Menopause,estrogens and frailty

Abstract

The controversy surrounding the results from the Women’s Health Initiative (WHI) trials published a decade ago caused a significant decline in the use of menopausal hormone replacement therapy. However, these results have been vehemently contested and several lines of evidence suggest that in perimenopausal and non-obese women, estrogen therapy may indeed be of benefit. There is ample proof that menopause causes a loss of musculoskeletal tissue mass and quality, thereby causing a loss of health and quality of life. There is also solid evidence that hormone replacement therapy in itself prevents most of these effects in connective tissue in it self. Besides the independent, direct effects on the musculoskeletal tissues, estrogen deficiency also reduces the ability to adequately respond and adapt to external mechanical and metabolic stressors, e.g. exercise, which are otherwise the main stimuli that should maintain musculoskeletal integrity and metabolic function. Thus, normophysiological estrogen levels appear to exert a permissive effect on musculoskeletal adaptations to loading, thereby likely improving the outcome of rehabilitation following critical illness, musculoskeletal trauma or orthopedic surgical therapy. These effects add to the evidence supporting the use of estrogen therapy, particularly accelerated gain of functional capacity and independence following musculoskeletal disuse.     

Hysterectomy and sexual function

Hysterectomy is one of the most common major gynaecological operations performed in the UK and the USA. Its impact on sexual function is a major cause of preoperative anxiety. Unfortunately, this anxiety is seldom articulated by patients, nor recognized and discussed by clinicians. Reports about the impact of hysterectomy on sexual function have been conflicting, partly due to the use of different and often unsatisfactory parameters to assess sexual function. The aim of this review is to assess the current evidence about the effect of hysterectomy on sexual function. Female sexual function is governed by psychological, social and physiological factors. A new model of 'the sexual response cycle', comprising physical, emotional and cognitive feedback, helps explain the sexual difficulties that arise before and after hysterectomy. Evidence is lacking for sexual dysfunction caused by the disruption of local nerve and blood supply, or by changing anatomical relationships. Removal of the ovaries at hysterectomy is associated with no change or even an improvement in sexual function, particularly in women on hormone replacement therapy. Thus, overall, hysterectomy improves sexual function, regardless of surgical method or removal of the cervix. This is probably due to the amelioration of the symptoms that have previously had a negative effect on sexual function.     

Hormones and sexual function.

Female sexual function, as well as sexual dysfunction often seen during menopause, is assumed to be closedly related to the hormonal milieu of the body, particularly that of the target organs of the sex steroids. Estrogen as the hormone associated with female reproductive functioning is given first consideration in treating complaints of dysfunction, especially dyspareunia. However, simply restoring some, or all, of the estrogenization of the premenopausal years does not always lead to improvement in overall sexual functioning. Decreased libido is often still present in situations that appear to be anatomically satisfactory. Thus, exogenous testosterone, in a number of dosage forms, is often used adjunctively. Although the results are often gratifying, side effects may be a problem for some women. Treated women should be monitored for increased facial oiliness, acne, hirsutism, and alopecia.     

Female sexual function and dysfunction

This article identifies models of sexual function, defines and categorizes sexual dysfunction, and identifies therapeutic modalities for patients who have sexual dysfunction. Additionally, it discusses some of the questionnaires used to evaluate sexual function.     

Comparison of overall sexual function, sexual intercourse/activity, sexual satisfaction, and sexual desire during the three trimesters of pregnancy and assessment of their determinants

IntroductionPregnancy affects women's sexual function. However, few reports have addressed this phenomenon.AimTo examine overall sexual function and three dimensions of the Taiwan version of the Female Sexual Function Index and to assess their determinants during the three trimesters of pregnancy.MethodsCross‐sectional investigation of 663 pregnant women using the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form, the Body Image Scale for Pregnant Women, and demographics questions.Main Outcome MeasuresUrinary incontinence, body image, obstetrical history, demographics, and other factors potentially influencing overall sexual function, intercourse/activity, satisfaction, and desire during pregnancy.ResultsMean scores for overall sexual function, intercourse/activity, and satisfaction differed significantly among the three trimesters (P = or <0.02), whereas mean scores for sexual desire did not. Mean scores for overall sexual function and intercourse were significantly lower during the third trimester than during the first trimester (P < 0.001) or second trimester (P < 0.001). Mean score for satisfaction was significantly higher during the third trimester than during the first trimester (P = 0.01). Significant effects included the following: (i) the discomfort and infertility experiences on overall sexual function and on intercourse, the interaction between body image and artificial abortion on satisfaction, spontaneous abortion on desire during the first trimester; (ii) the full‐time work and infertility experiences on overall sexual function and on intercourse, the interactions between body image and medical condition on desire during the second trimester; and (iii) the interaction between gestational age and HoLou ethnicity on overall sexual function, the interaction between body image and discomfort on overall sexual function and on intercourse, the interactions between body image and infertility experiences and gravidity on satisfaction, urinary incontinence on desire during the third trimester.ConclusionsResults demonstrated that biopsychosocial and cultural factors affected Female Sexual Function Index (FSFIT) scores throughout pregnancy. Chang S‐R, Chen K‐H, Lin H‐H, and Yu H‐J. Comparison of overall sexual function, sexual intercourse/activity, sexual satisfaction, and sexual desire during the three trimesters of pregnancy and assessment of their determinants. J Sex Med 2011;8:2859–2867.     

