An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women

The prevalence of urinary incontinence (UI) and related urogenital symptoms (UGS) was investigated in a random sample (n = 4206) of women from the 1900-20 birth cohorts residing in the city of G?teborg. It was reported by 16.9% of the respondents that they currently had UI and by 22.7% that they had regularly suffered from this complaint at some time in their lives. The prevalence of UI increased (P less than 0.001) with rising age, from 13.9% in the 1920 birth cohort to 24.6% in the 1900 birth cohort. Over 50% of the sufferers reported daily incontinence. An objective assessment was performed in a subsample (n = 300) of the women complaining of UI. In 14 cases (4.6%) the diagnosis could not be confirmed, while in the remainder UI was classified by type as follows: stress incontinence 24%, urge incontinence 49% and mixed incontinence 27%. The number of urinary tract infections (UTI) reported by the respondents increased (P less than 0.001) with rising age. UGS such as pruritus, burning, pain and vaginal discharge were reported by 11% of the respondents. The reported frequency of local vaginal discomfort did not increase with age, unlike that of UI and UTI. Systemic or local oestrogen treatment was being received by 9.2% of the respondents.     

A longitudinal cohort study of elderly women with urinary tract infections

AIMS: the prevalence of urinary tract infections (UTI), urinary incontinence (UI), estrogen-use and overall mortality in a cohort of elderly women who had been treated for UTI in 1985-86 was re-assessed 10 years later. MATERIAL AND METHODS: a random sample of 6000 women from the birth cohorts 1900, 1905, 1910, 1915 and 1920 were invited in 1986 to complete a questionnaire about UTI, UI and estrogen use (response rate 70%; n = 4206). Treatment with antibiotics for UTI during 1985-86 was reported by 688 (17%) women. In 1995 a similar questionnaire was sent to the women from this group who were still alive (n = 434). Mortality in the women with a history of UTI was compared with an aged-matched control group of women who did not have UTI during 1985-86. RESULTS: the questionnaire was completed and returned by 361 (83%) women. Treatment for at least one UTI during the last 9 years was reported by 219 (61%) women. The number of episodes varied: 35% had one to two UTI, 28% had three to four UTI, 27% five to ten UTI and 10% had had more than 10 UTI. In 1986, the prevalence of UI was higher in women with a history of UTI than in the total population sample (30 vs. 17%; P < 0.001). The prevalence of UI had increased from 30% in 1986 to 33% in 1995 (P < 0.05). Mortality in the women with a history of UTI was higher than in the aged-matched control group (37 vs. 28%; P < 0.001). A total of 162 (45%) women had received estrogen therapy at some time after the age of 60 years and 140 (39%) reported that they were currently taking low potency estrogens. CONCLUSION: elderly women with a history of UTI had a continued high occurrence of UTI and UI, and overall mortality was higher in these women than in an age-matched control group of women from the total population.     

Prevalence of fractures among 10,000 women from the 1900 to 1940 birth cohorts resident in Gothenburg.

The prevalence of fractures in women aged 45-86 years resident in the city of Gothenburg, Sweden, was investigated by means of a postal questionnaire. A sample of 10,000 women from seven birth cohorts (1900-1940) was obtained at random from the population register. The response rate was 70.1% in the 1900-1920 and 81.0% in the 1930 and 1940 birth cohorts. When the prevalence of fractures sustained between 25 and 46 years of age was analyzed a higher figure emerged for women from the 1930 and 1940 birth cohorts than for those from the 1900-1920 cohorts, indicating an increasing incidence of fractures over time. There was a significant independent correlation between early menopausal age and a high rate of fractures. Menopausal age decreased with increasing tobacco consumption. There was also a significant independent correlation between tobacco-smoking and a high fracture rate. The prevalence of tobacco-smoking increased from 30.0 to 38.1% between the 1930 and 1940 birth cohorts, which may further increase the fracture risk in future years. Despite increasing vitality and longevity among the elderly in Gothenburg, there are indications that the number of fractures will increase in the future.     

