Influence of obesity and menopausal status on serum leptin, cholecystokinin, galanin and neuropeptide Y levels.

Obesity occurs in 60% of women after menopause and is characterized by an excess of adipose tissue that depends on several orexigenic (neuropeptide Y (NPY) stimulates carbohydrate ingestion, galanin stimulates fat intake) and anorectic (leptin, cholecystokinin (CCK)) factors. Both leptin and insulin can reduce hypothalamic NPY production and secretion. Behavior related to the consumption of food is probably attributed to the NPY-galanin signalling route. We investigated basal levels of serum leptin, CCK, galanin and NPY in 16 non-obese premenopausal women, in 15 obese premenopausal women (body mass index (BMI) 34.6 +/- 1.3 SD) and in ten obese postmenopausal women (BMI 34.7 +/- 1.5 SD) to determine the relationship between obesity, menopause and these neuropeptides. Obese premenopausal women had three-fold elevations of serum leptin (32.1 +/- 3.2 ng/ml) in comparison to non-obese premenopausal women (10.3 +/- 1.5 ng/ml), but similar levels to those in obese postmenopausal women (35.3 +/- 4.1 ng/ml). In all 44 patients and in both sub-groups of premenopausal and postmenopausal women, serum leptin exhibited a strong positive correlation with BMI (r = 0.8692, p < 0.0001; r = 0.8803, p = 0.0001; r = 0.8184, p = 0.0001, respectively). Serum galanin values showed a statistically significant increment in the obese postmenopausal group (51.1 +/- 8.1 pg/ml) compared to both premenopausal groups: the non-obese (34.9 +/- 5.8 pg/ml) and the obese (36.0 +/- 5.5 pg/ml). Non-obese menstruating women demonstrated NPY levels (175.0 +/- 12.8 pg/ml) significantly higher than those of obese premenopausal women (126.0 +/- 12.1 pg/ml) and obese postmenopausal women (138.1 +/- 15.4 pg/ml). CCK values showed no differences between non-obese and obese pre- and postmenopausal groups. Basal insulin values were elevated in both obese groups compared to non-obese premenopausal women. Significantly increased leptin and galanin levels in postmenopausal obese women coupled with decreased NPY levels revealed some changes in the neuropeptides regulating eating behavior, which may be the reason for the onset of postmenopausal obesity.     

The contribution of menopause to changes in body-fat distribution.

OBJECTIVE: To investigate whether menopause contributes to changes in body-fat distribution, irrespective of aging or obesity. METHODS: The subjects were 545 premenopausal (aged 16-55 years; mean +/- standard deviation, 37.7 +/- 9.1 years) and 219 postmenopausal (aged 45-65 years, 58.0 +/- 5.0 years) women. Baseline characteristics included age, body mass index (BMI), and menopausal status (premenopause or postmenopause). The ratio of trunk fat to leg fat (trunk-leg ratio) was estimated by dual-energy X-ray absorptiometry. The trunk-leg ratio and baseline characteristics were compared between the 2 groups. In all subjects (n = 764), possible correlations between the trunk-leg ratio and the baseline characteristics were determined using univariate and multivariate analysis. In postmenopausal women, the relationship of the trunk-leg ratio to YSM or age after adjusting for BMI was investigated. RESULTS: The trunk-leg ratio and BMI were significantly higher in postmenopausal women than in premenopausal women. In all subjects, age and BMI were positively correlated with the trunk-leg ratio (r = 0.445 and 0.587, respectively, p < 0.0001). Menopause was also positively correlated with the trunk-leg ratio on univariate regression analysis (standardized regression coefficient = 0.369, p < 0.0001). On multiple regression analysis, age, BMI, and menopause were independently correlated with the trunk-leg ratio (p < 0.05). In postmenopausal women, age and YSM were positively correlated with the trunk-leg ratio, independent of the BMI (p < 0.01). CONCLUSIONS: Menopause contributes to a change in body-fat distribution, irrespective of aging or obesity.     

