The association of serum oestradiol level, age, and education with cognitive performance in peri- and late postmenopausal women

Objectives

To evaluate whether healthy women show cognitive changes after menopause and whether the possible changes are oestrogen-, age- or education-dependent.

Methods

Forty-eight women, 21 perimenopausal (aged 43–51 years) and 27 late postmenopausal (aged 59–71 years), participated in the study. Verbal and visuomotor functions, visuoconstructive skills, visual and verbal episodic memory as well as attention were evaluated.

Results

Perimenopausal women performed better than postmenopausal women. Serum oestradiol (E₂) level was included in the model in perimenopausal women only given the lack of endogenous oestrogen in postmenopausal women who were also not using hormone therapy (HT). In perimenopausal women, lower E₂ was associated with better visual episodic memory (p < .05), and older age was related to poorer verbal episodic memory (p < .05). In postmenopausal women, more education was associated with better performance in verbal and visuomotor functions, attention as well as verbal episodic memory (p < .05), older age was related to poorer performance in the visuoconstructive test and visual episodic memory (p < .05).

Conclusions

Perimenopausal women had better cognitive performance compared to late postmenopausal women. In perimenopausal women the effect of E₂ was minor. In both groups, age modified cognitive performance, but more so in postmenopausal women. Education did not have any effect on cognitive performance in perimenopausal women, whereas in postmenopausal women education exceeded age as a source of variation. Thus the relevance of education for better cognition was accentuated after menopause.     

Association between bone,body composition and strength in premenarcheal girls and postmenopausal women

Aim: The study examined whether associations between bone, body composition and strength are age dependent.

Subjects and methods: Two age levels (premenarcheal girls and postmenopausal women on HRT) were studied in a 10-month follow-up. Bone, lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA), and strength was measured using an isokinetic dynamometer.

Results: In girls, significant correlations were found between mass (lean, fat and body mass), strength and most bone characteristics (r = 0.15–0.93). At the proximal femur changes in bone mineral density (BMD) were moderately related to changes in body composition. In the women, body mass and lean mass were significantly correlated with most bone characteristics (r = 0.34–0.82). Low to moderate correlations were observed between changes in bone and changes in body composition. After controlling for lean mass the relation between strength and bone was no longer significant.

Conclusions: In premenarcheal girls, bone is partly determined by mass, with lean mass the most important predictor at the femoral sites. In postmenopausal women, lean mass is an important determinant of bone mineral content (BMC) and BMD, but changes in BMD are related to changes in fat. The relation between strength and BMD is mainly attributable to the relation between lean mass and BMD. The contributory effects of soft tissue to bone change over different life periods.     

Association between bone, body composition and strength in premenarcheal girls and postmenopausal women

AIM: The study examined whether associations between bone, body composition and strength are age dependent. SUBJECTS AND METHODS: Two age levels (premenarcheal girls and postmenopausal women on HRT) were studied in a 10-month follow-up. Bone, lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA), and strength was measured using an isokinetic dynamometer. RESULTS: In girls, significant correlations were found between mass (lean, fat and body mass), strength and most bone characteristics (r = 0.15-0.93). At the proximal femur changes in bone mineral density (BMD) were moderately related to changes in body composition. In the women, body mass and lean mass were significantly correlated with most bone characteristics (r = 0.34-0.82). Low to moderate correlations were observed between changes in bone and changes in body composition. After controlling for lean mass the relation between strength and bone was no longer significant. CONCLUSIONS: In premenarcheal girls, bone is partly determined by mass, with lean mass the most important predictor at the femoral sites. In postmenopausal women, lean mass is an important determinant of bone mineral content (BMC) and BMD, but changes in BMD are related to changes in fat. The relation between strength and BMD is mainly attributable to the relation between lean mass and BMD. The contributory effects of soft tissue to bone change over different life periods.     

Relation between abdominal subcutaneous fat tissue thickness and inflammatory markers during pregnancy

Introduction

Subcutaneous abdominal fat thickness (SCFT) is important for predisposition to metabolic and cardiovascular diseases. Our aim was to evaluate maternal SCFT and metabolic changes (such as insulin resistance and high inflammatory markers) during pregnancy.

