Menopause and Hormone Replacement Therapy

Natural Cures For Menopause

Natural Cures For Menopause

Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?

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Surviving Perimenopause

To give you an even better idea of just what kind of useful and practical information youll find in Perimenopause: Have It, Live It, Love It!, heres a partial list of the topics covered extensively in this ebook: Learn about the 26 signs of perimenopause both common and not so common symptoms. Find out what your symptoms are Not telling you 18 perimenopause symptoms that are linked to other serious medical conditions. Learn how you can treat your symptoms Without the use of drugs and pills. Over 50 home remedies with recipes and instructions to help you cope with various perimenopause symptoms. What you need to prepare Before your visit to your doctor, including how to make sure your doctor listens to you and takes your symptoms seriously, and reaches the right diagnosis. Get tips and techniques to re-ignite your sex life. Its not too late to bring passion back to the bedroom. Perimenopause pregnancy? Get your facts straight whether you are trying to conceive or prevent a pregnancy. Make sense of the changes that are happening to your body and the ones that are happening inside your head. Learn techniques you can apply today to get better sleep and to overcome perimenopause insomnia. Discover what you can do now to prevent osteoporosis which attacks women after they hit menopause and is easily preventable only if you start now! Identify if you are estrogen deficient or estrogen dominant and find out which remedies work for each type. Determine whats actually causing your irregular periods, Pms and heavy bleeding. Learn how to tell when youll hit menopause. Understand medical jargon so you dont come out of a doctor consultation more confused than before you went in. Understand the link between hormonal changes in your body and your mood swings and depression. Find out what to expect when you have perimenopause the common and not-so-common transformations that can really affect the way you live. Get access to information that your doctor may not be telling you. Realize that you can do something about that weight youre putting on around your waist and thighs and why old dieting methods that worked for you in the past are next to useless now. Learn about the different kinds of tests your doctor may ask you to get and actually know what theyre for.

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Hormone Replacement Therapy HRT

Until recently, doctors often prescribed hormone replacement therapy to postmenopausal women, not only to help control the symptoms of menopause, but also to reduce their risk for coronary artery disease. They had reason for doing so numerous large observational studies concluded that those taking estrogen after menopause were one-third to one-half as likely to have heart attacks or develop cardiovascular disease as those who didn't. But more recent randomized controlled trials burst the HRT bubble. Several large trials have concluded that hormone replacement therapy doesn't help prevent heart problems and may even cause them. The American Heart Association now advises physicians not to prescribe hormone replacement therapy solely to prevent heart attacks and strokes in women with cardiovascular disease. But some experts believe that future research may still determine that, for some women, hormone replacement therapy helps prevent heart disease. Most of the clinical trials thus far...

Menopausehormone replacement therapy

Limited data are available about the effects of menopause and HRT on prevalence of the metabolic syndrome. More data are available on the effects of menopause and HRT on various measures of central obesity but there are conflicting results. Menopause is associated with increased amounts of abdominal visceral fat and there appears to be an effect that is independent of ageing (Poehlman and Tchernof, 1998 Tchernof etal., 1998).

Menopause and Insomnia

Menopause is a time of major hormonal, physical, and psychological changes, and sleep disturbance is one of the hallmark symptoms. More than half of women complain of difficulty falling asleep, less restorative sleep, and daytime sleepiness during this life stage, and these sleep problems are frequently accompanied by depression and anxiety. Sleep can also be disrupted by the most common manifestation of menopause the hot flashes, hot flushes, and night sweats that occur in the majority of women. Hot flashes are unexpected feelings of heat all over the body. They are often accompanied by hot flushes sweating and dilation of the blood vessels, which causes redness in the face, neck, and upper chest. These symptoms are caused by decreasing levels of estrogen. Hormone replacement therapy (HRT) is the most frequent treatment for reducing menopausal symptoms, but its use is controversial. In addition to cutting a woman's risk of osteoporosis, HRT reduces the incidence of hot flashes, which...

Menopause 309

Menopause The period during which menstruation ends permanently the end of a woman's period of fertility. Diagnosis of menopause is indicated by the absence of menses accompanied by symptomatology and strengthened when serum LH and FSH are found to be elevated, indicating failure of the ovaries to produce estrogen in the presence of adequate hypothalamic pituitary stimulation. Definitive diagnosis is indicated by the completion of 12 months without menses. Women generally develop some signs of estrogen depletion prior to the cessation of periods. Until the periods have stopped for 12 months, conception is still possible and contraceptive measures should be taken. Menopause usually occurs naturally between ages 45 and 55. It may also be surgically induced, or occur prematurely. Early onset of menopause is not uncommon in HIV-positive women. Compounding a possible association with HIV are factors such as anemia, chronic illness, weight loss, tobacco use, use of street drugs...

