Resistance of pelvic arteries and plasma lipids in postmenopausal women: comparative study of tibolone and continuous combined estradiol and norethindrone acetate replacement therapy

OBJECTIVE: We sought to compare vascular resistance and plasma lipids in postmenopausal women assigned to tibolone (a synthetic estrogen replacement steroid) therapy or continuous combined hormone replacement therapy. STUDY DESIGN: Pulsatility and resistance indexes in pelvic arteries (color Doppler transvaginal ultrasonography) and lipids were monitored in this double-blind 1-year trial of 100 women randomized to either 2.5 mg tibolone or 2 mg 17beta-estradiol plus 1 mg norethindrone acetate daily. RESULTS: Both indexes of the arcuate arteries (uterine arteries) were significantly reduced beyond 3 and 6 months (12 months) from baseline, respectively, by the combined regimen compared with tibolone alone. Tibolone increased the resistance index of arcuate arteries but did not affect uterine arteries. There was no effect of either regimen on the internal iliac arteries. The medians of the percentage changes from baseline of high-density lipoprotein cholesterol (triglycerides) were significant between groups after 1 year, as follows: -17% (-16%) in the tibolone group and -4% (+15%) in the combined group, respectively. Both regimens similarly reduced total and low-density lipoprotein cholesterol and lipoprotein Lp(a). CONCLUSION: Hormone replacement therapy may induce different or opposite changes of both vascular resistance and lipids. It is unknown whether these findings may modify cardiovascular risk.     

Effects of oral and transdermal hormone replacement therapy on internal carotid artery pulsatility indices in postmenopausal women. A prospective, randomized, comparative study.

OBJECTIVE: To compare the effects of oral and transdermal hormone replacement therapy on the internal carotid artery pulsatility index in postmenopausal women. STUDY DESIGN: Thirty-seven women were randomized to six months of treatment with oral (n = 19) or transdermal (n = 18) sequential combined hormone replacement therapy. The internal carotid artery pulsatility index was assessed by color Doppler ultrasound at baseline and after six months of treatment. RESULTS: Carotid artery pulsatility indices were significantly lower than the mean of 0.939 +/- 0.139 at 0.860 +/- 0.084 in the oral hormone replacement group and significantly lower than the mean of 0.928 +/- 0.092 at 0.891 +/- 0.046 in the transdermal hormone replacement therapy group (P = .042) after six months of treatment. The mean changes in the carotid artery pulsatility index between the oral and transdermal hormone replacement groups were nonsignificant (-0.078 +/- 0.131 and -0.037 +/- 0.067, respectively; P = .53). There was a significant negative correlation between the change in pulsatility index during treatment and baseline values in the carotid artery (r = -.81, P = .001), but no correlation was found with time since menopause and serum estradiol level. CONCLUSION: Oral and transdermal sequential hormone replacement therapy are similarly effective at six months in reducing impedance to flow in the internal carotid artery.     

Effects of 15 months of 17 beta-estradiol and dydrogesterone on systolic cardiac function according to quantitative and Doppler echocardiography in healthy postmenopausal women

OBJECTIVE: Our goal was to investigate the short-term and intermediate effects of low-dose hormone replacement therapy on echocardiographic parameters of cardiac function in healthy postmenopausal women. STUDY DESIGN: In a prospective, controlled study 30 healthy postmenopausal women (mean age, 52 +/- 3 years) were randomly assigned to 2 groups. Women in the hormone replacement therapy group (n = 15) received 1 mg micronized 17 beta-estradiol daily sequentially combined with 5 or 10 mg dydrogesterone for 14 days of each 28-day cycle during 12 months and thereafter 2 mg 17 beta-estradiol combined with 10 mg dydrogesterone for a period of 3 months. The control group (n = 15) received no treatment. M-mode, quantitative 2-dimensional, and Doppler echocardiographic measurements were performed at baseline and within the 17 beta-estradiol phase at 3, 12, and 15 months. RESULTS: After 12 months significant differences in change between the 2 groups were found for left ventricular end-diastolic and left ventricular end-systolic diameters, left ventricular mass index, and stroke volume index. These differences were caused by changes in the control group rather than in the hormone replacement therapy group, in which no significant within-group changes were found. All other parameters measured showed no effect. CONCLUSION: Within 15 months of 17 beta-estradiol and dydrogesterone treatment no clinically relevant differences were found in the M-mode, quantitative 2-dimensional, and Doppler echocardiographic parameters measured in this study. It is suggested that 15 months of treatment probably is too short a period for detection of direct effects on the heart itself.     

