Ovarian size in postmenopausal women

Ovarian volumes have been determined by pelvic ultrasonography in 2246 apparently healthy postmenopausal women of whom 2221 were included in the statistical analysis. Factors associated with gonadal size have been identified, and reference ranges for derived indices have been determined for use (in association with criteria for abnormal morphology) in a screening programme for ovarian carcinoma. The right ovary was present in 98.9% of subjects and the left in 99.1%. The mean (SD; range) of right and left ovarian volumes were 3.58 (1.40; 1.00-14.01) and 3.57 (1.37; 0.88-10.9) ml respectively. Significant predictors of ovarian volume were years since the menopause, weight, parity, age at menopause, a history of hormone replacement therapy, and previously diagnosed breast cancer. Abnormal ovarian volumes were assessed from a score equal to the (observed mean log volume (MLV) minus the predicted MLV)/0.327. A simplified nomogram has been prepared for routine clinical use. The relative abnormality of one ovary was assessed from a ratio score equal to loge (larger ovarian volume/smaller ovarian volume)/0.211 compared with the 99th centile for the Gaussian distribution.     

Ovarian masses in postmenopausal women.

In an attempt to evaluate the significance of malignant tumors in postmenopausal women, we reviewed the charts of 380 postmenopausal women over 50 years of age, operated on in our department for adnexal masses, from January 1st 1980 to December 31st, 1989. Two hundred and ninety-seven benign (78.2%) and 83 malignant (21.8%) tumors were found. In our group of patients the rate of malignancies increases significantly with the size of the lesion. Of the malignant tumors 25.1% were in the age group 50-60 years, 16.3% in the age group 60-80 years and 58.6%, a fourfold increase in the rate of malignancies, in the over 80 age group. Although surgery might pose problems in older patients, we conclude, on the basis of our experience, that surgical treatment should be considered for all adnexal masses in postmenopausal women.     

Ovarian production of estrogens in postmenopausal women

We investigated the possible secretory capacity of the ovaries of 79 postmenopausal women with and without endometrial carcinoma using chemical, enzymehistochemical and ultrastructural methods. The mean serum levels of estrone, estradiol and total estrogens were higher in ovarian effluent blood than the corresponding values in cubital venous blood. There was a positive correlation between the difference of total estrogens in ovarian and cubital vein sera and, on the other hand, enzymehistochemical and ultrastructural findings in ovarian tissue. No statistical differences were found in the peripheral mean values of estrone and total estrogens between the two groups. The mean level of estradiol, however, seemed to be higher and that of estriol lower in the carcinoma patients than in the control groups.     

Ovarian and adrenal contributions to peripheral steroid levels in postmenopausal women.

Serum levels of cortisol (F), pregnenolone (delta5-P), 17-hydroxypregnenolone (17-delta5-P), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), progesterone (P), 17-hydroxyprogesterone (17-P), androstenedione (A), testosterone (T), dihydrotestosterone (DHT), androst-5-ene-3beta, 17beta-diol (delta5-diol), estrone (E1), and estradiol-17beta (E2) were measured in 10 postmenopausal and 5 premenopausal women before (control) and after 7 days of Dexamethasone (post-dex). Control and post-dex levels of delta5-P, P, DHT, T, and F were not different (P greater than 0.05) in premenopausal versus postmenopausal women, while the control levels of 17-P, DHEA, DHEA-S, A, delta5-diol, and E2 were lower in the postmenopausal women (P less than 0.05). Assuming post-dex levels equal ovarian contribution, the ovarian contribution of 17-delta5-P, 17-P, DHEA, delta5-diol, A, E1, and E2 and the adrenal contribution (control-post-dex) to DHEA, DHEA-S, 17-P, A, and delta5-diol was significantly lower (P less than 0.05) in postmenopausal subjects.     

Ovarian mucinous adenocarcinoma with functioning stroma in postmenopausal women: aromatase and SF-1 expressions

Background

A high serum estradiol (E2) level is occasionally detected in postmenopausal women with common epithelial ovarian tumors with functioning stroma. It has been proven that functioning stroma has the capacity to convert androgens to estrogens. However, the mechanism of the initiation and development of functioning stroma remains unclear.

