Long-term effects of a combination of isoflavones, agnus castus and magnolia extracts on climacteric symptoms and cardiometabolic risk profile in postmenopausal women

OBJECTIVE

To evaluate the long-term effects of a combination of isoflavones, agnus castus and magnolia extracts (combined isoflavone compound [CIC]) on climacteric symptoms and cardiometabolic risk in symptomatic postmenopausal women.

METHODS

This interventional, prospective study evaluated climacteric symptoms, mood and sleep disorders using the 21-item Greene Climacteric Scale (GCS) and 7-item Insomnia Severity Index (ISI) questionnaires; and cardiovascular, metabolic and thrombotic risk markers at baseline (T0) and after 12 months of CIC treatment (T1).

RESULTS

In healthy postmenopausal women (N = 71), 12-month CIC treatment significantly reduced patient-reported vasomotor symptoms (100% vs. 17%), mood disorders (67% vs. 25%) and sleep disorders (89% vs. 19%%) (all p < .001) compared with baseline; and significantly improved GCS psychological, somatic, and vasomotor domain scores and ISI sleep disturbance scores (all p < .05). CIC significantly reduced systolic (p = .022) and diastolic blood pressure (p < .001), and heart rate (p < .001); glucose concentrations (p = .018), HOMA index (p = .013), and ALT (p = .035), homocysteine (p = .005) and NT-proBNP (p = .003) levels.

CONCLUSIONS

Long-term CIC therapy improved vasomotor symptoms, mood disorders, sleep disorders, hemodynamic measurements and cardiometabolic risk markers in healthy postmenopausal women.

CLINICALTRIALS.GOV IDENTIFIER

NCT03699150.

The effect of diet and exercise on climacteric symptomatology

BACKGROUND AND OBJECTIVES

This study aimed to explore the effects of health education, diet and exercise interventions on the climacteric symptoms of perimenopausal women.

METHODS AND STUDY DESIGN

A total of 78 perimenopausal women in a gynaecological clinic from June 2018 to August 2018 were recruited and divided randomly into the following three groups: A (centralised education alone), B (health education + per-sonalised diet guidance) and C (health education + personalised diet guidance + intensive resistance exercise). The changes in diet score, exercise habits and climacteric symptoms were observed after 3 months.

RESULTS

There was no difference between groups in food intake scores and total scores before the interventions. After the interventions, the total diet score of group C was higher than in groups A and B, and the red meat score decreased significantly (p<0.05). After the interventions, the number of resistance exercises per week in group B increased significantly. The number of aerobic exercises and resistance exercises per week in group C also increased significantly (p<0.05). The total score for climacteric symptoms in the three groups decreased significantly before and after the interventions (p<0.05), and the scores for insomnia and sexual disorders in group A decreased significantly (p<0.01). In group B, there was a significant effect on the improvement of moderate and severe climacteric symptoms (p<0.01), and the scores for seven other common symptoms (i.e. hot flushes, sweating, irritability, depression, suspicion, fatigue, joint pain, muscle pain, palpitations and sexual disorders) decreased significantly (p<0.05).

CONCLUSIONS

Centralised health education, personalised dietary guidance and intensive resistance exercise improved the menopausal symptoms experienced by peri-menopausal women; the most indicative changes of this improvement were obtained using combined health education and personalised dietary guidance.

Effects of peripheral oxytocin administration on body weight, food intake, adipocytes, and biochemical parameters in peri- and postmenopausal female rats

Recent studies have revealed that the administration of oxytocin has beneficial effects on the regulation of body weight, food intake, and metabolic functions, especially in obese individuals. Obesity is common in women after the menopause and drives many components of metabolic syndrome. Weight gain in menopausal women has been frequently reported. Although obesity and associated metabolic disorders are frequently observed in peri- and postmenopausal women, there are few medical interventions for these conditions. In this study, we evaluated the effects of chronic oxytocin administration on appetite, body weight, and fat mass in peri- and postmenopausal female rats. Sixteen naturally premenopausal or menopausal rats were intraperitoneally injected with oxytocin (1,000 μg/day) for 12 days. The daily changes in their body weight and food intake were measured at the same time as the oxytocin and vehicle injections. Intraperitoneally administering oxytocin for 12 days significantly reduced food intake, body weight, and visceral adipocyte size. In addition, oxytocin administration caused reductions in serum triglyceride and low-density lipoprotein-cholesterol levels, while it did not disturb hepatic or renal functions or locomotor activity. This is the first study to show the effects of oxytocin on the metabolic and feeding functions of peri- and postmenopausal female rats. Oxytocin might be a useful treatment for metabolic disorders caused by the menopause or aging.

Validity and precision of the International Physical Activity Questionnaire for climacteric women using computational intelligence techniques

This study aimed to evaluate the validity and precision of the International Physical Activity Questionnaire (IPAQ) for climacteric women using computational intelligence techniques. The instrument was applied to 873 women aged between 40 and 65 years. Considering the proposal to regroup the set of data related to the level of physical activity of climacteric women using the IPAQ, we used 2 algorithms: Kohonen and k-means, and, to evaluate the validity of these clusters, 3 indexes were used: Silhouette, PBM and Dunn. The questionnaire was tested for validity (factor analysis) and precision (Cronbach's alpha). The Random Forests technique was used to assess the importance of the variables that make up the IPAQ. To classify these variables, we used 3 algorithms: Suport Vector Machine, Artificial Neural Network and Decision Tree. The results of the tests to evaluate the clusters suggested that what is recommended for IPAQ, when applied to climacteric women, is to categorize the results into two groups. The factor analysis resulted in three factors, with factor 1 being composed of variables 3 to 6; factor 2 for variables 7 and 8; and factor 3 for variables 1 and 2. Regarding the reliability estimate, the results of the standardized Cronbach's alpha test showed values between 0.63 to 0.85, being considered acceptable for the construction of the construct. In the test of importance of the variables that make up the instrument, the results showed that variables 1 and 8 presented a lesser degree of importance and by the analysis of Accuracy, Recall, Precision and area under the ROC curve, there was no variation when the results were analyzed with all IPAQ variables but variables 1 and 8. Through this analysis, we concluded that the IPAQ, short version, has adequate measurement properties for the investigated population.

Elevated leptin levels in healthy climacteric women from Northeastern Brazil: an effect of age or adiposity?

OBJECTIVE

Climacterium is associated with elevated leptin levels and increased risk of cardiovascular disorders. Conflicting data diverge on whether high leptin levels in climacterium reflect increasing adipose mass or, at least partially, age-related hormonal changes. This study addresses this issue in women from a Brazilian state with a low human development index.