Raloxifene reduces impedance to flow within the uterine artery in early postmenopausal women: a 2-year randomized, placebo-controlled, comparative study

OBJECTIVE: We sought to investigate the long-term effect of raloxifene and continuous combined hormone replacement therapy (ccHRT) on impedance to flow within the uterine artery in postmenopausal women. STUDY DESIGN: A prospective, randomized, double-blind, placebo-controlled 2-year study was performed in 95 postmenopausal women. They received either 60 mg of raloxifene daily (raloxifene 60 group), 150 mg of raloxifene daily (raloxifene 150 group), ccHRT, or placebo. At baseline and thereafter every 6 months, color Doppler ultrasonography was used to measure the pulsatility index (PI) of the uterine artery. RESULTS: After 24 months of treatment, compared with placebo, significant decreases were found in the PI in the raloxifene 150 group (P = .021) and in the ccHRT group (P = .007). In the raloxifene 150 group compared with the placebo group, after 6 and 24 months, decreases were observed in median PI of -5% and -15%, respectively, and in the ccHRT group decreases of -2% and -19%, respectively, were found. CONCLUSION: Long-term use of 150 mg of raloxifene daily or ccHRT reduces impedance to flow within the uterine artery. This indicates that high-dose raloxifene may exert cardiovascular protection.     

Time since menopause does not affect plasma viscosity, plasma thromboxane levels and Doppler findings.

OBJECTIVES: To evaluate whether the use of transdermal hormone replacement therapy (HRT), in women within 5 years of menopause compared with women who were postmenopausal for > 5 years, would significantly influence thromboxane B2 levels, plasma viscosity and Doppler flow parameters at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries. METHODS: Thirty-five normal-weight (body mass index > 19 and < 25 kg/m(2)) postmenopausal women (age 54.6 +/- 3.9 years, mean +/- standard deviation) participated in the study and were divided into two groups (Group I: n = 19, time since menopause < 5 years; and Group II: n = 16, time since menopause > 5 years). Patients were treated with a continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every 2 months. They were studied at baseline and after 6 months (in the estrogen-only phase of the cycle). RESULTS: Results showed a beneficial effect of hormone substitution after 6 months of therapy. Baseline plasma viscosity was similar in both groups, and decreased significantly after therapy in both Group I (-17.5%) and Group II (-15.6%). Plasma levels of thromboxane B(2) were similar at baseline and diminished equally in Group I and Group II (-85.6% and -85.2%, respectively) after treatment. Doppler assessment of the pulsatility index at the level of uterine, internal carotid, ophthalmic and bladder wall arteries showed no differences between groups at baseline and revealed a significant reduction of vascular impedance at the end of the treatment in both groups. CONCLUSIONS: Time since menopause does not affect the potential hemodynamic benefits of HRT in normal-weight women.     

尼莫地平对妊高征患者视网膜中央动脉血流的影响

目的观察尼莫地平对妊高征患者视网膜中央动脉血流的影响。方法应用彩色多普勒超声,检测１４例妊高征患者口服尼莫地平前后视网膜中央动脉血流变化,计算搏动指数（ＰＩ）,并与同期１４例静脉滴注硫酸镁治疗者进行比较。结果口服尼莫地平后视网膜中央动脉ＰＩ显著降低,由０９２±０１４降低至０７５±０２２。同时收缩压由２０７±２５ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降低至１９８±１５ｋＰａ,舒张压由１４４±２３ｋＰａ降低至１３６±１９ｋＰａ。结论尼莫地平可扩张视网膜中央动脉,对脑部其它小动脉可能也有相似作用。     

Effects of low-dose continuous combined conjugated estrogens and medroxyprogesterone acetate on menopausal symptoms, body weight, bone density, and metabolism in postmenopausal women.

