Natural Menopause Relief Secrets

Natural Female Hormone Balance Program

Joan Atman with the help and inspiration from Dr Stephanie put down this book. Dr Stephanie is the mastermind behind this helpful guide. He is a nutritionist and a medical practitioner who has been very active in this case. Joan Atman is an international Life coach and Energy medicine specialist. The Natural Female Hormone Balance program is a 28 day Hormone reset Detox program for female. It is a very easy and gentle program that is designed by the author to support the female body detox and eventually regain the normal hormonal balance. All the tips and the dietary changes discussed in the program will kick start the body's natural ability to balance hormones. This eventually helps your body look and feel incredible. The full program contains 6 modules designed to lead you step by step through the Hormone reset Detox program. This program is available in PDF formats. The author has also included some video and audio tutorials. You can download the program and print or just download the PDF file, the Videos and the Audio. Continue reading...

Natural Female Hormone Balance Program Summary


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Assessing Risk of Vertebral Fracture in Postmenopausal Women

Data from a cross-section study on vertebral fracture prevalence were used to compare the abilities of BMD by DXA vs. vertebral strength and the strength-capacity by BCT for vertebral fracture risk assessment7. Forty postmenopausal women with a clinically-diagnosed vertebral fracture (confirmed semiquantitatively) due to moderate trauma (cases mean age, 78.6 9.0 years) were identified from an age-stratified sample of Rochester, MN women, and were compared to 40 controls with no osteoporotic fracture (70.9 6.8 years). Results indicated that DXA-based BMD for the spine or total hip were not significantly different between fractures and controls, but age-adjusted BCT-measures of vertebral strength and load-to-strength ratio (the reciprocal of strength-capacity) were 23 lower and 36 higher, respectively. The age-adjusted odds ratio per standard deviation increase for the load-to-strength ratio measure was 3.2 (p 0.05), versus a nonsignificant value of 0.70 for spine region BMD by DXA....

Postmenopausal estrogen replacement therapy

Until menopause women generally suffer from a lower rate of vascular diseases, including ischemic stroke. This has been attributed to a protective effect of estrogen and thus research has focused on the beneficial effect of postmenopausal hormone therapy for the prevention of cardiovascular diseases and stroke. However, a meta-analysis of nine observational studies indicated an increased risk of stroke -especially of ischemic stroke - in women using hormone replacement therapy, with RR for overall and ischemic stroke respectively of 1.1 (95 CI 1.0-1.2) and 1.2 (95 CI 1.0-1.4) 82 . Another meta-analysis including 28 randomized controlled trials found a significant increase in total stroke RR of 1.3 (95 CI 1.1-1.5) and ischemic stroke RR of 1.3 (95 CI 1.1-1.6) for women using hormone replacement therapy 83 . A Cochrane systematic review came to the same conclusion and found hormone replacement therapy to be associated with an increased risk of stroke in primary prevention trials (RR 1.4...

Menopause The Hormonal Hostage

I've often heard women say that the change of life is one of the touchiest times in their lives. The body and mind that they have become accustomed to for 40+ years are now different and often unpredictable. This change is a natural transition in a woman's life as fertility comes to an end. Menopause refers to a point when a woman stops ovulating and menstruating. Pre- or perimenopause lasts about five to ten years before the last period. This transition is marked by irregular menstruation, showing the decline in your body's ovary production of the reproductive hormones estrogen and progesterone. Typically, the last period occurs around age 50. Hormone replacement therapy, or HRT, is the only satisfactory therapy that conventional medicine offers to relieve such symptoms as hot flashes. When estrogens are contraindicated because of a family history of breast cancer, other medications are prescribed to control symptoms. HRT stands for hormone replacement therapy, which attempts to...

Menarche Pregnancy Menopause Do They Affect Seizures

Changes in reproductive hormonal status associated with menarche,19 pregnancy,20,21 and menopause22 may all affect clinical manifestation of seizures. Menopause The generally accepted belief is that menopause has little effect on epilepsy. Earlier this century, for instance, castration was used unsuccessfully to treat epilepsy in women.28 In some patients seizures may cease at the time of menopause, whereas in other patients seizures may worsen.22 The term menopause refers to a complex process and a variable end point that may differ significantly from person to person. Although estrogen levels decline as ovarian function diminishes, progesterone declines before estrogen, with resulting elevation of E P serum ratios.29 Early during menopause, for example, anovulatory cycles may develop and lead to increased E P ratios that would be expected to promote the occurrence of seizures. At the end of the process, estrogen production by the ovaries may become essentially undetectable and may...

Hormone Replacement Therapy

Hether she has a hysterectomy or not, every woman who lives to the age of menopause will confront the issue of hormone replacement. Hormone replacement therapy (HRT) has become one of the most discussed and debated issues related to women's health. The increased number of women encountering menopause as the baby boomer generation goes through middle age ensures that the discussion will continue and intensify. There are still many questions about the risks and benefits of hormone replacement, but a number of large studies are addressing those questions and perhaps will resolve controversies in coming years. Women who have a hysterectomy and bilateral oophorectomy may need to address the issue of HRT somewhat earlier in their lives than most women. Women who have their uterus, but not their ovaries, removed face another dilemma trying to figure out when they become menopausal, without the clue of monthly menstrual periods. Fortunately, a great deal of valuable information is available...

Symptoms of Menopause

Eighty percent of women will experience hot flashes when they become menopausal. Other symptoms include night sweats, difficulty sleeping, memory loss, irritability, and mood changes. Later, most women will experience vaginal dryness. Sometimes urinary symptoms such as leakage, frequency, and urgency occur because of the loss of estrogen action on the urogenital tissues, which include the urethra and the supporting tissues around the bladder. Without estrogen these tissues may atrophy somewhat over time. The lack of ovarian hormones may also contribute to the development of osteoporosis, a gradual thinning of the bone that increases the risk of fractures. As estrogen decreases, blood lipids, especially cholesterol and LDL, increase. At one time it was thought that these changes contributed to the development of cardiovascular disease and that supplementation with estrogens in menopause would protect against heart disease. Recent data from large studies (WHI, HERS, which are discussed...

Hormone Replacement Therapy 183 Making the HRT Decision

Whether to use hormone replacement therapy after hysterectomy is a personal decision that you should make in consultation with a medical professional who knows your full medical history and your concerns. Most women who start HRT after hysterectomy find that the hormones are beneficial in improving the immediate symptoms of menopause and in improving their sense of well-being. Every woman has individual needs, but in general we recommend HRT for treatment of menopausal symptoms in women who are already menopausal when they have a hysterectomy and notice the development of menopausal signs and symptoms (hot flashes, night sweats, trouble sleeping, and so on) at any time after their hysterectomy, even if their ovaries have not been removed. Initially, estrogen therapy will significantly reduce the number and frequency of hot flashes and other symptoms of menopause. You may not notice full effects until you have been on the medication for one month. We know from our patients and from the...

Press Acu Points to Pause Your Menopause

Acupoints For Menopuase

The natural process of menopause has been getting comforting help from Oriental Medicine for centuries. As you've already read, diet, exercise, and a healthy outlook are key components of any comprehensive treatment plan. Hot flashes, dry skin, vaginal dryness, increased thirst, insomnia, forgetfulness, and anxiety are part of the deficient heart yin pattern in Oriental Medicine. The term deficient yin in this case often refers to the reduction in estrogen. The term heart addresses not only the organ itself, but the accompanying forgetfulness, insomnia, palpitations, and mood changes. Stop smoking Premature menopause is the early shutdown of the ovaries before age 40. Smoking is assoa'ated with this premature reduction in the estrogen level. Because estrogen is important in bone formation, smoking also puts you at risk for osteoporosis and health-jeopardizing bone fractures. Pausing menopause. Pausing menopause. Stock up on soy The British medical journal Lancet reported that Japanese...

Perimenopause Menopause and Migraine

Perimenopause is described as the decade preceding menopause when hormonal fluctuations may begin. Menopause is defined as the absence of menstruation for 1 year. The average age of menopause is approximately 53, and an increase in migraine due to the fluctuating hormones of perimenopause may present a challenge to both the patient and physician. Following a natural menopause, approximately 60-70 of women have an improvement in their migraine. In contrast, 40-70 of women who undergo a surgical menopause causing an abrupt cessation of female hormones may actually experience a worsening of their migraine (see Table 18.18). Hormone replacement therapy (HRT) has a variable effect on migraine. The Women's Health Study, a population-based study of 17,107 postmenopausal women, reported that those using HRT were 1.42 times more likely to report migraine than non-users. Other studies have shown a variable response, with approximately 50 of women demonstrating no change and approximately 25 who...

