The association of hysterectomy and menopause: a prospective cohort study

OBJECTIVE: To determine whether or not hysterectomy leads to an earlier onset of the menopause. DESIGN: A prospective cohort study. SETTING: Gynaecology service of large urban hospital. POPULATION: Premenopausal women with and without hysterectomy. METHODS: Multivariate survival analysis techniques were used to adjust for differences in initial follicle stimulating hormone (FSH) levels, body mass index, smoking and unilateral oophorectomy between the groups. MAIN OUTCOME MEASURES: FSH levels were measured for five years following hysterectomy and compared with the comparison group. Menopause was defined as a single FSH measurement of at least 40 IU/L. RESULTS: Two hundred and fifty-seven women undergoing hysterectomy were compared with 259 women who had not undergone a hysterectomy. Fifty-three women (20.6%) in the hysterectomy group and 19 women (7.3%) in the comparison group reached menopause over the five years of the study. Women in the hysterectomy group with a pre-operative FSH <10 IU/L reached menopause 3.7 years (95% CI 1.5-6.0 years) earlier than women in the comparison group independent of BMI, smoking and unilateral oophorectomy. Twenty-eight women in the hysterectomy group had unilateral oophorectomy and 10 (35.7%) of these women reached menopause over the five years of follow up. Women in the hysterectomy group with unilateral oophorectomy reached menopause 4.4 years (95% CI 0.6, 7.9 years) earlier than women with both ovaries in the hysterectomy group independent of baseline FSH, BMI and smoking. CONCLUSIONS: Hysterectomy is associated with an earlier onset of menopause. Hysterectomy with unilateral oophorectomy is associated with an even earlier onset of the menopause in this study.     

The endocrine transition around menopause--a five years prospective study with profiles of gonadotropines, estrogens, androgens and SHBG among healthy women.

OBJECTIVE: The purpose of this study was to investigate the hormonal changes during the menopausal transition in a non-clinical population. METHODS: Fifty-nine healthy Norwegian women participated in a five year prospective longitudinal study during the transition from pre- to post-menopause, starting one to four years before menopause, and ending one to four years postmenopausal. None of these women were given hormone replacement therapy (HRT). Blood samples were collected every 12 months and luteinizing hormone (LH), follicle stimulating hormone (FSH), steroid hormone binding globuline (SHBG), prolactin (PRL), estradiol (E2), estrone (E1), testosterone, androstendione, dehydroepiandrostendione-sulphate (DHEA-S), and thyroid stimulating hormone (TSH) were analyzed. RESULTS: The serum levels of FSH and LH, E2 and E1 profile essentially confirmed previous data obtained in cross-sectional studies. A continuous increase in serum FSH and LH and a concomitant fall in E2 and E1 were observed in all women before menopause and in the two postmenopausal years. Both androstendione and testosterone showed a decline three years before menopause. After the menopause, however, there were fluctuations in the testosterone levels. Androstendione correlated positively with both E2 and E1 and testosterone postmenopausally. Body mass index (BMI) did correlate with testosterone, but not with androstendione. BMI correlated negatively with SHBG. No correlation was found between BMI and E2, E1, FSH and LH. CONCLUSION: This longitudinal prospective study of hormonal changes during the transition from pre- to postmenopause indicates that not only estrogen hormonal changes, but androgen hormonal changes as well, precedes the menopause by several years.     

Heterozygosity for the classical galactosemia mutation does not affect ovarian reserve and menopausal age