Low intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures compared to hormone-treated and untreated postmenopausal women and premenopausal women without fractures.

OBJECTIVE: To assess the intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures. METHODS: A total of 203 women were recruited from a bone densitometer directory. The disc heights measured were those between the 12th thoracic and 3rd lumbar vertebrae. The discs were assigned the symbols D, whereby D(1) refers to the disc between the 12th thoracic and 1st lumbar vertebrae. The disc height of the group of women (n = 38) with osteoporotic vertebral fractures was compared to the disc heights of hormone-treated women (n = 47), untreated postmenopausal women (n = 77) and another group of premenopausal women (n = 41). RESULTS: The total disc height (D(1) - D(3)) (mean +/- standard deviation) in the fracture group was 1.58 +/- 0.1 cm, significantly lower (p < 0.0001) than in the untreated group (1.82 +/- 0.06 cm), which in turn was significantly (p < 0.0001) lower than in the hormone-treated group (2.15 +/- 0.08 cm) and in the premenopausal group (2.01 +/- 0.09 cm). CONCLUSION: The fracture group was noted to have the lowest intervertebral disc height compared to the other three groups. The hormone-treated and the premenopausal women had the highest disc heights recorded. These results may be due to the effect that the menopause and senescence have on the discal connective tissue components. This may lead to loss of the shock-absorbing properties of the intervertebral disc and an altered discoid shape, influencing the occurrence of osteoporotic vertebral body fractures.     

Effect of non-weight-bearing body fat on bone mineral density before and after menopause

OBJECTIVE: To investigate the difference in the effect of non-weight-bearing body fat mass on bone mineral density between premenopausal and postmenopausal women. METHODS: We studied 252 regularly menstruating premenopausal women and 213 postmenopausal women with right side dominance. Age, years since menopause (in postmenopausal women), height, weight, and body mass index were recorded. Bone mineral density of non-weight-bearing sites (ie, arms), weight-bearing sites (ie, lumbar spine including L2-4 and legs), and body fat mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Body fat mass was also measured by dual energy x-ray absorptiometry. RESULTS: Body fat mass did not differ between groups. In postmenopausal women, body fat mass correlated positively with bone mineral density of the left leg (r =. 41, P <.001), right leg (r =.36, P <.001), left arm (r =.31, P <. 001), and lumbar spine (r =.27, P <.001). The correlation between body fat mass and bone mineral density of the left arm remained significant after adjusting for age, years since menopause, and height. In premenopausal women, body fat mass correlated positively with bone mineral density of left leg (r =.37, P <.001) and right leg (r = 0.31, P <.001), but correlated weakly with bilateral arms (r < or =.19) and lumbar spine bone mineral density (r = 0.13, P <.05). CONCLUSION: The effect of non-weight-bearing body fat on bone mineral density was greater in postmenopausal than premenopausal women.     

Relative influence of age and menopause on total and regional body composition changes in postmenopausal women

OBJECTIVE: We measured total and regional body composition to evaluate the differences in body composition associated with menopause and to determine whether the changes in fat distribution were more related to age or to menopause. STUDY DESIGN: Two hundred five healthy white women who had never received estrogen replacement therapy were studied according to menopausal status and age. Bone mass and body composition were measured by dual x-ray absorptiometry. The proportions of android and gynoid fat were calculated in all women and differences were sought by statistical analysis. RESULTS: Compared with premenopausal women, postmenopausal women were characterized by a significant increase in the proportion of android fat and the ratio trunk fat/leg fat, whereas the absolute amount of body fat mass did not significantly change. The different variables of android fat distribution tended to correlate better with years since menopause than with age. In multiple linear regression, years since menopause was a predictor of body fat mass and fat trunk, whereas age was not a predictor of any of the fat distribution variables. CONCLUSIONS: This study underlines the early changes in body fat distribution with a shift of body fat toward a more central location in postmenopausal women. This change in fat distribution appears to be more related to menopause than to age and might, together with other factors, contribute to explain the increased cardiovascular risk reported in postmenopausal women. (Am J Obstet Gynecol 1996;175:1594-600.)     