OBJECTIVE: The purpose of this study was to determine the effects of a low dose of conjugated equine estrogens and medroxyprogesterone acetate plus calcium supplementation on bone density, metabolism, body weight, and symptoms in young postmenopausal women. STUDY DESIGN: Sixty postmenopausal women, aged 45 to 56 years, were randomized in an open-label, 2-year trial that compared treatment with low-dose continuous combined hormone replacement therapy that contained 0.3 mg of conjugated equine estrogens and 2.5 mg of medroxyprogesterone acetate plus 1000 mg of calcium per day or treatment with 1000 mg of calcium per day alone. Menopausal symptoms were evaluated for the first 12 weeks of the study; bleeding profiles, bone mineral density, bone turnover, and body weight were assessed for 24 months. RESULTS: After 24 months, we evaluated 15 subjects in the control group (with a 50% drop-out rate) and 23 patients (with a 23% drop-out rate) in the low-dose continuous combined hormone replacement therapy group. Low-dose continuous combined hormone replacement therapy was effective in reducing menopausal clinical symptoms and provided a favorable bleeding profile and minimal side effects. In comparison with basal values, bone mineral density significantly (P <.05) increased by 2.72% +/- 0.3% in the low-dose continuous combined hormone replacement therapy group and decreased by 7.9% +/- 0.8% (P <.05) in the control group after 24 months, with parallel changes in bone metabolism marker action. In the control group, body mass index significantly (P <.05) increased from baseline value with a weight gain of 3%; in the low-dose continuous combined hormone replacement therapy group, the body mass index did not change after 24 months of treatment, and the 1.3% gain in body weight was not significant. CONCLUSION: Low-dose continuous combined hormone replacement therapy can alleviate subjective symptoms and minimize body transformations that are associated with early menopause and provide an effective protection against the activation of bone turnover and osteoporosis.     

Color Doppler and hormone replacement therapy: the role of thromboxane and plasma viscosity.

The aim of the study was to evaluate the plasma thromboxane and plasma viscosity in relation with Doppler flow parameters in postmenopausal patients treated with hormone replacement therapy. Thirty-two postmenopausal (follicle-stimulating hormone > 40 IU/l and estradiol < 100 pmol/l) women (mean age +/- SD, 54.7 +/- 2.9 years) participated in the study and were submitted to continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every second month. Doppler resistances at the level of the uterine and internal carotid arteries, thromboxane plasma levels and plasma viscosity were analyzed in basal condition and after 1, 3 and 6 months. During hormone supplementation, the pulsatility index significantly decreased at the level of the analyzed arteries. Similarly, plasma thromboxane levels and plasma viscosity were significantly reduced. Significant correlations were found between thromboxane plasma concentrations, plasma viscosity and uterine artery resistances. Thus hormone replacement therapy seems to be responsible for both direct and indirect modifications at the level of the vessel wall physiology.     

Effects of hormone replacement therapy on plasma viscosity and Doppler variations in postmenopausal non-smokers and heavy smokers.