Causes of Memory Problems

Like Michael, many patients with memory problems who come for evaluation discover that the cause is something that they never imagined could impair their ability to think and remember. Often, the cause is a common condition (such as depression) or a disorder that increases the risk of cerebrovascular disease and heart disease (such as poorly controlled high blood pressure or diabetes). Other causes of memory loss are hormonal changes that occur naturally during certain stages of life. For women, hormonal fluctuations following childbirth and around menopause can make them feel less sharp. Men also go through a phase of significant hormonal change as they age a drop in testosterone level has been linked with age-related memory problems. Still other causes of memory loss are unhealthy habits (such as excessive alcohol use and getting too little exercise or sleep) or a lack of intellectual challenge.

Collagen Receptor Deficiency and Bleeding

Evidence for the importance of integrin a2 p1 in platelet function was obtained in a patient with mild bleeding problems related to strongly reduced expression of integrin a2p1 (Nieuwenhuis et al. 1985). Platelet aggregation in response to various types of collagen and adhesion to collagen under static and flow conditions was markedly reduced, and the few platelets that adhered failed to spread. In this and in a second female patient, symptoms disappeared after menopause, accompanied by normalisation of the a2 p1 expression, suggesting that the gene defect was located in the promoter region of a2p1 chains, the bleeding defect thus rather reflecting defective hormone regulation of gene expression. In a 66-year-old man with a myeloproliferative disorder and prolonged bleeding time but no bleeding history, a deficient collagen-induced aggregation and aberrant adhesion to collagen were found, due to an acquired deficiency in integrin a2 p1 (Handa et al. 1995). The first patient with a...

Selective Estrogen Receptor Modulators

These new drugs, sometimes called designer estrogens, appear to affect blood lipids in much the same way that estrogen does but possibly without the increased risk for breast cancer and endome-trial cancer associated with hormone replacement therapy. Raloxifene (Evista), one of these drugs, has been shown to decrease levels of LDL, but unlike estrogen does not reliably elevate HDL cholesterol, though it may increase one of the HDL subfractions. Also unlike estrogen, raloxifene doesn't elevate triglyceride levels. Raloxifene is approved for osteoporosis prevention, and recent preliminary studies suggest that it may be effective at reducing breast cancer risk. Like estrogen, however, it does increase the risk of blood clots in the legs. Overall, I don't use raloxifene as a pri- 33.

Erasistratus of Chios

Estrogen and the brain A growing body of research suggests that the female hormone estrogen may play a protective role against memory loss and Alzheimer's disease and may also improve brain function. in fact, the sharp decrease in estrogen during menopause may be one reason why women are 50 percent more likely to contract Alzheimer's disease at midlife. While the research has not yet clearly proven the role of estrogen as a brain protector, one study of 2,418 women in southern California showed that those who took estrogen supplements after menopause were 40 percent less likely to have Alzheimer's. in this study, the higher the dose of estrogen, the lower the risk of Alzheimer's. in other studies of women over age 65, women who had taken estrogen supplements continuously since menopause had significantly higher scores of verbal memory than other women. While extensive research has also found that estrogen significantly reduces the risk of heart disease and osteoporosis, it is far from...

Definition of the Disease

Bone turnover or remodeling is a finely orchestrated process involving interactions between osteoblasts, osteoclasts, and osteocytes. By some estimates, the skeleton is completely remodeled every 10 years. For a healthy individual, more bone is formed during the first three decades of life than is lost, with peak bone mass and density occurring between ages 30 and 36. After this, more bone is lost on an annual basis than formed, although the rate of loss is hardly noticeable for most (< 1 each year in both genders). When a woman enters menopause, the rate of loss accelerates and as much as 2 is lost each year for about 5 years or so. Type 1 osteoporosis is characterized by an accelerated rate of bone resorption in other words, high bone turnover in response to declining estrogen concentrations. Calcium concentrations increase, leading to suppression of parathyroid hormone (PTH) secretion. This form of the disease occurs at a greater frequency in women and typically has the greatest...

Treatment and Monitoring

Currently available drug therapy focuses on suppression of bone resorption. Because of the relationship between estrogen and bone resorption, hormone replacement therapy was for many years the first therapeutic option. But this changed in 2002 when data from the Women's Health Initiative suggested increased risks of breast cancer, coronary artery disease, stroke, and pulmonary embolism with a combined estrogen-progesterone formula. Although these risks were not found with other estrogen therapies, there was concern that for many women the risks outweighed the bone benefits. For these women, and when hormone therapy is contraindicated, there are other options. The bisphospho-nates are probably the most frequently prescribed drugs for the treatment of osteoporosis and osteopenia. Alendronate, the most widely used of the class, acts by inhibiting farnesyl diphosphate synthase within the osteoclast, causing the cell to undergo premature apopto-sis. Second- and third-generation...

