Assessment of women in midlife

BACKGROUND

Midlife is much more than menopause. At the time of their life when women may be experiencing symptoms relating to decreased ovarian function, they are also confronted with a range of physical and psychosocial issues that may affect their wellbeing.

OBJECTIVE

This article outlines the range of clinical presentations of women in midlife and discusses assessment of these presentations in the context of the individual woman's life.

DISCUSSION

Women in midlife present to doctors for a variety of reasons including information and preventive health, vasomotor or other symptoms of oestrogen deficiency, menstrual disorders, breast disorders, sexual difficulty, relationship and family issues, or mood disorders. Forming an effective doctor-patient partnership to address these issues requires time, empathy, good interpersonal skills, comprehensive and sensitive history taking and examination skills, and a good knowledge of relevant research.

Bone density-related predictors of blood lead level among peri- and postmenopausal women in the United States: The Third National Health and Nutrition Examination Survey, 1988-1994

Because of the long half-life of lead stored in bone (years), skeletal lead stores may be a source of endogenous lead exposure during periods of increased bone demineralization, such as menopause. To test the hypothesis that postmenopausal bone resorption increases blood lead levels, the authors examined cross-sectional associations of bone density-related factors with blood lead levels among women aged 40-59 years from the Third National Health and Nutrition Examination Survey (1988-1994). Factors related to bone turnover were significant predictors of blood lead level. Bone mineral density was significantly inversely related to blood lead levels in log-linear multivariate models that adjusted for age, race/ethnicity, smoking, education, household income, alcohol use, and residence (urban/rural). With menopausal status added to the model, naturally and surgically menopausal women had adjusted median blood lead levels that were 25% and 30% higher, respectively, than those of premenopausal women (2.0 microg/dl). Current use of hormone replacement therapy was associated with significantly lower adjusted median blood lead levels (1.8 microg/dl) than past use (2.6 microg/dl) and never use (2.2 microg/dl). Lead stored in bone may significantly increase blood lead levels in perimenopausal women because of postmenopausal bone mineral resorption. Attention to factors that prevent bone loss may lessen or prevent this endogenous lead exposure.

Endometrial safety and tolerability of triphasic sequential hormone replacement estradiol valerate/medroxyprogesterone acetate therapy regimen

OBJECTIVE

Two randomized comparative multicenter studies were conducted to establish the endometrial safety and tolerability of a triphasic sequential hormone replacement estradiol valerate/medroxyprogesterone acetate (E2V/MPA) therapy regimen.

METHODS

Study 1 was a randomized, double-blind, clinical phase III study in 399 postmenopausal women, following parallel-group design with two groups. The duration of study treatment was 12 or 13 cycles of 28 days. A double-dummy technique was used to ensure blinding in the study. The investigational drugs were E2V/MPA triphasic and E2V/MPA biphasic (Diviseq and Divina, respectively; Orion Pharma). In study 2, a total of 341 subjects were randomly allocated by computer into two parallel groups receiving either E2V/MPA or estradiol/norethisterone acetate triphasic (E2/NETA, Trisequens; Novo Nordisk A/S) for 12-13 cycles. The study was an open, clinical phase III trial with a randomized, parallel-group design. Endometrial biopsies combined with transvaginal ultrasound were undertaken before and at the end of treatment during the progestogen phase. Bleeding patterns and symptom control were assessed throughout both studies.

RESULTS

E2V/MPA triphasic was found to have similar endometrial effects and bleeding patterns to those with E2V/MPA biphasic and E2/NETA triphasic. Climacteric symptoms were relieved as quickly and effectively as with the two comparator treatments. No adverse drug reactions specific to E2V/MPA triphasic were observed. At the end of the study, the proportions of secretory samples were 67.1% for the combined E2V/MPA triphasic groups, 65.6% for the E2V/MPA biphasic group and 71.6% for the E2/NETA triphasic group. One case of hyperplasia occurred in the E2V/MPA triphasic group. Thus the incidence of hyperplasia for the combined groups was 0.33%.

CONCLUSIONS

The triphasic E2V/MPA regimen was well tolerated and produced endometrial effects similar to those of the two comparators. Extending estrogen during the so-called treatment-free week with a lower dose of estradiol was effective in controlling vasomotor symptoms.

