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Female Menopause – All Phases Women experience two phases—perimenopause and menopause. The latter is the ending stage of menses; therefore, “post menopause” technically doesn’t exist. Patients evidence a wide range of symptoms, which can be assuaged with hormone modulation. Some studies suggest an “androgen” deficiency, which if treated can positively affect a sense of well-being and also restore sexual desire. Review current research and medical articles on female menopause to better help your female patients. Combination Hormone Replacement Therapy Linked to Lower-Risk Breast Cancers.pdf
The types of breast tumors
that occur after combination
hormone replacement therapy
in the peri- and
post-menopausal period tend
to have a better prognosis
than those that occur after
estrogen-only replacement
therapy, Swedish researchers
report. Hormones and Sexuality During Transition to Menopause.pdf
This study confirms the
observation that sexual
dysfunction increases over
the menopausal transition.
Several factors associated
with sexual dysfunction
include low DHEAS, absence
of a sexual partner,
anxiety, and children under
the age of 18 living at
home. NAMS Updates Recommendations on Diagnosis and Management of Osteoporosis in Postmenopausal Women.pdf
To address the need for
standards of care as they
relate to
menopause-associated health
conditions, the North
American Menopause Society
(NAMS) has updated its
evidence-based guidelines on
the diagnosis, prevention,
and treatment of
osteoporosis in
postmenopausal women. The
full report was published in
the May/June 2006 issue of
Menopause. Serum Leptin Concentrations in Pre- and Postmenopausal Women on Sex Hormone Therapy.pdf
According to this study,
Endogenous E(2) and
androgens in premenopausal
women and estrogen and
estrogen-progestin therapies
in postmenopausal subjects
do not influence serum
leptin concentrations.
Leptin level is related to
body mass and BMI, but not
to sex hormone status. The
distribution of adipose
tissue and the type of
obesity (android or gynoid)
have no influence on serum
leptin concentration. The
correlation between serum
leptin level and blood
pressure requires further
investigation.
This study demonstrated
that the beneficial effects
of isoflavones in menopausal
women could be more related
to platelet function than to
improving classical
cardiovascular risk factors. Testosterone Aromatization and Cognition in Women: A Randomized, Placebo-Controlled Trial.pdf
This study did not
observe any effects of
aromatase inhibition on
cognition in healthy,
estrogen-treated
postmenopausal women treated
with testosterone. This may
be due to insufficient study
power or a true lack of
effect. However, the
findings highlight that the
detection of subtle changes
in cognition in well women
require the development of
sensitive instruments and
large randomized, controlled
trials. Combined Estrogen and Testosterone Use and Risk of Breast Cancer in Postmenopausal Women.pdf
According to this study,
consistent with the
elevation in risk for
endogenous testosterone
levels, women using estrogen
and testosterone therapies
have a significantly
increased risk of invasive
breast cancer.
Safety and Adverse Effects
of Androgens: How to Counsel
Patients.pdf
Questions still persist
after the release of the
July 2002 Women’s Health
Initiative findings
regarding hormone therapy.
Researchers have been
looking at the data to see
if certain changes in dosage
or initiation age could
still provide benefits to
women.
Effects of Estrogen with and without Progestin on Urinary Incontinence.pdf
The conclusion of this
study was that conjugated
equine estrogen alone and
CEE + MPA increased the risk
of UI among continent women
and worsened the
characteristics of UI among
symptomatic women after 1
year. Conjugated equine
estrogen with or without
progestin should not be
prescribed for the
prevention
This study concluded that
the synthesis of CRP is not
affected by a history of
ICP. It is readily and dose
dependently stimulated by
oral but not by transdermal
E2 in as soon as 2 wk. Predictors of Decreased Libido in Women During the Late Reproductive Years.pdf
This study concluded that
decreased libido in the late
reproductive years is
associated with a pronounced
fluctuation in total
testosterone over time.
Other independent risk
factors for decreased libido
include vaginal dryness,
depression, and living with
children. Sexual dysfunction
is a complex disorder,
related to physiological and
psychosocial factors,
requiring further
investigation. HRT Scare Study Was Flawed, Say Scientists.pdf
According to a group of
leading researchers, the
American study that
triggered a worldwide scare
over the risks of Hormone
Replacement Therapy was
fundamentally flawed and not
applicable to most women
going through the menopause.
