Velocity of ultrasound at the patella: Influence of age,menopause and estrogen replacement therapy

Determination of apparent velocity of ultrasound (AVU) in bone has been proposed as a valuable tool for discriminating between normal and osteoporotic women. We have studied the influence of age, menopause and estrogen replacement therapy (ERT) on AVU at the patella in a large sample of pre- and postmenopausal women. Three hundred and eighteen woman aged 40–60 year participated in the study (112 women were premenopausal, 21 were perimenopausal and 185 were postmenopausal of whom 110 had received ERT for a minimum of 1 year). AVU was determined as the mean of four measurements at each patella using a Signet instrument (Osteo-Technology, Framingham, MA). An age-dependent decline in AVU was observed only after menopause (r=–0.33,p=0.0055); in premenopausal women there was a slight but not significant decrease in AVU with age (r=–0.12,p>0.05). AVU was significantly lower in postmenopausal women compared with premenopausal women (1882±84 m/s vs 1961±73 m/s,p<0.05). ERT prevented the menopause-related fall in AVU. There was a significant positive correlation between the duration of ERT and AVU measurements. Our findings demonstrate a pronounced influence of estrogens on AVU at the patella, supporting the concept of a protective role of ERT in bone stability. AVU measurements therefore merit further investigation as an inexpensive method for predicting fracture risk that does not expose the subject to radiation.     

Increase in plasma lactate at the menopause and its relation to the "anion gap"

The mean plasma anion gap (Na + K + Ca + Mg)--(Cl + HCO3(-) + HPO4(2-) + protein), was significantly higher in post-menopausal women compared with pre-menopausal women (8.04 mEq/l compared with 7.03 mEq/l). This change was due, in part, to an increase in the plasma lactate concentration and to smaller increases in citrate and pyruvate concentrations. There were also changes in bicarbonate and chloride concentrations which suggested an increase pH of approximately 0.02 U. Together, these changes accounted for 46% of the increase in the "anion gap", leaving 54% unexplained. It is suggested that the rise in plasma lactate concentration may be due to mild alkalosis and that this change may account for the rise in plasma urate concentration which also occurs at the menopause.     

Climacteric expression and social context

Though on questioning, women everywhere would probably admit to subjective sensations, known to be associated with climacteric physiological changes, few actively complain of any discomfort these produce. ‘Climacteric symptoms’ are confined to the West. Their absence elsewhere has hitherto been explained by the stress-free-climacteric women enjoy in most other cultures. The rewards of middle life in these cultures are, however, generally limited to women who have raised sons. Others are as liable to stress as Western women. This article suggests that the absence of climacteric symptoms among them is because middle-life stress is not associated in these cultures with illness but is expressed in practical social counteraction.The expression of climacteric stress in medical terms also depends on the manner the climacteric is reached and its general relationship to the menstrual history. The onset of the climacteric tends to have a much higher profile when families are limited, a social custom almost confined to the West. Avoidance of pregnancy and promiscuity also result in troublesome morbid changes at this time. In fact it was these which first brought climacteric women to doctors. As this occurred when, coincidentally, care of the sick became an important aspect of Western culture, the welding of climacteric disturbances and medicine became inevitable.Biologically ‘worthless’, a climacteric woman is regarded as ‘nothing’ in most cultures. Her social standing depends entirely on her sons. Childless women have, however, evolved various compensatory strategems. They manage to obtain social children or, at times, even profit by their very worthlessness. The climacteric expression resembling the menopausal syndrome most, in non-Western countries, is the almost universal fear, throughout the southern and eastern Mediterranean, that a husband may discover the climacteric sterility of his wife and marry a second young and fertile woman. Nonetheless neither this syndrome, nor other behavioral disorders at this time, utilize the physiological sensations of the climacteric as symptoms.     

Estrogen therapy and risk of cognitive decline: results from the Women's Estrogen for Stroke Trial (WEST)

OBJECTIVE: This study was undertaken to assess whether estrogen therapy (ET) reduces the risk of cognitive decline in women with cerebrovascular disease. STUDY DESIGN: We conducted a randomized, double-blind trial of estradiol 17beta versus placebo for secondary stroke prevention in 664 postmenopausal women with a recent stroke or transient ischemic attack. The Mini-Mental State Examination (MMSE) and 5 domain measures were obtained at baseline and exit. RESULTS: Among 461 women withdrawn alive without stroke, ET did not have a significant effect on cognitive measures after an average of 3 years (relative risk of MMSE decline: 0.74, 95% CI, 0.49-1.13). In women with normal MMSE at entry, estrogen was associated with less decline (relative risk, 0.46, 95% CI, 0.24-0.87). CONCLUSION: In this study, estradiol did not have significant effects on cognitive measures. However, in women with normal function at baseline, there may be a benefit for ET in reducing the risk for cognitive decline.     