Case Presentation

We present two cases of elevated E2 levels in elderly women with ovarian mucinous adenocarcinomas that contained functioning stroma. Immunohistochemical evaluation revealed high expression levels of aromatase and steroidogenic factor-1 (SF-1), which is considered to be a master regulator of steroidogenesis, in their ovarian stroma.

Conclusions

These cases suggest that overexpression of SF-1 may promote estrogen biosynthesis through regulation of P450 aromatase expression in ovarian tumors with functioning stroma; this in turn induces high serum E2 levels in postmenopausal women with common epithelial ovarian tumors.

     

Effects of estrogen and progestin on aortic size and compliance in postmenopausal women

OBJECTIVE: Our purpose was to determine whether sex steroids alter aortic size and compliance in postmenopausal women. STUDY DESIGN: Twenty-six postmenopausal women were randomized to receive either conjugated estrogens 0.625 mg per day (group 1) or conjugated estrogens 0.625 mg per day and medroxyprogesterone 2.5 mg per day (group 2). Aortic cross-sectional area was measured by magnetic resonance imaging before and after 3 months of hormone therapy. RESULTS: Estradiol levels increased in both group 1 and group 2 (p < 0.0001). Ascending aortic cross-sectional area increased from 439 ± 7 mm² to 466 ± 7 mm² in group 1 (p < 0.008) but was unchanged in group 2. Within the range of aortic pressures studied, no change in aortic compliance could be detected. CONCLUSION: Estrogen therapy in postmenopausal women was associated with an increase in aortic size; but this effect was not detectable with the addition of progestin. The potential antagonistic effect of progestin on estrogen-induced aortic enlargement suggests that the favorable cardiovascular effects of postmenopausal estrogen therapy cannot be automatically extended to the combination estrogen-progestin. (Am J Obstet Gynecol 1996;174:1708-18.)     

Raloxifene in postmenopausal women

Since the diffusion of the WHI's trial and MWS results, which reported a negative risk/benefit balance of hormone therapy, the management of postmenopausal women has deeply changed over the last 2-3 years. In particular, for the prevention of osteoporosis, the use of other efficient agents tends now to be more widely recommended rather than estrogens. The SERMs with raloxifene are new molecules that have estrogen agonist effects on bone and estrogen antagonist or neutral effects on endometrial and breast tissue. The efficacy of raloxifene to inhibit postmenopausal bone loss as well as to reduce the incidence of vertebral fractures has been demonstrated in women at high risk for osteoporosis through a large randomized placebo-controlled trial involving several thousands of postmenopausal women (MORE trial). Furthermore, the extraskeletal effects of raloxifene might represent an advantage for a global management approach of postmenopausal women, although to date, its exclusive indication is namely the prevention of osteoporosis. However, the estrogen antagonist effects of raloxifene on breast tissue as well as its good safety profile with regard to both the endometrium and the risk of heart diseases are likely to make raloxifene of particular interest for women around the age of 60 years old. Adverse events associated with raloxifene only included an increase in the absolute risk of venous thromboembolism in a comparable manner as with estrogen therapy. Also, its lack of efficacy in reducing hot flushes or preventing vaginal dryness may limit its use in young symptomatic postmenopausal women. Also, its lack of reimbursement in women with no prior fragility fracture must be taken into account.     

Ovarian endodermal sinus tumor in a postmenopausal woman

BACKGROUND: Ovarian endodermal sinus tumor is rare in postmenopausal women. CASE: We report the case of a 75-year-old woman with a pure endodermal sinus tumor of the ovary. CONCLUSION: We believe this to be the oldest patient reported with an ovarian endodermal sinus tumor. The histogenesis of this entity in older patients may be different than when it occurs in young women.     

Pelvic abscesses in postmenopausal women

Seventeen postmenopausal women with pelvic abscesses were cared for at the Los Angeles County-University of Southern California Women's Hospital during the past eight years. Nine had experienced either postmenopausal bleeding or uterine instrumentation, or both, within the prior six months. Findings from physical examination and various laboratory and roentgenologic studies did not significantly help in improving the accuracy of preoperative diagnosis. In four, the abscess was associated with intra-abdominal pathologic conditions, and six had poorly controlled adult onset diabetes mellitus. Transfusion was required in eight patients. Two patients had a prolonged hospital stay because of pulmonary and septic complications. One patient had carcinoma of the ovary while another had carcinoma of the cervix uteri that was undiagnosed preoperatively. Our conclusion is that about one-half of postmenopausal patients with pelvic and tubo-ovarian abscesses have postmenopausal bleeding. The remainder may have associated intra-abdominal infective pathologic findings or a malignant condition of the genital tract. Expeditious surgical treatment should be undertaken.     