The relative contributions of menopause and aging to postmenopausal reduction in intervertebral disk height.

AIM: To evaluate, in a population of normal women, the effects of aging and menopause on the height of intervertebral discs by measuring the intervertebral disk space, between the 12th thoracic and 4th lumbar vertebrae, by dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS: The study was conducted on 2455 consecutive women attending our Department, from whom 464 normal women were selected. The measurement was validated utilizing a spine phantom. RESULTS: The phantom mean intervertebral disk space was 0.44 cm, with a coefficient of variation of 1.4%. The coefficients of variation in premenopausal, early postmenopausal and elderly women were 2.2, 2.0 and 6.0%, respectively. Values of intervertebral disk space were stable from age 20 to 50 years, thereafter showing a significant (p < 0.05) decrease, negatively correlated with both age and years since menopause (p < 0.0001). In postmenopausal women younger than 60 years, a correlation (p = 0.042) was evident between intervertebral disk space and years since menopause, but no correlation was evident with age. In women over 60 years, no correlations were found between intervertebral disk space and either age or years since menopause. In three groups of age-matched women (47.5 +/- 1.5 years, n = 39 in each group), intervertebral disk space was significantly (p < 0.0001) lower in postmenopausal than in both premenopausal and perimenopausal women. CONCLUSION: The DXA measurement of intervertebral disk space is precise. After menopause, intervertebral disk space shows a progressive decrease that almost entirely occurs in the first 5 - 10 years since menopause, suggesting that the estrogen decrease may rapidly change connective tissue metabolism in the intervertebral disks.     

Precedence of the shift of body-fat distribution over the change in body composition after menopause

AIM: This study investigated the sequence of certain phenomena after menopause: decrease in bone mineral density (BMD), change in body composition (lean and fat components), and the shift toward upper body fat distribution. METHODS: Subjects were 188 postmenopausal women aged 50-65 years old. They were divided into four subgroups based on 4-year increments in age. Regularly menstruating women (n = 51) aged 50-53 years old served as controls. Age, height, weight, and years since menopause were recorded. Body fat mass, percentage of body fat (%fat), lean body mass (LBM), lumbar spine (L2-4), total body BMD, and the trunk-leg fat mass ratio were measured by dual-energy X-ray absorptiometry. RESULTS: In postmenopausal women (n = 42) aged 50-53 years, BMD was lower compared to age-matched controls (P < 0.05), while other variables did not differ. Trunk-leg fat mass ratio in women aged 54-57 years or more was significantly higher than that in control. LBM was significantly lower while percentage fat was significantly higher in women aged 58-61 years old or more. CONCLUSION: An initial event during the menopausal process is BMD loss, which is followed by body fat distribution shift, then LBM loss and reciprocal increase in body fat mass.     

Menopause-related differences in inflammation markers and their relationship to body fat distribution and insulin-stimulated glucose disposal.

OBJECTIVE: To determine whether postmenopausal status is associated with elevated plasma inflammation markers compared to premenopausal status, and how this explains differences in fat distribution and insulin-stimulated glucose disposal. DESIGN: Cross-sectional. SETTING: Clinical research center. PATIENT(S): Forty-five premenopausal women and 44 postmenopausal women. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) were measured by ELISA. Intraabdominal, subcutaneous abdominal, and total fat were measured by computed tomographic scan and dual-photon x-ray absorptiometry. Insulin-stimulated glucose disposal was measured by euglycemic clamp. RESULT(S): The TNF-alpha was higher in postmenopausal compared to premenopausal women (4.81 +/- 1.99 vs. 3.54 +/- 0.85 pg/mL). Interleukin-6 and CRP did not differ by menopausal status. In both premenopausal and postmenopausal women, CRP was related positively to total fat. The CRP was related to intraabdominal fat only in postmenopausal women and was negatively related to insulin-stimulated glucose disposal in both premenopausal and postmenopausal women. CONCLUSION(S): Postmenopausal status is characterized by higher TNF-alpha. The CRP may be associated with increased cardiovascular risk in postmenopausal women by its association with higher intraabdominal fat. Higher CRP is associated with lower insulin-stimulated glucose disposal in both premenopausal and postmenopausal women.     