Female patients with classical galactosemia (galactose-1-phosphate uridyltransferase [GALT] deficiency) frequently suffer from premature ovarian failure, despite treatment with a galactose-restricted diet. Earlier research has suggested an association between heterozygosity for GALT mutations and early menopause. This study evaluates the effect of carriership for classical galactosemia on ovarian reserve and menopausal age. Proven female carriers of classical galactosemia were recruited via the Dutch Galactosemia Society. All 58 participants underwent a structured interview regarding fertility, smoking status, and menopause. To determine ovarian reserve, 42 premenopausal GALT carriers underwent ovarian antral follicle count (AFC) by transvaginal ultrasound and early follicular phase blood sampling for hormonal measurement of follicle-stimulating hormone (FSH), inhibin B, and anti-Müllerian hormone (AMH). These ovarian reserve parameters were compared with a cohort of proven fertile women (n = 166). The mean age at menopause in GALT carriers was 49.7 years, which is not different from the mean age at menopause in the general population in the Netherlands. There was no difference in FSH, inhibin B, and AMH levels or in the AFC (when corrected for age and smoking status) between 42 premenopausal GALT carriers and controls. The authors conclude that there is no evidence that GALT mutation carriership affects ovarian reserve or menopausal age.     

Endometrial thickness of postmenopausal breast cancer patients treated with tamoxifen.

The effect of administration time of tamoxifen was assessed in 52 postmenopausal patients with mammary cancer in order to evaluate its effect on endometrium and serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol. Mean age of the patients was 61.5 years, 23% had a history of smoking, mean body mass index (BMI) was 26.9 kg/m(2), and mean age at menarche, menopause and administration time of tamoxifen was 12.9, 48 and 3.5 years, respectively. Serum FSH and LH concentrations were decreased by 41.8% and 44.9%, respectively, compared with mean normal postmenopausal levels. The FSH decrement was associated with BMI and LH level, whereas the LH decrement was associated with patient age and FSH concentration. Endometrium thickness <5 mm was reported in 60.5% of the patients, while endometrium thickness >/=5 mm was found in 39.5% of the cases. Histology revealed that 75% of the patients had atrophic endometrium; the remaining patients (25%) did not show atrophic changes. Administration time of tamoxifen was not associated with endometrial thickness or with serum FSH and LH concentrations.     

FSH levels in relation to hysterectomy and to unilateral oophorectomy

OBJECTIVE: To examine the association between hysterectomy, unilateral oophorectomy, and ovarian status, measured by FSH concentrations, in women aged 35-49 years. METHODS: From the National Health and Examination Survey III, 1716 women aged 35-49 years were studied. Information on menopausal status, surgical history (hysterectomy, single or bilateral oophorectomy), smoking, and other characteristics was collected in a structured interview, height and weight were measured, and one blood sample was collected. We used logistic regression to analyze FSH concentration in relation to hysterectomy and oophorectomy, controlling for age, ethnicity, body mass index, smoking, education, nulligravidity, and exercise. RESULTS: Hysterectomy with unilateral oophorectomy was associated with an increased prevalence of elevated FSH (above 20 IU/L) (adjusted odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3, 4.6) compared with women who had not had hysterectomies or oophorectomies. Among women with two ovaries, hysterectomy was associated with increased prevalence of elevated FSH (adjusted OR 1.5, 95% CI 1.0, 2.5). As a comparison of the effect size, the observed association between hysterectomy and elevated FSH was smaller than the association between FSH and current smoking (OR 2.0), a factor associated with a 1-2 year decrease in mean age at natural menopause. CONCLUSION: Although the differences in FSH levels were small, there was evidence of elevated FSH in women who have had hysterectomies, even if at least one ovary remained.     

The impact of serum FSH and estradiol on postmenopausal osteoporosis related to time since menopause

Aim: To determine the impact on osteopenia/osteoporosis of serum follicle-stimulating hormone (FSH), estradiol levels and time since menopause in a group of Turkish postmenopausal women. Methods: Four hundred and thirty-three healthy postmenopausal women seen at the Marmara University Menopause Outpatient Clinic were enrolled for this prospective cohort study. The women were allocated to one of three groups according to the bone mineral density (BMD) of the lumbar vertebrae and total hip, as measured by dual energy X-ray absorptiometry (DEXA). Serum FSH, estradiol levels, age and time since menopause were compared between the groups. Results: The mean serum FSH, LH, estradiol and testosterone levels for women with normal, osteopenic and osteoporotic BMD at lumbar vertrebra L1-L4 and total hip were comparable. Time since menopause had a stronger predictive value for low BMD (osteopenia or osteoporosis) in the lumbar and hip areas than did serum FSH or estradiol levels. Conclusions: Our study showed that neither FSH nor E2 has a strong impact on postmenopausal BMD. However it appears that time since menopause has a weak non-significant association with postmenopausal osteopenia and osteoporosis.     