Menopause hormone therapy,migraines, and thromboembolism

Migraine, a common form of headache, is a highly prevalent and disabling condition with a predilection for females. Migraines are neurovascular diseases. The two main types of migraines are migraines with and without aura, and several subtypes exist. There is a strong link between sex steroids and migraines. In women, migraine remissions are associated with stable and critical oestrogen levels. The literature reveals an association between migraine with aura and stroke, with a higher incidence in the young compared with that in the old. The absolute risk of stroke is low; tobacco use and a high dose of oral oestrogens may increase the risk. Early diagnosis, follow-up, and nonhormonal symptomatic and preventive treatments address the neglected area of migraines. Judicious use of hormones throughout the lifespan as needed would improve the quality of life.     

Menopause,energy expenditure,and body composition

OBJECTIVES: The effects of menopause transition on metabolic and cardiovascular disease risk in women are unclear. It is unknown whether estrogen deficiency, aging, or a combination of both factors are independent contributors to a worsening health profile in women. We considered the effects of menopause transition and hormone replacement therapy on body composition, regional body fat, energy expenditure, and insulin sensitivity. METHODS: A brief review of current literature that has considered the role of menopause transition and hormone replacement therapy on body composition, energy expenditure, and insulin sensitivity with an emphasis on longitudinal investigations. RESULTS: Preliminary evidence suggests that natural menopause is associated with reduced energy expenditure during rest and physical activity, an accelerated loss of fat-free mass, and increased central adiposity and fasting insulin levels. Hormone replacement therapy has been shown to attenuate these changes. Longitudinal and longer intervention studies are needed to confirm these initial findings. CONCLUSIONS: Menopause transition may represent a risky period in a woman's life, 'triggering' adverse metabolic and cardiovascular processes that predispose women to a greater incidence of obesity-related comorbidities. Dietary, exercise, and hormonal interventions specifically targeted at premenopausal women may help mitigate the worsening cardiovascular and metabolic risk profile associated with menopause.     

Menopause,a global perspective

This paper attempts to provide a global perspective of the menopause as a period in a woman's life. It is growing in length, year after year and there is a need to place these years in the overall context of ageing. There are many fallacies about ageing. The most serious is the view describing old people exclusively as a burden for society, when in fact they can and should be considered as a resource. Women live longer almost everywhere in the world. Growing evidence indicates that the process of ageing differs in a considerable way in the two sexes. This difference may, at least in part, be due to sex-related differences in the regulation of stress response mediators. In addition, variability in the mitochondrial genome also displays a sex-specific impact on longevity. Restricting the discussion to longevity in the female, a paramount role must be given to sex hormones in improving a woman's ageing. Indeed, it is the fall in oestradiol production that qualitatively changes the ageing perspective in the human female, since oestrogen secretion plays a major role in guaranteeing a woman's psycho-physical equilibrium during the fertile period. These considerations represent the philosophical basis for post-menopausal hormone replacement therapy.     

Postpartum female sexual function

Although many women experience sexual problems in the postpartum period, research in this subject is under-explored. Embarrassment and preoccupation with the newborn are some of the reasons why many women do not seek help. Furthermore, there is a lack of professional awareness and expertise and recognition that a prerequisite in the definition of sexual dysfunction is that it must cause distress to the individual (not her partner). Sexual dysfunction is classified as disorders of sexual desire, arousal, orgasm and pain. However, in the postpartum period the most common disorder appears to be that of sexual pain as a consequence of perineal trauma. Health care workers need to be made aware of this silent affliction as sexual morbidity can have a detrimental effect on a women's quality of life impacting on her social, physical and emotional well-being.     

Female sexual function and gynecological disorders

Female sexual dysfunction is a common problem among the general population. Indifferent from males is not dependent solely on the physiological function of the genital organs. Partnership, body image perception and other physiological factors play a crucial role in the evaluation and treatment of female sexual dysfunction (FSD). The following article revise the most current literature regarding common gynecological disease and its association with sexual function.     

Bariatric surgery and subsequent sexual function

The purpose of this article is to appraise the literature and provide an analysis to determine whether weight loss by bariatric surgery has a positive or negative impact on sexual function in both male and female patients.     

Female sexual function and gestational diabetes

IntroductionThe number of women with gestational diabetes mellitus (GDM) is growing worldwide in parallel with the obesity epidemic. The diagnosis of GDM leads to substantial modifications in the daily routine of these women, and these adjustments could potentially affect their sexual function. There are no previous studies on the sexual function of patients with GDM.AimThe aim of this study was to investigate the sexual function of patients with GDM in comparison with healthy pregnant women at the same gestational age.MethodsBrazilian women in the third trimester of pregnancy with and without GDM were invited to participate in this cross‐sectional study while waiting for their antenatal care visits at a single public tertiary teaching institution between March and December 2010. The Brazilian version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function.Main Outcome MeasuresDesire, arousal, lubrication, orgasm, sexual satisfaction, and pain during and after coitus in the last 4 weeks, measured according to a standardized and validated questionnaire.ResultsA total of 87 participants were enrolled (43 healthy women and 44 with GDM). There were no significant differences in the sociodemographic characteristics of both groups. The total FSFI scores of GDM patients was 21.0 ± 9.59 compared with 22.3 ± 9.17 for healthy women (P = 0.523). Difficulty in desire was the most common sexual dysfunction symptom in both groups, being reported by 42% and 50% of GDM and healthy women, respectively (P = 0.585).ConclusionThe sexual function of Brazilian patients with GDM does not differ significantly from that of healthy pregnant women at the same gestational age. Ribeiro MC, Nakamura MU, Scanavino Mde T, Torloni MR, and Mattar R. Female sexual function and gestational diabetes. J Sex Med 2012;9:786–792.