Communicating through the media

There are great dangers in trying to use the media as a vehicle for manipulating rather than communicating, because it is so unpredictable and unreliable. It is, however, an unfortunate reality that the upward channels to the NHS Executive and government are so tenuous that often only pressure from the media has any effect. Health stories are part of their stock-in-trade, readily carried without much attempt at checking the facts or putting them in context, partly one suspects because of the corrupting effect of deadlines and the desire for a scoop. Bricks can indeed be made without straw if they need only last a day or two. Transparently inaccurate or overstated items display an eerie lack of basic knowledge about medicine, for example one day both the Independent and the Daily Mail announced that Australian scientists have developed the first nano-machine which will enable doctors to provide an instant diagnosis of virtually all known diseases, and on another occasion BBC Radio 4...

Epilepsy Patient and Family Guide Second Edition

Principles of drug therapy, (5) discuss anticonvulsants, (6) discuss surgical therapies, and (7) describe other epilepsy therapies. The third section is entitled Epilepsy in Children and consists of 10 chapters that discuss (1) epilepsy in infancy, (2) Epilepsy in childhood, (3) epilepsy in adolescence, (4) outgrowing epilepsy, (5) intellectual and behavioral development, (6) how to tell children and others about epilepsy, (7) how to live an active life, (8) the education of children with epilepsy, (9) mental handicaps and cerebral palsy, and (10) how children can cope with epilepsy after their parents are gone. The fourth section is entitled Epilepsy in Adults and consists of six chapters that address (1) living with epilepsy, (2) pregnancy and menopause, (3) parenting by people with epilepsy, (4) employment issues for people with epilepsy, (5) mental health in adult patients with epilepsy, and (6) epilepsy in the elderly. The fifth sections entitled Legal and Financial Issues in...

Mate Choice and Courtship as Social Events

Mate choice that takes into account the qualities of a potential mate's relatives would have favored hominids who spread their courtship effort out across their lifetimes. In childhood and old age their courtship would be vicarious, carried out on behalf of their relatives. In the prime of life it would be mostly for themselves, but also for their sexually active relatives. We should not expect to see fitness indicators used exclusively after puberty and before menopause, only that they are then directed at different targets.

Selection of Controls

The choice of controls for any study requires careful consideration. In particular controls should be free of the disease at the time they are serving as controls. Consider a case-control study looking at the risk of hormone replacement therapy (HRT) for cervical cancer. Women taking HRT may be required to have an annual cervical smear. Other women, not on HRT, may be required to have a smear only every 3 years and they may also have less incentive to turn up for screen. Thus women on HRT may be more likely to have a cervical cancer detected, whereas some of the controls may have cervical cancer, but it has not been detected yet. One of the major difficulties with case-control studies is in the selection of a suitable control group, and this has often been a major source of criticism of published case-control studies. This has led some investigators to regard them purely as a hypothesis-generating tool, to be corroborated subsequently by a cohort study.

Reproductive Endocrinology and Infertility

The endocrine system, which is responsible for releasing hormones that modulate the development of the ovum, is one of the most intricate and complex regulatory systems. For the specialist in reproductive endocrinology and infertility (REI), establishing a pregnancy for couples suffering from infertility is extremely rewarding. Their practice also extends to the treatment of hormonal and reproductive disorders affecting women, children, men, and mature women. Reproductive endocrinologists gain special competence in advanced microsurgical procedures, such as reversal of tubal ligation, treatment with fertility drugs, and methods of assisted reproduction (in vitro fertilization and insemination). With vast knowledge and expertise on the physiology of reproduction, REI specialists medically and surgically treat a variety of complex hormonal disorders, such as infertility, endometriosis, recurrent pregnancy loss, menopause, and ovulatory dysfunction.

Improvement of endothelial function

Endothelial dysfunction leads to defects in insulin-mediated glucose uptake. Blockade of vascular nitric oxide synthesis with L-arginine analogue also impairs endothelial dependent va-sodilation. Endothelial function improves with exercise, a low-fat, low-carbohydrate diet, and with use of statins and ACE inhibitors (Table 5) 29,59,67 . Angiotensin I blockade has not shown any improvement of endothelial dysfunction, but benefit has been noted with peroxisome pro-liferator activated receptor gamma (PPAR-y) stimulator, antioxidants, hormone replacement therapy, and L-arginine 66,68,69 . In addition, the ACE inhibitor quinapril significantly improved endothelial function in multiple studies, both in normotensive volunteers and in subjects with coronary artery disease 70-77 .

Hygiene Challenges Posed by Irregular Uterine Bleeding

The perimenopause is a transitional time between the reproductive years and menopause. Ovarian steroid hormone production decreases in stages, beginning with a drop in progesterone, reduced levels of both estrogen and progesterone and, finally, a depletion of both hormones to postmenopausal levels. Irregular uterine bleeding and spotting can occur during this transition, necessitating anticipatory or daily use of sanitary pads or panty liners.