Hysteroscopic myomectomy in postmenopausal women

STUDY OBJECTIVE: To review the findings in postmenopausal patients undergoing hysteroscopic myomectomy. DESIGN: Retrospective case-controlled study (Canadian Task Force classification II-2). SETTING: Private practice. PATIENTS: Eighteen women with postmenopausal bleeding and two asymptomatic women with abnormal ultrasounds. INTERVENTIONS: Hysteroscopic myomectomy in 19 patients, with concomitant destruction of the endometrium in 4 patients, and resectoscopic biopsy in 1 patient. MEASUREMENTS AND MAIN RESULTS: Three patients underwent subsequent gynecologic surgery. One had hysteroscopy to evaluate and remove an asymptomatic residual myoma found on ultrasound. A sarcoma was found in two of the symptomatic patients. Two patients underwent hysterectomy-one for a sarcoma and the other for a carcinoma of the cervix. One patient has had further postmenopausal bleeding. CONCLUSION: Women who have a submucosal myoma that becomes symptomatic in the menopausal period may be at increased risk for a sarcoma.     

Plasma estrogens in postmenopausal women

The concentration of plasma estrone and estradiol was measured in different groups of postmenopausal women; including physiologic menopause, castration menopause, and those who in addition to menopause had diabetes, hypertension, or cardiac disease. The mean values for estrone were 41 pg. per milliliter and for estradiol 13 pg. per milliliter. There was no statistical difference in the levels of plasma estrogen in all groups of postmenopausal women studied. In 3 individuals, studies of estrogens in ovarian vein blood suggested a nonovarian origin of estrogen.     

Adnexal torsion in postmenopausal women

Little has been published about adnexal torsion among postmenopausal women. To address this question, we reviewed the records of all postmenopausal women with a postoperative diagnosis of ovarian neoplasm over a 10-year period. Among 301 tumors, 19 (6%) underwent torsion. Serous cystadenoma was the most frequent tumor type. No malignant neoplasm underwent torsion in this series. Adnexal torsion is not limited to women of reproductive age.     

Tuboovarian abscess in postmenopausal women

A retrospective review was done on all patients at Tampa General Hospital with a surgically confirmed tuboovarian abscess between March 31, 1983, and April 30, 1988. Patients were grouped according to their menopausal status. Sixty-three were identified. Fifty-four were premenopausal and nine postmenopausal. The median ages of the two groups (26 and 52, respectively) were significantly different. The premenopausal patients had a significantly lower median parity and were significantly more likely to have a prior history of gonorrhea and/or pelvic inflammatory disease. The postmenopausal patients were significantly more likely to have contributing medical problems and to have concomitant genital tract pathology. Such pathology, found in 13% of the premenopausal patients, consisted mainly of large leiomyomata uteri. In 3 (33.3%) of the postmenopausal patients there was a strong preoperative suspicion of a coexisting pelvic abscess originating in the genital tract. Two of the patients developed septic shock shortly before surgery. Concomitant pelvic pathology was present in six patients (66.7%), with four of them having genital tract malignancies. An attempt at early recognition and surgical management of tuboovarian abscess is important in postmenopausal women. There is little to be gained by delaying surgical treatment, and the patient is at significant risk of deterioration. In addition, surgical exploration appears to be vital to the recognition and treatment of concomitant pelvic malignancy or other pathologic conditions that may be contributing to the abscess.     

Sexual assault in postmenopausal women

Sexual assault is a crime of violence affecting modern American society. Victims of sexual assault tend to be women from a broad cross-section of social, economic, ethnic, and age groups. The postmenopausal woman is not immune from sexual assault and is increasingly a victim. The author presents the topic of sexual assault within the general framework of the physician's role in caring for a postmenopausal victim of this crime.