According to this study,
the use of CEE increases the
risk of stroke, decreases
the risk of hip fracture,
and does not affect CHD
incidence in postmenopausal
women with prior
hysterectomy over an average
of 6.8 years. A possible
reduction in breast cancer
risk requires further
investigation. The burden of
incident disease events was
equivalent in the CEE and
placebo groups, indicating
no overall benefit. Thus,
CEE should not be
recommended for chronic
disease prevention in
postmenopausal women.
Formulations and Use of
Androgens in Women.pdf
According to this study,
for women aged 65 years or
older, hormone therapy had
an adverse effect on
cognition, which was greater
among women with lower
cognitive function at
initiation of treatment. The Women’s Health Initiative 2004 – Review and Critique.pdf
This article reviews the
published results from the
Women’s Health Initiative
(WHI) and their various
interpretations. The WHI was
designed to define the risks
and benefits of
interventions, notably
hormone therapy, to
potentially prevent heart
disease, breast and
colorectal cancer, and
osteoporotic fractures in
postmenopausal women.
The results of this study
help, in part, to explain
DHEA's complex effects on
cognition. The diverse
effects of sex steroids
across tasks underscore the
importance of identifying
the specific cognitive
mechanisms influenced by sex
steroids and emphasizes that
one should not expect sex
steroids to produce
homogeneous effects across
cognitive tasks. Potential Anabolic Effects of Androgens on Bone.pdf
With the decrease of
estrogen at menopause, the
need for androgens increases
in post-menopausal women.
Androgens also appear to be
important for the bone
health of women who are
pre-menopausal.
Review by
Amazon.com of Suzanne
Somers’ book The Sexy
Years: Discover the Hormone
Connection: The Secret to
Fabulous Sex, Great Health,
and Vitality, for Women and
Men.
Hot Flashes and Androgens: A Biological Rationale for Clinical Practice.pdf
This article discusses
the important role androgens
play in the treatment of hot
flashes. It also emphasizes
the need to individualize
treatment for menopausal
women. Low Androgenization Index in Elderly Women and Elderly Men with Alzheimer's Disease.pdf
The authors of this study
investigated whether
testosterone levels and
testosterone availability
differ between older lean
subjects with and without
Alzheimer's disease (AD).
Sex hormone binding globulin
(SHBG) and estradiol levels
were higher, whereas the
free androgenization index
(FAI) was lower, in lean
subjects with AD than in
lean subjects without AD.
Factors involved in the
increase of SHBG secretion
could have an important role
in the lower testosterone
availability of subjects
with AD. The Role of Androgens in Female Sexual Dysfunction.pdf
Although there are no
FDA-approved androgen
therapies at this time,
increased attention is being
paid to low androgen
concentrations in the
treatment of female sexual
dysfunction (FSD).
This study concluded that
estrogen therapy alone did
not reduce dementia or MCI
incidence and increased the
risk for both end points
combined. Pooling data for
estrogen alone and estrogen
plus progestin resulted in
increased risks for both end
points. Use of hormone
therapy to prevent dementia
or cognitive decline in
women 65 years of age or
older is not recommended.
This study demonstrates
that estrogen plus progestin
increases BMD and reduces
the risk of fracture in
healthy postmenopausal
women. The decreased risk of
fracture attributed to
estrogen plus progestin
appeared to be present in
all subgroups of women
examined. When considering
the effects of hormone
therapy on other important
disease outcomes in a global
model, there was no net
benefit, even in women
considered to be at high
risk of fracture.
This study concluded that
relatively short-term
combined estrogen plus
progestin use increases
incident breast cancers,
which are diagnosed at a
more advanced stage compared
with placebo use, and also
substantially increases the
percentage of women with
abnormal mammograms. These
results suggest estrogen
plus progestin may stimulate
breast cancer growth and
hinder breast cancer
diagnosis.
The aim of this study was
to investigate the effects
of HRT on the serum levels
of hormones and cytokines
regulating bone turnover in
88 postmenopausal women with
active rheumatoid arthritis
(RA) randomly allocated to
receive HRT plus calcium and
vitamin D3 or calcium and
vitamin D3 alone for 2
years.