Difference in the relative contribution of lean and fat mass components to bone mineral density with generation

AIM: To investigate whether the relative contribution of body composition (lean and fat mass component) to bone mineral density (BMD) differs depending on generation or menopause. METHODS: Subjects were 302 premenopausal women aged 30-49 years old and 197 postmenopausal women aged 50-69 years old. They were classified into four subgroups with 10-year increments. Age, height, weight and years since menopause (YSM) were recorded. Lumbar spine (L2-4), total body BMD, body fat mass, lean body mass (LBM), and the percentage of body fat (%fat) were measured using dual-energy X-ray absorptiometry. The correlation of body composition with BMD was investigated. RESULTS: The mean age at menopause was 50.2 +/- 4.1 years old. On Pearson's correlation test, LBM was positively correlated with BMD of the two sites in all groups. In a group aged 60-69 years, both the %fat and body fat mass were correlated with BMD. On multiple regression analysis, LBM was the principal BMD determinant in women aged less than 60 years, while body fat mass and percentage fat were the principal BMD determinants in women aged 60-69 years. Mean %fat in the group aged 60-69 years was 35.5 +/- 7.3%, which was significantly higher than that in the group aged 50-59 years (33.0 +/- 6.7%, P < 0.05). CONCLUSION: Although LBM still influences BMD up to 10 years after menopause, the body fat mass initially influences BMD after 60 years of age. These difference may be attributable to certain aging-related factor(s).     

Assessment of fat tissue distribution impact on selected prothrombin and fibrinolytic factors in pre- and postmenopausal women

OBJECTIVES: Objective was to examine the relationship of obesity, body fat distribution fasting plasma insulin concentrations and triglycerides of pro-thrombotic and fibrinolitics factors in pre and postmenopausal women. MATERIAL AND METHODS: We assessed 24 (13 nonobese and 11 obese) postmenopausal and 44 (15 obese and 29 non obese) premenopausal women. Plasma concentration of PAI-1 ag,PAI-1 activity, fibrinogen, tPA-1 akt, tPA ag, von Willebrand factor, fasting plasma insulin, and the lipid pattern (cholesterol, TG, HDL, LDL) was measured. The body fat distribution was assessed by waist-to-hip circumference measuring. RESULTS: Postmenopausal subjects had higher PAI-1 act. and PAI-1 ag (p < 0.05 and 0.001 respectively), vWf and lower ATIII. There was direct correlation between PAI-1 act., Fibrinogen and BMI in both groups of patients together and in premenopausal group PAI-1 act correlated directly and tPA ag/act. indirectly with plasma insulin concentrations. CONCLUSIONS: Plasma concentrations of the pro-thrombotic factors are increased in obese and postmenopausal women and correlate directly with BMI and indirectly with plasma insulin concentrations. Plasma concentrations of anti thrombotic factors indirectly correlated with WHR and with plasma insulin concentrations.     

Effects of postmenopausal hormone replacement therapy on body fat composition.