Perimenopausal knowledge of mid-life women in northern Taiwan

BACKGROUND

This work has been carried out keeping in view that although knowledge related to perimenopause is an important health issue for women worldwide, little information is known about mid-life Taiwanese women's knowledge of perimenopause.

OBJECTIVE

The aim of this paper was to explore the level of perimenopausal knowledge of mid-life women in northern Taiwan, to describe the relationship between demographic factors and women's knowledge, and to identify what information health providers need to offer them.

DESIGN

A cross-sectional descriptive survey was conducted.

METHOD

The Perimenopausal Knowledge Questionnaire was used to collect data. The study was carried out in August 2000 to September 2001. A convenience sample was recruited from traditional Chinese medicine clinics, gynecology clinics and communities in northern Taipei.

RESULTS

Our findings indicated that the overall mean correct answer weighted Perimenopausal Knowledge score of these mid-life women was 46.31. The rank of weighted scores from highest to lowest was: (1) self-care during perimenopause, (2) the perception of perimenopause, (3) knowledge related to hormone replacement therapy and (4) body changes associated with the declined oestrogen in perimenopause. Only educational level was significantly associated with Perimenopause Knowledge level (P < 0.01). Less than 20% (n = 353) of the women answered the items that measured self-management of symptoms related to perimenopause correctly. Less than 1.4% of the women knew that taking hormone replacement therapy required a physician's prescription and subsequent regular health check-ups.

CONCLUSION

Participants lacked adequate knowledge about perimenopause. RELEVANCE TO CLINICAL PRACTICES: Health providers need to provide factual information about the normal body changes of perimenopause, self-management of perimenopausal disturbances and appropriate use of hormone replacement therapy.

[Survey of health status and healthcare service demand of perimenopausal women in Guangdong]

OBJECTIVE

To understand the health status and healthcare service demand of perimenopausal women in Guangdong Province so as to explore the mode and methods for implementing climacteric and senectitude healthcare.

METHOD

Using the method of stratified and cluster sampling and according to the geographical features of Guangdong Province, we selected 4 500 perimenopausal women aged 40-65 years from 5 relatively small cities (representatives of the urban areas) and 4 counties (representatives of the rural areas) for this survey.

RESULTS

The average age of natural menopause was 48.6 years in this cohort of women, and was 48.9 years in women from the urban areas and 48.3 years in those from the rural areas. The total incidence of diseases was similar in the urban and rural areas (38.5% vs 39.5%), accounting for an incidence of 39% in the total subjects. The 6 most prevalent diseases were bone and joint disease (12.5%), hypertension (9.2%), myoma of the uterus (6.8%), gastric or duodenal ulcer (5.2%), cardiac disease (2.7%) and diabetes mellitus (2.2%). In bone and joint disease, knee joint disease and lumbar vertebrae disease were the commonest (34.3% vs 32.8%), and the incidence of bone fracture was 2.5%. Perimenopausal syndrome had a prevalence rate of 68.1%, and the most distressful symptoms were sleeplessness, muscular, bone and joint pain, fidgety, dizziness, of which 86.8% were mental symptoms and 86.0% body symptoms. Women(71.2%) with perimenopausal symptoms received no medical treatment, and only 20.5% had ever sought medical care in the department of obstetrics and gynecology, often taking traditional Chinese medicines (53.9%). Only 1.4% of the symptomatic women received hormone therapy, the rate varied from 1.0% in the rural areas to 1.8% in the urban areas.

CONCLUSION

Perimenopausal syndrome and its related diseases severely affect the physical and mental health of perimenopausal women, who demand extensive healthcare services.

Women's conditions occurring in men: breast cancer, osteoporosis, male menopause, and eating disorders

Each of the four disorders discussed in this article emphasizes its significance in the morbidity and mortality of men. Recent research has improved the ability to identify many of the key risk factors that could predispose men to breast cancer, osteoporosis, male menopause, and eating disorders. There is a significant need for further research into each of these conditions, as most studies have been conducted on women. The myths that these disorders are just a feminist issue can be ignored no longer. Nurses are in a prime position to help men identify and analyze their risks and help them select appropriate prevention and screening strategies to improve their knowledge and quality of life.

