received a great deal of attention (see Chapter 14).

Facial and body hair

Pituitary Tumour

Hirsutism is an excessive growth of coarse hair in the female on the face, trunk and limbs in the pattern normally seen in males. The pubic hair spreads from its normal Hat-topped distribution up towards the umbilicus, this being described as a male escutcheon. Mild hirsutism is a common condition, often associated with higher than average levels of testosterone. In some subjects it may be a cause of considerable psychological distress. Some increase in facial hair is common after the menopause.

The SHBG Gene

Plasma SHBG levels are lower in adult men than in women, presumably because of suppression by androgens and stimulation by estrogens. SHBG levels increase as men grow older (21,22) but are reduced in elderly women (23). The rise in SHBG in elderly men has been attributed to GH deficiency (24), and the decline through menopause has been attributed to a predominating effect of estrogen deficiency.

Menstrual Disorders

Menstrual abnormalities include flow that is too scanty (oligomenorrhea) or too heavy (menorrhagia), and the absence of monthly periods (amenorrhea). Dysmenorrhea, when it occurs, usually begins at the start of menstruation and lasts 1 to 2 days. Together these disorders are classified as dysfunctional uterine bleeding (DUB). These responses may be caused by hormone imbalances, systemic disorders, or uterine problems. They are most common in adolescence or near menopause. At other times they are often related to life changes and emotional upset.


Phyto-oestrogen (phytoestrogen) is a term applied to non-steroidal plant materials displaying oestrogenic properties. Pre-eminent amongst these are isoflavonoids. These planar molecules mimic the shape and polarity of the steroid hormone estradiol (see page 279), and are able to bind to an oestrogen receptor, though their activity is less than that of estradiol. In some tissues, they stimulate an oestrogenic response, whilst in others they can antagonize the effect of oestrogens. Such materials taken as part of the diet therefore influence overall oestrogenic activity in the body by adding their effects to normal levels of steroidal oestrogens (see page 282). Foods rich in isoflavonoids are valuable in countering some of the side-effects of the menopause in women, such as hot flushes, tiredness, and mood swings. In addition, there is mounting evidence that phyto-oestrogens also provide a range of other beneficial effects, helping to prevent heart attacks and other cardiovascular...


Many biologic and psychological factors may lead to sexual problems. Insufficient vaginal lubrication may develop secondary to Sjogren's syndrome or menopause artificial lubrication may help. If pain is interfering with sexual satisfaction, an extra (or earlier) dose of medication (within the hour) may be helpful. Some patients find it helpful to take a warm bath to relax and minimize stiffness. If pain is less at certain times of day, suggest having sex at those times. Some patients report postcoital pain relief, perhaps as a consequence of feeling loved and the release of endorphins.


Hormone replacement therapy therefore seems to be a valuable adjunct to conventional obesity treatment, but further knowledge of the association between the metabolic and the neuroendocrine aberrations in abdominal obesity is needed before we fully understand the place of hormonal treatment in subjects with visceral obesity.