SUBJECTS AND METHODS

A case-control study was conducted, enrolling 136 women from the state of Maranhão, 52 (38.2%) climacteric and 84 (61.8%) non-climacteric. Biometric, biochemical, hormonal and immunological parameters were analyzed.

RESULTS

Climacteric women showed a moderately increased waist/hip ratio (0.894 versus 0.834, p < 0.05), sustained body mass index (27.46 versus 28.68, p > 0.05) increased leptin levels (9.59 versus 7.13, p < 0.05) and no evidence of metabolic syndrome. No other parameters were altered. The climacteric cohort didn't show significant body fat gains but displayed a typical age-related redistribution of adipose tissue. Even so, leptin levels were significantly elevated compared with non-climacteric women.

CONCLUSIONS

Altogether, these data support the hypothesis that leptin is elevated, at least partially, as a function of age and climacterium and is not necessarily correlated with metabolic dysfunction and systemic inflammation. Further studies are needed to evaluate the impact of higher leptin levels on postmenopausal women. Arch Endocrinol Metab. 2020;64(3):276-81.

Hormonal therapy in menopausal transition: implications for improvement of health-related quality of life

The study aim was to assess scores of the Menopause Rating Scale (MRS) among women who use and desire to use hormonal therapy (HT), as well as to evaluate factors contributing to HT use and desire to use HT among women in menopausal transition. A total of 513 mid-aged women participated in the study. Data were collected using socio-demographic questionnaire, MRS and Beck Depression Inventory. The prevalence of current HT use was 9.7%, while 4.5% of women who did not use HT expressed a desire to start using HT. The MRS cutoff score for HT use was 10.5 and 11.5 among those who desire to use HT. Living in the central city districts, having lower body mass index, younger age at menopause, more gynecological illnesses, and worse MRS were associated with HT use. Living in the central city districts, having fewer births, more gynecological and chronic illnesses and having more depressive symptoms were associated with the desire to use HT. Mid-aged women who perceive their quality of life as poor due to climacteric symptoms should be advised to consider HT to improve their health status and everyday functioning.

Effect of symptoms of climacteric syndrome, depression and insomnia on self-rated work ability in peri- and post-menopausal women in non-manual employment

OBJECTIVE

The aim of the study was evaluation of the relationship between severity of symptoms of climacteric syndrome, depressive disorders and sleep problems, and the self-rated work ability of peri-menopausal and post-menopausal women in non-manual employment.

MATERIAL AND METHODS

The study included 287 women aged 45-60 years, employed in various institutions as non-manual workers. Work Ability Index, Greene Climacteric Scale, Beck Depression Inventory, and Athens Insomnia Scale were used.

RESULTS

The examined peri-menopausal and post-menopausal women in non-manual employment obtained good work ability on the Work Ability Index. The severity of menopausal syndrome, according to the Greene Climacteric Scale, was moderate, placing the examined women between results for the general population of women and the pattern for menopausal women. Depressive disorders ranked between low mood and moderate depression. No depression was observed in 59% of the women, whereas moderate depression was observed in 39%, and severe depression in only 2%. Sleep disorders were on the border of normal range. As many as 46% of the women had no sleep problems, which was on the border of normal range in 36%. Only 19% of the examined women suffered from insomnia. Work ability correlated negatively with depression and insomnia severity, as well as with psychological and vasomotor symptoms of climacteric syndrome, but not to its somatic symptoms.

CONCLUSIONS

Preventing the occurrence and treatment of menopausal symptoms, sleep and mood disorders may contribute to maintaining the work ability of women in peri- and post-menopausal age.

Metabolic syndrome and sexual function in postmenopausal women

OBJECTIVE

The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women.

SUBJECTS AND METHODS

This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participant's sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data.

RESULTS

The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01).

CONCLUSION

We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.

Abdominal adiposity change in white and black midlife women: The study of women's health across the nation

OBJECTIVE

The principal objective of this investigation was to compare the naturalistic intra-abdominal adipose tissue (IAAT) change among black and white women during midlife.

METHODS

A cohort of 222 (56%) white and 171 (44%) black midlife women were investigated in the Fat Patterning Study at the Chicago site of the Study of Women's Health Across the Nation. The subjects' total body fat was assessed by dual-energy X-ray absorptiometry and IAAT by a planimetric computed tomography (at the level of L4 -L5 ) annually over up to 4 years.

RESULTS

The total body fat at initial evaluation was higher in black women (45.1% ± 8.2%) when compared with white women (41.3% ± 8.7%, P < 0.001) and did not significantly change over the longitudinal follow-up. No significant racial differences were found in the mean annualized gain of IAAT (4.4% ± 0.5%) in models adjusted for total body fat, initial IAAT, age, race, time and race interaction, physical activity, depressive symptoms, menopausal status, and menopausal hormone therapy.

CONCLUSIONS

During a naturalistic observation, black and white midlife women had similar abdominal fat gain adjusted for differences in baseline adiposity. These data inform future research aimed to prevent IAAT gain during the critical midlife period of rising cardiovascular risk.

Is it andropause?

In primary care practice, it is not unusual to encounter male patients in their 50s or older who report having loss of libido, erectile dysfunction, fatigue, and depression. Such signs and symptoms may signal an age-related decline in androgen levels, which commonly begins after age 40. However, psychologic problems and medical illness often confound the diagnosis. Drs Tan and Pu, who are currently conducting research on androgen deficiency, discuss the diagnostic difficulties of the physiologic phenomenon of andropause and offer a comprehensive approach to clinical assessment and laboratory evaluation.

Detection of Golden apples' climacteric peak by laser biospeckle measurements

In this paper, we report a study in which a laser biospeckle technique is used to detect the climacteric peak indicating the optimal ripeness of fruits. We monitor two batches of harvested Golden apples going through the ripening phase in low- and room-temperature environments, determine speckle parameters, and measure the emitted ethylene concentration using gas chromatography as reference method. Speckle results are then correlated to the emitted ethylene concentration by a principal component analysis. From a practical point of view, this approach allows us to validate biospeckle as a noninvasive and alternative method to respiration rate and ethylene production for climacteric peak detection as a ripening index.

Potential health benefits of continuous LNG-IUS combined with parenteral ERT for seamless menopausal transition and beyond--a commentary based on clinical experience

OBJECTIVE

To comment on the acceptability and potential health benefits of the continuous use of the levonorgestrel-releasing intrauterine system (LNG-IUS), combined with estrogen substitution, for seamless transition through the menopause, in women with climacteric symptoms.