Role of the nonhuman primate for research related to women's health

This overview of the current status of medical problems that affect women is related to current studies on pathophysiology and therapeutic interventions using nonhuman primates to demonstrate the utility of the primate model for the study of disease processes in women. The current medical literature on women's health is compared with the literature on nonhuman primate research. The findings reviewed in the articles of ILAR Journal Volume 45 Issue 2 of 2004 are evaluated in the context of the scope and problems associated with disease entities in women. Nonhuman primate research with known information regarding women's disease is discussed, and the utility of the animal model for the study of human disease is highlighted, based on its significant relevance due to similarities of nonhuman primate and human subjects' physiology, metabolism, and responses to therapeutic interventions. Additional advantages of the animal model include the ability to control the experimental environment and the capacity to perform chronic study procedures. These findings allow us to utilize the nonhuman primate as the most relevant model in the animal world for the study of human disease processes.

Low-dose transdermal estradiol for symptomatic perimenopause

OBJECTIVE

To determine whether low-dose transdermal estrogen therapy is associated with a reduction in vasomotor symptoms in women who continue to have menstrual cycles.

DESIGN

An open-label, observational evaluation conducted over 12 months in 22 consecutive perimenopausal women with vasomotor symptoms.

RESULTS

Improvement in vasomotor symptoms was reported by 16 (73%) of women evaluated. Of responders, 11 characterized symptom relief as complete and 6 as moderate. Fifteen (68%) of the women remained on transdermal estrogen at 12 months. No adverse health-related events were attributed to estrogen therapy.

CONCLUSION

Low-dose transdermal estrogen is well tolerated and was associated with a reduction in complaints of vasomotor symptoms before menopause. The steady-state pharmacokinetics of transdermal delivery of unopposed estrogen may be advantageous in a population sensitive to fluctuations in circulating hormone levels.

Urinary beta-FSH subunit concentrations in perimenopausal and postmenopausal women: a biomarker for ovarian reserve

OBJECTIVE

The purpose of this study was to develop an integrative assessment of pituitary follicle-stimulating hormone (FSH) secretion and to validate these measurements in a population of perimenopausal (PERI) and postmenopausal (POST) women.

DESIGN

In this cross-sectional study, 170 POST and 20 PERI women collected first-void morning urine samples and had a single blood sample drawn on the same day. For comparison, 11 midreproductive-aged women had urine samples collected for one menstrual cycle. In addition, one 48.5-year-old woman collected daily urine samples for 4 consecutive years during her menopausal transition. Urine samples were assayed for estrone glucuronide (E1G) and pregnanediol-3-glucuronide (PdG) and were normalized to creatinine. An ELISA assay was developed for measurement of the free beta-FSH subunit in urine.

RESULTS

Mean age (+/- SD) of the PERI and POST women were 48.1 +/- 3.0 and 52.8 +/- 4.1 years, respectively. Mean serum FSH levels were 9.5 +/- 5.8 and 79.3 +/- 32 IU/L (P < 0.001) in the PERI and POST women. Mean urinary beta-FSH/Cr for the PERI were 1.8 +/- 1.2 ng/mg; for the POST, 9.3 +/- 4.5 ng/mg (P < 0.001). Mean estradiol, E1G/Cr, and PdG/Cr levels were also significantly different between the two groups. There was a high correlation between serum FSH and urinary beta-FSH/Cr for the PERI (r = 0.584, P = 0.007) and POST (r = 0.54, P < 0.001), with minimal overlap in the urinary beta-FSH/Cr levels between the PERI and POST groups. A significant correlation between PdG/Cr and urinary beta-FSH/Cr was observed for POST (r = 0.581, P = 0.002). No correlation was seen between urinary beta-FSH/Cr and E1G/Cr or estradiol levels. In the perimenopausal participant, who collected 4 years of daily urine samples, urinary beta-FSH/Cr levels progressively increased during the follicular phase and, by the fourth year, there were persistent, almost tonically high elevations of beta-FSH/Cr in the urine.

CONCLUSIONS

Urinary beta-FSH subunit measurements are a useful marker for monitoring ovarian function during the menopausal transition. Urinary free beta-FSH subunit concentrations reflect pituitary FSH secretion and serve as a biomarker for ovarian reserve.

Negotiating the maze: the meaning of perimenopause

What does it mean for a woman to experience perimenopause? Some women pass through perimenopause with relative ease while others report hot flashes and multiple disruptive symptoms. The physiological, psychological, and social variables that influence women during the change of life have not been fully examined. Using a phenomenological method of inquiry, this study explored the reflective, lived experiences of 3 perimenopausal women. Interpretation of the data revealed five explanatory themes: (1) Unpredictable Symptoms; (2) Lack of Information; (3) Influence of Others; (4) Fear of Growing Old; and (5) Making the Transition. The results of this study may be obtained from the author: dbfnp@yahoo.com.