Developing nutritionallyenhanced cerealbased foods 1351 Current status

Opment of products containing pharmacologically active compounds. One group of compounds that has attracted interest is the phyto-oestrogens. These are plant compounds which bear a structural similarity to the female sex hormone oestra-diol and fall into three broad chemical categories isoflavones, coumestans and lignans. They are thought to have beneficial health effects with regard to cardiovascular disease, certain cancers and the menopause (Bingham et al, 1998). A number of baked products, for example breads containing soya, linseed and or flax and with high contents of phyto-oestrogens, have been released (Dalais et al, 1998 Payne, 2000). These have sometimes been referred to as 'Sheila' breads, reflecting their Australian origin.

Telling Good Studies from Bad continued

A real-life example of the problems of observational studies is what happened with hormone replacement therapy (HRT). The data suggesting that HRT was good for the heart was based on observational studies. When HRT was put to a randomized controlled test, the old thinking was reversed. How could this be We now assume that the women in the observational studies who took HRT also had healthier lifestyles that contributed to the fact that they suffered fewer heart problems. Preliminary data. Before a company or the government will fund a large, expensive trial (some of them run into the millions of dollars), they want to see preliminary data that support the researchers' hypothesis. Retrospective studies are done first, because they are cheaper. However, their results may not hold up when the larger prospective study is finally done. This is exactly what happened with hormone replacement therapy. The retrospective studies made HRT look great, but the randomized, prospective study showed...

Skeletal Adaptation To Loading

The skeleton changes considerably throughout its lifespan. These changes in bone mass are in line with maintenance of the structural integrity of the skeleton that is required to support body mass. Bone mass increases linearly during childhood, peaks at sexual maturity, and plateaus at 20-30 yr of age. Bone mass thereafter decreases mildly and linearly until the end of the life in men, whereas in women bone mass falls rapidly and transiently after menopause. The skeletal adaptation to external loading and unloading throughout life occurs through changes in bone architecture and mass in response to exercise, immobilization, and weightlessness. Increased strain applied on the skeleton increases bone formation, reduces bone resorption, and increases bone mass to optimize bone resistance and reduce fracture risks. Inversely, decreased skeletal strain reduces bone formation and increases bone resorption to optimize the bone structure with respect to mechanical strength. It has been...

Victorian Ideals and Religious Fervor

The division of labor required by the new industrial economy redefined the ideals of masculinity and femininity (33). The separation of work from home life cemented the division between the roles of men and women, mainly in the middle classes (49). In this newly defined role, women were confined to the home and thought to be frail, passive, and passionless (50-52). By the middle of the 19th century, men were thought of as producers whereas women were considered to be reproducers. This growing sexual division of labor was underscored by medico-scientific theories that posited the naturalness of this divide by arguing that women's passive nature left them ill-equipped for the competitive world of education, work, and politics. Women's delicate nervous system, monthly illness, smaller brain, and specific reproductive organs all made them unhealthy to vote, work, go to college, or participate in the public arena (53). The Victorian ideal of a woman as nurturing, affectionate, intuitive,...

Differential Diagnosis of Hypercoaguability

There are many important causes of hypercoagulation, some are inherited and others are acquired. Heritable causes of hypercoagulation include common polymorphisms of the F5 and F2 genes (factor V Leiden and prothrombin G20210A, respectively) and more rare mutations in proteins C, S, antithrombin III, and 5,10-methylenetetrahydrofolate reductase (MTHFR). In this patient the protein S and antithrombin II activities were normal. The normal homocysteine values are consistent with normal activity of the MTHFR protein. Acquired causes are numerous, including hypercoaguability of malignancy, antiphospholipid antibody, chronic medical illness, paroxysmal nocturnal hemoglobinuria, pregnancy, surgery, smoking, estrogen-containing oral contraceptives, and hormone replacement therapy.

Prevention of Cardiovascular Outcomes in Type 2 Diabetes Mellitus Trials on the Horizon

Clinical trials addressing the relationship between intervention to lower glucose and CV events are awaited with great interest. Furthermore, no outcomes studies have been conducted with insulin analogs or thiazolidinediones. Clinical practice is informed by the best available data, but epidemiologic studies can lead one astray, as was the case with hormone replacement therapy as a technique to reduce CVD 1 .

Nitric Oxide And Progenitor Cell Mobilization

Today, NO produced by eNOS appears to be the common denominator of a variety of stimuli including VEGF (see above), HMG-CoA reductase inhibitors (statins), angiotensin converting enzyme (ACE) inhibitors, estrogen and exercise, all identified as inducers of progenitor cell mobilization. Hence, in the early post-myocardial infarction (MI) phase, an increase in ROS production and a decrease in MMP9 activity in the bone marrow are associated with the reduced EPC mobilization 23 . Interestingly, this is reversed by drugs like ACE inhibitors 23 and statins 23, 24 , in part through their capacity to increase NO production and or eNOS expression. Similarly, estradiol can increase EPC mobilization post-MI through a facilitating effect on eNOS activity and subsequent activation of MMP9 25 . These data suggest a potential benefit of hormone replacement therapy for the management of MI in postmenopausal women and have probable implications with regard to the sex discrepancy in the occurrence of...