DESIGN AND METHOD

Evaluation of the recent hormone replacement therapy literature and the acceptability of the combined parenteral estrogen and intrauterine LNG-IUS regimen in a group of approximately 100 women, above 48 years of age, using LNG-IUS for contraception, who developed climacteric symptoms requiring estrogen substitution.

MAIN OUTCOME MEASURES

acceptability and continued use of the method for the treatment of climacteric symptoms and for prevention.

RESULTS

The combination of intrauterine progestogen delivery to suppress the endometrium, in combination with systemic estrogen, is highly acceptable resulting in a high continuation of use due to the absence of side effects and erratic bleeding in the large majority of women.

CONCLUSION

The study suggests that parenteral estrogen replacement therapy combined with intrauterine progestogen delivery for endometrial suppression in the perimenopause is highly practical and beneficial, providing enhanced quality of life. There are strong arguments to categorize the regimen as probably the most effective, safest and best accepted route resulting in high patient compliance as well as potentially providing maximal benefits for peri- and postmenopausal women.

The "Aging Males' Symptoms" Scale (AMS): predictive value for lowered circulating androgens

BACKGROUND

Symptoms of the "male climacteric" are often at least in part referred to an age-dependent decline of serum androgen levels. Therefore, we evaluated the relationship of climacteric symptoms as assessed by the "Aging Males' Symptoms" (AMS) Questionnaire with circulating androgen levels.

METHODS

146 ambulatory men (age, 27-85 years) were surveyed with the AMS Questionnaire and sampled for serum values of total testosterone (tT) and sexual hormone binding globulin (SHBG). Free testosterone (fT) was calculated from tT and SHBG. A total AMS score ≥37 was considered pathological; the lower limits for tT and fT were set to 8 nmol/l and 180 pmol/l, respectively.

RESULTS

A significant deficit in tT and fT was shown in 25 (17.1%) and 34 (24.5%) men, respectively; the AMS Questionnaire showed pathological results for 66 (45.2%) men. In predicting a tT deficit, the AMS Questionnaire rendered a sensitivity of 76% and a specificity of 61.6%, only. However, multiple regression analysis revealed a significant correlation of lowered tT with a pathological somatovegetative and psychological AMS subscore (p = 0.042 and p = 0.01) and a correlation of lowered fT with a pathological sexual subscore (p = 0.039).

CONCLUSION

In predicting hypogonadism the AMS Questionnaire in total did not render a sufficient diagnostic efficiency.

Reproductive depression

Reproductive depression is the depression in women that is related to the hormonal changes of the menstrual cycle, pregnancy and the menopause and is manifested clinically as premenstrual depression, postnatal depression and climacteric depression. These three components occur in the same vulnerable women in that a woman with depression in the menopausal transition will usually have a history of premenstrual syndrome (PMS; premenstrual dysphoric disorder [PMDD]), would have been in a good mood during pregnancy and then develop postnatal depression. When the periods return the depression becomes cyclical as PMS. These three conditions are effectively treated with transdermal estrogens which should be the first-choice therapy rather than antidepressants. Estrogens can be used together with antidepressants. The critical time to prevent long-term mood problems is the correct treatment of postnatal depression. In women with low energy and libido, often a side effect of antidepressants, the addition of transdermal testosterone is useful. These women with reproductive depression are often progesterone/progestogen intolerant and a smaller dose or duration of progestogen is a necessary compromise. Alternatively a Mirena IUS or rarely a hysterectomy is required.

[Climacteric complaints?]

Three women are presented with climacteric bleeding problems, typical climacteric complaints and atypical climacteric complaints. The importance of a taking a careful case history is discussed. An overview of diagnostic and therapeutic options is presented.

Use of venlafaxine in psychiatric disorders and climacteric syndrome: is a therapeutic bridge?

OBJECTIVE

To verify the efficacy of the double-action mechanism of venlafaxine for depression and climacteric symptoms.

METHODS

A group of 20 postmenopausal women (age range 40-60 years) with diagnosis of major depressive disorder, generalized anxiety disorder and climacteric symptoms was enrolled. All participants received venlafaxine (75 mg/day) for 2 months. Clinical checkup and evaluation test were repeated every 2 weeks for 2 months of treatment.

RESULTS

Before treatment, the mean scores for the clinical evaluation scales (Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale) were 13.9 and 18.7, respectively (mild-moderate severity). The general level of psychopathology was not particularly high (Symptomatology Checklist-90, mean total 103), the most common psychopathological dimensions were depression and somatization. The sample suffered from mild climacteric syndrome (Kupperman Index Score, mean = 19.1). Clinical improvement was visible after 2 weeks of treatment and continued until the last checkup, 2 months after the start of treatment (final Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores: 5.1 and 6.3, respectively). Kupperman Index Scores at the end of the treatment period demonstrated complete resolution of the climacteric syndrome (mean score = 6.57).

CONCLUSION

Venlafaxine is efficacy in treating both psychiatric disorders and climacteric symptomatology.

Relationship between estrogen, vasomotor symptoms, and heart rate variability in climacteric women

The present study investigated resting cardiac autonomic function in Japanese climacteric women using heart rate variability (HRV) power spectral analysis to evaluate the relationship between HRV indices and estrogen, as well as the ability of each HRV index to predict vasomotor symptoms. Forty-five peri- and postmenopausal women completed a questionnaire about the presence of vasomotor symptoms (hot flashes, sweating). To analyze the relationship between HRV and hot flashes or sweating, we classified subjects into groups based on symptoms and combinations of symptoms: no hot flashes (H1), hot flashes (H2), non-sweating (S1), sweating (S2), neither hot flashes nor sweating (V1), either hot flashes or sweating (V2), and both hot flashes and sweating (V3). Values for total power and the low-frequency component of HRV were significantly lower in the H2 group than in H1 (p < 0.05); values for total power and the high-frequency and low-frequency components of HRV were significantly lower in group S2 than S1 (p < 0.05); and values for total power and the high-frequency and low-frequency component of HRV were significantly lower in groups V2 and V3 compared to V1 (p < 0.05). Clinical diagnosis of climacterium relies upon subjective complaints of patients. Our findings suggest that HRV indices may help to evaluate vasomotor symptoms.