Transdermal estrogen for female stress urinary incontinence in postmenopause

Objective: To evaluate the effect of transdermal estrogen for stress urinary incontinence in postmenopause. Study design: An open within patient, dose-finding study with transdermal 17-β-estradiol combined with cyclic medroxyprogesterone acetate was conducted over 9 months in 21 patients (mean age 57.3 years) suffering from urodynamically verified mild to moderate stress incontinence without detrusor instability. Results: Subjective improvement was noted in 16 out of 21 patients (76%). The dose level of 50 μg was better tolerated than 100 μg and sufficient enough to achieve continence. Conclusion: Transdermal estrogen therapy plays an adjuvant role in conservative therapy for mild to moderate stress urinary incontinence in postmenopausal women.     

Prevalence, 1-year incidence and factors associated with urinary incontinence: a population based study of women 50–74 years of age in primary care

Objectives: To study prevalence, incidence, remissions and factors associated with urinary incontinence in women 50–74 years of age. Methods: Cross-sectional study of prevalence and associated factors and a 1-year prospective study of incidence and remissions. A random sample of 698 women were invited for a gynecological examination in general practice in three municipalities in Northern Norway in 1994–1995. Five hundred and seven (73%) met for the first consultation, 489 of them for the second one. Questionnaires were answered by women and doctors during consultations at inclusion and 1 year later. Prevalence was estimated at three levels of evidence. Results: Any leakage was reported by 47% and regularly by 31%. For 19%, leakage was objectively demonstrated and claimed to be a social or hygienic problem. Incontinence was associated with high body weight, with poor ability to contract pelvic floor muscles and with previous gynecological operations excluding hysterectomy. Three women (0.6%) developed regular incontinence during the year of investigation. There was no convincing case of spontaneous remission. Conclusion: Urinary incontinence is very frequent in women aged 50–74 years and about one in five are potential patients needing treatment. Urinary incontinence is an enduring condition with little tendency for remission without treatment.     

Characteristics of women with hysterectomy

Socio-demographic and health information, including history of hysterectomy/oophorectomy, was obtained in a telephone survey of 2137 women aged 40–52. Subjects were randomly selected from a list of all women with a driver's license in Pittsburgh, Pennsylvania. Results showed that 27.3% of women surveyed reported having had a hysterectomy. Women who had undergone hysterectomy were more often black, less educated, older and heavier; and reported less frequent alcohol consumption, younger age at birth of first child and earlier menarche than women who did not report hysterectomy. Forty-seven precent of blacks reported hysterectomy compared with 24% of whites (P < 0.01) and blacks were significantly younger at surgery than whites (mean age 38.5 vs. 39.6 yr, P < 0.05). Results of multivariate analyses showed age, black race, less than a college education, menarche before age 12 and having no children to be associated with an increased risk of hysterectomy (P < 0.01). Additional multivariate analyses conducted separately for blacks and whites showed that, for whites but not blacks, the higher a woman's educational attainment the less likely she was to report having had a hysterectomy (P < 0.01). Black women with no children more often reported hysterectomy than those wit. children (P < 0.01), but this relationship was not found among whites. These findings show the distribution of hysterectomy in the population to vary by race, education and parity.     

The prevalence of and potential risk factors for female urinary incontinence in Beijing, China

OBJECTIVES: To survey and evaluate the prevalence and potential risk factors of female urinary incontinence (UI) in Beijing, China. DESIGN: A population-based cross-sectional study was performed from April to July 2005. We randomly sampled 1.0% of female residents aged 20 years and older from year 2000 national census data, totaling 5,300 women. All of the women were interviewed face to face using a modified questionnaire based on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Data were collected and analyzed. RESULTS: The overall prevalence of female UI was 38.5%. Prevalence rates of female stress urinary incontinence (SUI), female urge urinary incontinence, and female mixed urinary incontinence were 22.9%, 2.8%, and 12.4%, respectively. The prevalence rate of female UI was more than 50% in postmenopausal women. In multiple logistic models, multiple vaginal deliveries (odds ratio [OR]=2.1; 95% CI: 1.443-3.179), age (OR=1.7; 95% CI: 1.039-2.742), postmenopausal status (OR=1.5; 95% CI: 1.182-1.983), chronic pelvic pain (OR=1.4; 95% CI: 1.134-1.814), obesity (OR=1.4; 95% CI: 1.205-1.721), lack of exercise (OR=1.3; 95% CI: 1.105-1.509), constipation (OR=1.3; 95% CI: 1.109-1.586), and hypertension (OR=1.2; 95% CI: 1.053-1.474) were identified as potential risk factors of female SUI. No association between female SUI and offspring birth weight, occupation, or chronic diseases was observed in this study. Only 12.8% of women with UI and 7.4% of women with SUI seek medical help. CONCLUSIONS: UI is a major disorder that affects female quality of life. The prevalence of female UI is high (38.5%) in Beijing. Among the different types of UI, SUI was the most prevalent (22.9%). Potential risk factors identified for female SUI were multiple vaginal deliveries, age, postmenopausal status, chronic pelvic pain, obesity, lack of exercise, constipation, and hypertension.     