The major diseases of bone resorption

Menopause and lack of oestrogen Menopause and lack of oestrogen Oestrogens (hormone-replacement therapy) several types, with or without Osteoporosis. The past decade has witnessed a remarkably greater awareness of osteoporosis as a major health problem that is associated with profound socioeconomic consequences (Fig 4). There have been impressive advances in understanding the epidemiology and pathogenesis of osteoporosis and its associated fractures, in the application of physical and biochemical methods to its diagnosis and evaluation, and in the therapeutic approaches to prevention and treatment of postmenopausal and other forms of osteoporosis (Table 1). There are several recent good reviews (Compston & Fogelman 1999, Ralston 1997, Royal College of Physicians 1999). Despite these advances much remains to be done, and the development of better and more cost-effective methods of treatment must remain a high priority. The essential features are bone loss, particularly due to lack...

Vaginal douche See douche

Vaginal fluid All women secrete moisture and mucus from membranes that line the vagina. Vaginal fluids provide lubrication, help keep the vagina clean, and maintain the acidity of the vagina to prevent infections. The walls of the vagina may be almost dry to very wet. The vagina tends to be dry before puberty, during lactation, and after menopause, as well as during the part of the menstrual cycle right after the flow. It tends to increase in moisture around ovulation time, during pregnancy, and when the person is sexually aroused. when a woman is under stress, secretion also increases. The discharge is clear or slightly milky and may be somewhat slippery or clumpy. when dry it may be yellowish. Vaginal fluids normally cause no irritation or inflammation of the vagina or vulva.

Perineal Hygiene Among Older Women

Genital hygiene is of particular importance to the health and well being of older women. The consequences of inadequate hygiene vary. Mild skin irritation and fungal or bacterial skin infections become more common in older people who have a diminished capacity to care for themselves. Atrophic vulvovaginitis is prevalent after menopause. Moreover, the risk of pressure ulcers and incontinence dermatitis can be significant when older women suffer impaired mobility and urinary or fecal incontinence. Health conditions linked to genital hygiene in older women are described in the following sections.

Changes in the Vulva and Vagina Throughout Life

Labia Minora Puberty Changes

The vulva and vagina change over the course of life. The most salient changes are hormonally mediated and are linked to the onset of puberty, the menstrual cycle, pregnancy, and menopause. This chapter reviews the morphology and physiology of the vulva and the vagina from infancy to old age (Table 1). Because of inter-individual variations, the age definition of each life stage is approximate. The newborn period lies between birth and one month of age early childhood refers to between one and eight years of age. Puberty usually occurs between eight and 15 years, although the age criteria for premature puberty are controversial. The reproductive years begin at menarche (mean age of about 12 years) and continue through the perimenopause. Menopause is defined to begin one year following the final menstrual period menstruation ceases at a median age of 50 in Western industrialized countries. Source Adapted from Ref. 57. MENOPAUSE AND OLDER AGE Menopause is the permanent cessation of...

Alternatives to Tamoxifen

In 2003, Buzdar reported on new findings, comparing anastrozole (1 mg once daily) alone and in combination with tamoxifen (20 mg once daily). In summary, he states that anastrozole is quite effective (a) in breast cancer prevention (b) in the early stages of breast cancer as already documented and (c) also in cases of receptor-positive cancer that has progressed since the menopause.

Alveolar proteinosis See pulmonary alveolar

Amenorrhea Absence or suppression of menstruation. Amenorrhea is normal before puberty, after menopause, and during pregnancy and lactation. Primary amenorrhea is the failure of the menstruation cycle to begin at puberty this may result from a congenital defect in the reproductive organs. The term usually refers to a condition caused by reasons other than these. secondary amenorrhea is the suspension of menstruation after it has been established at puberty, and may result from an illness, a change of environment, or irradiation or removal of the uterus or ovaries. it is also associated with certain metabolic disorders (obesity, malnutrition, diabetes) and certain systemic diseases (syphilis, tuberculosis, nephritis). Amenorrhea may also result from emotional causes (excitement, anorexia nervosa), pituitary disorders (hormonal imbalance of estrogen, progesterone, or follicle-stimulating hormone), or eating disorders (obesity, anorexia).

Mutations In The Gene That Encodes The Androgen Receptor

AIS females are often considered quite attractive by contemporary standards, and they are often taller than the average woman. The health implications of AIS are risk of testicular cancer, infertility, gonadectomy, hormone replacement therapy, and, eventually, osteoporosis. Psychologically, they are as stable and happy (or not) as women with two X chromosomes who end up coping with fertility issues. They can be expected to live perfectly happy, normal lives and, when they so choose, become parents of adopted children or stepchildren.