Postmenopausal Women

Menopause is defined as 12 months without a menstrual period. After that 12-month period, any bleeding is abnormal. A large Danish study found a 10 prevalence of postmenopausal bleeding (Astrup, 2004). Bleeding episodes decreased as the time since menopause increased. The main concern in a postmenopausal woman with bleeding is endometrial carcinoma. Between 10 and 20 of all post-menopausal bleeding will be caused by malignancy (Hale and Fraser, 2007). Evaluation of postmenopausal bleeding can be done effectively with either a pelvic ultrasound or an office endometrial biopsy. A pelvic ultrasound can assess the thickness of the endometrium, the endometrial stripe. A stripe less than 4 mm in diameter is the cutoff to exclude endome-trial cancer (Tabor et al., 2002). An office endometrial biopsy is an excellent diagnostic test to evaluate endometrial tissue (Dijkhuizen et al., 2000). In some postmenopausal women, however, cervical stenosis precludes a successful biopsy. In this...

Perimenopausal Women

Abnormal bleeding in the 5 to 10 years before menopause is very common. The most common pathology is anovula-tion caused by declining numbers of ovarian follicles and decreasing inhibin B levels (Jain and Santoro, 2005). Peri-menopausal women may also bleed from structural lesions (most often uterine fibroid tumors) or bleeding disorders. Evaluation of a perimenopausal woman with abnormal

About the Female Reproductive Organs

The rhythms of a woman's menstrual cycle and interruptions in this rhythm during pregnancy and menopause alert women to their bodily functions throughout their lives. When your reproductive organs change or malfunction, various tests provide clues to the problem. Imaging tests provide important medical information to your doctors and help you to understand your own anatomy and how your reproductive system functions.

Burden of Disease

Ovarian cancer is the fifth leading cause of cancer deaths in women, with an estimated 22,000 new cases and 14,600 deaths in 2009 (SEER, 2009). Most women have non-localized disease at diagnosis. Risk factors for developing ovarian cancer include having a first- or second-degree relative with ovarian cancer, being a carrier of the BRCA1 or BRCA2 gene mutations, and taking estrogens after menopause. Oral contraceptive use and parity have a protective effect, reducing the risk of disease (Nelson et al., 2004b).

Effectiveness of Early Detection and Intervention

Hormone replacement therapy does not prevent CHD in postmenopausal women (Anderson et al., 2004 Rossouw et al., 2002), and evidence does not support a benefit from vitamin supplements (Lee et al., 2005). There is good evidence that screening for CAS with an ultrasound leads to important harms, including strokes from confirmatory tests or surgery. For men at increased risk for CHD, aspirin prophylaxis decreases the rate of CHD events and for women at increased risk of strokes, aspirin decreases the rate of strokes (Berger et al., 2006 USPSTF, 2009). The ideal dose is uncertain, but low doses (75 mg) are as effective as high doses

Adverse Effects of T4 and Bone Mineral Density

Thyroid hormone is known to increase osteoclastic activity.83 It is documented that patients with untreated Graves' disease will develop bone loss.84 This is because of persistently high levels of circulating thyroid hormone levels for prolonged periods. There is controversy regarding how patients who have had thyroidectomy for thyroid cancer should be managed. In general, TSH suppression with high-normal T3 and T4 levels is recommended. There are conflicting opinions about the risks and benefits when patients' serum TSH levels are chronically suppressed.85,86 Recently, Quan and associates analyzed the effect of thyroid hormone on bone mineral density in 11 studies that also describe confounding factors relevant to bone loss.87 They concluded that thyroid hormone suppression treatment does not affect bone mineral density in premenopausal women and in men. However, the effect of TSH suppression in postmenopausal women remains controversial.

See Your Doctor Within 24 Hours

Possible cause You may have a crush fracture of a vertebra as a result of osteoporosis, in which bones throughout the body become thin and weak. osteoporosis is symptomless unless a fracture occurs. The disorder is most common in women who have passed the menopause. However, a prolonged period of immobility will also lead to the development of osteoporosis. Action Initial treatment for the pain is with painkillers. Your doctor may also request bone densitometry (below). Specific treatment for osteoporosis depends on the underlying cause. However, in all cases, it is important that you try to remain active and take weight-bearing exercise, such as walking.

Beliefs on Which It Is Based

Oversensitivity to Influences and Ideas Centaury for difficulty saying no and neglecting one's own interests Walnut for stabilizing emotions during life transitions such as adolescence and menopause, for breaking past links and adjusting to new beginnings Holly for envy suspicion, revenge, and hatred.

Listing relevant outcomes

While all important outcomes should be included in Cochrane reviews, trivial outcomes should not be included. Authors need to avoid overwhelming and potentially misleading readers with data that are of little or no importance. In addition, indirect or surrogate outcome measures, such as laboratory results or radiologic results (e.g. loss of bone mineral content as a surrogate for fractures in hormone replacement therapy), are potentially misleading and should be avoided or interpreted with caution because they may not predict clinically important outcomes accurately. Surrogate outcomes may provide information on how a treatment might work but not whether it actually does work. Many interventions reduce the risk for a surrogate outcome but have no effect or have harmful effects on clinically relevant outcomes, and some interventions have no effect on surrogate measures but improve clinical outcomes.

Few Words About the Dangers of Alcohol

I am not suggesting that all non-drinking women should rush out and start consuming alcohol. Because other studies have shown an increase in risk of breast cancer from even moderate drinking, younger women and women who may be at increased risk for breast cancer should discuss their decision regarding drinking with their own doctors before making changes in their lifestyle. We must keep in mind, however, that a post-menopausal woman in the United States is much more likely to die from heart disease or stroke diseases for which she would be at a lower risk if she consumed a little alcohol than she is to die of breast cancer.

Physiology Of Bone Remodeling And Bone Turnover

Based upon the varying influences of bone resorption and formation, osteoporosis is subdivided into two categories low-turnover and highturnover osteoporosis. The low-turnover state describes a situation in which normal bone homeostasis is altered by decreased osteoblast activity however, the osteoclast activity remains normal. Low bone mineral density (BMD) in this setting, therefore, is a result of reduced bone formation. Conversely, the high-turnover state is characterized by increased activity of both osteo-blasts and osteoclasts. However, osteoclasts are activated to a greater extent. The bone remodeling process is shifted toward bone resorption, resulting in an imbalance of bone turnover that causes osteoporosis. High turnover osteoporosis is the most common form and appears at menopause, while low turnover osteoporosis occurs following drug interventions including chemotherapy, steroids, and prolonged bisphosphonate use.

Influence of testosterone on sexual behaviour in women

The most powerful design for the study of the specificity of testosterone influence involves hormone replacement therapy in women who are oophorectomized. It is common clinical practise to treat these patients with estrogen replacement, but substitution of testosterone is also sensible as the women are deprived of ovarian androgen production as well. Several studies on naturally or surgically menopausal women have shown - without contradictory evidence - that administration of testosterone, either alone or in addition to an estrogen replacement regimen, is more effective than estrogens alone or a placebo. In particular, an increase in sexual

Neurotransmitter Correlates

Another means of making inferences about brain serotonin in humans involves neuroendocrine challenges. For example, researchers have infused serotonin agonists such as fenfluramine into subjects' veins, which bind to serotonin receptors in the hypothalamus and cause release of the hormone prolactin from the pituitary gland into the peripheral circulation. Thus, the prolactin response to d,l-fenfluramine is thought to provide an index of brain serotonergic function. A number of studies conducted on this topic (but not all) have revealed inverse relationships between fenfluramine-induced prolactin release and indices of behavioral aggression and hostility in personality-disordered patients. Studies utilizing other serotonin agonists such as meta-chlorophenylpiperazine and ipsapirone have also revealed inverse associations with prolactin release and ratings of hostility in personality disordered subjects (Coccaro, 1998). Although comor-bid alcoholism was a potential confounding factor in...

Calcium and Healthy Bones

Calcium intake in the later years is equally important for maintaining healthy bones. (I hope you already did all the right things in your first 30 years.) With age, your bones gradually lose their density (that is, calcium), which is especially true in menopausal women. People who take in adequate amounts of calcium can help slow down this process and defy those brittle bones of old age.

Patient demographics

Patients are more susceptible to certain problems at different times of life. Postural syndrome is more likely to be present in the young, whilst young to old adults have derangements and dysfunctions. Osteoporosis is generally only relevant in the elderly, esperially postmenopausal women, although there are exceptions. With increasing age spinal degeneration is more likely to be present, the intervertebral disc becomes dehydrated and fibrosed, and osteophytes and other bony changes can occur around the zygapophyseal and uncovertebral joints and vertebral bodies (Taylor and Twomey 2002). Such changes may predispose to spinal stenosis affecting nerve roots or the spinal cord. MalignanCies are also more common in the older age group. Completely new onset of headache or neck pain in older patients who have never experienced this before is also a possible warning symptom.