Managing urinary incontinence across the lifespan

In the 1996 baseline surveysoftheAustralianLongitudinal StudyofWomen’s Health (ALSWH), 36.1% of mid-age women (45–50) and 35% of older women (70–75) reported leaking urine. This study aimed to investigate (a) the range of self-management strategies used to deal with urinary incontinence (UI); (b) the reasons why many women who report leaking urine do not seek help for UI; and (c) the types of health professionals consulted and treatment provided, and perceptions of satisfaction with these, among a sample of women in each age group who reported leaking urine “often” at baseline. Five hundred participants were randomly selected from women in each of the mid-age and older cohorts of the ALSWH who had reported leaking urine “often” ina previous survey. Details about UI (frequency, severity, and situations), self-management behaviors and help-seeking for UI, types of health professional consulted, recommended treatment for the problem, and satisfaction with the service provided by health care professionals and the outcomes of recommended treatments were sought through a self-report mailed follow-up survey. Most respondents had leaked urineinthe last month (94% and 91% of mid-age and older women, respectively), and 72.2% and 73.1% of mid-aged and older women, respectively, had sought help or advice about their UI. In both age groups, the likelihood of having sought help significantly increased with severity of incontinence. The most common reasons for not seeking help were that the women felt they could manage the problem themselves or they did not consider it to be a problem. Many women in both cohorts had employed avoidance techniques in an attempt to prevent leaking urine, including reducing their liquid consumption, going to the toilet “just in case,” and rushing to the toilet the minute they felt the need to. Strategies are needed to inform women who experience UI of more effective management techniques and the possible health risks associated with commonly used avoidance behaviors. There may be a need to better publicize existing incontinence services and improve access to these services for women of all ages.     

Bone turnover and its relationship with bone mineral density in pre- and postmenopausal women with or without fractures

Objective: This work was carried out in order to investigate possible relationships between bone turnover rate, as evaluated by bone biomarkers and skeletal mass, as evaluated by bone mineral density (BMD). Method: Fifty-eight normal women and 30 female patients with osteoporotic fractures were enrolled. Three groups were defined: (1) fertile subjects (n=24), mean age 33.7±8.1 years; (2) postmenopausal women (n=32, including 11 patients with fractures) whose BMD values, in terms of T score, were less than −2.5 S.D. below the young adult mean obtained in our laboratory (mean age 61.7±7.9 years; and years since menopause (ysm), 12.6±8.3); (3) postmenopausal women (n=32, including 19 patients with fractures) whose BMD values in terms of T score, were below −2.5 S.D. (mean age 62.9±8.6 years; and ysm 15.9±9.0). Groups II and III characterised, by inclusion criteria, by significant different mean BMD values, were similar as far as chronological and menopausal age were considered. Metabolic tests included a short urine collection to determine calcium, hydroxyproline, cross-linked N-telopeptides of type I collagen (NTx) and creatinine (Cr); half-way through this collection, a blood sample was taken for the measurement of total alkaline phosphatase activity (ALP) and tartrate-resistant acid phosphatase activity (TRAP). BMD at lumbar spine was evaluated. Results: There were significant differences amongst the three groups in mean ALP (P<0.001, by analysis of variance) TRAP (P<0.006) and NTx/Cr (P<0.001) values, but not as far as mean values of calcium/Cr or hydroxyproline/Cr ratios were concerned. Considering the group as a whole, there were significant inverse correlations between NTx/Cr, ALP, TRAP and BMD controlling for both age (r=−0.392, P<0.001; r=−0.447, P<0.001 and r=−0.327, P<0.002, respectively) and ysm (r=−0.374, P<0.001; r=−0.474, P<0.001 and r=−0.333, P<0.002). Conclusions: Our results indicate, that, even after controlling for both ageing and oestrogen status, there is an inverse relationship between bone mass (that at a given time represents the balance of all previous metabolic events) and a biochemical marker (which reflects bone turnover at the time of examination). These findings are in line with the belief that increased bone turnover should be regarded as a risk factor for osteoporosis. Furthermore, our results indicate that, unless there is no increase of hepatic isozyme, total ALP still maintains a possible role as a first analysis to evaluate bone turnover before requesting markers with greater specificity, sensitivity but also more expensive and whose analysis is sometimes time-consuming.     