Sleep characteristics of menopausal insomnia: a polysomnographic study

Although menopausal insomnia is of clinical significance, the essential features of this form of disrupted sleep are poorly understood. The aim of the present study was to identify the sleep characteristics of menopausal insomnia by using overnight polysomnography (PSG). Twenty-one subjects with menopausal insomnia (MI) and 13 sex- and age-matched normal control (NC) subjects without sleep complaints took part in the present study. All MI and NC subjects underwent PSG on two consecutive nights. In comparison with NC, MI subjects had non-specific findings such as significantly shorter total sleep time, longer sleep latency, higher wake time after sleep onset, and lower sleep efficiency. As for rapid eye movement (REM) sleep variables, MI subjects had significantly shorter total REM sleep time, fewer numbers of REM sleep periods, longer REM latency, and higher REM density than did the NC subjects. As for the time course of REM density, REM density during the first 3 h period of nocturnal sleep was significantly higher for MI than for NC subjects. Unlike NC subjects, REM density for MI subjects did not tend to rise progressively during nocturnal sleep. The MI subjects had objective evidence of disrupted sleep and the most striking characteristics of this dysfunction were observed in REM sleep variables. The sleep characteristics of MI subjects were found to differ in REM sleep variables from those of patients with major depression (except for REM density). Menopausal insomnia patients appear to be similar to patients with generalized anxiety disorder accompanied by severe sleep disruption. These data lend support to the clinical distinction between menopausal insomnia and insomnia associated with major psychiatric disorders.

Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging

OBJECTIVES

To To compare testosterone undecanoate versus propionyl-L-carnitine plus acetyl-L-carnitine and placebo in the treatment of male aging symptoms.

METHODS

A total of 120 patients were randomized into three groups. The mean patient age was 66 years (range 60 to 74). Group 1 was given testosterone undecanoate 160 mg/day, the second group was given propionyl-L-carnitine 2 g/day plus acetyl-L-carnitine 2 g/day. The third group was given a placebo (starch). Drugs and placebo were given for 6 months. The assessed variables were total prostate-specific antigen, prostate volume, peak systolic velocity, end-diastolic velocity, resistive index of cavernosal penile arteries, nocturnal penile tumescence, total and free testosterone, prolactin, luteinizing hormone, International Index of Erectile Function score, Depression Melancholia Scale score, fatigue scale score, and incidence of side effects. The assessment was performed at intervals before, during, and after therapy.

RESULTS

Testosterone and carnitines significantly improved the peak systolic velocity, end-diastolic velocity, resistive index, nocturnal penile tumescence, International Index of Erectile Function score, Depression Melancholia Scale score, and fatigue scale score. Carnitines proved significantly more active than testosterone in improving nocturnal penile tumescence and International Index of Erectile Function score. Testosterone significantly increased the prostate volume and free and total testosterone levels and significantly lowered serum luteinizing hormone; carnitines did not. No drug significantly modified prostate-specific antigen or prolactin. Carnitines and testosterone proved effective for as long as they were administered, with suspension provoking a reversal to baseline values. Only the group 1 prostate volume proved significantly greater than baseline 6 months after testosterone suspension. Placebo administration proved ineffective. Negligible side effects emerged.

CONCLUSIONS

Testosterone and, especially, carnitines proved to be active drugs for the therapy of symptoms associated with male aging.

Menstrual bleeding patterns in pre- and perimenopausal women: a population-based prospective diary study

BACKGROUND

To investigate natural menstrual bleeding patterns in pre- and perimenopausal women, a prospective observational population study was carried out.

METHODS

A total of 1616 (80.8%) of a population-based sample of 2000 Danish women aged 45-54 years answered an initial questionnaire. Of 1059 women with natural gynecological functions, 951 (89.8%) completed 1 year of daily recording of bleeding. Of these women, 592 were pre- or perimenopausal and were included in this study.

MAIN OUTCOME MEASURES

Length and heaviness of bleeding episodes, including frequency of spotting, flooding and prolonged bleeding, according to regularity of cycles.