Material and methods

A total of 92 pregnant women between 24–28 weeks of gestation were enrolled in the study. The SCFT was measured by ultrasonography and patients were divided into 2 groups according to thickness of maternal SCFT and body mass index (BMI). Groups were compared with each other for oral glucose loading test (OGL) results, and for haematological, biochemical and fetal biometric parameters.

Results

After analysis of frequency for SCFT, the most appropriate cut-off value for grouping patients was found to be 15 mm for SCFT. In 48 cases SCFT was over 15 mm. High C reactive protein (CRP) was found in 47.9% (23) of cases with SCFT over 15 mm. Serum haemoglobin A_1c (HbA_1c) level was significantly correlated with SCFT thickness. The most important factors for determination of OGL level were found to be serum HbA_1c level, BMI and SCFT. In obese subjects (BMI ≥ 25 kg/m²), levels of inflammatory markers and SCFT thickness were higher. The CRP and γ-glutamyltransferase (GGT) levels were significantly correlated with BMI and SCFT.

Conclusions

High SCFT during pregnancy is associated with elevated inflammatory marker levels and HbA_1c. Pregnant women with thicker SCFT may be susceptible to the development of metabolic complications of pregnancy, such as gestational diabetes mellitus (GDM) and hypertension, as well as risk of future metabolic and cardiovascular disease.     

Association between elevated serum hepatic enzyme activity and total body fat in obese humans

To investigate the associations between obesity and serum hepatic enzyme activities, we measured total body fat (TBF), body mass index (BMI), and hepatic biochemical parameters in 732 apparently healthy adults. TBF was assessed using a body fat analyzer. Serum activities of alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and lactate dehydrogenase (LD) were determined by standard spectrophotometric methods. Mean activities (+/- SD) of serum ALT and AST in men with high fatness were 51.2 +/- 12.6 U/L and 32.9 +/- 9.2 U/L, which were significantly higher than those in men with low fatness (23.5 +/- 7.4 U/L and 22.5 +/- 7.8 U/L, p < 0.01). Of 147 men with high fatness, 56 (38.1%) had serum ALT levels above the upper limit of normal, whereas only 9.5% (31/328) of men with low or desirable fatness showed elevated serum ALT activities (p < 0.01). Serum ALT, AST, and GGT activities correlated significantly with TBF in both overweight men and women. Among subjects having high TBF, those with fatty liver showed significantly higher incidence of elevated hepatic enzymes, compared to those without fatty liver. In short, elevated serum hepatic enzyme activities are associated with TBF and a high prevalence of fatty liver is observed in subjects with elevated TBF.     

Quantification of human body fat tissue percentage by MRI

The MRI‐based evaluation of the quantity and regional distribution of adipose tissue is one objective measure in the investigation of obesity. The aim of this article was to report a comprehensive and automatic analytical method for the determination of the volumes of subcutaneous fat tissue (SFT) and visceral fat tissue (VFT) in either the whole human body or selected slices or regions of interest. Using an MRI protocol in an examination position that was convenient for volunteers and patients with severe diseases, 22 healthy subjects were examined. The software platform was able to merge MRI scans of several body regions acquired in separate acquisitions. Through a cascade of image processing steps, SFT and VFT volumes were calculated. Whole‐body SFT and VFT distributions, as well as fat distributions of defined body slices, were analysed in detail. Complete three‐dimensional datasets were analysed in a reproducible manner with as few operator‐dependent interventions as possible. In order to determine the SFT volume, the ARTIS (Adapted Rendering for Tissue Intensity Segmentation) algorithm was introduced. The advantage of the ARTIS algorithm was the delineation of SFT volumes in regions in which standard region grow techniques fail. Using the ARTIS algorithm, an automatic SFT volume detection was feasible. MRI data analysis was able to determine SFT and VFT volume percentages using new analytical strategies. With the techniques described, it was possible to detect changes in SFT and VFT percentages of the whole body and selected regions. The techniques presented in this study are likely to be of use in obesity‐related investigations, as well as in the examination of longitudinal changes in weight during various medical conditions. Copyright © 2010 John Wiley & Sons, Ltd.     

Attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy among Norwegian women

In order to investigate women's attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy (HRT) 1019 women over 17 years of age constituting a representative sample of the Norwegian female population were interviewed in 1990 as part of a monthly national opinion poll (response rate 96.5%). Women's magazines proved to be the most important source of information on hormone therapy. Only in the over-45 age group were doctors mentioned frequently as information sources. A high self-assessed information level was associated with a positive attitude towards hormone therapy. Those who had obtained information from a doctor were more positive than those who had not. More than half of those who expressed an opinion believed that hormone therapy increased the risk of heart infarction, stroke, breast cancer and cancer in general. There was a strong association between a negative attitude, towards using hormones and belief in an increased risk of serious disease. The women were more positive towards the use of HRT for the prevention of osteoporosis and for postmenopausal urogenital complaints than for the alleviation of climacteric symptoms.     

糖耐量减低的绝经后女性血浆和肽素水平与血糖的相关性

目的:观察糖耐量减低的绝经后女性血浆和肽素水平与血糖的相关性.方法:将80例新发糖耐量减低(空腹血糖≤6.2 mmol/L,7.8 mmol/L≤甲餐后2h血糖≤9.4 mmol/L)的绝经后女性,年龄56～59岁,依据基线时和肽素水平,分成A组(＜5 pmol/L)、B组(＞20 pmol/L组),每组各40例.分析两组间基线时和6个月后和肽素、血糖的差异.结果:基线时,A组与B组组间的和肽素差异有统计学意义(P＜0.05),而在体重、空腹全血血糖、早餐后2h血糖、空腹血清三酰甘油、血清总胆固醇、血清低密度脂蛋白胆固醇、平均动脉压、血清肌酐水平、年龄等指标上结果相似,差异无统计学意义.经调整生活方式及口服阿司匹林(100 mg/d)、瑞舒伐他汀(10 mg/d)6个月后,在和肽素水平、空腹血糖、早餐后2h血糖指标上,B组明显高于A组,差异有统计学意义(P＜0.05).B组中有新发糖尿病16例,而A组没有.结论:在糖耐量减低的绝经后女性中,高血浆和肽素水平会进一步加重糖耐量减低,促使糖尿病的发生.     

Association between C-reactive protein and pulmonary function in postmenopausal women

Objectives

The objective of this study is to investigate the association of CRP and impaired pulmonary function in postmenopausal women.

Methods

The study was carried out in Gangnam Severance Hospital in Korea between March 2006 and October 2008. A total of 5978 healthy women subjects (age range, 20–75 years) were recruited from Seoul. We performed a cross-sectional study to evaluate the association of CRP with impaired pulmonary function, especially the restrictive pattern in 1555 nonsmoking postmenopausal women. We evaluated CRP as a categorical variable and constructed three groups (a very low risk group, CRP < 0.5 mg/dl; a low risk group, 0.5–1.0 mg/dl; a medium and high risk group, 1.0–10.0 mg/dl). The odds ratios (ORs) for a low FVC were calculated across all three groups.

Results

CRP levels are negatively associated with forced expiratory volume (FEV₁)/forced vital capacity (FVC) and FVC after adjustment for confounding variables. The adjusted ORs (95% CIs) for a low FVC according to three groups were 1.00 (reference), 2.08 (1.03–4.20), and 2.55 (1.31–4.98) in postmenopausal women after adjusting for confounding variables.

Conclusions

In summary, increased C-reactive protein (CRP) levels are strongly and independently associated with impaired pulmonary function and more frequent a low FVC in postmenopausal women.     