Different dopaminergic control of plasma luteinizing hormone, follicle-stimulating hormone and prolactin in ovulatory and postmenopausal women: effect of ovariectomy

The main aim of this study was to evaluate the effect of dopamine infusion on plasma luteinizing hormone (LH), follicle-stimulating hormone, (FSH) and prolactin (PRL) after acute (1 week postovariectomy) and chronic (postmenopausal women) estrogen withdrawal. We also studied the same group of postmenopausal women after ovariectomy to evaluate the possible influence of other gonadal factors on the endocrine effects of dopamine. In order to have a further indication of neuroendocrine dopamine activity on pituitary secretions, we measured the change in plasma LH, FSH and PRL after the administration of metoclopramide, a dopamine receptor antagonist. Our findings confirm that in fertile women dopamine infusion inhibits plasma LH and FSH levels and show that 1 week after ovariectomy the LH decrease during dopamine administration is still present whereas the FSH decrease is not. In all groups of patients, dopamine significantly inhibited plasma PRL levels. Metoclopramide increased plasma LH levels in reproductive-age women before ovariectomy, but not in postmenopausal women. Plasma FSH levels did not change in any group and PRL levels increased after metoclopramide administration in all subjects. The present findings show that dopamine regulation of LH is impaired in long-term menopause, but not shortly after ovariectomy. These changes in LH control are not followed by similar changes in PRL secretion, which remains under tonic inhibitory regulation by dopamine. The different behavior of LH and FSH after ovariectomy and in postmenopause shows the independence of LH and FSH regulation.     

Follicular phase hormone levels and menstrual bleeding status in the approach to menopause

OBJECTIVE: (1) Characterize the relationship between follicular phase hormone levels and menstrual bleeding patterns in the approach to menopause; (2) identify racial differences in hormone levels; (3) determine independent contributions of menstrual status, race, age, BMI, and smoking to hormone levels. DESIGN: Randomly identified, population-based cohort, stratified to obtain equal numbers of African American and Caucasian women, prospectively followed for 5 years. SETTING: Women in Philadelphia County, PA, identified by random-digit telephone dialing. PARTICIPANT(S): Women aged 35 to 47 years with regular menstrual cycles at enrollment (N = 436). DATA COLLECTION: Blood sampling twice in each of 7 assessment periods during days 1-6 of the cycle, menstrual dates identified through structured interview and daily symptom reports, anthropometric measures and standardized questionnaires at each assessment period. MAIN OUTCOME MEASURE(S): Serum levels of follicular E(2), FSH, inhibin B, and LH. RESULT(S): The mean levels of E(2), FSH, inhibin B, and LH were differentially associated with the 5 menstrual status groups defined by changes in bleeding patterns. Significant changes in hormone levels occurred prior to missed menstrual cycles for inhibin B, FSH, and LH. All hormones had a highly significant interaction between menstrual status and BMI. African American women had significantly lower levels of E(2) and LH compared to Caucasian women in univariate analyses. The interaction of race, menstrual status, and BMI was highly significant (P<.001) for E(2), with African American women having lower E(2) levels until postmenopause, when E(2) levels were higher in AA women with BMI > or =25 and BMI > or =30. CONCLUSION(S): Levels of E(2), FSH, LH, and inhibin B are significantly associated with menstrual bleeding patterns in late reproductive age women and differentiate the earliest stages of the menopausal transition. Racial differences in mean levels of E(2) appear strongly mediated by BMI.     