Age-specific prevalence of,and factors associated with,different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire

Objective

The aim of this study was to document the age-specific prevalence of different types of urinary incontinence (UI) in women and to identify the risk factors associated with each type of UI.

Design

A detailed self-administered questionnaire was mailed to 542 community-dwelling women, aged 24–80 years. The questionnaire included a validated instrument, the Questionnaire for Urinary Incontinence Diagnosis (QUID), for the assessment of stress, urge and mixed UI.

Results

Five hundred and six of the 542 women provided data (93.4%). The overall prevalence of any UI was 41.7% [95% confidence interval (CI): 37.2–45.8%]. Of the 210 women reporting UI, 16% [95% CI: 12.9–19.3%] reported stress only; 7.5% [95% CI: 5.2–9.8%] reported urge only and 18% [95% CI: 14.7–21.5%] reported a mixed pattern. Stress incontinence was most common amongst middle-aged women (25.3% of women aged 35–44 years), while urge incontinence was most common in women over the age of 75 years (24.2%). In logistic regression analyses, obesity (p < 0.001) and being parous (p = 0.019) were found to be significantly associated with stress incontinence, increasing age (p = 0.002) with urge incontinence, and being overweight (p = 0.035) or obese (p < 0.001) and having had a hysterectomy (p = 0.021) with mixed incontinence.

Conclusions

UI is a highly prevalent condition in women living in the community. Stress, urge and mixed incontinence have different age distributions and risk factors. These data are important in understanding the etiology, management and possible prevention of these conditions.     

The effect of aging on the electromyographic activity of pelvic floor muscles. A comparative study among stress incontinent patients and asymptomatic women

Objectives: Pelvic floor muscle training (PFMT) is commonly used in combination with biofeedback devices for stress urinary incontinence. A new electromyography (EMG)-based home-use device for PFMT is tested for healthy and stress incontinent patients. Subjects and methods: Altogether 31 women with genuine stress incontinence (GSI) and 35 controls without urinary symptoms were measured with a vaginal surface EMG probe. EMG activity during three rapid contractions (5 s) in supine and standing positions were observed. Results: Mean values of three rapid contractions were 17.0 μV (range 6.5–59.0, S.D. 10.5) in the supine position and 12.9 μV (range 5.0–33.0, S.D. 5.9) in the standing position among incontinent patients and 19.5 μV (range 9.0–43.5, S.D. 8.4) and 18.2 μV (range 8.0–43.5, S.D. 8.7) among the controls, respectively. A significant difference (P=0.006) was found in the mean values of three rapid contractions in the standing position between GSI patients and asymptomatic women. In regression analysis, EMG values were dependent on age (P=0.004 in the supine, P=0.009 in the standing) in both groups, but not on parity, body mass index (BMI) or episiotomies. Conclusions: In the study groups, the EMG activity of pelvic floor muscles (PFMs) decreased during aging. Although the tested surface EMG device showed a tendency that incontinent patients have lower PFM activities especially in the standing position, the value of surface EMG method as a diagnostic tool is not well established. However, the tested EMG-based device for PFMT will be helpful as guidance for incontinent patients.     