Radiographic assessment of vertebral fractures

Radiographic diagnosis is considered to be the best way to identify and confirm the presence of osteoporotic vertebral fractures in clinical practice. Traditionally, conventional lateral radiographs of the thoracolumbar spine have been visually evaluated by radiologists or clinicians to identify vertebral fractures. However, there is still no internationally agreed definition for vertebral fracture. One global prospective study (the IMPACT study 6 ) compared the results of local radiographic reports from five continents with that of subsequent central readings in more than 2,000 postmenopausal women with osteoporosis. This study demonstrated that vertebral fractures were frequently underdiagnosed radiologically worldwide, with false-negative rates as high as 30 despite a strict radiographic protocol that provided an unambiguous vertebral fracture definition and minimized the influence of inadequate film quality. It was concluded that the failure was a global problem attributable to...

Female Reproductive System Big Picture

The female reproductive system consists of the ovaries, uterine tubes, uterus, vagina, and external genitalia. These organs remain underdeveloped for about the first 10 years of life. During adolescence, sexual development occurs and menses first occur (menarche). Cyclic changes occur throughout the reproductive period, with an average cycle length of approximately 28 days. These cycles cease at about the fifth decade of life (menopause), at which time the reproductive organs become atrophic.

Diagnosis and Treatment

You should be certain that you receive notification about the report on your Pap smear. If you receive a report of an abnormal finding on a Pap smear, or if your doctor observes anything abnormal in the internal examination, it means you need a biopsy to obtain further information. If you are diagnosed with ASCUS, we recommend having the Pap smear repeated. If there is any indication of inflammation, it's a good idea to treat the cervical or vaginal infection before the smear is repeated. In women who are menopausal and are not receiving hormone replacement therapy, before repeating the Pap smear we recommend treatment for several weeks with estrogen, using a vaginal insert or cream or sys

Alternatives to radiographic assessment of vertebral fractures

The use of fan-beam DXA images for quantitative (morphometric) assessment of spinal fractures has been reported in both research applications and pharmaceutical trials 4, 11, 19, 21, 28, 37, 38, 46 . Clinical studies demonstrated the feasibility of visual evaluation of fan-beam lateral DXA spine images compared to conventional lateral spine radiographs in postmenopausal women, with a strong overall agreement of 96.3 37, 38 . This agreement was approximately as strong as that found among different morphometric techniques 15, 21 . The images permitted visual assessment of about 90 of all vertebrae. The main shortcoming of the MXA scans in comparison with conventional radiographs is the inferior image quality that limits the evaluation of vertebrae in the upper thoracic spine. This is less of a concern if MXA is used as a screening tool for conventional radiography and this approach may help reduce the radiation dose in the diagnosis and monitoring of osteoporosis.

Theoretical Issues

Two mutually informing analytic frameworks have been central to much recent fertility research the life course and the proximate determinants frameworks. The biological nature of fertility determines the structure of each framework. In fact, both frameworks rest on very straightforward observations. The life course perspective adopts a sequential model because children tend to be born one at a time, not in lots (Namboodiri 1972 198). Moreover, because women are biologically restricted to having children only between menarche and menopause, fertility may be considered as an irreversible, time-limited sequence.

The role of 5areduction and aromatization of testosterone in the muscle

After menopause, women tend to gain weight and experience an increase in body mass index (Gambacciani etal. 1997) mostly due to fat mass accumulation (Burger et al. 1995 Dallongeville et al. 1995) this weight gain is attenuated in women who receive estrogen replacement therapy. These data contradict the widely held notion that hormone replacement therapy is associated with significant weight gain. Taken together, the collective body of experimental data suggests that aroma-tization of testosterone might also be important in mediating androgen effects on body composition. Further studies are needed to determine the important role of estrogens in regulation of body composition.

Pleasant Summer

Taken hormone replacement pills ever since the onset of her menopause and continued them for twelve years. Two months prior to her discussion with me, Joan had discontinued hormone replacement because she had learned that the treatment increases the risk of breast cancer.

Investigation of topical and transdermal delivery in human subjects

While the majority of emulsion dosage forms are intended for localized delivery and treating skin conditions, there is an increasing interest in developing emulsion-type formulations for transdermal drug delivery. As shown in Table 3.1, an emulsion containing estradiol has been commercialized as a transdermal delivery system for hormone replacement therapy (HRT).

Longitudinal perspective

The experimental evidence on the possibility of increasing bone strength by exercise in older adults is still weak compared to the 'training effects' indirectly obtained in the athlete studies. Several exercise interventions have shown positive changes in BMD, but the magnitude of these changes (on average 1-2 per year vs. controls) 63 , at least in the short term, remains low in terms of bone strength and fracture prevention. The question remains as to whether more strength-demanding, fast and unusual loading patterns which have been suggested to be osteogenic in pre-menopausal women and early postmenopausal women with hormone replacement therapy are at all feasible for most older people, or whether outcomes other than BMD (e.g. moment of inertia and mass distribution, see 30 , or collagen structure and metabolism) would be more relevant and sensitive to the effects of exercise.

Clinical use in osteoporosis

Bones, which leads to an enhanced fragility of the skeleton and therefore to a greater risk of fracture. It is defined as present in women when the bone mass is more than 2.5 SD below that of the young woman (t score). It is a very common disorder which will become even more common with the increase in life expectancy. It is also frequent in men, although less so than in women. Its main cause is the continuous loss during life of both cancellous and cortical bone, which is exacerbated in women after the menopause. The second contributory factor is failure to achieve adequate peak bone mass during adolescence. The causes of these changes are not yet clear, although genetic factors are involved, at least for the latter. sphonates, was estrogen replacement after the menopause. However, it has recently been shown that estrogens increase the risk of breast cancer, and increase instead of decrease cardiovascular insults 20 . Calcitonin is sometimes used, but parenteral administration can...

Conservative Followup in Clinically Detected Primary Hyperparathyroidism

Silverberg and coworkers44 reported a 10-year prospective follow-up of 121 HPT patients, 61 of whom were subjected to parathyroidectomy (according to indications established at the National Institutes of Health Consensus Conference Statement, 1991, concerning diagnosis and management of asymptomatic HPT4), whereas 60 patients did not undergo surgery. The majority of nonoperated patients were asymptomatic, but in some patients surgery was not undertaken despite the presence of kidney stone disease. All nonoperated symptomatic patients with kidney stones experienced progressive disease with recurrent stone attacks during follow-up, whereas none of the operated patients had such recurrences. Among nonoperated, asymptomatic patients, 27 had progressive disease with worsened hypercalcemia, increased hypercalciuria, and decrease in bone mineral the remaining patients had apparently stable disease. The authors concluded that women with HPT seemed to be at risk for disease progression with...

Progression of Symptoms

The clinical manifestations of HPT tend to be related to the level of hypercalcemia, even if this is not always evident because of slow disease progression, individual susceptibility, and to some extent also gender and age dependence of symptoms.45 Younger men are particularly likely to experience renal stones, sometimes even with only mild hypercalcemia. For renal stones, the individual susceptibility is more important than the level of hypercalcemia, and the risk for this particular symptom is probably most efficiently revealed by the patient's history. Urinary calcium excretion has been an uncertain predictor of the risk for kidney stones among patients who have previously not had this symptom.46 Males excrete 25 to 30 more calcium in the urine than females, and whites also have higher excretion than blacks.46 In postmenopausal women, renal stones occur infrequently (generally less than 5 ) and are often clinically silent. cortical bone of nearly 20 among current patients with...

Variation in the estrogen receptor

Several polymorphisms of intronic sequences of the estrogen receptor a gene which are in linkage dysequilibrium with each other were previously found to modulate the response of HDL-cholesterol levels to estrogen replacement therapy in menopause (Herrington etal. 2002). We did not find any significant association of ER polymorphisms with cardiovascular risk factors or the presence of coronary artery disease in men (Hersberger and von Eckardstein, unpublished data). In an autopsy study, a pvuIpolymorphism in the estrogen receptor a was found associated with the extent of complicated coronary artery atherosclerotic lesions in men older than 53 years (Lehtimaki etal. 2002).

Historical Perspective

Herbal remedies continue to play a significant role in human medicine. Chemical investigations have identified many of the active principles in many commonly used products. These products are often sold as dietary supplements rather than ethical pharmaceutical products. Because these products are complex mixtures of many natural products there is a need to establish criteria for their standardization. This situation is complicated by the natural variation in secondary metabolites produced by closely related species of medicinal plants. Owing to the possibility that variations in the composition of the products will result in unpredictable potency, the herbal products industry has been developing quality control standards. Black cohosh, for example, which is taken for the relief of menopausal symptoms, has a number of signature triterpenoid constituents including, actein, 23-epi-26-deoxyactein, and cimigenol-3-O-arabinoside (Figure 6.2). These compounds can be identified by coupled...