Pancreatic Pathways Molecular Epidemiology And The Study Of Geneenvironment Interactions

CYP17 encodes P450c17a, an enzyme with 17a-hydroxylase and 17,20-lyase activities at key branch points in estradiol biosynthesis. A polymorphism in the 5'UTR promoter region of CYP17 (T27C) creates an Sp1 (CCACC box) promoter site and the A2 (27C) allele has been associated with higher levels of steroid hormones, including estradiol, and with breast cancer susceptibility in some studies.134 Using data obtained in our population-based case-control study of pancreatic cancer carried out in the San Francisco Bay Area, we conducted an analysis of the CYP17 polymorphism, as well as menstrual and reproductive risk factors for pancreatic cancer.135 We used a mass spectrometry-based method to determine CYP17 genotypes in 308 cases and 964 controls. Our results show a statistically significant inverse association between the A2 allele and pancreatic cancer risk for A1 A2 heterozygotes, OR 0.77, 95 CI 0.57-1.0 for A2 A2 variant homozygotes, OR 0.62, 95 CI 0.42-0.94, relative to A1 A1...

Exogenous Sex Hormones

The risk of pancreatic cancer associated with the use of exogenous hormones such as oral contraceptives (OCs) and hormone replacement therapy (HRT) has been evaluated in a limited number of epidemiologic studies. Of the studies that evaluated use of HRT and pancreatic cancer risk, two studies found inverse associations,72,73 while two studies found positive associations with risk.74-76 In a network of case-control studies,76 HRT use for 2 or more years was associated with a decreased risk odds ratio (OR 0.7, 95 CI 0.2-3.1) , while HRT use of less than 2 years was associated with an increased risk (OR 2.0, 95 CI 1.0-4.1), although CIs included unity. Of the studies that evaluated OC use and pancreatic cancer risk, two studies reported reduced risk estimates for pancreatic cancer with OCs,73-74 while two studies reported a positive association.66,75 In general, precision of the risk estimates was limited by small sample sizes. Using data from our population-based case-control study of...

Increasing Abdominal Girth

A 59-year-old woman, gravida 2 para 1 presented to her primary care physician with a 2-month history of abdominal bloating, early satiety, and increasing abdominal girth. She has a medical history significant only for essential hypertension and depression that have been responding well to medications. She has been postmenopausal for 7 years and has not been on hormone replacement therapy. Prior to menopause she used the copper-T intrauterine device (IUD) for contraception. She denied any vomiting, diarrhea, constipation, or urinary frequency. Screening colonoscopy performed at age 50, routine annual mammography, and annual cytologic screening of the uterine cervix have all been within normal limits. Her only prior operation was a cesarean section. A family history revealed maternal breast cancer, diagnosed at age 62. She does not smoke, drinks occasionally, and does not use any illicit drugs or over-the-counter medications.

Middle Aged Woman with Colles Fracture

On physical examination, the patient is a 5-ft-tall, 94-lb middle-aged woman who describes herself as physically fit and in good health. She reports running 3-4 miles 3 times per week and participating in additional physical exercise that includes weight and resistance training. Her past medical history includes two full-term, uneventful pregnancies, menopause at age 41, but no history of thyroid disease, diabetes, or Cushing syndrome. A daily multivitamin supplement is her only current medication. She has never received hormone replacement therapy. She has no documented family history of osteoporosis, although she recalls her grandmother losing height as she aged and developing a dowager's hump, and notes that her 80-year-old mother appears to be losing height as well. The following laboratory results were obtained

A 46Year Old Female with a Painful Swollen Right Calf

A 46-year-old obese Caucasian woman presented to her general internist with recent onset of flushed skin and sweating. Over the previous 6 months she has noticed her hair thinning and complained of increasing irritability. She described occasional alcohol use and a 30-year history of 1 pack per day of tobacco use. The physician diagnosed early-onset menopause and discussed options for symptom management and prevention of osteoporosis. Conjugated estrogen therapy was initiated. Eight weeks later, the patient came to the emergency department with pain, redness, and swelling of the right calf. Venous Doppler studies confirmed deep venous thrombosis. Laboratory investigations characterized her coagulation status, and genetic tests for F5 (factor V) and F2 (prothrombin) mutations, associated with heritable predisposition to venous thrombosis, were performed

Acquired Hypercoagulable Disorders

Hormone Replacement Therapy-related Thrombosis Historically, hormone replacement therapy (HRT) has been used to reduce the progression of osteoporosis, relieve the symptoms of menopause, and reduce the cardiovascular risk profile. Several studies including the Heart Estrogen Progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) have shown an increased risk of venous thromboembolism with the use of HRT. A two- to four-fold increased risk, compared to nonusers, has been shown.26,29 Similar to oral contraceptives, the risk of venous throm-boembolism is highest during the first year of HRT. Once HRT is discontinued, the risk of thrombosis returns to baseline. Additionally, increasing age has been associated with an increased risk of venous thrombosis. Several studies also have shown an increased risk in patients using HRT who had lower extremity fractures, recent surgery, previous venous thromboembolism, cancer, and obesity.29 Also similar to oral contraceptive pills,...