AIM: To evaluate the effects of different types, regimens and administration routes of hormone replacement therapy (HRT) on body fat composition indices in postmenopausal women at increased risk of anthropometry-related cardiovascular disease (CVD). METHODS: Fifty-nine postmenopausal women (aged 41-57 years, mean +/- standard deviation: 49.9 +/- 3.8 years) with body mass index (BMI) > or =25 kg/m(2) participated in this 6-month, prospective, randomized single-blind study. Subjects were assigned into three groups and received transdermal estradiol (E2)/norethisterone acetate (NETA) (50 microg E2 daily for 14 days followed by 50 microg E2/0.25 microg NETA daily for 14 days; transdermal group, n = 19), transdermal continuous E2/oral medroxyprogesterone acetate (MPA) (50 microg E2/5 mg MPA daily; transdermal/oral group, n = 19) or oral continuous E2/NETA (1 mg E2/0.5 mg NETA daily; oral group, n = 21). Anthropometric indices (body weight, height, and hip and waist circumferences) were measured, and BMI and waist-to-hip ratio (WHR) were calculated, before and after treatment. Also, the thickness of subcutaneous abdominal fat was measured by ultrasound. Depending on waist circumference (WC), the subjects were divided into two risk groups: increased-risk group with WC <88 cm (n = 32) and high-risk group with WC > or =88 cm (n = 27). Also, the effects of HRT were evaluated separately in subjects with median subcutaneous fat of <33 mm (n = 29) and those with median subcutaneous fat of > or =33 mm (n = 30). RESULTS: Overall, all three types of HRT caused a significant decrease in both WC and subcutaneous fat (p < 0.001), and also in WHR (p < 0.05). There was no significant difference in baseline (p > 0.05) and final values (p > 0.05) between HRT groups. In each group, all types of HRT significantly decreased WC and subcutaneous fat (transdermal group: p < 0.001 and p < 0.05; transdermal/oral group: p < 0.001 and p < 0.01; oral group: p < 0.001 and p < 0.001, respectively), while body weight, BMI and WHR changed only insignificantly (p > 0.05). In the increased-risk group, body weight increased significantly (p < 0.05) while WC and subcutaneous fat decreased significantly (p < 0.001 and p < 0.001). As for the high-risk group, there was a significant decrease in WC and subcutaneous fat (p < 0.001, p < 0.001) while the remaining parameters did not change significantly. However, BMI showed a tendency to increase in the increased-risk group, while there was a decrease in all measurements in the high-risk group. Regardless of the drugs used and baseline subcutaneous fat, WC and subcutaneous fat decreased significantly at the end of the treatment (subcutaneous fat <33 mm: p < 0.001 and p < 0.01; subcutaneous fat > or =33 mm: p < 0.001 and p < 0.001, respectively). CONCLUSIONS: The three different types of HRT have comparable effects on central fat tissue in women at increased risk of anthropometry-related CVD. Indeed, the three combinations of HRT reduced fat tissue in the central part of the body. However, the overall effect of HRT was more marked in women with WC > or =88 cm and subcutaneous fat > or =33 cm. Whether HRT increases body weight depends on the body composition indices of individuals before treatment.     

Relationship of upper body obesity to menstrual disorders

BACKGROUND: The purpose of the present study was to investigate the relative contribution of upper and lower body obesity to obesity-related menstrual disorders. METHODS: Women with polycystic ovary syndrome (PCOS) were excluded from the study. Eighty-three obese women with a body mass index (BMI, Wt/Ht2) of more than 25 kg/m2 were classified into two groups according to their menstrual status: one with menstrual disorders (n = 39; mean age +/- standard deviation, 31.6 +/- 4.9 years) and the other group (controls) with regular menstruation (n = 44; 32.2 +/- 4.4 years). Age, age at menarche, height, weight, and BMI were recorded. Trunk fat mass, leg fat mass, the ratio of trunk to leg fat mass amount (trunk-leg fat ratio), body fat mass, and the percentage of body fat were measured by whole-body scanning with dual-energy X-ray absorptiometry. Baseline characteristics and anthropometric variables were compared between the two groups. RESULTS: Trunk-leg fat ratio in women with menstrual disorders was 1.48 +/- 0.29, which was significantly higher than that in controls (1.25 +/- 0.38, p < 0.01). Trunk fat mass was also significantly higher in women with menstrual disorders than in controls (14.9 +/- 4.1 kg vs. 12.9 +/- 3.8 kg, p < 0.05). However, BMI, percentage of body fat, body fat mass, and leg fat mass did not differ between the two groups. Age, age at menarche, height, and weight did not differ between the two groups. CONCLUSION: Upper body, but not lower body, obesity is associated with menstrual disorders.     