Distribution and Incidence

Peptic ulcer dyspepsia is rare in people under the age of 20, but by age 30, 2 percent of the males and 0.5 percent of the females in a population have developed the condition. For men, the incidence increases steadily with age, reaching a peak of around 20 percent in the sixth decade of life. The incidence for women remains low, about 1 percent, until menopause, after which it climbs as rapidly as in men. A morbidity rate of nearly 14 percent has been re

Epidemiology and etiology

Osteoporosis is the most common skeletal disorder, affecting over 10 million Americans. Additionally, over 30 million Americans have low bone mass. The prevalence of vertebral fracture in postmenopausal women is greater than 20 . Only one in three Osteoporosis can be classified as either primary (no known cause) or secondary (caused by drugs or other diseases). Primary osteoporosis is most often found in postmenopausal women and aging men, but it can occur in other age groups as well. The prevalence of osteoporosis varies by age, gender, and race ethnicity. The risk of fracture increases exponentially with each decade in age over 50.8 Residents of nursing homes may be at an even higher risk of fracture. Both men and women lose bone as they age. However, women have accelerated bone loss surrounding menopause due to loss of estrogen. Men have some protection from osteoporosis due to their large bone mass and size and the absence of menopause. Fragility fractures of the hip and spine are...

Local Regional Radiation Therapy

In two recent, long-term randomized studies of high-risk premenopausal women with breast cancer treated with modern radiation therapy and chemotherapy techniques versus chemotherapy alone, there were fewer local recurrences, and overall survival was significantly higher among women treated with combined therapy.94,101 These results have led to renewed interest in fractionated radiation therapy in this additional high-risk group of patients. The Southwest Oncology Group

Microsurgical Resection

With multivariate analysis.139 In the M.D. Anderson study, significant factors predicting survival with univariate analysis included younger age (positive effect), higher KPS score (positive effect), and preoperative systemic disease status (both no evidence of disease vs. systemic disease, and controlled vs. active systemic disease).98 All three remained significant on multivariate analysis. Factors not found to be statistically significant in the Sloan-Kettering study included age, lesion size, neurologic functional status, positive axillary nodes, and supra-tentorial versus infratentorial location. Systemic disease status was not analyzed. Factors not found to be statistically significant in the M.D. Anderson study included menopausal status, supratentorial versus infratentorial location, subtotal versus total resection, and the presence or absence of chemotherapy.

Postoperative Estrogen in Women Patients

Women undergoing CABG are likely to be postmenopausal because coronary artery disease is more prevalent in post-menopausal women (young diabetic women are the exception). Many studies suggest that women at high risk for coronary artery disease or those who already have the disease will benefit from estrogen therapy. This group includes women who have undergone CABG or angioplasty. Another large study is currently testing these results, but, in the meantime, physicians should strongly consider treating all of their postmenopausal CABG patients with estrogen unless they are at very high risk for breast or uterine cancer.

Demographic Characteristics

Examination of age and gender effects continues to be an important topic of research. To the extent that there are gender differences in age of onset, questions arise about the disease process itself. If schizophrenia has an earlier onset in males, and this onset tends to be more insidious than in females, then what biologic factors might account for this For example, some studies have shown that the gender difference in age of onset is more often found in sporadic cases rather than familial schizophrenia (e.g., DeLisi et al., 1994). Another hypothesis tested by the Mannheim research program was that an elevated vulnerability threshold for women until menopause'' could be due to the sensitivity-reducing effect of estrogen on D2 receptors in the central nervous system'' (Hafner et al., 1998). Identification of these factors might provide clues about disease-promotion mechanisms.

What do you do now

The RCVS syndrome most often affects young women, especially during the puerperium, but also occurs at menopause and is found at all ages. Many of the patients have had a history of migraine. Some patients have developed this syndrome after carotid endarterectomy. The use of serotonin reuptake inhibitors prescribed for depression, and cannabis especially smoked in a binge can provoke the syndrome. Drugs such as phenylpropanolamine, cocaine, and amphetamines can also precipitate identical syndromes. Women are affected much more often than men, and the postpartum and early menopausal periods are frequent times of onset.

Diabetic Macroangiopathy Accelerated Atherosclerosis

Premature development of coronary heart disease (CHD) is the leading cause of morbidity among diabetic patients. Type 1 diabetic patients who are not troubled with diabetic nephropathy will likely experience CHD as early as their third or fourth decade, depending on the duration of their diabetes. The onset of renal disease in type 1 patients will further accelerate this timetable. Premenopausal status does not protect diabetic women from CHD.

The Oestrus That Never

Place throughout the monthly menstrual cycle, after ovarian cycles cease at the menopause, or as a result of ovariectomy. This is not to imply that the menstrual cycle and ovarian hormones have no effects upon human sexual behaviour I shall return to this subject later in this chapter. However, since women do not experience circumscribed periods of sexual receptivity, anthropologists have sought to explain how and why, there has been loss of oestrus during human evolution. Nor is it obvious when ovulation is likely to occur during the human menstrual cycle, as women do not exhibit external cues, such as the oestrogen-dependent sexual skin swellings found in chimpanzees and some Old World monkeys. Thus, in addition to searching for the reasons why oestrus was lost in human ancestors, scientists have sought to explain the origins of concealed ovulation. Symons (1979), for example, proposed that 'estrus was lost some time after humans last shared a common ancestor with any living...

Possible MCI Therapies

Despite promising basic science research, estrogen has not consistently shown benefits in treating or preventing cognitive disorders. The data currently do not support the use of this agent for the treatment of AD. In one meta-analysis (LeBlanc et al., 2001) examining nine randomized controlled trials and eight cohort studies with respect to the role of estrogen and cognition, women with menopausal symptoms showed improvement in verbal memory, vigilance, reasoning, and motor speed but no benefit in other cognitive domains. Asymptomatic women did not improve. Likewise, clinical trials have failed to demonstrate benefits for coronary artery disease, cerebrovascular disease, osteoporosis, and cognition. Further, its long-term use may be contraindicated in women with intact uteruses due to the potential risk of endometrial hyperplasia, endometrial cancer, gallstones, and breast cancer.

Gender Effects In The Myocardium

Many recent reports suggest gender differences in pressure-overload hypertrophy (Weinberg et al. 1999) and FHC (Maron et al. 1999). In addition, penetrance of FHC has been shown to be significantly lower in females (Charron et al. 1997). A recent report by Maron et al. (1999) describes that women diagnosed with HCM are older (postmenopausal) and present with a more severe form of the disease with higher mortality. Similarly, we have observed gender-specific differences in our MyHC mutation model of FHC (Olsson et al. 2001). In the FHC mice, hearts exhibit increased systolic contraction in an isolated working heart model at 4 months of age with decreased diastolic function, probably due to hypertrophy in both sexes. At 10 months of age, however, hearts of female mice show preserved systolic function with continued diastolic dysfunction, whereas hearts of male mice are dilated with systolic impairment and worsening dias-tolic function (Olsson et al. 2001). Evidence has been accumulating...

Primary Prevention Trials

Thus, several strategies can be considered for primary prevention trials. In the first strategy, healthy individuals would be treated in an attempt to delay the onset of disease. The main advantage of this design is that the results would be gener-alisable to other healthy individuals. Because of the large sample size and high costs associated with this strategy, enrichment strategies should also be considered. These include enrolling older subjects, subjects with a positive family history of AD, and subjects at risk because of the presence of an apo E4 allele. Several primary prevention trials for AD are currently preparing to get underway utilising some of these strategies. A second strategy would be to find subjects who are already randomised to compounds of interest in trials for other indications to which cognitive endpoints could be added. This has already been successfully accomplished within the framework of the Women's Health Initiative (WHI) where approximately 8000...

Abdominal Hysterectomy

Leslie, in her own words, freaked out when her doctor told her it was time for her to have a hysterectomy. Her doctor had been monitoring Leslie's fibroids for seven years, and as Leslie went through menopause, she expected them to shrink. She never had any symptoms, but even after menopause, the fibroids continued growing, and her doctor told her they would soon interfere with the functioning of some of her organs.

Additional clinical variables

Endogenous bio-available testosterone levels were reported to be inversely associated with depressive mood assessed with the Beck Depression Inventory in older men in the Rancho Bernardo Study (Barrett-Connor et al. 1999). In a study of selected men aged 50 to 70 years, who participated in a screening program on prostate cancer and 'andropause', there was an inverse correlation between free testosterone and depressive symptoms assessed on the Carroll Rating Scale, but serum free testosterone was not related to the prevalence of a significant score for depression (Delhez et al. 2003). In contrast others reported that declining bio-available testosterone levels were associated with lower levels of depressive symptoms on the Hamilton Depression Scale in men 55 to 76 years old (Perry et al. 2001).