云南宁蒗地区摩梭人体脂肪参数对肺通气功能的影响

目的：探究云南宁蒗地区摩梭人的身体脂肪参数对肺通气功能的影响,为改善摩梭人身体素质提供依据。 方法：随机抽取云南宁蒗地区摩梭人365 名（ 男性139 名,女性226 名）为研究对象,采用生物电阻抗法对所有 受试者进行人体成分的测量,分析体脂肪参数（BFP）与肺活量（VC）、用力肺活量（FVC）、第1 秒用力呼气量（FEV １）、第1 秒用力呼气量占用力肺活量比值（FEV1/FVC）等肺通气功能指标的关系。所得数据经SPSS20.0 统计软 件包进行统计学处理。结果：云南宁蒗地区摩梭人的体脂分布大多处于正常范围,尤其是女性;BFP过高的以男 性居多;不同BFP组间的男、女性摩梭人的VC差异有统计学意义,但FVC、FEV1、FEV1/FVC 差异均无统计学意义; 肺活量体质量指数均随着BFP的增加呈下降趋势,差异有统计学意义。但不分高低的BFP除与肺活量体质量指数 呈负相关,与其余肺通气功能主要指标之间均无相关;在男性摩梭人中,BFP过轻组的肺活量体质量指数与身体 各部位脂肪参数无相关性,其他2 组肺活量体质量指数与身体各部位脂肪参数呈负相关。女性摩梭人BFP过低组、 标准组和过高组的肺活量体质量指数与身体各部位脂肪参数均呈负相关。结论：云南宁蒗地区摩梭人BFP升高是 肺通气功能下降损伤的危险因素,肺活量体质量指数随BFP的增加而减低。     

Association of the A1330V and V667M polymorphisms of LRP5 with bone mineral density in Greek peri- and postmenopausal women

Wnt signaling through low-density lipoprotein receptor-related protein 5 (LRP5) is an important determinant of bone mass regulation.

Objective

To explore the influence of two LRP5 single nucleotide polymorphisms (SNPs) A1330V and V667M on bone mineral density (BMD) and serum levels of osteoprotegerin (OPG), receptor activator of nuclear factor-κB ligand (RANKL) and bone metabolic markers in a Greek female population.

Study design

Two hundred and nine postmenopausal and twelve perimenopausal women aged 40–63 years were enrolled. All participants underwent spinal BMD evaluation. Genotyping of A1330V and V667M polymorphisms was performed by real-time polymerase chain reaction. Levels of OPG, soluble RANKL (sRANKL) and bone metabolic markers were measured.

Results

As regards A1330V SNP, women carrying CT/TT genotypes had lower spinal BMD than women with CC (p < 0.0001). Regarding V667M SNP, spinal BMD was lower in women with GA/AA than in women with GG genotypes (p < 0.0001). These differences remained significant after adjustment for age, years since menopause and body mass index. The A1330V and V667M polymorphisms were in strong linkage disequilibrium. A significant interaction between A1330V and V667M SNPs on spinal BMD was revealed. The haplotype with both risk alleles of the two SNPs (AT) conferred more risk for low BMD than the haplotypes with one risk allele (GT or AC) or the haplotype-reference (GC) (p = 0.046, p = 0.045, and p = 0.010, respectively). No effect was observed on circulating OPG, sRANKL levels and bone metabolic markers.

Conclusions

These findings demonstrate that the A1330V and V667M polymorphisms are associated with low BMD in peri- and postmenopausal Greek women.     

Carotid atherosclerosis and the risk factors in early postmenopausal Chinese women

Objectives

To describe the distribution of intima-media thickness (IMT) and the prevalence of plaque by carotid segments, walls and sides, and to examine their associated risk factors in asymptomatic, early postmenopausal Chinese women in Hong Kong.

Methods

Between 2002 and 2004, the study recruited 518 postmenopausal women aged 50–64 years. They were examined by B-mode ultrasound to measure the IMT and the prevalence of plaque at the near and far walls of common carotid (CCA), bifurcation (bulb), and internal carotid (ICA) of both the left and right carotid arteries. Blood pressures, obesity indices, lipids and glucose levels, sociodemographic, medical and lifestyle factors were also obtained.