Bone density patterns after normal and premature menopause

Objectives: The investigation of the effect of time and type of menopause on bone mineral density (BMD) at different ages. Methods: Five hundred and fourteen women, who had never received any hormonal substitution were studied in a cross-sectional design: 177 with normal (NMP), 210 with surgical (SUMP) and 127 with premature natural (EMP) menopause. Age at menopause was 49.1±3.9, 38.3±4.7 and 38.1±4.2 years (mean±1 S.D.), respectively. BMD was measured at L2–L4 vertebrae and proximal femur by the DEXA method. Results: EMP women presented significantly lower vertebral BMD than NMP women in the 45–55-years segments (P<0.001), but did not differ from SUMP women. This group exhibited lower vertebral BMD than NMP between 45 and 50 years (P<0.001). Regarding femoral neck, EMP women exhibited lower values than SUMP in the 45–50 and 55–65 age segments (P<0.001) whereas SUMP women presented significantly higher BMD values than NMP women after 55 years of age (P<0.001). The percentages of women with vertebral BMD (T-score values) in the osteoporotic range were significantly greater in EMP compared with either NMP or SUMP groups (both P<0.001) whereas in femoral neck lower in SUMP than the other two categories. Conclusions: Women with either natural or surgical premature menopause exhibit lower BMD of trabecular bone compared with normal menopause women at the age segments 45–55 and 45–50, respectively. However, surgical menopause women exceed normal menopause women in their mixed bone BMD values after 60 years as well as premature natural menopause women at almost all age segments.     

Quantitative peripheral computed tomodensitometric study of cortical and trabecular bone mass in relation with menopause

Changes in total, cortical and trabecular bone mass were studied using quantitative peripheral computed tomodensitometry on the forearm of 58 normal eugonadal premenopausal women and 116 normal postmenopausal women to evaluate the evolution of bone components with age. In premenopausal women, no changes were seen in any bone component. In postmenopausal women, only trabecular bone mass diminished in the first 5 years after menopause (P < 0.05). It continued to decrease in the next 5 years (P < 0.05), but not later. Cortical bone mass experienced a significant loss 6–10 years after menopause (P < 0.001), and more than 15 years after menopause (P < 0.0005). These results are similar to those obtained with other techniques, and document the differing behavior of the cortical and trabecular bone components with years of menopause.     

Menstrual and reproductive factors and hip fractures in post menopausal women

Objectives: We analyzed the relationship between menstrual and reproductive history and risk of hip fractures in post-menopausal women using data from an Italian case-control study. Methods: Cases were 206 post-menopausal women admitted for fractures of the hip/proximal femur to a network of teaching and general hospitals in Milan, Italy. The comparison group consisted of 590 post-menopausal women admitted to the same network of hospitals for acute, non-neoplastic, non-hormone-related conditions, other than traumatic or orthopedic disorders. Odds ratios (OR) of hip fracture were derived from unconditional multiple logistic regression. Results: No relation emerged between risk of hip fractures and age at menarche, lifelong menstrual cycle pattern and age at menopause. In comparison with women with age at menopause ≥53 years, the multivariate OR of hip fractures were 1.2, 1.1, 1.2 and 0.5 in women with menopause at 50–52, 45–49, 40–44 and before 40 years (X₁² trend 0.21). In comparison with nulliparae, the estimated age-adjusted OR was 0.6 (95% confidence interval, CI, 0.4–0.9) for parous women, but the multivariate estimate was not significant (OR 0.8, 95% CI 0.6–1.3) and the multivariate trend in risk with number of births was not significant either. No relation emerged between hip fractures and age at first and last birth, and history of abortions. Conclusions: This study found no relevant influence of menstrual and reproductive factors on the risk of hip fractures in post-menopausal women. However, this is not in contrast with the observation of a short-term effect of menopause and, more in general, female hormone levels on osteoporosis and hence on hip fractures.     