Who should be considered for treatment

There exist a number of questionnaires that are being used in clinical or epi-demiological settings to help describe and semi-quantify symptoms in different areas that are of relevance to elderly men, such as questionnaires on self-perceived health status, on depressive mood, on urinary symptoms, on erectile function, or on coping with activities of daily living. Morley et al. (2000) proposed a dedicated instrument, the ADAM screening questionnaire for androgen deficiency in aging males. The available information suggests that this questionnaire, although relatively sensitive to detect men with decreased free or bio-available testosterone, lacks the required specificity to be a valid instrument for diagnosis in the individual subject (Delhez etal. 2003). The Aging Males' Symptoms Scale (AMS) was developed by Heinemann et al. (1999) in Germany to help describe and quantify the clinical syndrome of'andropause', but was not intended to screen for low serum testosterone and was not...

Tightfitting and nona bsor bent clothing

Estrogen enhances Candida adherence to vaginal epithelial cells and yeast-mycelial Transformation this is supported by the fact that infection rates are lower before menarche and after menopause except in women Taking hormone replacement therapy)r while rates are hiyher during pregnancy

Possible benefits of androgen replacement in women

To examine the possible benefits of androgen replacement in women, it may be best to use the complications of the male hypogonadotropic state as a template, reviewing the evidence in that particular area in regards to women. Some provisos need to be noted the state of the art of androgen replacement in women is rapidly changing, so the existing data is confounded by multiple modalities of androgen replacement, most of which are not physiological regimens. Some studies use surgically menopausal subjects while others do not. Much of the data is also based on cross-sectional studies of endogenous androgen levels and outcomes, with all the limitations of non-randomized epidemiologic data. Multiple studies demonstrate clear evidence that testosterone replacement enhances sexual function in hypogonadal men. In women, there is also strong data in this regard. The best-known study demonstrating a beneficial effect of androgen replacement on sexual function in women was published in 1987...

Subarachnoid Hemorrhage SAH

The incidence of SAH increases with age (mean age of approximately 50 years) and is higher in women than in men. Blacks are at higher risk than whites. Population-based mortality rates for SAH have progressively declined, and the survival rate after SAH has improved since the 1970s. The risk of SAH is increased during the third trimester of pregnancy. SAH due to aneurysm rupture is a leading cause of maternal mortality, contributing to between 6 and 25 percent of maternal deaths. Significant risk factors for SAH include smoking, hypertension, and heavy alcohol use. Use of oral contraceptives, hormone replacement therapy, hypercholesterolemia, and physical activity are not significantly related. During pregnancy, there is also a greater risk of AVM rupture y , y

Patient Encounter Part 1

BB is a 65-year-old woman who presents with a history of a small, hard lump in the upper outer quadrant of her right breast. This lump has been there for at least 3 months. She reports having mammograms in the past that were normal, but she has not had one in about 3 years. The lump in her breast is not painful. She has no nipple discharge or drainage from that breast and the skin appears normal. The left breast is normal. She has a history of hypertension and has been postmenopausal for approximately 10 years. She does not smoke and drinks an occasional glass of wine. She has no family history of breast cancer, but does have a sister with ovarian cancer at age 58 and her father had prostate cancer at age 85. She began menses at age 10, had two pregnancies (first at age 25) with two healthy daughters, and has taken Prempro since menopause at age 55 (for 10 years).

Prevention and Early Detection

Breast cancers in premenopausal and postmenopausal women. to reduce the incidence of spinal fractures in postmenopausal women at high-risk for The Study of Tamoxifen and Raloxifene (STAR) trial compared the two agents in postmenopausal women who were considered to be at increased risk (as determined by the Gail model)25 for developing invasive breast cancer.26 Although there was a similar reduction in the incidence of breast cancer, raloxifene had a superior safety profile with regards to uterine cancer and thromboembolic events. Thus, raloxifene is the chemopreventive agent of choice for postmenopausal women at high-risk for breast cancer. Since premenopausal women were not included in the STAR trial, tamoxifen is the only agent approved for reducing the risk of breast cancer in younger patients.

Hypoactive Sexual Desire Disorder

Female sexual desire is a complex interaction among biologic, psychological, social, interpersonal, and environmental components. Ovarian function, especially ovarian androgens, may play an important role. In women age 20 to 49, HSDD is almost threefold more likely in surgical postmeno-pausal women than premenopausal women. However, no significant difference in HSDD exists between naturally or surgical postmenopausal women over age 50 (Leiblum et al., 2006). Medical illnesses, such as thyroid disease, chronic pain conditions, urinary incontinence, and depression anxiety, may negatively impact sexual desire. Medications can affect sexual drive, especially selective serotonin reuptake inhibitor (SSRI) antidepressants, antihypertensives, antipsy-chotics, and narcotics. Fear of pregnancy or sexually transmitted infection and discord or communication difficulty in a couple's relationship may diminish sexual desire. The clinician must explore all aspects of the biopsychosocial model when...

Unifocal Langerhans Cell Histiocytosis Intracranial

Occurrence of LCH as a unifocal intracranial lesion is very rare. When reported, the regions involved included the hypothalamus (although this more commonly occurs with multifocal involvement), cerebellum,15 or cerebral hemispheres.7,18 In the absence of multifocal lesions, the diagnosis is virtually impossible to predict based on the nonspecific imaging findings alone. Therefore these lesions are usually subject to the treatment algorithm applied to suspected brain tumors, which would involve either an attempt at open resection or biopsy. This can be a particularly difficult task for hypothalamic lesions, which usually need to be accessed by either an open craniotomy or, if feasible, an endoscopic transventricular route. However, once the diagnosis of LCH is confirmed, the treatment options can be better defined. Following a gross-total resection of an intracranial LCH lesion, most patients should be observed without any further therapy.7,8,18 In the setting of a biopsy or incomplete...

A lternatives to Hormone Replacement

Other medications may alleviate some the symptoms of menopause. None are as effective as estrogen in reducing hot flashes, however. These medications include selective serotonin reuptake inhibitors (SSRIs, often Many advocates of alternative medical approaches have publicized the use of soy products to alleviate menopausal symptoms. However, the few studies that have been done so far have shown that most of these soy preparations have little or no effect on symptoms of menopause in most women. But a diet rich in soy protein has been shown to reduce total cholesterol, LDL cholesterol, and triglycerides. And eating a diet containing large amounts of soy protein doesn't seem to have any adverse side effects.

Treatment of Special Populations

Premenopausal Women The NOF recommends measuring bone mineral density in premenopausal women with specific risk factors for osteoporosis, such as medical condition or medication, in whom treatment would be considered.1 Premenopausal women at risk for osteoporosis should follow all nonpharmacologic recommendations for exercise and adequate calcium and vitamin D intake. Currently, no good data are available regarding pharmacologic therapy on fracture reduction in this population. Bisphosphonates should be Compared to postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide has also been studied, but no data are yet available on fracture rates. At this time, alendronate and teriparatide are FDA-approved for the treatment of osteoporosis in men. Dae to proven benefit in reducing fractures and relative safety, alendronate should...

Physical Examination

Vaginal Palpation

Lichen sclerosus, previously known as kraurosis vulvae, is a relatively common condition in which the genital skin shows a uniform reddened, smooth, shiny, almost transparent appearance. It is a destructive inflammatory condition with a predilection for genital skin. It is much more common in women, although it can be seen in men with involvement of the glans penis and foreskin. Whitish atrophic patches of thin skin are typical, as is fine crinkling of the skin. Pruritus is a common symptom, and the fragile skin is susceptible to secondary infection. Although most common in white and Latino postmenopausal women, lichen sclerosus may be seen in patients of all ages. It is rare in African-American women. Lichen sclerosus should be thought of as a premalignant lesion because one complication is the development of squamous cell carcinoma. Figure 19-9 shows an early stage of lichen sclerosus in a female patient. Notice the resorption of the labia minora the clitoris is preserved. Figure...

Mecanism Of Centripetal Lipid Accumulation Supraclavicular Fat And Face

The clinical findings of hyperprolactinemia in women of reproductive age include amenorrhea, galactorrhea, and infertility. In most cases, changes in the menstrual cycle result in early evaluation and diagnosis of hyperprolactinemia, and thus most premenopausal women present with microprolactinomas (1 cm), because changes in libido are not detected early. Hyperpro-lactinemia in both sexes can also be associated with anxiety, depression, fatigue, emotional instability, and hostility.10,11 Hypogonadism is separated into primary (dysfunction of the testis or ovary) or central (pituitary or hypothalamic). Clinical manifestations of hypogonadism in prepubertal children cause no symptoms, whereas in adolescents hypogonadism leads to delayed or absent pubertal development. In adult women, hypogonadism causes amenorrhea, infertility, loss of libido, vaginal dryness, and hot flashes. In men, hypogonadism leads to loss of libido, erectile dysfunction, and infertility. Causes of primary...