Vaginal pH is similar to follicle-stimulating hormone for menopause diagnosis

OBJECTIVE: This paper is intended to demonstrate whether vaginal pH value is associated with menopausal status and symptoms, to review the sensitivity of follicle-stimulating hormone or vaginal pH to diagnose menopause, to compare these findings to a group of practice patients, and to determine whether vaginal pH could be used in place of follicle-stimulating hormone as an initial screen to determine menopause. STUDY DESIGN: Sixteen studies regarding vaginal pH and menopausal symptoms before and after estrogen administration were analyzed. Two epidemiologic studies that reported follicle-stimulating hormone or vaginal pH with menopause were reviewed. These findings were compared with similar data from the practice of one of the authors (J.C.C.). RESULTS: Menopausal women who do not receive estrogen therapy have a weighted average vaginal pH of 6.0, which is reduced significantly to 4.5 with estrogen therapy. To diagnose menopause, follicle-stimulating hormone >or=15 or >or=20 mIU/mL in the Third National Health and Nutrition Examination Survey had a sensitivity of 65% to 68%. In a study in Costa Rica, where 3 definitions of menopause were used, a pH of >5.0 had a sensitivity of 64% to 67%. From the practice patients, the 95% confidence interval sensitivities and positive predictive values of vaginal pH and follicle-stimulating hormone to diagnose menopause overlapped, while a pH 4.5 indicates menopause, because it demonstrates a similar sensitivity as follicle-stimulating hormone in epidemiologic studies. In the practice patients, the sensitivity of follicle-stimulating hormone was no different than vaginal pH in the diagnosis of menopause. Furthermore, with estrogen therapy, a vaginal pH of 相似文献   

Tools for making correct decisions regarding hormone therapy. Part II. Organ response and clinical applications

OBJECTIVE: To review existing scientific knowledge of the complicated and variable behavior and response to hormone therapy (HT) of different organs during aging, and to summarize long-term consequences on human health. DESIGN: A MEDLINE computer search was performed to identify relevant articles. RESULT(S): Five body organs were evaluated. [1]. Physiologic aging of the bone has deleterious consequences on women's health and quality of life. Bone fractures could be attributed to the combination of estrogen depletion and osteoporosis, mechanisms of applied forces, and disturbed brain function, partially reversible by timely estrogen administration. [2]. Estrogen seems to have a profound neuroprotective effect. As physiologic aging of the brain is an unhealthy phenomenon, possible intervention is justified. The therapeutic time window seems crucial. [3]. The differentiation between response of a healthy or already damaged organ to sex hormones is the key factor to understanding the possible cardioprotective effects. [4]. Based on doubling time of tumor cells, intracrinology, epidemiological data on breast cancer, and behavior of breast cancer survivors in response to estrogen treatment, estrogen seems to be mainly a promoter and even a protector of breast cancer survivors. [5]. Colon cancer appears to be an estrogen-dependent tumor with a wide therapeutic window, as every report regardless of age and dose demonstrates protective effects. CONCLUSION(S): Knowledge of each organ's response to aging and sex hormone substitutions demonstrates that the organs could benefit from properly designed intervention. In the wake of the publication of the Women's Health Initiative study, which shocked the medical community, we suggest that the results be reevaluated according to the aforementioned principles, and that menopausal medicine could play an important role.     

Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women

OBJECTIVE: To determine the natural history of simple unilocular adnexal cysts in asymptomatic postmenopausal women. METHODS: Eight thousand seven hundred ninety-four asymptomatic postmenopausal women underwent transvaginal ultrasound as part of routine gynecological check-up at our institution between January 1995 and June 2002. All patients in whom a simple unilocular adnexal cyst was found out were offered surgical treatment or conservative follow-up with serial transvaginal ultrasound at 6-month intervals. In all these cases, serum CA-125 levels was determined. RESULTS: Two hundred twenty-three simple adnexal cysts in 215 women were found out (prevalence: 2.5%). Annual incidence did not change significantly. Sixty-six (30.6%) women were lost after initial diagnosis. One hundred and forty-nine patients with 153 cysts were entered ultimately in the study. Forty-five (30%) underwent surgery (34 after initial diagnosis and 11 during follow-up). A total of 49 cysts were removed. The most frequent histological diagnosis was serous cystadenoma (84%). There was a case of a stage IA ovarian carcinoma (2% of the cysts removed, 0.6% of all the cysts included in the study). One hundred and four patients with 104 cysts underwent conservative follow-up throughout the study period. Forty-six (44%) of these cysts resolved spontaneously (74% of them within 2 years). In 14 (30%) of these women, a new cyst was diagnosed when follow-up went on. In 58 patients, cysts persisted during all study period (median follow-up: 48 months, range: 6-90 months), 69.6% of them remained unchanged, 17.2% increased, and 17.2% decreased. Patients in whom cysts resolved spontaneously had a shorter menopausal time (P=0.001) and tend to be younger (P=0.06). No differences were found regarding cysts' features. CONCLUSION: The risk of malignancy of simple adnexal cysts in asymptomatic postmenopausal women is low. Almost half of them will resolve spontaneously during follow-up. Most of those that persist remain unchanged. Asymptomatic postmenopausal women having simple adnexal cysts can be managed conservatively with a very reasonable degree of reassurance.     

The office hysteroscopic evaluation of postmenopausal patients

Objective The objective was to characterize postmenopausal women with endometrial polyps and to evaluate their significance.Methods The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyps. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings.Results Of the 181 eligible patients, 34 had endometrial hyperplasia (4 cases of them had endometrial carcinoma). The 144 patients using hormone replacement therapy had significantly higher rate of endometrial hyperplasia than non-hormone users (p<0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories.Conclusion Postmenopausal endometrial polyps is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.