OBJECTIVES: To evaluate the effects of transdermal hormone replacement therapy (HRT) on some biological cardiovascular risk factors, specifically thromboxane B2 level and plasma viscosity. Furthermore, we investigated Doppler flow modifications at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries, and evaluated whether there were significant differences, in the examined parameters, between postmenopausal women who were non-smokers and heavy smokers. METHODS: Forty-three postmenopausal women (age 53.6 +/- 3.3 years, mean +/- standard deviation) participated in the study and were divided into two groups (Group I: n = 21, normal controls; and Group II: n = 22, heavy smokers). Patients were treated with continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every 2 months. They were studied at baseline and after 6 months (in the estrogen-only phase of the cycle). RESULTS: Results showed a beneficial effect of hormone substitution after 6 months of therapy. Plasma viscosity decreased significantly after 6 months of therapy both in non-smokers and heavy smokers (-18% and -14%, respectively). Plasma levels of thromboxane B2, which were similar at baseline, underwent a dramatic reduction in both Group I and Group II (-93% and -88%, respectively). Doppler assessment of pulsatility index at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries showed a significant reduction in vascular impedance at the end of treatment in both groups. However, the treatment was significantly less beneficial, in terms of the analyzed factors, in heavy smokers. CONCLUSIONS: Cigarette smoking represents a cardiovascular risk factor that can only partially be modified by the administration of transdermal HRT.     

A double-blind, placebo controlled study of postmenopausal oestrogen replacement therapy and carotid artery pulsatility index

Objective To determine whether postmenopausal oestrogen replacement therapy affects carotid artery pulsatility index.
Design A prospective double-blind placebo controlled trial.
Setting University associated teaching hospital.
Participants Twenty-eight postmenopausal women who were more than 12 months postmenopausal and who had not taken exogenous oestrogen.
Interventions Independent randomisation to receive oral oestradiol (2 mg daily) or placebo for 20 to 24 weeks.
Main outcome measures Internal carotid artery Doppler pulsatility index, measured within one centimetre of the carotid bifurcation.
Results Replicate data were available from 27 women. The mean pulsatility index decreased by -0.11 in 15 women receiving oestradiol, compared with a mean rise of 0.05 in the 12 women who received placebo (  P = 0.006  , 95% CI for treatment difference 0.06–0.31).
Conclusions Oestrogen replacement decreases postmenopausal carotid artery pulsatility index, probably reflecting decreased peripheral vascular resistance. This is a further mechanism whereby hormone replacement therapy may impart cardiovascular protection.     

Carotid vascular resistance in long-term estrogen users

OBJECTIVE: To compare carotid vascular resistance in long-term estrogen users with that of age-matched nonusers. METHODS: Pairwise comparisons between 18 long-term users of 17beta-estradiol (E2) implants (mean age 67.8 years, mean duration of treatment 18.8 years, range 5.8-33.9 years) and 18 age-matched (+/- 2 years) nonusers. We used color Doppler ultrasound to assess pulsatility index (PI) and resistance index (RI) in common, external, and internal carotid arteries. RESULTS: Estrogen users compared with age-matched nonusers had significantly lower mean values for common carotid RI, -4%; -0.04 (95% confidence interval [CI] -0.07, -0.03, P =.036) and marginally significant for PI, -12%; -0.25 (95% CI -0.54, 0.04, P =.087). Differences in external and internal carotids were smaller and insignificant. Age was a determinant of internal carotid vascular resistance in estrogen users and nonusers. Increasing pairwise differences in external carotid vascular resistance with advancing age (r = 0.55; P =.02), with magnitudes of mean group differences indicate a modest but true effect of long-term estrogen therapy on vascular resistance in common carotids, less in external, and negligible in internal carotid arteries. The study had an 80% power to detect a 10% mean difference (0.08 units) in common carotid RI at the 5% level. The standard deviation was considerably lower for estimates of RI than for PI. CONCLUSION: Long-term estrogen therapy was associated with minor reduction of vascular resistance in common carotid, less in external, and negligible in internal carotid arteries. Effects on carotid vascular resistance do not seem to be a major mechanism in the long-term protective effect of estrogen therapy on cardiovascular risk.     

Neutral effect of ultra-low-dose continuous combined estradiol and norethisterone acetate on mammographic breast density.