Results

The mean IMT was 0.76 ± 0.12 mm (range: 0.53–1.33 mm). IMT was significantly thicker on the far wall than on the near wall and differed among segments (being thickest at the bulb and the narrowest at the ICA). 21.8% had at least one plaque in the carotid artery with most of the plaque found at the bulb area. Systolic blood pressure had statistically significant relationship with IMT that were fairly homogeneous among different segments. Lipids were associated with the CCA and bulb IMT, but not the ICA IMT. Diabetes predicted only CCA IMT. Older age, higher waist–hip-ratio and low-density lipoprotein cholesterol were significant predictors of plaques at all sites combined.

Conclusions

We described the distribution of IMT and the prevalence of plaque in asymptomatic, early postmenopausal Chinese women. Associations of risk factors with IMT of different arterial segments were also observed.     

Association between respiratory function and osteoporosis in pre- and postmenopausal women

OBJECTIVE: To investigate the relationships between respiratory function and osteoporosis, 132 premenopausal and 98 postmenopausal women were evaluated. METHODS: Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry. Pulmonary function and anthropometric parameters were measured using a spirometer and a body composition analyzer. RESULTS: Lumbar spine and proximal femur BMDs in postmenopausal women with forced expiratory volume in 1s (FEV1) > or = 92.0% averaged 0.83 +/- 0.12 g/cm2 and 0.67 +/- 0.11 g/cm2, which were significantly above the values (0.76 +/- 0.14 g/cm2 and 0.61 +/- 0.12 g/cm2, P < 0.05) in those with FEV1 <92.0%. The prevalences of osteoporosis at lumbar spine and proximal femur were 59.2 and 46.9% in the postmenopausal women with peak expiratory flow rate (PEFR) <5.12 l/s, significantly higher than those of osteoporosis at the corresponding sites in the women with > or = 5.12 l/s (36.7 and 20.4%, P < 0.05). Lumbar spine and proximal femur BMDs were positively correlated with FEV1 (r = 0.28, P < 0.05; r = 0.31, P < 0.05) and PEFR (r = 0.35, P < 0.05; r = 0.23, P < 0.05) in postmenopausal women; however, no significant correlations were observed in premenopausal women. CONCLUSION: Pulmonary function seems to be more closely associated with BMD in postmenopausal women than in premenopausal women. Poor respiratory function may be an indicator of postmenopausal women at increased risk of osteoporosis.     

Comparison between 1 year oral and transdermal oestradiol and sequential norethisterone acetate on circulating concentrations of leptin in postmenopausal women

BACKGROUND: Oral and transdermal postmenopausal hormone replacement therapy (HRT) affects lipid and glucose metabolism differently, which is of significance in the release of leptin by adipocytes. Moreover, oestrogen and progesterone can stimulate leptin secretion in women of reproductive age. Therefore, we compared the effects of oral and transdermal oestrogen plus progestin regimen on plasma leptin in 38 healthy postmenopausal women with normal body mass index (BMI), who wished to use HRT to control incapacitating climacteric symptoms. METHODS: The women were randomized to treatment with oral HRT (2 mg oestradiol on days 1--12, 2 mg oestradiol plus 1 mg norethisterone acetate (NETA) on days 13--22, and 1 mg oestradiol on days 23--28, n = 19), or with transdermal HRT (50 microg/day of oestradiol on days 1--13, and 50 microg oestradiol plus 250 microg/day NETA on days 14--28, n = 19) for 1 year. Plasma samples were collected before and at oestradiol + NETA phase after 2, 6 and 12 months treatment and were assayed for leptin. RESULTS: The baseline leptin, ranging from 3.3 to 34.9 microg/l, was significantly associated with BMI (r = 0.78, P < 0.0001 ), but showed no difference between women in oral HRT (geometric mean 13.9 microg/l, 95% confidence interval (CI) 10.1--17.6 microg/l) or transdermal HRT group (geometric mean 12.0 microg/l, 95% CI 9.7--14.3 microg/l). Neither oral nor transdermal oestradiol + NETA caused any significant changes in plasma leptin (or BMI) after 2, 6, or 12 months of treatment. CONCLUSION: Leptin is an unsuitable factor to detect oestradiol + NETA-induced metabolic changes in postmenopausal women.     