Terminology and History

Sensitivity of the nerves supplying the vulva that was distinct from other gynecologic conditions, such as vaginismus. With the exception of redness, there were no physical abnormalities, and symptoms were triggered by friction, air, bathing, and or pressure. Dyspareunia, or pain with intercourse, was cited as the most devastating symptom and often the reason a woman consulted a physician. Thomas attributed the origins of this vulvar pain to menopause or a morbid mental state (4). Because surgical removal of the labia minora and other vulvar tissues did not cure the patient, opium, chloroform, tannin, nitric acid, and local sedatives were recommended as potential treatments. Although this disorder was highlighted again by Skene in 1899 in Treatise on the Diseases of Women (5), there is little published literature until the late 1970s.

Metabolic toxicity 311

Current standards of care for HIV-positive women neither approve nor forbid the use of hormone therapies or oral contraceptives for birth control or menstrual regulation. There is no present information that would alter treatment strategies for amenorrhea, dysmenorrhea, premature or natural menopause, or premenstrual syndrome in immunocompromised clients. Research into the etiology as well as the effect of absent menstruation on the immune and endocrine health of women is needed.

Women and Epilepsy

Summary Women and Epilepsy, a brochure from Epilepsy Ontario, presents information on how seizure disorders relate to the various phases of a woman's life, from puberty to menopause. The first section focuses on adolescence, highlighting (1) menstruation, (2) relationships and disclosure, (3) and birth control. The second section discusses prepregnancy planning, focusing on fertility and libido as they relate to epilepsy. The third section looks at pregnancy, examining (1) the role of heredity, (2) seizures during pregnancy, (3) possible complications during pregnancy, (4) drugs and the developing fetus, (5) nutrition, (6) labor and delivery, and (7) breast feeding. The fourth section focuses on practical concerns for women with small children, including recommended safety precautions. The fifth section discusses epilepsy and menopause. The brochure opens out into a poster entitled Women and Epilepsy.


Long-term side effects, which are usually results of anticancer drug and radiation treatment, can include infertility, early menopause, cataracts, and secondary cancers. A patient may experience any of several complications as a result of this treatment, including infections and bleeding, most often from the nose or mouth, under the skin, or in the intestinal tract. Liver disease may also develop in the weeks and months that follow the treatment. In addition, graft-versus-host disease (GVHD) is a frequent complication of allogeneic bone marrow transplantation. In GVHD, the donor's bone marrow attacks the patient's organs and tissues, increasing the likelihood of infection and impairing the ability of the body to function. Around half of allogeneic bone marrow transplantation patients suffer some type of GVHD. Most of the cases are short term and mild. Some cases turn out to be chronic and more severe. GVHD does not result from autologous transplantation.

Antimuscarinic drugs

Prior to secretion, the mature hormone undergoes glycosylation and dimerization to produce a 140-kDa dimer of identical disulphide-linked subunits. High levels of AMH are produced by Sertoli cells during foetal and postnatal testicular development. In the human female, AMH is produced by ovarian granulosa cells from 36 weeks of gestation to the menopause.


Many women notice problems with memory during menopause, when their estrogen levels drop dramatically. It could be that estrogen benefits memory by protecting neurons, as some laboratory studies suggest. As for men, those with high levels of testosterone in their blood have better visual and verbal memory than men with low testosterone levels, according to a large study reported by the National Institute on Aging. Low testosterone may increase the risk of memory disorders. Men with low testosterone were more likely to develop Alzheimer's disease in a study reported in the journal Neurology in 2004.


Isoflavones do appear to exert some health benefits. The majority of data available relate to their effects on menopausal symptoms. Consumption of as little as 30 mg of soy isoflavones, in soy protein or as an extract, reduces vasomotor menopausal symptoms by approximately 30 to 50 , including the placebo effect, or approximately 10 to 20 after subtracting the placebo effect. Soy protein and isoflavones work together to lower LDL cholesterol and increase HDL cholesterol. Benefits to bone health are less certain, although some data suggest that they may prevent bone loss over the short term. Effects on breast cancer risk are complex. Isoflavones are likely to be cancer preventive when consumed early in life, but a few animal studies that show stimulation of breast cancer cell growth raise sufficient concerns that phytoestrogen supplements should not be recommended for women at high risk of breast cancer.