OBJECTIVE: To compare the effects of two different ultra-low doses of continuous combined hormone therapy and placebo on mammographic breast density in postmenopausal women. METHODS: A subpopulation of 255 postmenopausal women from the CHOICE trial were randomly assigned to 0.5 mg 17beta-estradiol (E2) + 0.25 mg norethisterone acetate (NETA), 0.5 mg E2 + 0.1 mg NETA, or placebo. Women using hormone replacement therapy (HRT) up to 2 months prior to the study were excluded; 154 women fulfilled the inclusion criteria. Mammograms were performed at baseline and after 6 months. Breast density was evaluated by visual classification scales and a computer-assisted digitized technique. RESULTS: No significant differences were detected between the active treatment groups and the placebo group in the digitized quantification. The mean baseline values for density around 20% were unchanged after 6 months. Also, visual classifications showed no increase in breast density in any study group. CONCLUSION: In contrast to currently available bleed-free regimens, the new ultra-low-dose combination of 0.5 mg E2 and 0.1 mg NETA seems to have very little or even a neutral effect on the breast. Both digitized quantification and visual assessment of breast density were unchanged after 6 months. Larger prospective studies should be performed to confirm this new finding.     

Time since menopause does not affect plasma viscosity,plasma thromboxane levels and Doppler findings

Objectives.?To evaluate whether the use of transdermal hormone replacement therapy (HRT), in women within 5 years of menopause compared with women who were postmenopausal for >?5 years, would significantly influence thromboxane B₂ levels, plasma viscosity and Doppler flow parameters at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries.

Methods.?Thirty-five normal-weight (body mass index >?19 and <?25?kg/m²) postmenopausal women (age 54.6?±?3.9 years, mean?±?standard deviation) participated in the study and were divided into two groups (Group I: n?=?19, time since menopause <?5 years; and Group II: n?=?16, time since menopause >?5 years). Patients were treated with a continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every 2 months. They were studied at baseline and after 6 months (in the estrogen-only phase of the cycle).

Results.?Results showed a beneficial effect of hormone substitution after 6 months of therapy. Baseline plasma viscosity was similar in both groups, and decreased significantly after therapy in both Group I (–17.5%) and Group II (–15.6%). Plasma levels of thromboxane B₂ were similar at baseline and diminished equally in Group I and Group II (–85.6% and – 85.2%, respectively) after treatment. Doppler assessment of the pulsatility index at the level of uterine, internal carotid, ophthalmic and bladder wall arteries showed no differences between groups at baseline and revealed a significant reduction of vascular impedance at the end of the treatment in both groups.

Conclusions.?Time since menopause does not affect the potential hemodynamic benefits of HRT in normal-weight women.     

Effects of hormone replacement therapy on plasma viscosity and Doppler variations in postmenopausal non-smokers and heavy smokers

Objectives.?To evaluate the effects of transdermal hormone replacement therapy (HRT) on some biological cardiovascular risk factors, specifically thromboxane B₂ level and plasma viscosity. Furthermore, we investigated Doppler flow modifications at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries, and evaluated whether there were significant differences, in the examined parameters, between postmenopausal women who were non-smokers and heavy smokers.

Methods.?Forty-three postmenopausal women (age 53.6?±?3.3 years, mean?±?standard deviation) participated in the study and were divided into two groups (Group I: n?=?21, normal controls; and Group II: n?=?22, heavy smokers). Patients were treated with continuous estradiol transdermal supplementation and 12-day courses of medroxyprogesterone acetate every 2 months. They were studied at baseline and after 6 months (in the estrogen-only phase of the cycle).

Results.?Results showed a beneficial effect of hormone substitution after 6 months of therapy. Plasma viscosity decreased significantly after 6 months of therapy both in non-smokers and heavy smokers (–18% and –?14%, respectively). Plasma levels of thromboxane B₂, which were similar at baseline, underwent a dramatic reduction in both Group I and Group II (–93% and –?88%, respectively). Doppler assessment of pulsatility index at the level of the uterine, internal carotid, ophthalmic and bladder wall arteries showed a significant reduction in vascular impedance at the end of treatment in both groups. However, the treatment was significantly less beneficial, in terms of the analyzed factors, in heavy smokers.