Androgen dynamics in women

Fig. 17.1 Androgen dynamics in premenopausal women. Fig. 17.1 Androgen dynamics in premenopausal women. Testosterone, the most clinically relevant circulating androgen, has both an adrenal contribution (about 25 ) and an ovarian contribution (about 25 ), but is mostly produced by peripheral bioconversion from circulating A4A (Burger 2002). By virtue of its relatively large ovarian contribution, serum testosterone is probably the best measure of ovarian androgen production. Dihydrotestosterone (DHT) is produced almost exclusively in target tissues by 5a-reductase action on circulating testosterone circulating levels are negligible and felt to be largely a reflection of spillover from the primarily intracrine action of this hormone. The circulatory androgen dynamics in premenopausal women are illustrated in Fig. 17.1. Androgen dynamics in women are subject to three temporal phenomena ovarian cyclicity, the decline of the adrenal androgens with age (adrenopause), and ovarian follicular...

Patient Encounter 1 Part 1

A 67-year-old female with history of coronary artery disease, diabetes, and GI reflux presents to your clinic complaining of persistent flatulence, bloating, and feels she is getting fat. After discussing the symptoms with her, you learn that her reflux symptoms are recent onset and her proton pump inhibitor is working. However, for the past 3 or 4 months, she also has irregular bleeding and occasional cramping, which has been frustrating for her because she thought that ended years ago when she went through menopause. She reports her menses began when she was 9 and lasted all way until she was 61. She has two sisters in good health and a brother with diabetes. She has been married for 25 years with no children. The physician orders a CA-125 and CT scan that both come back positive and suggestive of ovarian cancer.

Accreditation Commission for Acupuncture and Oriental Medicine AGAOM

Menopause, 171-172 eight directions, 55-56 pulse, 13-15 tongue, 12-13 dianhea, 189-190 dysmenonhea, 167-170 ear infections, 142-144 eczema, 195-197 electro-acupuncture, treatments, 104 endometriosis, 177-179 facelifts, 197-199 fibromyalgia, 65-66 headaches, 59-61 healthful lifestyle tips, 251-252 herbal medicine, 47-49 HIV AIDS, 218-219 hypertension, 220-221 IBS, 186-187 indigestion, 191-193 infertility, 156-158 injuries, 101 insomnia, 225-227 jumper's knee, 88-89 knee pain, 87-88 licenses, 244 magnets, 45-46 Margaret Naeset, 75 medical histories, 14-15 menopause, 170-172 moxibustion, 41-42 nasal congestion, 126-127 infertility, 157-158 insomnia, 227 insurance, 261-262 magnetics, 9 menopause, 171-172 migraine headaches, 61 nasal congestion, 126-127 nausea, 152 neck pain, 64-65 Oriental Medicine, 94-96 palm pressure, 30 postpartum depression, 163-164 pressure types, 32-34 Q , 8

Definition Advantages and Disadvantages of Hemithyroidectomy

The advantages of this surgical approach are that, when compared with total thyroidectomy, surgical complications including permanent hypoparathyroidism and bilateral recurrent laryngeal nerve palsy are lower, even when an inexperienced surgeon performs the operation. In patients treated in this manner, only one of the two recurrent nerves and two or three of the four parathyroid glands are at risk. Most patients are also euthyroid postoperatively, so that lifelong thyroid hormone replacement therapy is unnecessary. When we recently examined thyroid function by measuring serum thyroxine (T4), triiodothyronine (T3), and TSH concentrations in 150 patients who had hemithyroidectomy, 95 (63 ) of all patients examined were euthyroid, 31 (21 ) had subclinical hypothyroid (low T4 and normal T3 with abnormally high TSH), and 24 (16 ) were hypothyroid.

Valerian Root Valeriana Officinalis

Use Three decades of extensive research have shown that valerian root is like a minor tranquilizer. It is known as a sleeping aid, and it might be useful for insomnia, mild anxiety and restlessness, lowering blood pressure, and reducing symptoms of menstruation and menopause. To date, it has not been proven to be habit-forming.

Acu Points to Block the Bleeding

Many women who come to my practice are opting to use acupuncture and Oriental Medicine to stop the pain and excessive bleeding from fibroids and cysts. I make sure that they have been properly examined and diagnosed by their conventional physician to rule out any malignant growths. Over 30 percent of all hysterectomies (removal of the uterus) in the United States are done to remove uterine fibroids. Since these growths shrink after menopause, avoiding surgery is an option some women are choosing, and Oriental Medicine is a helpful partner.

Hyperprolactinemia and Prolactinomas

Hypersecretion of prolactin may be physiologic or pathologic in origin. Physiologic stimulators include exercise, pain, breast stimulation, sexual intercourse, general anesthesia, and pregnancy. Pathologic causes of hyperprolactinemia include prolactinomas, decreased dopaminergic inhibition of prolactin secretion through pharmacologic agents, and decreased clearance of prolactin. Early manifestation of prolactin hypersecretion is galactorrhea and menstrual irregularities, notably amenorrhea, in women and erectile dysfunction or loss of libido in men. Rarely, galactorrhea with gynecomastia can occur in men. These patients are at risk of developing osteoporosis secondary to hypogo-nadism as well as a result of the direct inhibitory effect of prolactin on bone formation. Galactorrhea is rarely found in postmenopausal women with hyperprolactinemia, in whom mass effect of prolactinomas may cause the principal

Suggested Reading

Headache. 2006 46(CME Suppl 2) S61-S68. Tepper SJ, Zatochill M, Szeto M, Sheftell F, Tepper DE, Bigal M. Development of a simple menstrual migraine screening tool for obstetric and gynecology clinics the menstrual migraine assessment tool. Headache. 2008 48 1419-25. Tepper SJ, Kriegler JS. Update on menstrual migraine. Female Patient. 2009 34 1-6. Victorino CC, Becker WJ. Menopausal migraine. Curr Pain Headache Rep. 2007 6 153-7.

Assessing applicability Biologic issues affecting applicability

Age is an important prognostic factor in almost any condition. For example, shorter survival times with recurrent breast cancer are predicted in women of ages younger than 35 years (irrespective of menopausal status)'7'. Survival is also significantly lower for children with ependymoma who are less than 4 years of age'8'. On the other hand, older females with cervical cancer'9' and advanced ovarian cancer'10' have poorer survival.

Levocarnitinein Libido

In cystic fibrosis, 303, 304, 306, 308, 309 in sickle cell anemia disease, 1145t Lung transplantation. See also Solid-organ transplantation acute rejection, signs and symptoms of, 944t epidemiology and etiology of, 941 Lupus erythematosus, allergic drug reaction, 929t Luteinizing hormone at menopause, 870-871 in menstrual cycle, 843, 856, 856f Luteinizing hormone-releasing hormone, 1546 Luteinizing hormone-releasing hormone agonists in breast cancer, 1485, 1486t in cancer, 1468

What are some of the side effects of hormonal therapy and how are they treated

Significant impact on bone mineral density. Low testosterone levels affect bone mineral density in men almost the same as low estrogen levels in women. The use of androgen deprivation therapy, whether it is via orchiec-tomy or LHRH analogue or LHRH antagonist with or without antiandrogen, causes decreased bone mineral density. There is an average loss of 4 per year for the first 2 years on hormone therapy and 2 per year after year 4, which is similar to the loss in women after removal of the ovaries or natural menopause. This loss of bone mineral density in men taking hormone therapy occurs for at least ten years and probably accounts for the increased incidence of fractures 5 to 13.5 of men taking hormone therapy have fractures compared to 1 in men with prostate cancer who are not receiving hormone therapy. The cause of hot flashes and sweating (vasomotor symptoms) associated with hormone therapy (shots or orchiectomy) is not well known. The symptoms are similar to those that women...

Impulse Control Disorders in Parkinson s Disease

There have been very few studies that examine the impact of PD on sexual functioning in women with PD. What little evidence that exists suggests that women with PD often experience a decline in sexual desire and a reduced ability to experience orgasm during sex. Sex can be uncomfortable due to lack of lubrication and desire. For women with PD who have experienced menopause, the decline in sexual interest may be due to both menopause and to PD.

Pharmacologic Treatment

Estrogen is an antiosteoporotic agent that has been shown to increase bone mass and thus decrease the risk of vertebral and hip fracture by approximately 30 to 40 as compared with patients taking placebo. Estrogen, however, has been found to increase rates of stroke and deep vein thrombosis, whereas combined estrogen and progesterone therapy is associated with increased risks of cardiovascular disease, breast cancer, dementia, and gallbladder disease. As a consequence, estrogen is mainly used in the early postmenopausal period to treat postmenopausal syndrome and then lowered to the least effective dose to control symptoms. Because of the risks of estrogen formulations, this precludes their use as primary agents in the treatment of osteoporosis. SERMs are a class of agents that bind to estrogen receptors. They have a significant effect on breast tissue and bone cells however, they act as antagonists in the other receptor sites. Of the SERMs currently being used for clinical settings,...