A new biological carrier for follicle stimulating hormone: an aid for the diagnosis of menopause

The excretion of follicle stimulating hormone (FSH) was measured in urine samples collected every 2 weeks and on biological carriers (sticks) collected for 15-30 weeks from 10 perimenopausal women aged 38-53 (median 48 years), with a recent history of irregular menstrual cycles following regular cyclicity. In the 3 months preceding the menopause, long cycles were common and 8 of the 10 women experienced intermenstrual intervals lasting 50 days. FSH excretion was usually elevated to within the postmenopausal range (less than 8 mIU/ml), and only 1 woman excreted the low levels which are characteristic of fertile young women. Overall, FSH levels were higher in the period between 15 and 20 weeks after the menopause (18.3 +/- 6.2 mIU/ml) than in the first 4 weeks (9.6 +/- 5.2 mIU/ml). 95% correlation was found in parallel measurements of FSH attached to the biological carrier, the stick. It is proposed that the biological carrier, the stick, for FSH measurements in urine samples can help physicians to distinguish intervals of amenorrhea from the menopause: 2-3 measurements of FSH attached to the stick in an interval of 1 week can give a reliable answer.     

The influence of cigarette smoking on a population of infertile men and women

Purpose

This study aimed at investigating the effect of cigarette smoking on semen parameters in infertile men and on antral follicle count (AFC) and reproductive hormone levels in infertile women.

Methods

In 648 men (200 smokers and 448 non-smokers) sperm concentration, motility and morphology were compared according to smoking status. In the female population, AFC and basal follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol were measured in 296 women (102 smokers and 194 non-smokers). Statistical analysis of data was performed using t test, χ²-test and Spearman’s correlation.

Results

Among the male population, smokers had significantly lower sperm concentration and motility than non-smokers. Sperm normal morphology was reduced in smokers, although this difference did not reach statistical significance. No significant correlation was found between sperm parameters and the intensity of smoking. In the female population, AFC was reduced in smokers compared with non-smokers. Women who smoked had significantly higher FSH levels. No significant difference was found in LH and estradiol levels according to smoking status. The number of pack-years was negatively correlated to AFC and positively correlated to FSH levels.

Conclusion

Cigarette smoking is associated with damaging effects on sperm parameters in infertile men and with ovarian reserve alteration in infertile women, as reflected by reduced AFC and increased FSH levels. Every smoker should be encouraged to stop smoking to prevent the damage of the toxins contained in cigarette smoking and preserve their own reproductive potential.     

Effects of female sex hormones on caffeine-induced epileptiform activity in rats

Research on female sex hormones has demonstrated that estrogen aggravates epileptogenesis. Theoretically, this means that the frequency of epileptic attacks should be decreased in epileptic women during menopause. However, although epilepsy attacks are reported to decrease in some women during menopause, they may not change in others. Increases in attack frequency have even been reported during menopause in some epileptic women. This study has investigated the effects of estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) on caffeine-induced epileptiform activity in rats. Estrogen was found to increase epileptiform activity in a dose-dependent manner via its own receptors. In contrast, progesterone had no effect on epileptiform activity. FSH and LH suppressed epileptiform activity at low doses; however, at high doses they enhanced it. In conclusion, we suggest that the occurrence or aggravation of epilepsy, despite estrogen deficiency in the menopausal or post-menopausal period, is related to excessive accumulation of FSH and LH.     

Hormonal function after ovarian transposition to the abdominal subcutaneous fat tissue

We previously reported a new technique for ovarian transposition to the abdominal subcutaneous fat tissue (OTAFT) following hysterectomy. The purpose of this study is to assess the hormonal function after OTAFT. From 1993 to 2000, OTAFT was performed in 27 patients (group A). Forty-two women underwent hysterectomy and retained ovaries without transposition (group B). In 19 cases, bilateral oophorectomy with hysterectomy was performed, and they received a hormone replacement therapy (HRT) (group C). Serum follicle-stimulating hormone (FSH) level of patients was monitored every 2-12 months, and the time of menopause (defined as FSH >40 mIU/mL two times consecutively) was determined in groups A and B. After a median follow-up of 65 months, cumulative ovarian survival did not show significant difference between group A and group B (HR = 0.52, 95% CI = 0.17-1.16; P= 0.10). In patients who were 40 years old or younger, ovarian function declined significantly in group A compared to group B (HR = 0.29, 95% CI = 0.02-0.91; P= 0.04). However, FSH level of postmenopausal patients in group A was not different from FSH level of patients in group C, but FSH level of postmenopausal patients in group B was significantly higher than FSH level of patients in group C (P= 0.002). Although the procedure of OTAFT may somewhat affect the ovarian function, the transposed ovary in postmenopausal women presumably still secrete a small amount of estrogen which is equivalent to an estrogen level by HRT.     