Prophylaxis of osteoporosis with calcium, estrogens and/or eelcatonin: comparative longitudinal study of bone mass

Objective: To evaluate three different therapeutic regimens for the prevention of osteoporosis in natural and surgical postmenopausal women who had been found to have rapid bone loss in analytical studies. Methods: A total of 104 naturally or surgically postmenopausal women were studied, and subsequently followed-up during 1 year for avoidance of the influence of seasonal variation on bone mass, a factor overlooked in several studies. They were randomized into four groups of 26 patients each: the untreated control group (mean age 50 ± 5 years); the hormonal replacement treatment (HRT) group (mean age 48 ± 6 years), which was treated for 24 days each month with transdermal 17β-estradiol, 50 mg/day, together with medroxiprogesterone, 10 mg during 12 days; the calcium group (mean age 50 ± 4 years), which was treated with elemental calcium, 1 g/day; and the calcitonin group (mean age 50 ± 5 years), which was treated for 10 days each month with eel calcitonin, 40 IU/day and with elemental calcium, 500 mg/day. Full-body bone densitometry, for measuring total body bone mineral content (TBBMC), was carried out in all the women at baseline and 1 year. TBBMC was corrected for body weight by dividing its value by body weight (TBBMC/W). Results: After 1 year TBBMC/W was lower in every group: −2.14% (P < 0.001) in the control group; −0.14% (P = NS) in the HRT group (P < 0.05 vs. controls); −0.18% (P = NS) in the calcium group (P < 0.05 vs. controls); and −0.06% (P = NS) in the calcitonin group (P < 0.01 vs. controls; P < 0.05 vs. calcium and HRT). Conclusions: These findings show that all three treatments are effective in the prevention of postmenopausal loss of bone mass.     

Dietary flour supplementation decreases post-menopausal hot flushes: Effect of soy and wheat

Plants contain compounds with oestrogen — like action called phytoestrogens. Soy contains daidzin, a potent phytoestrogen, and wheat flour contains less potent enterolactones. We aimed to show in 58 postmenopausal women (age 54, range 30–70 years) with at least 14 hot flushes per week, that their daily diet supplemented with soy flour (n = 28) could reduce flushes compared with wheat flour (n = 30) over 12 weeks when randomised and double blind. Hot flushes significantly decreased in the soy and wheat flour groups (40% and 25% reduction, respectively <0.001 for both) with a significant rapid response in the soy flour group in 6 weeks (P < 0.001) that continued. Menopausal symptom score decreased significantly in both groups (P < 0.05). Urinary daidzein excretion confirmed compliance. Vaginal cell maturation, plasma lipids and urinary calcium remained unchanged. Serum FSH decreased and urinary hydroxyproline increased in the wheat flour group.     

Influence of psycho-social factors on climacteric symptoms

Background: It has been suggested that psycho-social factors may be crucial in the development of climacteric symptoms. Material and methods: In order to evaluate the effect of psycho-social and biological factors on menopausal symptoms, Greene (climacterical symptoms), Cooper (psychosomatic symptoms of stress), Smilkstein (family dysfunction), Duke-UNC (social support) and Israel (life events) tests were passed to 300 Chilean women between 40 and 59 years of age. Data were evaluated with ANOVA, χ² and logistic regression using the Epi-info package. Results: Perimenopausal women had a significant increase in stress and climacteric symptoms; however comparing with pre and postmenopausal women, tests for life events, family dysfunction or social support did not show any differences. A history of premenstrual syndrome was the main risk predictor f or climacteric symptoms (OR: 3.6, IC: 1.5–8.5; P<0.03), followed by perimenopausal state (OR: 2.9, IC: 1.4–6.0; P<0.001) and negative life events (OR: 2.3, IC: 1.0–5.3; P<0.05). The psycho-social factors were predictors for anxiety and depression; on the other hand, perimenopausal state was a risk factor for somatic and vasomotor symptoms. During premenopause, women with regular cycles and vasomotor symptoms have more psychological symptoms and stress. Conclusion: Climacteric symptoms that appear in the perimenopause are more intense in those women who have a biological predisposition such as premenstrual syndrome and are modulated by psycho-social factors.     