RESULTS

The proportion of women with irregular cycles increased from 58.3% at age 45-46 years to 100% at age 53-54 years (P < 0.001). Irregularity of cycles was accompanied by increased variation in both length and subjective assessment of heaviness of bleeding episodes in the individual woman and between women (P < 0.001). Episodes of spotting (P < 0.001) and prolonged bleeding (10 days or more) (P < 0.001) were more common in women with irregular cycles. Subjective assessment of heaviness of bleeding episodes, however, was higher in women with regular cycles (P < 0.001). One or more episodes of flooding were recorded by 24.0% of all women irrespective of regularity of cycles (P = 0.40) but more frequently in younger women (P < 0.001).

CONCLUSIONS

Irregularity of cycle lengths at the end of the fertile period is common, and is accompanied by an increased inter- and intraindividual variation in the length and heaviness of bleeding episodes, including increased frequency of prolonged bleeding and spotting.

Andropause: endocrinology, erectile dysfunction, and prostate pathophysiology

This review summarizes major biological aspects of andrology of andropause, deficiency in androgens/growth hormones, and molecular parameters; erectile dysfunction (ED), the use of malleable, mechanical, inflatable devices as well as the application of Viagra (Sildenafil), alprotadil (Caverject), Yohimbine, and other drugs not yet approved by FDA, such as Papaverine, phentolamine (Vasomax), and apormorphine (Uprima); osteopenia/osteoporosis: testosterone/osteoporesis; supplementation during andropause: administration of andiogens, possible risk factors of androgens, calcium supplement and muscle mass; prostate pathophysiology: consequences of prostatectomy, prostate cancer, benign prostatic hyperplasia (BPH), hormone-dependent cancers; bladder and urethral dysfunction: neurological parameter, urodynamics technology; models on aging in male animals: comparative physiology of prostate of laboratory animals/farm animals; future research: functional anatomy of male reproductive organs, pharmacokinetics of osteoporosis, endocrinology/neuroendocrinology/chromosome anomalies supplementation during andropause, experimental animal models and future multicenter multidisciplinary research.

Perimenopause: an update

The field of perimenopause research is advancing our understanding of the physiological changes related to the menopausal transition and approaches to managing symptoms and preventing disease of advanced age. The impact of the perimenopause on women's health will become evident with the aging of the population.

Relationship between soft tissue body composition and bone mass in perimenopausal women

OBJECTIVES

Perimenopause, the transition into menopause, marks the beginning of accelerated bone loss, contributing to the development of osteoporosis, a major public health problem. This perimenopausal transition has also been associated with a decrease in body lean mass, an increase in fat mass, and an increase in body weight. How these changes in fat mass and lean mass may influence bone mineral density (BMD) is currently unknown. The purpose of this study is to determine the independent effect and relative contribution of lean mass and fat mass to BMD in perimenopausal women.

MATERIAL AND METHODS

The sample consisted of 43 sedentary perimenopausal women (age: mean = 49.6; S.D. = 3.2) with an intact uterus and ovaries, participating in a study of exercise and perimenopausal symptoms. Total body BMD, regional BMD, and soft tissue body composition were measured by dual-energy X-ray absorptiometry. Other measures including age, height, weight, and serum FSH and E2 were also obtained.

RESULTS

Findings revealed that 14% of these perimenopausal women had low bone mass (osteopenia) in the lumbar spine and/or the femoral neck. Overall body fat mass and lean mass had positive relationships with BMD of lumber spine and the femur. However, using multiple regression analyses, only lean mass and ethnicity remained significant predictors for BMD of the femoral neck (r2 = 45%) with lean mass explaining more variance than ethnicity. Lean mass was the sole predictor of total proximal femur BMD explaining 38% of the variance. Fat mass was not a significant predictor of BMD at any skeleton site.

CONCLUSIONS

These findings suggest that body lean mass, not fat mass, is a significant contributor to femoral BMD in perimenopausal women.

Quantitative ultrasound (QUS) of bone in the management of postmenopausal women

OBJECTIVES

Postmenopausal osteoporosis is becoming a major problem for healthcare institutions as it has a growing social and economic impact. The incidence of osteoporotic fractures is constantly increasing due to the increase in life expectancy. The gynaecologist plays an important role in establishing a "biological zero" in each perimenopausal patient, and controlling the rate of bone loss during postmenopausal period.