Conclusions.?Cigarette smoking represents a cardiovascular risk factor that can only partially be modified by the administration of transdermal HRT.     

Long-term effects of combined hormone replacement therapy on markers of endothelial function and inflammatory activity in healthy postmenopausal women

OBJECTIVE: To study the effects of combined hormone replacement therapy on markers of endothelial function and inflammatory activity. DESIGN: Prospective, randomized, controlled study. SETTING: Academic hospital. PATIENT(S): Healthy postmenopausal women with an intact uterus. INTERVENTION(S): For the first 12 months, the hormone replacement therapy group (n = 14) received oral E2, 1 mg daily, sequentially combined with 5 or 10 mg of dydrogesterone. Thereafter, they received oral E2, 2 mg daily, sequentially combined with 10 mg of dydrogesterone. The control group (n = 13) received no treatment. Data were collected at baseline and at 3, 12, and 15 months. MAIN OUTCOME MEASURE(S): Parameters of endothelial function and inflammatory activity. RESULT(S): During 12 months of follow-up, we observed decreases of 15% in plasma levels of endothelin-l, of 21% in soluble thrombomodulin, of 14% in von Willebrand factor, and of 12% in clottable fibrinogen in the hormone replacement therapy group compared with the control group. There was a 5% decrease in soluble E-selectin tevels. All significant changes were observed by 3 months and sustained after 15 months. Brachial artery flow-mediated vasodilatation and C-reactive protein levels did not change significantly. CONCLUSION(S): Long-term combined hormone replacement therapy with E2 and dydrogesterone in healthy women was associated with sustained improvement in some aspects of endothelial function and in clottable fibrinogen levels.     

Is median thoracic artery a target organ artery for estradiol and progesterone? a comparison with uterine artery

Purpose The aim of this study was to show the parallel evolution of the pulsatility index of the uterine artery and the one of the median thoracic artery.Study Design The study involved seven volunteer women, below 38, suffering from premature ovarian failure, who received E₂ and progesterone replacement therapy. Plasma levels of E₂, progesterone, follicle stimulating hormone and luteinizing hormone were measured and PI were studied and compared before treatment and on Days 13, 27 and 41.Results Before treatment, a high-resistance vascular for both arteries is uniformly found. The curves show with the increasing of the E₂ plasma levels, a decrease in the PI of UA and MTA with a fall at Day 13. We compared the mean values in MTA and UA PI. No statistical difference between the three mean values in PI obtained at Day — 1, Day 13 and Day 41 was demonstrated.Conclusion The results suggest that median thoracic artery is a target organ artery. Such as the UA, the MTA vascular resistance is according to the variations of plasma levels of E₂. In consideration of it rectilinear and superficial type, this led us to study this artery when we use different sorts of replacement therapy, and particularly in the oocyte donation program.     

Successful pregnancies after combined pentoxifylline-tocopherol treatment in women with premature ovarian failure who are resistant to hormone replacement therapy

OBJECTIVE: To determine whether treatment with combined pentoxifylline (PTX) and tocopherol (Vit.E) can improve uterine parameters in hormonal replacement therapy (HRT)-resistant women with premature ovarian failure (POF), for whom the outcome of assisted reproductive technology is usually negative. We previously reported that uterine radiation-induced fibrosis is reversible by combined PTX-Vit.E treatment. DESIGN: Case report. SETTING: Volunteer participants in an oocyte donation (OD) program in a French public hospital. PATIENT(S): Three women with POF (ages 36 +/- 2 years) using HRT exhibited uterine hormonoresistance, although they had high E(2) plasma levels. Their mean endometrial thickness was 4.9 mm, and they had an echogenic endometrium and thin uterine crosses. INTERVENTION(S): Between May 1998 and April 1999, treatment consisted of 800 mg of PTX combined with 1,000 IU of Vit.E daily for at least 9 months. MAIN OUTCOME MEASURE(S): Endometrial thickness, echogenicity, and pulsatility index of the uterine arteries, assessed by ultrasound and Doppler before and after treatment, and embryo implantation by IVF-OD. RESULT(S): PTX-Vit.E treatment was well tolerated and induced improvements, as mean edematous endometrial thickness increased to 7.4 mm, with nice uterine crosses. Three frozen-thawed ETs resulted in two viable pregnancies. CONCLUSION(S): In women with POF and uterine resistance to HRT, combined PTX-Vit.E reduces fibroatrophic uterine lesions and improves the uterine response to HRT, thus allowing embryo implantation and ongoing pregnancy.     