Serum leptin concentrations in pre- and postmenopausal women on sex hormone therapy.

AIM: The aim of the present study was to investigate the influence of endogenous estradiol and estrogen and estrogen-progestin therapies on concentration in pre- and postmenopausal women. MATERIALS AND METHODS: The study groups consisted of 26 women with surgical menopause (mean+/-standard deviation (SD): age 51.8+/-2.6 years, body mass index (BMI) 26.45+/-4.56 kg/m(2)), 54 with natural menopause (mean+/-SD: age 50.5+/-3.0 years, BMI 25.75+/-4.09 kg/m(2)) and 40 premenopausal controls (mean+/-SD: age 48.3+/-2.3 years, BMI 26.23+/-4.12 kg/m(2)). The group with surgical menopause received estradiol transdermally (50 microg/day) and those with natural menopause received additionally medroxyprogesterone acetate (5 mg/day) for the last 12 days of the cycle. Before and after 4 months of therapy, body weight, waist and hip circumferences and blood pressure were measured, and BMI and waist-to-hip ratio (WHR) were calculated. Serum leptin, follicle-stimulating hormone (FSH), estradiol (E(2)), testosterone, prolactin and dehydroepiandrosterone sulfate (DHEAS) were measured prior to and after treatment. RESULTS: Leptin concentrations did not differ statistically among the groups. No correlations between leptin and E(2), FSH, prolactin, testosterone and DHEAS concentrations were found in any of the groups before and after treatment. Leptin level correlated positively with body mass, BMI and hip and waist circumferences in all groups. There were no correlations between leptin and WHR in the pre- and postmenopausal groups. In the premenopausal group and in some postmenopausal groups, serum leptin level correlated with blood pressure. CONCLUSIONS: 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.     

Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception

OBJECTIVE: The purpose of this study was to determine the rate of early postmenopausal bone loss in women who had used depot medroxyprogesterone acetate contraception through to menopause. STUDY DESIGN: Bone mineral density at the lumbar spine and femoral neck was assessed prospectively over 3 years in 15 women who reached a natural menopause and who did not undergo hormone replacement therapy and in 16 long-term users of depot medroxyprogesterone acetate who discontinued depot medroxyprogesterone acetate only on reaching menopause. Of the latter, 5 women subsequently underwent hormone replacement therapy. RESULTS: Early menopausal bone loss was rapid in the control group (6% from both sites over 3 years), but the users of depot medroxyprogesterone acetate (who did not take hormone replacement therapy) showed little change in bone mineral density. Between-group differences were statistically significant at years 2 and 3 at both sites (P <.03-<.002). In the users of depot medroxyprogesterone acetate who underwent hormone replacement therapy, bone mineral density increased significantly (P <.03) at the lumbar spine and was stable at the femoral neck. CONCLUSION: Women who use depot medroxyprogesterone acetate through to menopause have attenuated rates of bone loss from the lumbar spine and femoral neck, presumably because they have already lost the estrogen-sensitive component of bone.     