Comparative study of climacteric symptoms in perimenopausal and postmenopausal women in Tabriz, Islamic Republic of Iran

The aim of this cross-sectional study was to describe menopausal symptoms in Iranian women in Tabriz, north-west Islamic Republic of Iran. A total of 200 women aged 45-55 years completed a Farsi version of the Greene climacteric scale. The mean total Greene scores for 20 items (1 item was excluded) were 29.34 (SD 9.84) for perimenopausal and 28.14 (SD 10.15)for postmenopausal women. Perimenopausal and postmenopausal women did not differ significantly in any of the subscales or individual items, except on 2 items: "difficulty in sleeping" and "parts of the body feeling numb or tingling". Comparisons with studies in other countries show that women in Tabriz suffer more menopausal symptoms than European woman.

[Official position of the Chilean Society of Climacteric on the management of climacteric women]

The health of many women is affected in the climacteric period, either by symptoms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most efficient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed according to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

A longitudinal population study of climacteric symptoms and their treatment in a random sample of Swedish women

OBJECTIVES

To assess, first, the prevalence and severity of symptoms associated with the climacteric period and their treatment and, second, the prevalence of exercise, smoking and body weight in a population-based sample of Swedish women.

MATERIAL AND METHODS

Prospective, longitudinal cohort study, initiated in 1992, in women aged 46, 50, 54, 58 and 62 years with a follow-up 6 years later. Information was obtained from the same women (n=3816) on both occasions using a postal questionnaire regarding sociodemographic variables, general and reproductive health, the occurrence of climacteric symptoms and their severity, and the use of hormone replacement therapy (HRT).

RESULTS

The prevalences of climacteric symptoms were as follows (1992/1998): vasomotor symptoms, 52%/62%; depression/irritability, 57%/65%; sleeping disturbances, 51%/69%; muscle/joint pain, 55%/70%; and loss of libido, 38%/57%. HRT with medium-potency estrogens was currently being used by 34% (1992: 14%), and 12% (1992: 8%) were using low-potency estrogens. The maximum prevalence of HRT (medium-potency estrogens) use was found in the 56-year-old group, at 46% (1992: 25% in the 54-year-old group). Body mass for the whole group had increased from 66.3 to 68.9 kg. Exercise was more frequent in all age groups in 1998 compared to 1992. There was a decrease in current smokers from 32 to 26% between the two periods. Compared with 1992, the women in all five birth cohorts considered themselves to be less healthy and quality of life had decreased for the whole group.

CONCLUSIONS

The prevalence of symptoms associated with the climacteric period and the use of HRT had increased markedly in this longitudinal study of the same women followed between 1992 and 1998. During the same period, smoking decreased, while body weight and exercise frequency increased.

EFFECTS OF AROMATHERAPY MASSAGE ON BLOOD PRESSURE AND LIPID PROFILE IN KOREAN CLIMACTERIC WOMEN

This study investigated the effects of aromatherapy massage on the lipid profile and blood pressure in Korean climacteric women. A wait-listed control group, pretest-posttest design was used. The subjects comprised 58 climacteric women: 30 in the experimental group and 28 in the control group. Aromatherapy massage using lavender, rose geranium, rose, and jasmine was given to the experimental group only. Each massage session lasted 30 minutes, and was performed once weekly for two 8-week periods with self abdominal daily massage at home. The intervention produced significant differences in the systolic blood pressure compare to pretreatment and significant differences in systolic and diastolic blood pressures at posttreatment between the two groups. These results suggest that aromatherapy massage may exert positive effects on blood pressure. However, more objective, clinical measures should be applied in a future study with a randomized placebo-controlled design.

Greene Climacteric Scale: norms in an Australian population in relation to age and menopausal status

OBJECTIVES

The aim of this study was two-fold: to assess climacteric symptoms and provide normative data for the Greene Climacteric Scale during the menopause transition, and to investigate the prevalence of climacteric symptoms in a representative sample of postmenopausal Australian women.

METHOD

A cohort of 500 premenopausal, perimenopausal and postmenopausal women aged 40-80 years participated in the Longitudinal Study of Ageing in Women (LAW study) at the Royal Brisbane and Women's Hospital, Brisbane, Australia. In year 1 of the study (2001), all participants completed the Greene Climacteric Scale and information regarding their menopausal status and the use of hormone therapy (HT) was obtained through a clinical interview with a qualified medical practitioner.

RESULTS

The 50-59-year age group achieved the highest scores on the vasomotor and the depression scales in comparison to other age groups. Significant differences were also evident on the vasomotor and the depression scales on the basis of menopausal status, especially in perimenopausal women. Approximately 10% of women in the 60-79-year age group continued to experience vasomotor symptoms.

CONCLUSION

Vasomotor symptoms, as assessed by the Greene Climacteric Scale, are common during the menopause transition and remain elevated for some years in a minority of older postmenopausal women. The norms presented in this study are appropriate for use in an Australian population.

Hormone replacement therapy diminishes hearing in peri-menopausal mice

We recently discovered that progestin in hormone replacement therapy (HRT) for post-menopausal women has detrimental effects on the ear and central auditory system [Guimaraes, P., Frisina, S.T., Mapes, F., Tadros, S.F., Frisina, D.R., Frisina, R.D., 2006. Progestin negatively affects hearing in aged women. Proc. Natl. Acad. Sci. - PNAS 103, 14246-14249]. To start determining the generality and neural bases of these human findings, the present study examined the effects of combination HRT (estrogen+progestin) and estrogen alone on hearing in peri-menopausal mice. Specifically, auditory brainstem responses (ABRs-sensitivity of the auditory system) and distortion-product otoacoustic emissions (DPOAEs-cochlear outer hair cell system) were employed. Middle age female CBA mice received either a time-release, subcutaneous implanted pellet of estrogen+progestin, estrogen alone, or placebo. Longitudinal comparisons of ABR threshold data obtained at 4 months of treatment revealed statistically significant declines in auditory sensitivity over time for the combined estrogen+progestin treatment group, with the estrogen only group revealing milder changes at 3, 6 and 32 kHz. DPOAE testing revealed statistically significant differences for the estrogen+progestin treatment group in the high and middle frequency ranges (15-29 and 30-45 kHz) after as early as 2 months of treatment (p<0.01 and p<0.001, respectively). Statistically significant changes were also seen at 4 months of treatment across all frequencies for the combined HRT group. These data suggest that estrogen+progestin HRT therapy of 4 months duration impairs outer hair cell functioning and overall auditory sensitivity. These findings indicate that estrogen+progestin HRT may actually accelerate age-related hearing loss, relative to estrogen monotherapy; findings that are consistent with the clinical hearing loss observed in aging women that have taken combination HRT.