Relationship between body fat distribution and bone mineral density in premenopausal Japanese women

OBJECTIVE: To investigate the relationship between body fat distribution and bone mineral density (BMD). METHODS: Subjects were 282 premenopausal women (mean age +/- standard deviation [SD], 38.8 +/- 8.5 years; range, 20-51 years) with regular menstrual cycles. Baseline characteristics included age, age at menarche, height, weight, body mass index ([BMI], weight/height(2)), and parity. Anthropometric characteristics including the ratio of trunk fat mass to leg fat mass (trunk-leg fat ratio), percentage of body fat, and total body lean mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Lumbar spine BMD (L2-4) was also measured by dual-energy x-ray absorptiometry. Correlations of BMD to baseline and anthropometric characteristics were investigated using univariate and multivariate analysis. RESULTS: Although height, trunk-leg fat ratio, and total body lean mass were positively correlated with lumbar spine BMD (r =.18, P <.01; r =.17, P <.01; and r =.25, P <.001; respectively), age at menarche was inversely correlated with BMD (r = -.19, P <.01). On multivariable analysis, trunk-leg fat ratio, height, age at menarche, and total body lean mass were still independently correlated with lumbar spine BMD (P <. 05). However, total fat mass was not correlated with BMD. CONCLUSION: Upper body fat distribution rather than overall adiposity is associated with lumbar spine BMD in premenopausal women. Humoral factors associated with body fat mass appear to influence lumbar spine BMD.     

Colposuspension for urinary stress incontinence in premenopausal and postmenopausal women

Sixty-nine premenopausal and 53 postmenopausal women had a colposuspension operation for urinary stress incontinence. A significant postoperative reduction (p less than 0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained in both groups. Postoperatively, 88.4 per cent of the premenopausal women were found to be dry compared with 66 per cent in the postmenopausal group (p less than 0.01). No differences were found preoperatively and postoperatively in the cystometric values or in the urethral pressure profiles at rest in both groups and between the groups. The pressure transmission ratios were significantly improved postoperatively in both groups. The postoperative transmission ratios in the premenopausal women were found to be significantly higher than those in the postmenopausal group, at the middle two-quarters of the urethra. Although surgical treatment for urinary stress incontinence in postmenopausal women results in lower cure rates than in younger women, it should be considered.     

Association between ghrelin levels and BMD: a cross sectional trial

Objective: Our aim was to determine whether the level of plasma total ghrelin varies with the menopause stage (pre-, peri-, and postmenopause). Participants and interventions: women were divided in three groups: premenopausal, perimenopausal and postmenopausal. All participants had bone mineral densitometry and blood assay of plasma ghrelin, estradiol E₂. Correlation between plasma ghrelin levels, their reproductive status and BMD was done. Results: The mean plasma level of ghrelin was significantly decreased in the perimenopausal and postmenopausal groups in comparison to the premenopausal group. A significant positive correlation was found between ghrelin and each of E₂ and BMD (at one or more of the three sites assessed) in all subjects, as well as, in peri- and postmenopausal women, whereas a significant negative correlation was found between ghrelin and FSH. Conclusion: It may be assumed that ghrelin can affect BMD. Whether ghrelin and estrogen work independent or through convergent mechanisms needs further studies.     

Comparison of bone mineral density and its variables between premenopausal and postmenopausal women

Objectives

To compare the bone mineral density (BMD) and its variables in premenopausal and postmenopausal women.