Physical activity,body fat,and serum c‐reactive protein in postmenopausal women with and without hormone replacement

The objective was to determine whether higher physical activity is associated with lower serum C‐reactive protein (CRP), independent of oral hormone replacement therapy (HRT) status and body fatness, in 133 postmenopausal women using a cross‐sectional exploratory design at a university research laboratory. The subjects were 133 postmenopausal women, age 50–73 years, with no evidence of coronary artery disease or diabetes. The main outcome measures were: serum CRP, physical activity as measured by Stanford 7‐day activity recall, body fat (both total and regional) as measured by dual energy X‐ray absorptiometry (DXA), and anthropometry (waist and hip circumference). Secondary outcome measures included fasting plasma glucose and insulin as well as fasting serum triglycerides, total cholesterol, high‐density lipoprotein cholesterol, and low‐density lipoprotein cholesterol. Higher physical activity energy expenditures were significantly associated with lower serum CRP levels (r = ?0.18, P = 0.041), independent of oral HRT use, age, smoking behavior, alcohol consumption, aspirin use, and statin use. However, in the complete multivariate model, which included body fat, older ages (P = 0.047), greater trunk fat masses (P < 0.001), any oral HRT use (P < 0.001), and unopposed oral estrogen use (P = 0.012) were the sole independent predictors of higher serum CRP levels. The complete multivariate model accounted for 58% of the variance in serum CRP. We conclude that the association between higher physical activity and lower serum CRP levels is dependent on the lower body fat of the more active women, yet independent of oral HRT use. Future intervention trials should determine whether diet‐ and exercise‐related reductions in body fat may be effective ways to diminish the proinflammatory effects of oral HRT in postmenopausal women. Am. J. Hum. Biol. 15:91–100, 2003. © 2002 Wiley‐Liss, Inc.     

Inhibin A and B in peri- and postmenopause

Objective: The aim of the study was to investigate the origin of inhibin A and B during the last years of the reproductive age and after menopause by measuring their levels in the ovarian and peripheral venous blood. Methods: The study population consisted of 43 women, aged 42–69 years (mean 50), who underwent hysterectomy with ovarian removal for a benign disease. A total of 24 of them were in follicular phase, 11 in luteal phase, and eight were postmenopausal. Peripheral and ovarian venous blood was collected for measurement of inhibin A and B. In addition, sex steroid hormone and gonadotropin levels were measured. Results: Ovarian venous inhibin B correlated significantly with ovarian estradiol secretion (r=0.5, P=0.001). The levels of inhibin B were significantly higher in the ovarian vein than in the peripheral vein (P=0.006). The highest inhibin B concentrations were detected in the mid-proliferative (mid-follicular) phase (median 31.6 pg/ml range 25.9–47.9). In postmenopausal women, inhibin B was not detectable. No correlation between FSH and ovarian inhibin B was found. Inhibin A rose rapidly in late proliferative (late follicular) phase (median 28.5, range <2–51.8) and dominated in the circulation throughout the luteal phase (median 20.9, range 8.8–60). For inhibin A, no concentration gradient existed between the ovarian and peripheral vein. Unlike inhibin B, inhibin A was detectable in ovarian and peripheral blood in postmenopausal women. A significant negative correlation between ovarian and peripheral inhibin A and FSH was found (r=−0.386, P=0.015; r=−0.345, P=0.034, respectively). Conclusion: Inhibin B correlates with ovarian estradiol secretion and seems to reflect follicular function. Inhibin A dominates in circulation during the luteal phase but is detectable at low concentrations both in follicular phase and even in postmenopause. Our findings suggest that inhibin A may play a role in FSH suppression in the female reproduction. In addition to the ovary, there may be extragondal source(s) of inhibin A.     

Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women

Our aim was to evaluate the prevalence of bacterial vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of bacterial vaginosis (assessed as a Nugent score of >or=7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for bacterial vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no bacterial-vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4*, and this group was considered separately from the intermediate flora group. A score of 4* was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in bacterial-vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of bacterial vaginosis in postmenopausal women.