Differential effects of transdermal estradiol and sequential progestogens on impedance to flow within the uterine arteries of postmenopausal women.

OBJECTIVE: To investigate the relationship between estradiol (E2), progestogen, and impedance to blood flow in the uterine artery. SUBJECTS: Twelve postmenopausal women treated for two cycles with transdermal E2, 0.05 mg/d, with either norethindrone acetate, 0.7 mg, or medroxyprogesterone acetate, 10 mg added sequentially. MEASUREMENTS: Transvaginal ultrasonography and color flow imaging were used to measure the pulsatility index in the uterine arteries before and during the E2-only and combined E2/progestogen phases. RESULTS: The mean pulsatility index fell to 53% of its pretreatment value within 12 days E2 administration (P < or = 0.0001) and was 66% of its pretreatment value in the combined phase (P < 0.005). Similar changes were seen in cycle 2. Time since menopause was correlated with the pretreatment pulsatility index (r = 0.674, P < 0.05) and change in pulsatility index on treatment (r = 0.856, P < 0.001). CONCLUSION: Gonadal hormones have a profound effect on arterial tone in postmenopausal women; this action may help explain some of the beneficial effects of estrogen on arterial disease risk.     

Predicting Risks of Preeclampsia and Small for Gestational Age Infant by Uterine Artery Doppler

Objective: To assess the value of uterine artery Doppler as a screening test for preeclampsia and/or having a small-for-gestational-age (SGA) infant in healthy pregnant women. Methods: Color Doppler ultrasound was used to examine both uterine arteries in 400 healthy pregnant women at 24.8 ± 2.0 (range, 22 to 28) weeks of gestation. The mean pulsatility index of both uterine arteries was calculated and the presence of an early diastolic notch in the waveform was noted. Results: Twenty-six (6.5%) of the 400 women developed preeclampsia and/or had an SGA infant. The optimal cutoff value for the mean pulsatility index in predicting preeclampsia and/or having an SGA infant was 0.857. When using a high mean pulsatility index and/or the presence of any early diastolic notch, the detection of preeclampsia and/or having SGA infant were a sensitivity of 76.9%, a specificity of 52.9%, a positive predictive value of 10.2%, and a negative predictive value of 97.1%, respectively. Conclusion: Women with an abnormal uterine artery Doppler great a considerably higher risk for developing preeclampsia and/or having an SGA infant.     

Doppler study of the uterine arteries and ovarian stroma in patients with polycystic ovary syndrome

Doppler analysis of the uterine arteries and ovarian stroma was performed by transvaginal ultrasound in 24 patients with polycystic ovary syndrome (PCOS) and 22 ovulatory women. Vascularization of the ovarian stroma was more abundant in patients with PCOS than in control women, but no significant difference in the mean pulsatility index (PI) was observed between groups (1.14 +/- 0.28 for the PCOS group and 1.05 +/- 0.19 for the control group). The mean PI of the uterine arteries was significantly higher in the PCOS group (PI = 3.7 +/- 0.8) than in the control group (PI = 2.9 +/- 0.4). In the patients with PCOS, no correlation was observed between PI and luteinizing hormone, testosterone or androstenedione levels. Obesity had no effect on uterine artery PI, with no significant differences in this index when the 3 groups were subdivided into obese and non-obese groups.