Testosterone enhances estradiol''s effects on postmenopausal bone density and sexuality

To investigate the role of androgens in increasing bone density and improving low libido in postmenopausal women, we have studied the long-term effects of estradiol and testosterone implants on bone mineral density and sexuality in a prospective, 2 year, single-blind randomised trial. Thirty-four postmenopausal volunteers were randomised to treatment with either estradiol implants 50 mg alone (E) or estradiol 50 mg plus testosterone 50 mg (E&T), administered 3-monthly for 2 years. Cyclical oral progestins were taken by those women with an intact uterus. Thirty-two women completed the study. BMD (DEXA) of total body, lumbar vertebrae (L1–L4) and hip area increased significantly in both treatment groups. BMD increased more rapidly in the testosterone treated group at all sites. A substantially greater increase in BMD occurred in the E&T group for total body (P < 0.008), vertebral L1–L4 (P < 0.001) and trochanteric (P < 0.005) measurements. All sexual parameters (Sabbatsberg sexual self-rating scale) improved significantly in both groups. Addition of testosterone resulted in a significantly greater improvement compared to E for sexual activity (P < 0.03), satisfaction (P < 0.03), pleasure (P<0.01), orgasm (P < 0.035) and relevancy (P < 0.05). Total cholesterol and LDL-cholesterol fell in both groups as did total body fat. Total body fat-free mass (DEXA, anthropometry, impedance) increased in the E&T group only. We concluded that in postmenopausal women, treatment with combined estradiol and testosterone implants was more effective in increasing bone mineral density in the hip and lumbar spine than estradiol implants alone. Significantly greater improvement in sexuality was observed with combined therapy, verifying the therapeutic value of testosterone implants for diminished libido in postmenopausal women. The favourable estrogenic effects on lipids were preserved in women treated with T, in association with beneficial changes in body composition.     

The values of urinary NTx in postmenopausal women undergoing HRT; the role of additional alendronate therapy

Objective: To determine the changes in levels of urinary NTx at the end of the 6th month of oral and transdermal hormone replacement therapy (HRT) and the effects of additional alendronate therapy for osteoporotic women. Method: Of 66 postmenopausal women 23 were treated with oral estradiol+norethisterone acetate (E+P), and 22 were treated with transdermal estradiol+norethisterone acetate. The third group consisted of 21 women with osteoporosis (bone mineral density<100 mg/cm³) and treated with oral E+P plus alendronate 10 mg/day. Result: Significant decreases of urinary NTx levels were seen after HRT in all study groups (P<0.05). But the decline of NTx levels was not different between the oral and transdermal HRT groups (P>0.05). There was no additional decrease in the levels of NTx with alendronate therapy (P>0.05) but NTx excretion diminished more in patients with high baseline levels. Conclusion: The decline of NTx at the end of the 6th month of HRT reflects the decrease of bone resorption and it is not related to the route of administration.     

Effects of postmenopausal hypoestrogenism on skin collagen

Objective: The aim of our study was to evaluate the effect of aging and postmenopausal hypoestrogenism on skin collagen content. Methods: Thirty-two women (mean age 48.78±9.86; year±S.D., range 28–68), 14 in premenopause and 18 in postmenopause, underwent skin biopsies performed during laparotomic operation. The amount of collagen type I, III and type III/type I ratio was evaluated by immunohistochemistry and computerised image analysis, and was related to age and years of postmenopause. Results: In the postmenopausal patients, a significant (P<0.01) decrease of percentage of skin collagen type I, type III and type III/type I ratio was observed in comparison to premenopausal women. The percentages of collagen type I, type III and type III/I ratio of all patients studied was significantly (P<0.01) correlated with chronological age (r=0.88, 0.89 and 0.61, respectively). Considering only postmenopausal subjects, the correlation with chronological age was significant (P<0.01) for collagen type I and type III of postmenopausal women (r=0.59, r=0.64, respectively), but not for the type III/I ratio (r=0.37, P=0.131). The percentages of collagen type I, type III and type III/I ratio of postmenopausal women showed a significant (P<0.01) inverse correlation with years of postmenopause (r=0.76, 0.73 and 0.73, respectively). Conclusions: Our data suggest that the decrease of skin collagen is an estrogen-related phenomenon.