What if my testosterone level is low What are the risks and benefits of testosterone therapy

Hypogonadism is a condition in which low levels of testosterone are found in association with specific signs and symptoms, including decreased desire (libido) and sense of vitality, erectile dysfunction, decreased muscle mass and bone density, depression, and anemia. When hypogonadism occurs in an older male, it is referred to as andropause, or androgen deficiency of the aging male. Hypogonadism is estimated to affect 2 to 4 million men in the United States, and its incidence increases with age. Only about 5 of affected males are being treated.

Pharmacologic Systemic Adjuvant Therapy

Consensus Development Conference on adjuvant therapy for breast cancer. The conference panel recommended consideration of adjuvant hormonal therapy for women whose tumors contain hormone-receptor protein regardless of age, menopausal status, involvement of axillary lymph nodes, or tumor size. They also recommended The short-term toxic effects of chemotherapy used in the adjuvant setting generally are well tolerated. Although a number of investigators have demonstrated a reduction in quality of life, most patients are able to maintain a reasonable level of function and emotional and social well-being during treatment.39 In general, supportive therapy of the patient receiving systemic adjuvant chemotherapy has improved in the past decade. Increased attention to the impact of symptoms on quality of life may account for some of this improvement. In addition, antiemetics that block serotonin and substance P have become available to assist in managing chemotherapy-induced nausea and...

The paradoxical effects of androgens on human hair growth

Normal Man Body

Menopause with age gradual decrease in Androgenetic alopecia has also been described in women, but the pattern of expression is normally different. Women generally do not show the frontal recession, but retain the frontal hairline and exhibit thinning on the vertex which may lead to balding (Ludwig 1977) (Fig. 6.3). Post-menopausal women may exhibit the masculine pattern (Venning and Dawber 1988). The progression of balding in women is normally slow and a full endocrinological investigation is recommended if a rapid onset is seen (Dawber and Van Neste 1995). Although female pattern hair loss is seen frequently in association with hyperandrogenism, other women frequently have no other symptoms of androgen abnormality. Therefore, there is some debate about whether androgen is essential for this hair loss in women (Birch etal. 2002) though this is still generally assumed. If, as occurs in men, the changes develop due to the genetically influenced, specific follicular responses within the...

Pharmacologic Systemic Therapy Endocrine Therapy

The pharmacologic goals of endocrine therapy for breast cancer are either to decrease circulating levels of estrogen and or to prevent the effects of estrogen on the breast cancer cell (targeted therapy) through blocking the hormone receptors or downregu-lating the presence of those receptors. Achievement of the first goal depends on the menopausal status of the patient, but achievement of the second goal is independent of menopausal status. Many endocrine therapies are available to target either goal of therapy, and combination studies also have been conducted in an attempt to combine differing mechanisms of action and improve outcomes. Unfortunately, combinations have not demonstrated any efficacy benefits but have increased toxicity. Therefore, combinations of endocrine agents for breast cancer are not recommended outside the context of a clinical trial. Patients often are treated with a series of endocrine agents, frequently over several years, before chemotherapy is considered....

Treatment and Consideration of Womens Issues in Headache

Abstract At menarche the incidence of migraine in girls increases. Migraine also changes at other key times in a women's life during menses, with the use of oral contraceptive therapy, and with pregnancy, lactation, and menopause. Each of these hormonal milieus is discussed in this chapter with relation to headache. The chapter includes sections on diagnosis of menstrual migraine, followed by discussion of acute, preventive, and miniprevention strategies. The impact and controversies of contraception in female migraineurs are considered, with special discussion on stroke risk. An extensive set of parts on migraine and pregnancy and lactation, with emphasis on practical treatment follows. The chapter ends with clinical pearls on treatment during perimenopause and menopause. Keywords Menstrual migraine Contraception and migraine Migraine stroke Pregnancy migraine Lactation and migraine Perimenopausal headache Menopausal headache

Historical Perspective On Clinical Trials In Breast Cancer

Hormonal therapy is a key component of therapy when tumours are hormone-receptor positive. Early trials focused on ovarian ablation by surgery or chemical means. The anti-oestrogen agent tamoxifen was introduced in the 1970s, at a time when there was high regard for the potential of cytotoxic agents, but little interest in hormonal therapies. Early small trials in metastatic breast cancer were equivocal and could have led to abandoning the agent. However, the weight of evidence from laboratory studies and several small trials pointed to superior efficacy with prolonged administration in ER positive disease. After a series of large randomised trials, tamoxifen is now regarded as standard therapy for pre- and post-menopausal women with ER positive tumours.25 Tamoxifen may be the single Oxford University, serves as a centre for data synthesis rather than actual conduct of clinical trials. Beginning in 1983, this group has collected data from virtually all major randomised trials...

Longlived Monkeys Have Life Spans Proportional To Human Centenarians

Post-reproduction expected from primate patterns. Hammer and Foley (1996) use body and raw brain volume estimates from fossil crania to predict early hominid longevity using a multivariate regression of log body weight and brain volume. Estimates based on regressions ofanthropoid primate subfamilies, or limited to extant apes, indicate a major increase in longevity between Homo habilis (52 to 56 years) and H. erectus (60 to 63 years), occurring roughly 1.7 to 2 million years ago. Their predicted life span for small-bodied H. sapiens is 66 to 72 years. From a catarrhine (Old World monkeys and apes) comparison group, Judge and Carey (2000) predict 91 years when contemporary human data are excluded from the equation. For early hominids to live as long or longer than predicted was probably extremely rare the important point is that the basic Old World primate design resulted in an organism with the potential to survive longer than a contemporary mother's ability to give birth. Notably,...

Patient Encounter 1 Part 1 Patient History

In osteoporosis, an imbalance in bone remodeling occurs. Most commonly, osteo-clastic activity is enhanced resulting in overall bone loss. However, a reduction in os-teoblastic activity and reduced bone formation can also occur in certain types of osteoporosis. Due to a decrease in endogenous estrogen, bone remodeling accelerates during menopause and up to 15 of bone is lost during the first 5 years after menopause. After this initial decline, bone loss continues to occur but at a much slower rate of up to 1 per year. The resultant bone loss and change in bone quality predispose patients to low-impact or fragility fractures.

Ovarian Cysts and Carcinoma

As mentioned, the initial evaluation of an ovarian cyst includes a transvaginal ultrasound. Premenopausal women should have pregnancy testing, and postmenopausal women should have CA-125 testing. Simple cysts are more likely to be benign, whereas complex cysts (with thick walls, irregularity, papillations, septa, and echogenicity) have a higher risk of More common in premenopausal women sharp, may have pelvic pressure Postmenopausal women

Clinical studies with finasteride in women

18.7.1 Study in postmenopausal women with androgenetic alopecia To determine whether finasteride has utility in the treatment of women with AGA (female pattern hair loss), a randomized, placebo-controlled, one-year study of 137 postmenopausal women with AGA was conducted (Price etal. 2000). Women were eligible if they were assessed by the investigator as being Ludwig class I to II (Ludwig 1977) and Savin scale hair density and pattern classification 3 to 5 (Savin 1994). At the end of one year, no benefit of finasteride treatment compared to placebo was demonstrated in any predefined efficacy endpoint, including macrophotographic hair count, global photographic assessment, investigator assessment, patient self-assessment, and histopathologic analysis of scalp biopsies (Whiting et al. 1999). Thus, the pathophysiology of AGA in postmenopausal women appears to differ from that of men with AGA. This difference in response between men and post-menopausal women is likely related to the...

Androgen deficiency states in women

Estrogen And Androgen Over Time Women

A core precept of endocrinology is that of an endocrinopathy, defined as a hormonal deficiency state with clearly defined adverse sequelae. This paradigm is best illustrated by hypothyroidism and subsequent replacement, or by male hypogonadism with testosterone replacement. In the previous section, we have hypothesized that a clear androgen deficiency state does not exist in women undergoing natural menopause, but there are several conditions that are associated with decreased levels of androgens in women. These include the use of postmenopausal hormone replacement therapy (HRT), (particularly orally administered), oral contraceptive use, pre-or postmenopausal oophorectomy, and adrenal suppression. Combined, these iatrogenic causes are prevalent enough to makeandrogen deficiency in women an extremely common condition. Several large-scale retrospective and prospective studies have demonstrated that with administration of oral HRT (either estrogen or estrogen-progestin combinations),...