Methods

In this cross sectional study, 62 premenopausal and 62 postmenopausal apparently healthy women were evaluated by a questionnaire. The dietary intake of calcium was evaluated by 24 hours recall method and using table for proximate principle of common Indian food by Indian Council of Medical Research (ICMR). BMD at lumbar spine, femoral neck and Ward’s triangle were measured by dual energy X-ray absorptiometry (DXA). A correlation between BMD and various variables were calculated for each of the two groups.

Results

The mean age of premenopausal and postmenopausal women was 32.46±7.8 and 51.74±7.1 years respectively. The body mass index (BMI), height and weight were comparable in both the groups. The daily intake of calcium was significantly higher in premenopausal women (p<0.01). Approximately, 17% of the postmenopausal women and 9.6% of the premenopausal women were having osteoporosis; 28.56% of the postmenopausal women and 43.54% of the premenopausal women were having osteopenia at the lumbar spine. The BMD at lumber spine was found to be statistically significantly higher in premenopausal women than that in postmenopausal women (p=0.03). BMD at lumbar spine, femoral neck and Ward’s triangle were positively correlated with height, weight, BMI in premenopausal as well in postmenopausal women.

Conclusion

A significant number of women had osteopenia during premenopausal period and osteoporosis in postmenopausal phase. By increasing awareness towards bone health in second and third decade, morbidity of osteoporosis can be reduced.     

Serum lipid peroxides and total antioxidant status in postmenopausal women on hormone replacement therapy.

Estradiol (E2) has antioxidant properties. The role of progestins in antioxidant defense is still unknown. We have evaluated the influence of E2 and E2 plus medroxyprogesterone acetate (MPA) on serum lipid peroxide (LPO) levels, a marker of free radical reactions, and serum total antioxidant status (TAS) in postmenopausal women. Subjects consisted of 26 women with surgical menopause, before and after 4 months of estrogen replacement therapy (ERT; E2), and 54 women with natural menopause on hormone replacement therapy (HRT; E2 plus MPA). Forty premenopausal women served as a control group. Serum E2 was estimated by radioimmunoassay, follicle-stimulating hormone by IRMA methods, LPO and TAS by colorimetric methods. Before therapy, LPO levels in the postmenopausal women were significantly higher (p < 0.001) than in the control group. After both ERT and HRT, LPO decreased significantly and did not differ between both groups and the control group. TAS was significantly lower in postmenopausal women (p < 0.001) than in the control group before therapy. After both ERT and HRT, TAS increased significantly and did not differ between both groups and the control group. We conclude that oxidative stress is increased after menopause. ERT and HRT inhibit the generation of free radicals and raise antioxidant potential to the levels found in premenopausal women. MPA did not influence the antioxidant action of E2.     

Influence of dietary and genetic factors on metabolic status in obese and lean postmenopausal women

This preliminary study addressed the possible associations between dietary ,genetic and hormonal factors that are involved in the development of menopausal obesity and its metabolic consequences. We performed anthropometrical ,hormonal and biochemical measurements and used a nutritional questionnaire on 43 postmenopausal women who were non-HRT-users (14 obese and 29 non-obese subjects ,mean age ± SD of 52.8 ± 4.6 years ,mean body mass 74.6 ± 4.6 kg). All of the women also had fat mass assessed by DPX-Lunar. From the 24-h dietary recall ,the nutrient intake in daily food rations was calculated using a computer program (Nutritionist IV ,San Bruno ,CA ,USA) based on our own database. Restriction fragment length polymorphism of the estrogen-receptor-α gene was determined with the PvuII restriction enzyme. Obese women widely under-reported their daily food intake. The analysis of body fat distribution showed that the total body weight and the percentage of total fat mass were significantly increased in the obese group (p = 0.001). We observed significantly higher leptin (20.56 ± 11.9 vs. 9.02 ± 2.8 ng/ml) and total cholesterol (but lower cholesterol HDL) ,triglycerides levels in the obese subjects (261.89 ± 48.8 vs. 248.23 ± 55.9; 52.17 ± 13.6 vs. 60.92 ± 13.04; 142.82 ± 61.02 vs. 106.61 ± 27.7 mg/dl). Except for diastolic blood pressure ,clinical variables were not significantly different between subjects with and without the PvuII ERα polymorphism. Allele frequencies of the ERα polymorphism did not differ from those previously reported (P-0.48 ,p-0.52) in our study. In this preliminary study we failed to find dietary and genetic factors involved in the pathogenesis of menopausal obesity. However ,our results provide support for the notion that the perimenopausal increase in visceral fat is a significant factor involved in the increased cardiovascular risk in postmenopausal women.     

Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery

IntroductionThe effect of transvaginal mesh (TVM) surgery on sexual function between premenopausal and postmenopausal women remains controversial.AimTo compare the changes in sexual function of premenopausal and postmenopausal women following TVM repair.MethodsOne hundred and fifty‐two consecutive women with symptomatic pelvic organ prolapse (POP) stages II to IV were referred for TVM procedures at our hospitals. Sixty‐eight women were included because they were sexually active and had complete follow‐up. All subjects were divided into the premenopausal (N = 36) and postmenopausal (N = 32) groups. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP‐Q) system and a personal interview with the Female Sexual Function Index (FSFI), Urogenital Distress Inventory (UDI‐6), and Incontinence Impact Questionnaire (IIQ‐7).Main Outcome MeasuresThe FSFI, UDI‐6, and IIQ‐7 questionnaires.ResultsThe mean age, rates of hypertension, and previous hysterectomy were significantly higher in the postmenopausal group (P < 0.05) compared with the premenopausal group. As for the POP‐Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) in both groups except for total vaginal length (P > 0.05). Similarly, the UDI‐6 and IIQ‐7 scores significantly decreased postoperatively (P < 0.01). After POP surgery, the score of the dyspareunia domain decreased significantly in the premenopausal group (P < 0.01) but was not the case for the postmenopausal group (P > 0.05). There were no significant changes in other domains and total scores in both groups (P > 0.05). However, higher rates of worsening dyspareunia and total scores were noted in the premenopausal group (P = 0.03 vs. 0.033).ConclusionTVM procedure is effective for the anatomical restoration of POP. However, individual domain of FSFI such as dyspareunia may worsen in the premenopausal women. Additionally, our results revealed that over one third of premenopausal women could have a worsening sexuality domain postoperatively, with significantly higher rate of deteriorated dyspareunia and total FSFI scores than postmenopausal women. Long C‐Y, Hsu C‐S, Wu M‐P, Lo T‐S, Liu C‐M, and Tsai E‐M. Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery. J Sex Med 2011;8:2009–2016.     

Body fat distribution as a risk factor of endometrial cancer

OBJECTIVE: To investigate the relative contributions of upper body fat distribution and overall adiposity to endometrial cancer risk. METHODS: Subjects were 63 postmenopausal women with endometrial cancer aged less than 70 years and 201 age-matched controls. Age, age at menopause, years since menopause, height, weight, and body mass index were recorded at the time of admission. The trunk-leg fat ratio, body fat mass, trunk fat mass, and the percentage of body fat were measured by dual-energy X-ray absorptiometry. RESULTS: Trunk-leg fat ratio was higher in endometrial cancer patients than in controls (1.40 +/- 0.59 vs 1.23 +/- 0.39, p < 0.05). Whereas, other variables including age at menopause, percentage of body fat, body fat mass, and body mass index did not differ between the 2 groups. On stepwise multiple regression analysis, the trunk-leg fat ratio was still correlated with the presence of endometrial cancer (p < 0.05). CONCLUSIONS: Upper body fat distribution rather than overall adiposity is associated with endometrial cancer risk.