RESULTS

Dual energy X-ray absorptiometry (DXA) has been widely used for the diagnosis and management of osteoporosis and represents a strong risk factor for fractures, but it presents several limitations with regards to diagnosis, treatment follow-up and differential diagnosis of secondary osteoporosis. In these last years quantitative ultrasound (QUS) technique has been introduced for the evaluation of bone status in postmenopausal women and several in vitro and clinical studies have demonstrated the reliability of the examination in terms of: reproducibility, evaluation of fracture risk, treatment follow-up, differential diagnosis. QUS has proven to be equally capable in the prediction of future osteoporosis related fractures in comparison to DXA. Large-scale cross-sectional and longitudinal studies have demonstrated the applicability of QUS in screening the female population during the climacteric period. QUS technique seems to be very efficient in identifying "fast losers", identifying subjects at risk for osteoporosis requiring second-level investigation (DXA, X-ray), diagnosing secondary osteoporosis.

CONCLUSION

If QUS is used in a systematic and rational manner in clinical practice, it is a valid technique for the prevention of osteoporosis in postmenopausal women.

Perimenopausal conception

Fertility, defined as the ability to achieve a pregnancy, declines gradually over the woman's lifespan. Although this decline seems to begin from the age of 30 years, it is more obvious between 35 and 40 and increases dramatically thereafter. The age of 41 is considered to be the point when fertility stops and sterility starts. The actual menopause occurs approximately 10 years after the substantial loss of conception potential. Thus, the biological rather than the chronological age of the woman can predict more accurately her fertility potential. This decline in female reproductive potential correlates with ovarian factors, although a slight contribution from the uterus itself and from the neuroendocrine axis cannot be excluded. The ovarian reserve decreases with advancing age, while a parallel decrease in the quality of the oocytes is present, as indicated by the increased incidence of oocyte aneuploidy. The endocrine function of the ovary also declines with age, the later becoming unable to sustain its normal function in the neuroendocrine axis. Additionally, the role of the various endometrial factors remains controversial. On the other hand, exposure to toxic factors and the increased prevalence of infertility-related diseases like endometriosis and PID, may also contribute. Spontaneous conception rates are minimal in perimenopausal women, mainly due to a qualitative and quantitative loss of female gametes. In the rare case of spontaneous conception achievement, complications are more likely. The application of classic ovulation induction and IVF may serve some selected cases, where the woman's ovarian biological age does not correspond to her chronological one. However, the implantation, clinical pregnancy, and live birth rates in women of advanced age undergoing IVF treatment, show very poor results. On the other hand, preimplantation genetic diagnosis is an accurate diagnostic tool for exclusion of genetically deficient embryos prior to embryo transfer. Oocyte donation seems to be the most reliable option of the perimenopausal woman, since the cumulative birth rates after four treatment cycles is approximately 80%. Cryopreservation of ovarian tissue may be an alternative in nulliparas women <40 years of age who want to have children in the future or women with the same desire who, unfortunately, have had pelvic radiotherapy, chemotherapy, oophorectomy, or premature menopause. This technique has given encouraging results in animals, but has not achieved pregnancies in humans. In the future, the use of drugs to block oocyte depletion as well as recent techniques, such as cytoplasmic or germinal vesicle transfer, will be more widely tested and may offer an option to the perimenopausal woman who wishes to conceive.

Effects of isoflavone supplements on bone metabolic markers and climacteric symptoms in Japanese women

A double-blind, placebo-controlled crossover study on the effects of 40~mg/d isoflavone supplements was carried out by 58 climacteric Japanese women. A questionnaire and an interview concerning climacteric symptoms, health status, dietary and exercise habit, and medical history were carried out, and the physical check-up and biochemical tests including sex-hormone analysis were made at baseline and after 4 and 8 weeks of treatment. Urinary isoflavones were separately measured from the frozen samples. Isoflavone treatment did not cause any adverse effects on anthropometric measures or blood chemistry. Urinary deoxypyridinoline, a marker of bone resorption decreased significantly with isoflavone treatment. This tendency was remarkable among equol producers. Plasma osteocalcin and bone mineral density did not change by the four-weeks treatment. As for climacteric symptoms, hot flash decreased significantly. Systolic and diastolic blood pressure of hypertensive participants decreased significantly after isoflavone treatment compared with baseline and the placebo treatment. Isoflavone supplementation offers benefits to reduce effectively on bone resorption enhanced by menopause. The treatment also showed an improvement of climacteric hot flash and hypertension. Equol producers showed better results.