The treatment of androgenpotentiated hair disorders

Finasteride, a 5a-reductase type 2 inhibitor, was developed to treat androgen-potentiated prostate disorders and is now available as an oral treatment for andro-genetic alopecia in men in many countries at a lower dose of 1 mg per day. Clinical trials demonstrated significant effects on stimulating hair regrowth in men with mild to moderate hair loss (Kaufman etal. 1998 Shapiro and Kaufman 2003). Even if hair did not regrow, balding progression was frequently halted. Unfortunately, no effects of finasteride have been seen in post-menopausal women with androge-netic alopecia (Price etal. 2000) use in pre-menopausal women requires ensuring against contraception in case of potential feminisation of a male fetus. The most common endocrine treatment, outside the USA, is the antiandrogen, cyproterone acetate, given with estrogen if the woman is premenopausal spiro-lactone or flutamide can be used as an alternative (Fruzzetti 1997 Lumachi and Rondinome 2003). Patients have to be...

Agerelated bone loss and osteoporosis

Primary osteoporosis related to aging has been classified as type II, or senile, osteoporosis. The type I disorder is related to the onset of menopause, and is thus termed postmenopausal osteoporosis. Other causes of osteoporosis can be secondary, such as that caused by long-term corticosteroid use or endocrinopathy. Peak bone mass is achieved between the ages of 16 to 25 years in most people. After this age, bone mass slowly, but continuously, decreases. The greater the amount of bone achieved during the peak period, the lower the chance that a person will develop osteoporosis later in life. Normal rates of bone loss are different in men and women. In men, bone mass is lost at a rate of 0.3 per year, while for women this rate is 0.5 . In contrast, bone loss after menopause, in particular the first 5 years after its onset, can be as high as 5-6 per year 17 . Because women live longer than men, it is believed that increased longevity places women at higher risk of senile osteoporosis.

Epidemiology And Risk Factors

Spinal osteoarthritis has been demonstrated through radiographic and cadaver studies to affect every adult age group.2,3 The prevalence of clinical spinal osteoarthritis increases with age, with elderly patients having the highest radiographic and symptomatic prevalence.1,3 There is also a significant gender difference in prevalence. Females are more likely than males to suffer from osteoarthritis in general. The gender difference is exacerbated after menopause and therefore greater in the elderly.1

Female breast anatomy

Breast Anteror Photos

With increasing age, and especially after the menopause, the glandular elements of the breast become less prominent and tend to be replaced by adipose tissue (fat). Fat attenuates the beam less than glandular breast tissue as a result, fatty breast is darker. Significant disease (which tends to be dense and produce high attenuation or bright areas on the film) is detected more easily. Younger breast tissue is denser (whiter), and the sensitivity of mammography in patients under 50 years of age is thus reduced. The younger breast is also more sensitive to the adverse effects of ionizing radiation, so ultrasound is often used as the first-line investigation in younger patients, especially under 35 years of age.

Summary and future directions

Androgens circulate in appreciable amounts in women. Female serum testosterone levels rely on a complex interplay of hormonal secretion and bioconversion of peripheral prehormones. Testosterone levels are proportional to ovarian and adrenal secretion and peripheral bioconversion of the adrenal androgens DHEAS and DHEA, the predominant circulating androgens. Adrenal androgen secretion attenuates with age in a cortisol-independent fashion due to involution of the reticularis zone of the adrenal cortex. As a result, as women age, less testosterone is produced from peripheral bioconversion of DHEAS and DHEA. With the onset of menopause, while ovarian folliculogenesis ceases, the remaining theca and stroma respond to the elevated, menopausal levels of LH by greatly increasing ovarian testosterone secretion. This compensatory mechanism attenuates the age decline in serum testosterone levels from declining adrenal androgens. The combined effects create a subtle decline in serum testosterone...

Genetics vs Lifestyle

Central obesity suggests increased visceral fat deposits, likely caused by increased production of peptides and other metabolic messengers. Hormonal influences most likely play a role in the distribution of fat. Central obesity is believed to result partly from increased androgenic effects, which is why men have a greater tendency for central obesity. Central obesity is also associated with hyperandrogenic states in women, such as polycystic ovary syndrome (PCOS). The increase in visceral deposition of fat that can occur after menopause in women may be related to a decrease in growth hormone and estrogen production (see Chapter 35).

The Goal of Evaluation

Subclinical Cushing

Garrapa and colleagues13 evaluated body composition and fat distribution, as measured by dual-energy x-ray absorptiometry (DEXA), in women with nonfunctioning clinically inapparent adrenal masses and in women with Cushing's syndrome compared with healthy controls matched for age, menopausal status, and body mass index. Women with clinically inapparent adrenal masses had larger waist circumference, reflecting intra-abdominal fat. The blood pressure was higher in patients with these tumors than controls, and 50 of patients were hypertensive. High-density lipoprotein (HDL) cholesterol levels and triglyceride mean values were also higher in patients with clinically inapparent adrenal masses than in controls. If central fat deposition, hypertension, and low HDL are important risk factors for cardiovascular disease, then patients with clinically inapparent adrenal masses, whether subclinically functioning or nonfunctioning, are at higher risk than the general population for cardiovascular...

Physiologic Effects of Corticosteroids

The physiologic effects of DHEA-S, DHEA, and androstene-dione are relatively weak, and they undergo conversion to testosterone in peripheral tissue. In females, androgens produced by the adrenal glands sustain normal pubic and axillary hair growth, and after menopause the adrenal glands are a major source of estradiol. However, in males, the high amount of androgens produced by the testis exceeds that produced by the adrenal glands.1

Clinical implications

Some clinicians argue that androgen replacement in the elderly male, in addition to possible benefits on muscle, bone, sexual and mental functions, has the potential to prevent atherosclerotic vessel diseases. However, androgens have such an extraordinary array of effects in vivo that it is hazardous to extrapolate isolated experimental findings to the wider clinical setting. It is premature to assume clinical benefits from manipulation of the sex steroid milieu based on biologically plausible mechanisms, or indeed on cross-sectional risk factor observational data in a complex multifactorial condition such as coronary artery disease. Interpretations of effects of pharmacological doses of androgens on arterial compliance and flow-mediated dilatation in particular must also be treated with circumspection. The lessons from estrogen hormone replacement in postmenopausal women are especially salutary. Despite the overwhelmingly positive but indirect evidence on risk factors and disease...

Treatment options in androgen insensitivity syndromes

Risk of a malignancy of the gonads should not be underestimated however, to date there is no report of a prepubertal or pubertal AIS-patient with a gonadal malignancy. In female patients with partial AIS caused by a mosaic mutation of the AR gene or decreased, albeit distinct, receptor activity due to a point mutation of the AR gene, the gonads should be removed before the beginning of puberty (Holterhus etal. 2002). Hormone replacement therapy in female patients with AIS will always include estrogens. However, when and if gestagens should be replaced and a cyclic replacement be given is debatable in these patients without Mullerian structures.

Exogenous androgen treatment in women

There is increasing interest in the use of testosterone as part of postmenopausal hormone replacement therapy, in particular to improve reportedly impaired sexual function (Davis and Tran 2001). Whether the concurrent use of testosterone will impact on the perceived benefits of estrogen hormone replacement therapy on the cardiovascular system is currently unknown. In a 20-year (1975-1994) retrospective survey ofthe Amsterdam Gender Dysphoria Clinic (vanKesteren 1997),293 female-to-male transexuals aged 17-70 years (mean 34) were treated for two months to 41 years (total exposure of 2418 patient-years) with oral testosterone undecanoate 160 mg daily or testosterone (Sustanon) 250 mg i.m. every 2 weeks. There was no excess of cardiovascular (or all cause) mortality or morbidity compared with the general female Dutch population. In an unmasked study, 40 postmenopausal women on conventional estorgen progestin hormone replacement additionally received either placebo or 40 mg testosterone...

Androgeninduced liver disorders

A consistent adverse feature of pharmacological androgen therapy, regardless of indication, is the risk of androgen-induced liver disorders (Ishak and Zimmerman 1987). These involve biochemical effects on hepatic function, hepatotoxicity (hepatitic or cholestatic) and liver tumor development (benign or malignant) and peliosis hepatis. These risks are a class-specific adverse effect of 17a-alkylated androgens, especially when used orally but no reliable estimates of the incidence or prevalence are available. The East German national sports doping programme involving oral 17a-alkylated androgens resulted in deaths from liver failure and chronic liver disease (Franke and Berendonk 1997). Every marketed 17a-alkylated androgen is associated with hepatotoxicity, whereas other androgens (1-methyl androgens, nandrolone, testosterone, dihydrotestosterone) are not hepatotoxic. Cholestasis and functional impairment of liver function (BSP retention, antipyrine clearance) are consistently impaired...



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