[The putative role and use of DHEA and its association with the hormone replacement therapy]

The putative role and use of dehydroepiandrosterone (DHEA) as replacement therapy for menopausal women has been under consideration during the latest years. DHEA is one of the main adrenal hormones that progressively reduces its plasmatic levels from the beginning of ageing. This phenomenon implies not only the reduction of the plasmatic androgens but also the decrease of a peculiar category of hormones, named neurosteroids, in particular one: allopregnanolone. This review aims to elucidate the peculiar aspects of DHEA administration and its putative use as substitutive/integrative hormonal treatment alone or in combination with the traditional hormone replacement therapy.

Acetyl-L-carnitine (ALC) administration positively affects reproductive axis in hypogonadotropic women with functional hypothalamic amenorrhea

BACKGROUND

Hypothalamic amenorrhea (HA) is characterized by neuroendocrine impairment that, in turn, negatively modulates endocrine function, mainly within the reproductive axis. HA presents with hypo-LH, hypoestrogenism and, until now, a definite therapeutic strategy has not yet been found. The aim of the following study was to test the efficacy of acetyl-L-carnitine (ALC) administration in HA-affected subjects.

POPULATION

Twenty-four patients affected by stress-induced HA were divided into two groups according to LH plasma levels: group A, hypo-LH (LH≤3 mIU/ml; no.=16), and group B, normo-LH (LH>3 mIU/ml; no.=8), were treated with ALC (1 g/day, per os) for 16 weeks.

DESIGN

Patients underwent baseline hormonal assessment, pulsatility test (for LH and FSH), naloxone test (for LH, FSH and cortisol) both before and after 16 weeks of treatment.

RESULTS

Under ALC administration hypo-LH patients showed a significant increase in LH plasma levels (from 1.4±0.3 to 3.1±0.5 mIU/ml, p<0.01) and in LH pulse amplitude (p<0.001). No changes were observed in the normo-LH group. LH response to naloxone was restored under ALC therapy. Maximal LH response and area under the curve under naloxone were significantly increased (p<0.05 and p<0.01, respectively). No changes were observed in the normo-LH patients.

CONCLUSIONS

Our data support the hypothesis of a specific role of ALC on counteracting the stress-induced abnormalities in hypo-LH patients affected by hypothalamic amenorrhea.

[Effects of Klamath Algae extract on psychological disorders and depression in menopausal women: a pilot study]

AIM

Menopause transition is able to induce a significant change in the quality of life of women and a growing demand for alternative treatments to hormonal therapy of the psychological and somatic/vasomotor symptoms related to menopausal transition has been observed in these last years. In this study we aimed to investigate the effect of a two-month supplementation period with the Klamath algae extract Klamin® on the general and psychological well-being of a group of 30 menopausal women, free from any hormonal therapy.

METHODS

Patients were randomly subdivided in 2 groups (15 patients each) and each of them was treated with Algae Klamath extract (Klamin®, Nutrigea, Urbino, Italy) (1600 g/day) or with placebo (vanilla tablets) for 8 weeks. Patients were evaluated both for the hormonal and psychological profiles (Symptom Rating Scale - Italian version [SRT] and Zung Self-Rating Scale) before and after the treatment interval.

RESULTS

Both groups of patients were similar in baseline conditions but significant changes were observed after the treatment interval in the group administered with Algae Klamath extracts. Though no hormonal changes occurred after the treatment interval in both groups, only patients under Klamin administration showed both SRT and Zung scales significantly improved, thus reporting a consistent change in their quality of life, for mood, anxiety and depressive attitude.

CONCLUSION

Since the Klamath extract did not show steroid-like effects on the hormonal parameters, it could be proposed as valid integration for those women seeking for alternative treatment to hormonal therapy so that to overcome many of the menopausal symptoms.

Hypothalamic amenorrhea: from diagnosis to therapeutical approach

Among secondary amenorrheas, hypothalamic amenorrhea (HA) is the one with no evidence of endocrine/systemic causal factors. HA is mainly related to various stressors affecting neuroendocrine control of the reproductive axis. In clinical practice, HA is mainly associated with metabolic, physical, or psychological stress. Stress is the adaptive response of our body through all its homeostatic systems, to external and/or internal stimuli that activate specific and nonspecific physiological pathways. HA occurs generally after severe stressed conditions/situations such as dieting, heavy training, or intense emotional events, all situations that can induce amenorrhea with or without body weight loss and HA is a secondary amenorrhea with a diagnosis of exclusion. In fact, the diagnosis is essentially based on a good anamnestic investigation. It has to be investigated using the clinical history of the patient: occurrence of menarche, menstrual cyclicity, time and modality of amenorrhea, and it has to be excluded any endocrine disease or any metabolic (i.e., diabetes) and systemic disorders. It is necessary to identify any stressed situation induced by loss, family or working problems, weight loss or eating disorders, or physical training or agonist activity. Peculiar, though not specific, endocrine investigations might be proposed but no absolute parameter can be proposed since HA is greatly dependent from individual response to stressors and/or the adaptive response to stress. This chapter aims to give insights into diagnosis and putative therapeutic strategies.