Endocrine alterations in response to calorie restriction in humans

This review focuses on research involving calorie restriction (CR) in humans and the resulting changes observed in endocrine and neuroendocrine systems. Special emphasis is given to the clinical science studies designed to investigate the effects of controlled, high-quality, energy-restricted diets on both biomarkers of longevity and on the development of chronic diseases of human aging. Prolonged CR has been shown to extend both the median and maximal lifespan in a variety of lower species such as yeast, worms, fish, rats and mice. The biological mechanisms of this lifespan extension via CR are not fully elucidated, but possibly involve significant alterations in energy metabolism, oxidative damage, insulin sensitivity and functional changes in both neuroendocrine and autonomic nervous systems. Most of the difficulty in characterizing the systemic endocrine and neuroendocrine changes with aging and CR is due to the limited capability to collect large and multiple blood samples from small animals, which are usually shorter lived, and hence the most studied. Ongoing studies of prolonged CR in humans are now making it possible to analyze changes in the "biomarkers of aging" to unravel some of the mechanisms of its anti-aging phenomenon. With the incremental expansion of research endeavors in the area of energy restriction, data on the effects of CR in non-human primates and human subjects are becoming more accessible. Detailed analyses from controlled human trials involving long-term CR will allow investigators to link observed alterations from body composition and endocrine systems down to changes in molecular pathways and gene expression, with their possible effects on aging.

Testosterone replacement therapy in the climacteric: benefits beyond sexuality

Testosterone therapy during menopause has a wide range of benefits that reach beyond the realm of human sexuality. This is a consequence not only of the widespread distribution of androgen receptors in various extragonadal tissues but also of the conversion of androgens to estrogens in the tissues in which aromatase expression is present. For this reason, testosterone therapy during the climacteric years will not only supply androgens but will also stimulate estrogen production in tissues that express aromatase. Furthermore, the bioavailability of androgens to the tissues depends not only on the rate of their production by the postmenopausal ovaries and adrenals but also on the circulating levels of sex hormone-binding globulin (SHBG). Tibolone inhibits SHBG production in the liver, thus increasing free testosterone levels. The association of tibolone with testosterone as a form of androgen replacement therapy during the climacteric is discussed, as is the use of low-dose testosterone, tibolone or the association of both in perimenopausal patients with signs of androgen deficiency. Testosterone treatment has a boosting effect not only on human sexuality but also on the sensation of well-being, a stimulatory effect conferred by the increase in beta-endorphins.

[Somatopause: the present state-of-art]

Somatopause is defined as the decline in the biological activity of the growth hormone (GH)-insulin-growth factor-I (IGF-I) axis that occurs gradually in both sexes from young adulthood throughout life. Somatopause is postulated to contribute to human aging because aging-related changes in body composition, bone structure, physical performance, cardiovascular system functions, and increased morbidity and mortality resemble the clinical picture and complications of adult growth hormone deficiency. However, animal and some epidemiological studies failed to show that low production of GH and IGF-I is detrimental to survival and health quality. Moreover, despite clear benefits of GH and its secretagogues in patients with GH deficiency, clinical studies assessing the effects of their administration to otherwise healthy older persons have provided conflicting results. The purpose of this article is to review the present state of knowledge on the age-related changes in the GH-IGF-I axis activity and to discuss pros and cons of the use of GH and GH secretagogues in older subjects.

Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms

OBJECTIVE

In a previous study, the special extract ERr 731 of Rheum rhaponticum significantly reduced vasomotor and other menopausal symptoms associated with perimenopause. This trial was conducted to confirm the efficacy of ERr 731.

DESIGN

A multicenter, randomized, placebo-controlled, clinical trial with 112 perimenopausal women with menopausal symptoms receiving either 1 enteric-coated tablet of ERr 731 (n = 56) or placebo (n = 56) daily for 12 weeks. Primary outcome criterion for efficacy of ERr 731 compared to placebo was the change of the Menopause Rating Scale (MRS) total score from day 0 to day 84. Other efficacy assessments analyzed included the number and severity of hot flushes, individual symptoms of the MRS, treatment outcome, and various safety parameters.

RESULTS

By 12 weeks, ERr 731 caused a highly significant reduction of the MRS total score from 27.0 +/- 4.7 points to 12.4 +/- 5.3 points when compared to the placebo-induced decrease from 27.0 +/- 5.3 points to 24.0 +/- 6.2 points (P < .0001). A significant reduction in each individual MRS item score, in hot flushes and the hot flush weekly weighted score, together with a marked improvement in treatment outcome were also observed (P < .0001). These results confirm the efficacy of ERr 731 in alleviating menopausal symptoms in perimenopausal women. Fourteen adverse events were reported in total: 11 by 5 women receiving ERr 731 and 3 by 3 women receiving placebo. ERr 731 was well tolerated by the majority of the women.

CONCLUSION

ERr 731 was confirmed to be effective for the treatment of menopausal symptoms in perimenopause.

[Association between climacteric symptoms and quality of life]

BACKGROUND

Several scales have been developed for symptom and qualityof life evaluation in climacteric women. Utian quality of life scale (UQoL) as well as SUMEVA scale has been validated in climacteric women.

OBJECTIVE

to find the correlation between SUMEVA and UQoL scales, and to determine if SUMEVA scale can be used as a quality of life scale.

PATIENTS AND METHODS

100 climacteric women between 40 and 60 years old were studied. Both scales were applied, UQoL (23 items) and SUMEVA (22 items). Statistical analysis, descriptive statistics, was used and Pearson's correlation coefficient was calculated.

RESULTS

Age mean was 47.4 +/- 5.6 years and BMI 29.9 +/- 21.0. Score of UQoL scale was 68.2 +/- 13.0 and that of SUMEVA was 47.1 +/- 30.3. A significant negative correlation between both scales was found (-0.323, p < 0.001).

CONCLUSIONS

SUMEVA scale allows to indirectly evaluating quality of life in climacteric patients.

[Adrenopause]

The hypothalamic-pituitary-adrenal axis activity in the aging people is characterised by an unexplained reduction of dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) secretion while ACTH and cortisol production remains relatively unchanged. This decline in the biological activity of the zona reticularis, referred to as 'adrenopause', may contribute to the physiology of human aging. The reduced endogenous concentrations of DHEA and DHEAS found in advancing age have been correlated with a constellation of health problems. Because these steroids seem to play a role in the maintenance of immunity, musculoskeletal integrity, and cardiovascular health, age-associated declines in adrenal androgen production may lead to decreased immune function, osteoporosis, and atherosclerosis. Despite clear benefits of DHEA administration in patients with adrenal insufficiency, the results of DHEA supplementation in healthy euadrenal subjects are not so clear-cut. Studies assessing its action on sexual function, metabolism and cardiovascular functions have provided conflicting results. This paper summarises the present state of knowledge on the age-related changes in adrenal androgen production and discusses pros and cons of DHEA use in older people.