This study concluded that
bone mineral content
increased to 14% with GH
treatment on top of HRT and
calcium/vitamin D in
postmenopausal women with
osteoporosis. There seems to
be a delayed, extended, and
dose-dependent effect of GH
on bone. Thus, GH could be
used as an anabolic agent in
osteoporosis. Endogenous Hormones and Bone Turnover Markers in Pre- and Perimenopausal Women: SWAN.pdf
This study tested the
hypothesis that higher serum
osteocalcin and urinary
N-telopeptide of type I
collagen (NTx)
concentrations would be
found in women with
increasing cycle
irregularity or increased
follicle stimulating hormone
concentrations. It concluded
that in these pre- and early
perimenopausal women, higher
FSH concentrations, but not
other serum reproductive
hormone concentrations, are
positively associated with
greater bone turnover prior
to the last menstrual
period.
This study concluded that
12 months of GH replacement
normalized IGF-I and
improved lipid profile and
cardiac performance in adult
GHD patients. A similar
period of GH deprivation
induced a further impairment
of lipid profile and cardiac
performance. This finding
strongly supports the need
of GH replacement in adult
GHD patients.
The Effects of Tibolone on Mood and Libido.pdf
According to this paper,
published studies indicate
beneficial effects of
tibolone on both libido and
mood, which otherwise
significantly compromise
physical, psychological, and
social well-being. Hence,
tibolone provides another
option for menopausal women
experiencing loss of libido
as part of their
symptomatology or who have
persistent low libido
despite adequate
estrogen/progestin
replacement therapy.
A study involving seven
normotensive, nondiabetic
GH-deficient adults (two
women) evaluated skin
capillary permeability and
capillary density. It found
that the growth hormone
deficiency syndrome is
associated with
microvascular alterations,
which are responsive to
growth hormone replacement. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women.pdf
This study concluded that
overall health risks
exceeded benefits from use
of combined estrogen plus
progestin for an average
5.2-year follow-up among
healthy postmenopausal US
women. All-cause mortality
was not affected during the
trial. The risk-benefit
profile found in this trial
is not consistent with the
requirements for a viable
intervention for primary
prevention of chronic
diseases, and the results
indicate that this regimen
should not be initiated or
continued for primary
prevention of CHD. Hormone Replacement Therapy, Insulin Sensitivity, and Abdominal Obesity in Postmenopausal Women.pdf
The authors concluded
that postmenopausal women
taking oral estrogen or
those taking a combination
of estrogen and HRT are more
insulin-resistant than women
not on HRT, even when women
are of comparable total and
abdominal adiposity.
This study examined the
interaction of alcohol and
low folate intake on the
risk of postmenopausal
breast cancer stratified by
tumor receptor status for
estrogen (ER) and
progesterone (PR). Because
the results were limited
primarily to ER- tumors, one
plausible interpretation of
these data is that alcohol
influences breast cancer
through its metabolite,
acetaldehyde, rather than
through effects on ER levels
and receptor-mediated
pathways. Androgen Replacement in Menopause.pdf
This article discusses
how interest is increasing
in the use of androgen
replacement not only for
women who have undergone
premature or surgical
menopause but also for those
who experience natural
menopause and premenopausal
loss of libido from
diminished free
testosterone.
Association of IGF-I Levels
with Muscle Strength and
Mobility in Older Women.pdf
In this Letter to the
Editor, the authors conclude
that the role of androgens
in women is becoming
increasingly more
recognized and
established. Certainly, the
use of androgens,
particularly
testosterone, has been shown
to influence life
aspects, such
as mood, women’s general
well being and
restoration of
sexual desire. However,
there is limited data
establishing
normal androgen values for
women of differing ages,
to enable us to
define those with "androgen
deficiency." They say it
is, therefore,
necessary to highlight the
incongruencies and
short-comings
of the paper by Laughlin
et al. (Laughlin G,
Barrett-Connor E,
Kritz-Silverstein D, Von
Muhlen D. 2000 Hysterectomy,
oophorectomy, and endogenous
sex hormone levels in older
women: the Rancho Bernado
Study. J Clin Endocrinol
Metab. 85:645–651), and the
need
for larger prospective
studies to establish the
variations in
testosterone
levels in women with age.