Elevated subclinical atherosclerosis associated with oophorectomy is related to time since menopause rather than type of menopause

OBJECTIVE: To compare common carotid artery intima-media thickness (IMT) between women who had natural menopause with those who had surgical menopause and to correlate IMT with time since menopause. DESIGN: Cross-sectional study. SETTING: University-based research clinic. PATIENT(S): One hundred eighty-nine healthy postmenopausal women who were not on hormone therapy (HT), age 46 to 81 (n = 132, women who did not have a prior hysterectomy or oophorectomy; n = 57, women who had undergone hysterectomy with bilateral oophorectomy). INTERVENTION(S): B-mode ultrasonography of the carotid artery, standardized questionnaires, and fasting blood samples were completed to evaluate the relationship between type of menopause, time since menopause, and subclinical atherosclerosis. MAIN OUTCOME MEASURE(S): Carotid artery IMT. RESULT(S): Mean (SEM) carotid artery IMT measurements were 0.74 (0.01) mm among women experiencing natural menopause and 0.81 (0.02) mm among women having bilateral oophorectomy (P=.02). After adjusting for years since menopause, the mean IMT did not differ between the two groups (0.77 [0.01] mm among natural menopause and 0.76 [0.02] mm among bilateral oophorectomy groups). The age-adjusted carotid IMT was significantly positively associated with years since menopause (P=.02). CONCLUSION(S): Earlier menopause is associated with elevated subclinical atherosclerosis. Because they have on average far earlier menopause, women with bilateral oophorectomy have elevated subclinical atherosclerosis compared with women of similar age who had natural menopause.     

Treatment of leiomyomas with luteinizing hormone-releasing hormone agonist

Twenty-five premenopausal women, 36-54 years of age, with uterine myomas were treated with 600-1,200 micrograms/day of luteinizing hormone-releasing hormone agonist (LHRHa) for 4 months. Eight patients reached menopause following the treatment with LHRHa (menopause group), while the resumption of menstruation occurred within 12 weeks after cessation of the therapy in 17 patients (menstruation group). Although the mean hemoglobin (Hb) concentration in the menopause group increased during treatment and was maintained within the normal range after cessation of the therapy, the Hb concentration in the menstruation group decreased after the resumption of menstruation. Both estradiol and CA125 in the menopause group were reduced during and after treatment. However, these parameters in the menstruation group increased concomitantly with the resumption of ovarian function. LH and FSH were suppressed during treatment, but these gonadotropins in the menopause group increased significantly to the levels of menopause. About a 50% reduction in uterine volume was observed in the menopause group. Three months after completing therapy, the restoration of uterine volume occurred in the menstruation group. Bone density findings in microdensitometry 12 weeks after cessation of the therapy did not differ significantly from those before the treatment. These results demonstrate that LHRHa therapy significantly reduces the uterine volume in patients with leiomyoma. It may be possible to treat selected patients with leiomyoma, including perimenopausal women and high surgical risk women with LHRHa, thus avoiding the need for surgery.     

更年期女性胆固醇水平调查与影响因素分析

目的研究胆固醇代谢与绝经的关联和可能的影响因素。方法对杭州市拱墅区963例40~60岁女性进行横断面调查,收集其月经史及其他临床资料,填写改良Kupperman更年期症状量表(mKMI),检测血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)水平。收集参与者教育程度、婚姻状态、职业状态、收入、居住地等社会人口资料。研究不同绝经状态女性胆固醇水平及高胆固醇血症、LDL-C升高的发生率,并分析年龄、绝经状态、FSH、E_2、社会人口等因素对血清胆固醇的影响。结果963例参与者平均年龄(51.0±5.6)岁,其中绝经前期302例(31.4%),围绝经期197例(20.5%),绝经后期464例(48.2%),绝经后参与者的平均绝经年龄(49.9±3.8)岁。在所有参与者中,绝经前期mKMI总分(6.36±6.43)显著低于围绝经期(10.30±7.88)和绝经后期(10.35±7.97)(P0.001)。绝经前后平均TC、LDL-C水平呈显著上升趋势,FSH、LH水平呈上升趋势,E_2水平呈下降趋势(P0.001)。所有参与者中高胆固醇血症比例为13.3%,LDL-C升高比例为15.0%,从绝经前期过渡到围绝经期、绝经后期的过程中,高胆固醇血症及LDL-C升高的发生率显著上升(P0.001)。Logistic多元回归分析表明FSH≥40IU/L是发生高胆固醇血症和LDL-C升高的危险因素(OR=2.821,95%CI=1.429~5.569,P=0.003;OR=2.587,95%CI=1.356~4.937,P=0.004),调整FSH水平后,年龄、绝经状态、E_2水平、社会人口因素与发生高胆固醇血症和LDL-C升高均无显著关联(P0.05)。结论相比绝经前期,围绝经期和绝经后女性平均TC、LDL-C上升,胆固醇水平升高的发生率增加,FSH水平升高可能是胆固醇代谢紊乱的内在机制,降低FSH水平可作为绝经激素补充治疗的目标和疗效指标。     