Evaluation of heart rate variability in trained and sedentary climacteric women

BACKGROUND

Changes in autonomic cardiac function are frequent during menopause, and various methods have been used to understand and minimize them.

OBJECTIVE

To study the interference of dynamic aerobic physical activity on heart rate variability (HRV) in climacteric women.

METHODS

Cross-sectional study that analyzed HRV in 15 menopausal women (mean age 56.8+/-4.9 years) who had participated in physical training (one-hour walks, 3 times a week) for at least two years (active group), and 15 menopausal women (mean age 56.5 +/- 3.7 years) who were sedentary (sedentary group). None of the volunteers received hormonal replacement therapy. HRV data were compared between the groups by means of the Mann Whitney U Test.

RESULTS

There were significant differences both in the frequency and time domains of the following variables of HRV (in medians) for the active e sedentary groups, respectively: total power (22,626.50 ms(2) and 4,432.10 ms(2)), low frequency component (741.20 ms(2) and 131.70 ms(2)), high frequency component (668.90 ms(2) and 131.70 ms(2)), standard deviations of RR intervals (51.60 ms and 22.50 ms), square root of the sum of squares of differences between the normal RR intervals (35.30 ms and 15.90 ms), and percentage of normal adjacent RR intervals greater than 50 ms (6.6% and 0.2%).

CONCLUSION

The study suggests that aerobic training may have afforded a significant improvement in the autonomic cardiac function of the menopausal women in the active group, and may be a useful option for preserving this functional condition without the need for hormonal replacement therapy.

Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial

OBJECTIVE

To investigate the efficacy and safety of the special extract ERr 731 from the roots of Rheum rhaponticum compared to placebo in perimenopausal women with climacteric complaints.

DESIGN

A multicenter, prospective, randomized, double-blind, placebo-controlled, clinical trial in which 109 women with climacteric complaints received either one enteric-coated tablet of ERr 731 (n = 54) or placebo (n = 55) daily for 12 weeks. Primary outcome criterion for efficacy was the change in Menopause Rating Scale II (MRS II) total score after 12 weeks. Other efficacy assessments analyzed number and severity of hot flushes, menopause-specific quality of life, number of bleeding/spotting days, and treatment outcome.

RESULTS

By 12 weeks, the MRS II total score and each MRS II symptom significantly decreased in the ERr 731 group compared to the placebo group (P < 0.0001). After 4 weeks, ERr 731 also significantly decreased the number and severity of hot flushes (P < 0.0001). After 12 weeks, the overall menopause-specific quality of life was significantly better in women treated with ERr 731 compared with placebo (P < 0.05). Treatment outcome assessed by investigators and participants was better in the ERr 731 group, and ERr 731 was better tolerated than placebo. There were no differences in gynecological findings including endometrial biopsies, bleeding, weight, blood pressure, pulse, and laboratory safety parameters between the treatment groups. No adverse events were classified as being related to the investigational medication.

CONCLUSIONS

Compared to placebo, ERr 731 significantly reduces the occurrence and severity of climacteric complaints in perimenopause. It is also safe and well tolerated.

Efficacy and tolerability of estradiol 1mg and drospirenone 2mg in postmenopausal korean women: A double-blind, randomized, placebo-controlled, multicenter study

OBJECTIVES

The aim of this study was to demonstrate that the therapeutic efficacy of an estradiol 1mg/drospirenone 2mg (E2/DRSP) preparation is superior to a placebo in postmenopausal Korean women with hot flushes and other climacteric symptoms, and to demonstrate that this treatment is both safe and tolerable.

METHODS

This was a double-blind, randomized, placebo-controlled, multicenter study over four 28-day treatment cycles. A total of 158 subjects were screened and 90 women were randomized into two treatment groups (E2/DRSP group, n=45; placebo group, n=45). The primary efficacy parameter was the individual relative change of hot flushes. The secondary efficacy parameters such as other climacteric, urogenital symptoms and vaginal bleeding patterns were also evaluated, and the occurrence of any adverse events was noted. In addition, physical, gynecological examinations and laboratory analyses were performed at the beginning and end of the study.

RESULTS

The mean number of hot flushes per week during treatment weeks 3-16 decreased by 48.1% during treatment with placebo, and by 84.4% during treatment with E2/DRSP (p<0.001). The E2/DRSP combination also reduced the incidence and intensity of menopausal symptoms in postmenopausal women. Most of adverse events was mild or moderate degree of intensity. None of the parameters measured in the study, including laboratory analyses, physical and gynecological examinations, vital signs, and weight, led to any concerns of safety.

CONCLUSIONS

The E2 1mg/DRSP 2mg combination tested in the study was efficacious and safe in the treatment of hot flushes and other climacteric symptoms in postmenopausal Korean women.

Acquired palmoplantar keratoderma

Palmoplantar keratodermas (PPKs) are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles. Traditionally they have been classified as either hereditary or acquired and are distinguished from each other on the basis of mode of inheritance, presence of transgrediens (defined as contiguous extension of hyperkeratosis beyond the palmar and/or plantar skin), co-morbidities with other symptoms, and extent of epidermal involvement, namely diffuse, focal, and punctate. As the terms hyperkeratosis and keratoderma have been used interchangeably throughout the literature, we define acquired keratoderma as a non-hereditary, non-frictional hyperkeratosis of the palms and/or soles that involves >/=50% of the surface of involved acral areas and that may or may not be associated with clinical and histologic inflammation. Given the numerous possible underlying causes for acquired PPKs, evaluation of patients presenting with acquired PPK can be a perplexing task. To facilitate such evaluations, this review categorizes the acquired PPKs as: keratoderma climactericum, drug related, malnutrition associated, chemically induced, systemic disease related, malignancy associated, dermatoses related, infectious, and idiopathic. In order to avoid the possibility of overlooking an underlying etiology and to eliminate excessive testing, we present an algorithm for assessing patients presenting with acquired PPK. The first step should include a comprehensive history and a physical examination, including a complete skin examination. If findings are consistent with a hereditary keratoderma, then a genetics consultation should be considered. Any findings suggestive of underlying conditions should be aggressively evaluated and treated. If no pertinent findings are identified after a history and a physical examination, laboratory and radiology studies should be undertaken in a systematic, logical fashion. In terms of treatment, the most successful results occur when the underlying etiology is diagnosed and treated. If no such etiology is evident, then conservative treatment options include topical keratolytics (urea, salicylic acid, lactic acid), repeated physical debridement, topical retinoids, topical psoralen plus UVA, and topical corticosteroids. Etretinate and acitretin have also shown some success as alternative treatments in recalcitrant cases.

Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder

BACKGROUND

We sought to determine the prevalence of, and association between, reproductive cycle-associated mood symptoms in women with affective disorders. We hypothesized that symptoms would correlate with each other across a woman's reproductive life span in both major depression (MDD) and bipolar I disorder (BP).

METHODS

2412 women with, MDD or BP were asked standardized questions about mood symptoms prior to menstruation, within a month of childbirth and during perimenopause. Lifetime rates for each of these symptom types were determined and an odds ratio was calculated correlating each of the types with the others.

RESULTS

Of 2524 women with mood disorders, 67.7% reported premenstrual symptoms. Of those at risk, 20.9% reported postpartum symptoms and 26.4% reported perimenopausal symptoms. The rates did not differ between women with MDD and BP but were significantly different from women who were never ill. The symptoms were significantly correlated in women with MDD with odds ratios from 1.66 to 1.82, but were not in women with BP.

LIMITATIONS

This is a secondary analysis of a sample that was collected for other purposes and is based upon retrospective reporting.

CONCLUSIONS

Reproductive cycle-associated mood symptoms were commonly reported in women with mood disorders and did not differ based on diagnosis. In MDD, but not BP, the occurrence of these symptoms was trait-like as the presence of one predicted the occurrence of the others. Further prospective study is required to clarify the determinants of this trait.

[Hormone replacement therapy: curse or blessing?]

There is a controversial discussion on the risks and benefits of hormonal replacement therapy (HRT), and many women and doctors have revised their opinions of HRT over the last few years. Complementary and alternative therapies can be considered an option to treat menopausal symptoms. The following issue summarizes the actual knowledge of treatment options of menopausal symptoms.

Fatores associados à intensidade das ondas de calor em mulheres em climatério

OBJECTIVE

To identify factors associated with the intensity of hot flashes in 334 climacteric women living in Campinas, São Paulo, Brasil.

METHODS

Secondary analysis of a data bank of a descriptive cross-sectional population-based study. Selection of 334 women reporting hot flashes aged 45-60 years was carried out through cluster sampling. Data were collected by home interviews using a structured, pre-tested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. Intensity of hot flashes was measured using the circulatory index. The variables analyzed were age, use of contraceptive methods and hormonal therapy, tubal ligation, body mass index, menopausal status, time since menopause, hysterectomy, bilateral oophorectomy and smoking. Statistical analysis was performed by using the median, absolute and relative frequencies according to the type of variable. The prevalence ratio (PR) was used to measure association. Bivariate analysis and multiple logistic regression with a 95% confidence interval (95% CI) were used to identify the factors associated with the intensity of hot flashes.

RESULTS

Women with time since menopause of over 61 months (PR: 0.59; IC 95%: 0.39-0.88) had a significantly lower chance of presenting intense hot flashes while the antecedent of bilateral oophorectomy (PR: 1.95; IC 95%: 1.08-3.50) was significantly associated with the intensity of hot flashes.

CONCLUSION

Both factors, time since menopause and bilateral oophorectomy, suggest hypoestrogenism as a common cause of more intense hot flashes. Women with these factors should receive specialized care to minimize the negative effects of hot flashes.

Treatment of dysfunctional uterine bleeding in the perimenopause: the effects of adding combined estradiol/norethisterone acetate therapy to goserelin acetate treatment--a randomized, placebo-controlled, double-blind trial

OBJECTIVE

To assess the effects of adding combined estradiol/norethisterone acetate therapy (CENT) to goserelin acetate treatment (GA) of dysfunctional uterine bleeding (DUB) in perimenopausal women.

METHODS

In a randomized, placebo-controlled, double-blind trial followed by an open follow-up study, 31 perimenopausal women with DUB were recruited from gynecological outpatient departments of two Dutch hospitals and randomized for treatment with either GA/placebo or GA/CENT for 6 months followed by 18 months of GA/CENT for all. The main outcome measures were abdominal pain, number of bleeding days, double-layer endometrial thickness (DET), Greene climacteric score (GCS), visual analog scale for well-being, bone mineral density (BMD) and mammographic density (BI-RAD score).

RESULTS

Abdominal pain, number of bleeding days and DET decreased in both groups, the between-group difference in decrease not being statistically significant. GCS initially showed significant improvement in the GA/CENT group. BMD decreased significantly in the GA/placebo group (-4.1%) compared with the GA/CENT group (-0.3%). Another 18 months of GA/CENT did not result in a lasting difference in BMD between groups. BI-RAD scores did not differ significantly between or within the two groups.

CONCLUSIONS

Adding CENT to GA treatment for DUB in perimenopausal women initially prevented BMD loss and improved climacteric complaints, while having no negative impact on vaginal bleeding, abdominal pain or BI-RAD scores. However, prolonged treatment did not result in a lasting prevention of bone loss.

Differential effect of hormone therapy and tibolone on lipids, lipoproteins, and the atherogenic index of plasma

The aim of our study was to assess the effect of various regimens and doses of hormone therapy and tibolone on the Atherogenic Index of Plasma (AIP). A total of 519 postmenopausal women attending our menopause clinic were studied in a prospective design. Women with climacteric symptoms were randomly assigned to receive 1 of the following regimens: tibolone 2.5 mg, conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA), 17beta-estradiol 2 mg plus norethisterone acetate 1 mg (E2/NETA), or 17beta-estradiol 1 mg plus norethisterone acetate 0.5 mg (low E2/NETA). Serum parameters were assessed at baseline and after 6 months and included total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoprotein A1 and apolipoprotein B. The AIP was assessed as the log (triglycerides [mmol/L]/HDL-C [mmol/L]). CEE/MPA treatment associated with lower mean LDL-C but higher mean triglyceride levels (-15.5 mg/dL +/- 3.6, P = 0.0001; 12.6 mg/dL +/- 4.8, P = 0.01). Furthermore, CEE/MPA treatment resulted in higher AIP levels (0.073 +/- 0.021, P = 0.001). On the contrary, both E2/NETA regimens and tibolone associated with lower mean triglyceride and HDL-C levels (E2/NETA, triglycerides: -9.8 mg/dL +/- 5.0, P = 0.049; HDL-C: -4.9 mg/dL +/- 1.8, P = 0.01, low E2/NETA triglycerides: -12.5 mg/dL +/- 4.1, P = 0.003; HDL-C: -4.7 mg/dL +/- 1.3, P = 0.001; tibolone, triglycerides: -21.9 mg/dL +/- 2.7, P = 0.0001; HDL-C: -12.7 mg/dL +/- 1.1, P = 0.0001). None of the 3 regimens had any effect on AIP. The effect of a particular regimen of hormone therapy on the lipid-lipoprotein profile differs depending on the parameter assessed. The use of unified markers such as AIP will be helpful in evaluating the overall effect of lipid-lipoprotein modulation on the cardiovascular system. In fact, the concurrent assessment of the therapy effect on both LDL-C and AIP may be more dependable in evaluating the cardiovascular impact of a given regimen.