This study concluded that
in physically frail elderly
women, 9 months of HRT
significantly increased BMD
compared with placebo in
clinically important
skeletal regions. Further
studies are needed to
determine whether these
osteogenic effects of HRT in
elderly women are associated
with a reduction in
osteoporotic fractures. Sexuality Among Older Women.pdf
According to this
article, in addition to
hormonal changes with aging,
disease and associated
medications may also
negatively affect sexuality.
Determining the impact of
medications, both alone and
in combination with others,
on quality of life must be
considered when providing
comprehensive care for
elderly patients.
The results of the
present study suggest that
the potency of GH is altered
in patients on transdermal
compared to oral estradiol
therapy. Further
investigation should be
undertaken to answer the
question whether the
increase in serum IGF-I
levels is due to lower serum
levels of estradiol or to
differences in the mode of
administration of estradiol.
This study examines the
cross-sectional association
of hysterectomy and
oophorectomy status,
chronological age, and years
since menopause with plasma
levels of total and
bioavailable testosterone
and estradiol,
androstenedione, estrone,
and sex hormone-binding
globulin (SHBG) in
community-dwelling
postmenopausal women who
were not using estrogen
replacement therapy. The Effects of Systemic Hormonal Replacement Therapy on the Skin of Postmenopausal Women.pdf
The aim of this study was
to determine the effects of
hormonal replacement therapy
on the skin of
postmenopausal women. It
concluded that hormonal
replacement for climacterics
increases skin collagen
content.
The present study
confirms short-term data
published in the literature
on a sex difference in rhGH
dose requirement in
GH-deficient patients. It
furthers extends the data by
demonstrating that this sex
difference in GH
responsivity persists and
changes during the 24 months
of the study. Moreover, it
shows that estrogen
replacement blunts the IGF-I
response to rhGH in women,
whereas in men with androgen
substitution the
responsivity increases over
time, thus bearing a risk of
undertreatment in women and
overtreatment in men.
The data from this study
highlight the value of large
longitudinal surveillance
databases in defining the
optimum dose regimen for GH
replacement and indicate
that women may need a higher
replacement dose of GH than
men.
This study concludes that
menopausal status and type 2
diabetes are associated with
impaired microvascular
reactivity. HRT
substantially improves
microvascular reactivity in
postmenopausal healthy
women. In contrast, the
effect of HRT on the
microvascular reactivity of
postmenopausal diabetic
women is less apparent.
However, the use of HRT
among women with diabetes is
associated with lower sICAM
levels, suggesting an
attenuation in endothelial
activation. Hormone Replacement Therapy and the Risk of Colorectal Cancer: A Meta-Analysis.pdf
This article concludes
that the risk of colon
cancer may be decreased
among recent postmenopausal
HRT users. Although data are
limited, the risk of fatal
colon cancer also may be
lower in HRT users. Postmenopausal Estrogen Replacement Therapy and Risk of AD: A Population-Based Study.pdf
The objective was to
study the association
between estrogen replacement
therapy in postmenopausal
women and AD using a
case-control design. These
results from a
population-based study
suggest that estrogen
replacement therapy is
associated with a reduced
risk of AD in postmenopausal
women.
This study concluded that
transdermal E2 at doses of
0.025, 0.05, 0.06, and 0.1
mg/day effectively prevented
bone loss in postmenopausal
women.
Growth Hormone Deficiency in Adulthood and the Effects of Growth Hormone Replacement: A Review.pdf
The importance of GH
throughout adult life is now
unequivocally accepted.
GH deficiency
is recognized to result in
alterations in body
composition,
physical
performance, psychological
well-being, and substrate
metabolism.
Many of these alterations
can be improved or corrected
with GH
replacement. The prospect
of GH replacement becoming
routine, however, does raise
a number of issues.
This article summarizes
that when compared with the
transdermal route, oral
estrogen reduces lipid(ox),
increases fat mass, and
reduces lean body mass. The
route of estrogen therapy
confers distinct and
divergent effects on
substrate oxidation and body
composition. The suppression
of lipidox during oral
estrogen therapy may
increase fat mass although
the fall in IGF-I may lead
to a loss of lean body mass.