Pharmacological options in resistent ovary syndrome and premature ovarian failure

PURPOSE: To present methods of treating women in apparent ovarian failure to allow them to ovulate and conceive. METHODS: Ethinyl estradiol was used to lower elevated serum follicle stimulating hormone (FSH) levels to restore down-regulated FSH receptors on the follicle. Ovulation and pregnancy rates were then determined. Aggressive progesterone (P) therapy in the luteal phase was also used. Lowering elevated serum FSH with gonadotropin releasing hormone agonists was also successful in inducing ovulation in these patients. RESULTS: Several anecdotal studies have demonstrated that ethinyl estradiol therapy can induce ovulation in women in apparent menopause and achieve live births. CONCLUSIONS: The advantage of ethinyl estradiol over other estrogens to induce ovulation in hypergonadotropic women is that it does not cross-react in the assay for serum estradiol and can allow detection of estradiol secretion by the follicle. Thus estrogen therapy is by far the most effective treatment.     

成都市围绝经期和绝经后妇女对激素替代治疗的认知和接受程度

目的 :调查成都市中老年妇女绝经状况和激素替代治疗 (HRT)的使用和认知状况 ,为有针对性地开展生殖健康服务提供依据。方法 :经调查表对成都市市区和郊县的190 6名 4 4岁以上妇女进行横断面研究。结果 :成都市妇女平均绝经年龄为 4 8岁 ,2 5 .4 %的妇女应用过HRT。近 1/3的妇女了解HRT。 5 0 %的妇女希望得到这方面的教育。获得信息的主要途径是医生、亲友、医学书籍和传媒。结论 :成都市中老年妇女的生殖健康知识较为贫乏 ,应将宣传教育和医学服务相结合 ,提高妇女的生活质量     

Symptoms in the menopausal transition: hormone and behavioral correlates

OBJECTIVE: To estimate the association of headache, irritability, mood swings, anxiety, and concentration difficulties with menopausal stage and with reproductive hormones in the menopausal transition. METHODS: Women in the Penn Ovarian Aging Study were assessed longitudinally for 9 years. Data were obtained from structured interviews, a validated symptom questionnaire, menstrual bleeding dates, and early follicular hormone measures of estradiol (E2), follicle-stimulating hormone (FSH), and testosterone. Menopausal stages were based on menstrual bleeding patterns. Other risk factors included history of depression, perceived stress, premenstrual syndrome, current smoking, age, and race. Generalized linear regression models for repeated measures were used to estimate associations among the variables with each symptom. RESULTS: Headache decreased in the transition to menopause and was significantly associated with menopausal stage in univariable analysis (P=.002). Mood swings were inversely associated with mean FSH levels (P=.005). Irritability was inversely associated with mean levels of FSH (P=.017) and testosterone (P=.008). In multivariable models, the independent contributions of other covariates were strongly associated with these symptoms: premenstrual syndrome (P<.001) and perceived stress (P<.001) for irritability and mood swings; P=.018 for headache. There was 80% power with 0.05 alpha to detect a decrease of 13% or more in the prevalence of the symptoms in the postmenopausal stage compared with the premenopausal stage. CONCLUSION: Headache significantly decreased in the transition to menopause. Irritability and mood swings also decreased in the menopausal transition as assessed by hormone levels. The findings indicate that these symptoms that are commonly linked with menopause diminish with the physiologic changes of the menopausal transition. LEVEL OF EVIDENCE: II.