Estrogen and hypertension

Menopause is accompanied by a dramatic rise in the prevalence of hypertension in women, suggesting a protective role of endogenous estradiol on blood pressure (BP). Both animal experimental and human clinical investigations suggest that estrogen engages several mechanisms that protect against hypertension, such as activation of the vasodilator pathway mediated by nitric oxide and prostacyclin and inhibition of the vasoconstrictor pathway mediated by the sympathetic nervous system and angiotensin. However, emerging evidence from recent clinical trials indicates a small increase, rather than decrease, in systolic BP with oral estrogen administration in postmenopausal women, without any detectable effect on diastolic BP. Mechanisms underlying this selective rise in systolic BP in postmenopausal women and oral contraceptive-induced hypertension in premenopausal women remain unknown, but the rise may be related to supraphysiologic concentration of estrogen in the liver. To date, transdermal delivery of estrogen, which avoids the first-pass hepatic metabolism of estradiol, appears to have a small BP-lowering effect in postmenopausal women and may be a safer alternative in hypertensive women.

Climacteric symptoms among Japanese women and men: comparison of four symptom checklists

OBJECTIVES

To explore whether Japanese kōnenki (climacteric) symptoms are unique to women or are experienced by men, to compare common symptom indices, and to explore the relationship between symptoms and soy intake.

METHODS

Two-week recall of 54 symptoms, an eight-item food frequency questionnaire, and views about kōnenki were collected from 60 individuals in Kanazawa, Japan. Factor analysis identified kōnenki-associated symptom groupings; Blatt-Kupperman, Simplified Menopausal Index, Lock, and Kanazawa symptom scores were calculated; and sex and kōnenki status differences were tested.

RESULTS

Thirty-two women and 22 men (mean age 48.7 years) provided complete questionnaires. Although males had higher prevalence of stress, irritability, and nervousness (p < 0.05), no men reported having kōnenki. Four of eight female symptom factors exhibited significant correlations with kōnenki status. All symptom index scores were lower in pre-kōnenki women than in peri-kōnenki women, but scores for men and women did not differ. Soy intake and Lock score were negatively correlated among women.

CONCLUSIONS

Several symptoms commonly associated with kōnenki in Japan are not unique to women and have higher prevalence in men. Inclusion of men in climacteric studies may permit identification of male climacteric symptoms and assessment of the specificity of many typical female climacteric symptoms, thus refining and standardizing symptom checklists.

Climacteric complaints among very low-income women from a tropical region of Brazil

CONTEXT AND OBJECTIVE

Climacteric symptoms may vary between different countries and cultures. Socioeconomic factors and climate may be implicated. The aim of this study was to identify climacteric symptomatology among very low-income Brazilian women, living in a hot and humid region.

DESIGN AND SETTING

This cross-sectional population-based study was conducted in Cuiabá, at Júlio Müller University Hospital, a tertiary institution.

METHODS

The study enrolled 354 climacteric women. The variables analyzed were social class, symptomatology and abnormal concurrent conditions. The study was approved by the hospital's research ethics committee.

RESULTS

Sixty-five percent of the participants (232/354) were very poor and had had little schooling. The number of symptoms per woman was 8.0 +/- 5.7. Hot flushes, nervousness, forgetfulness and fatigue were each found in nearly 60.0%. Tearfulness, depression, melancholy and insomnia were also frequent. Sexual problems were reported by 25%. The most relevant concurrent abnormal conditions reported were hypertension (33.9%), obesity (26.5%), arthritis/arthrosis (15.0%) and diabetes mellitus (9.6%). Hot flushes were associated with tearfulness, nervousness and forgetfulness.

CONCLUSION

Brazilian climacteric women of low income and low schooling present multiple symptoms. Vasomotor and psychosexual symptoms were the most prevalent disorders. Hot flushes were associated with nervousness, forgetfulness and tearfulness.

Cluster headache in women: relation with menstruation, use of oral contraceptives, pregnancy, and menopause

In contrast with migraine, little is known about the relation between cluster headache and menstrual cycle, oral contraceptives, pregnancy, and menopause. A population based questionnaire study was performed among 224 female cluster headache patients, and the possible effect of hormonal influences on cluster headache attacks studied. For control data, a similar but adjusted questionnaire was sent to healthy volunteers and migraine patients. It was found that menstruation, use of oral contraceptives, pregnancy, and menopause had a much smaller influence on cluster headache attacks than in migraine. Cluster headache can, however, have a large impact on individual women, for example to refrain from having children.

[Effects of thyroid disorders on the bone]

Interactions between thyroid hormones and the bone are complex and are still not fully understood. During development, thyroid hormone is essential for the recruitment and maturation of bone cells. A deficit of thyroid hormone during pregnancy and in the newborn leads to retardation of the skeleton. Hypothyroidism during later life causes a relevant decrease of bone turnover. Excessive amounts of thyroid hormone induce increased activity of osteoblasts and osteoclasts leading to high bone turnover and a loss of BMD, as the activity of osteoclasts predominates over the activity of osteoblasts. In subclinical hyperthyroidism, premenopausal women show no significant BMD loss, whereas postmenopausal women face a significant BMD loss. Men seem to have a limited, but significant bone loss in subclinical hyperthyroidism. Therapeutic consequences focus on the normalization of thyroid function, which can lead to restoration of BMD and normalization of bone turnover. In particular, patients on long-term suppressive L-thyroxine therapy or anti-thyroid drug medication benefit from additional antiresorptive treatment. This article surveys the complex interactions between thyroid hormones and bone cells and their effects on bone turnover, BMD and fractures according to the different states of thyroid function.