The route-dependent changes
in body composition observed
during estrogen replacement
therapy may have important
implications for
postmenopausal health. Postmenopausal Hormone Therapy. Is it Useful for Coronary Prevention?.pdf
This article states that
because about one of two
U.S. women die from
cardiovascular disease
(heart disease and stroke),
emphasis is warranted on
available data, which
suggest that the group of
women likely to experience
the greatest
cardioprotection from
hormone therapy are those
with defined coronary
disease or those at high
risk for occurrence; the
group of women least likely
to benefit are those at
increased risk for breast
cancer
Wrinkling, dryness and
atrophy were examined in
this study of 3875
postmenopausal women. The
goal of the study was to
determine the possible
effects estrogen has on all
three skin conditions. It
was concluded that the
results strongly suggest
that estrogen use prevents
dry skin and wrinkling
associated with aging.
Non-invasive techniques
were used to study the skin
properties of postmenopausal
women. The study included
women using hormone
replacement therapy (HRT)
and and some who were not
being treated with HRT. It
concluded that the women who
were receiving HRT had
greater skin thickness and
causal level than the
untreated women.
This study’s results show
the beneficial effects of
DHEA therapy in
postmenopausal women without
any significant side
effects. Fifteen
postmenopausal women were
studied for twelve months. Estrogen Replacement Therapy in Older Women: A Neuropsychological and Brain MRI Study.pdf
This study demonstrates
an association between
estrogen replacement therapy
and better cognitive
functioning and a lower rate
of clinically unsuspected
ischemic brain damage in
postmenopausal women. Effect of Oestrogen During Menopause on Risk and Age at Onset of Alzheimer's Disease.pdf
The interpretation of
this study is that oestrogen
use in postmenopausal women
may delay the onset and
decrease the risk of
Alzheimer's disease.
Prospective studies are
needed to establish the dose
and duration of oestrogen
required to provide this
benefit and to assess its
safety in elderly
postmenopausal women. Effect of Hormone Replacement Therapy for Menopause on the Mechanical Properties of Skin.pdf
This study of 114 healthy
women, including
non-menopausal and
menopausal with and without
HRT, evaluated the effect of
hormone replacement therapy
for menopause on the
mechanical properties of the
skin. It concluded
beneficial effects on some
of the properties. Skin Water-Holding Capacity and Transdermal Estrogen Therapy for Menopause: A Pilot Study.pdf
This study included two
groups of fifteen menopausal
women. The purpose was to
model and measure the
influence of
estrogen-transdermal HRT on
subtle physiological changes
taking place in the
epidermis during
perimenopause. Evidence of a Healthy Estrogen User Survivor Effect.pdf This article examined the relation between menopausal estrogen use and all-cause and cause-specific mortality in a cohort of over 49,000 women followed between 1979 and 1989 in the Breast Cancer Detection Demonstration Project (BCDDP) Follow-Up Study.Sturgeon, S.R., Schairer, C., Brinton, L.A., Pearson, T., & Hoover, R.N. (1995). Evidence of a healthy estrogen user survivor effect [Electronic version]. Epidemiology, 6(3), 227-231. Retrieved October 3, 2005.
This study concludes that
oral estrogen-androgen
increased vertebral bone
mineral density compared
with pre-treatment values
and relieved somatic
symptoms. Safety indices,
including lipoprotein
levels, indicated that the
combination was well
tolerated over the 2 years
of treatment.
This twelve-month study
examines the possible
increase in skin thickness
in postmenopausal women as a
result of being treated with
conjugated estrogens. The
results of the study may be
beneficial to women who are
looking for information
regarding the benefits of
estrogen replacement
therapy. Sex Hormones and Psychological Functioning in Postmenopausal Women.pdf
According to this paper,
women who seek medical care
around the time of menopause
frequently report changes in
one or more aspects of
psychological functioning.
The etiology of these
symptoms is likely
multifactorial and,
undoubtedly, individual and
sociocultural factors are
important determinants.
This study concluded that
subcutaneous oestradiol and
testosterone implants will
result in an increase in
bone mass even after many
years of oral oestrogen
replacement therapy.
Sex Hormones and Skin Collagen Content in Postmenopausal Women.pdf
The implication from the
findings in this study is
that oestrogen or
testosterone, or both,
prevents the decrease in
skin collagen content during
the aging process. It
concludes that it protects
skin in the same way as it
protects bone in menopausal
women. Skin biopsy
specimens were taken from
the participants.
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