Oestrogens reduce the rate of tryptophan metabolism, so where pellagra is common, twice as many women as men are affected. However, before puberty and after menopause there are no sex differences. It is generally believed that 1 NE is equivalent to 60 mg of tryptophan or 1 mg dietary niacin.

Endocrine factors

Endocrine disturbances can influence prevalence of the metabolic syndrome, specifically hyperandrogenaemia and polycystic ovary syndrome (PCOS) (discussed in more detail in Chapter 12). The menopause also may influence development of the metabolic syndrome and a summary of the relationships between the metabolic syndrome and menopause hormone replacement therapy (HRT) is discussed below. Also, low total testosterone and sex hormone binding globulin (SHBG) levels both independently predict development of the metabolic syndrome and diabetes in middle-aged Finnish men (Laaksonen etal., 2004). For further discussion of the role of androgens in obesity, see Marin and Arver (1998). The growth hormone-insulin-like growth factor (IGF) axis also may play a role in the development of the metabolic syndrome and this hormonal axis is discussed in more detail in Chapter 14. Similarities between Cushing's disease and the metabolic syndrome also suggest that a role for the glucocorticoid axis is...

Role of Bone Markers

Bone markers are also useful in the initial assessment of patients to identify patients who have accelerated bone turnover before the loss is detected by DEXA. A 4-year follow-up study of postmenopausal women found that those whose bone markers were increased above the reference range at menopause lost 3-5 times more bone compared to those whose markers were within the premenopausal ranges. Other studies have shown that high bone turnover reflected by increased bone marker concentrations is associated with increased fracture risk. Following changes in the concentrations of the bone markers is useful in assessing the patient's risk of fracture, particularly after therapy is initiated. Finally, with the availability of PTH, another potential role for bone markers has been proposed guiding the choice of therapy. Some investigators suggest that the antiresorptive agents (such as the bisphosphonates) are more useful in treating patients with type 1 osteoporosis, whereas those with type 2...

Art as an Adaptation

Art fits most of the other criteria that evolutionary psychology has developed for distinguishing genuine human adaptations from non-adaptations. It is relatively fun and easy to learn. Given access to materials, children's painting and drawing abilities unfold spontaneously along a standard series of developmental stages. Humans are much better at producing and judging art than is any artificial intelligence program or any other primate. Of course, just as our universal human capacity for language allows us to learn distinct languages in different cultures, our universal capacity for art allows us to learn different techniques and styles of aesthetic display in different cultures. Like most human mental adaptations, the ability to produce and appreciate art is not present at birth. Very little of our psychology is innate in this sense, because human babies do not have to do very much. Our genetically evolved adaptations emerge when they are needed to deal with particular stages of...


Full investigation accorded HIV-negative women to determine the cause of the abnormality. Heavy bleeding can cause anemia, a problem already prominent among women with advanced HIV infection, and can be a symptom of an underlying problem such as a fibroid tumor, blood clotting problems, or infection. Amenorrhea can be a symptom of pregnancy, ovarian cyst, ovarian failure, or menopause. Missing of two periods (if pregnancy is ruled out) requires investigation by pelvic exam and blood tests to determine whether the problem lies within the reproductive tract. In the course of identifying the cause of menstrual irregularities, women should report to their providers any change in drug therapy, use of recreational drugs, weight, and all related symptoms. menstruation The cyclic discharge of blood and mucosal tissues from the uterus through the vagina also called menses. It is brought on by reduced production of ovarian hormones and in healthy women occurs at approximately four-week...

Computer Simulations

Several studies have used computer models to gain more insight in the relation between bone remodeling and changes in the skeleton with age, during menopause, or in osteoporosis. The first models of cancellous bone treated the cancellous bone as a number of bone packages (22) or used trabeculae with a certain thickness distribution derived from published histomorphometric data (23). In these models, the trabeculae were not connected to form a cancellous architecture.


About 90 of lead is deposited in the skeleton, where it may remain for up to 25 years. In soft tissues, the half-life is 40 days. Lead accumulates in hair, nails and body fluids, and is excreted with urine. Early symptoms of lead poisoning in adults include abdominal and joint pains, headaches, motorial neuropathy, short-term memory loss, concentration disorders, and hyperactivity. A gray 'lead line' may appear on the border between teeth and gums. Lead accumulated in the skeleton may be released during periods of increased resorption, such as pregnancy, lactation, and menopause, causing anemia, hypertension, and hyperthyroidism. In acute cases of lead poisoning, a renal insufficiency may occur (Hu 1991, 2001 Hu et al., 1996).

Matched Design

We also have to avoid 'over-matching' in a paired case-control design. This would occur if, for the above example of the case-control study looking at the risk of hormone replacement therapy (HRT) on cervical cancer, cases and controls were both drawn from women who had been evaluated by uterine dilatation and curettage. Such a control group is inappropriate because agents that cause one disease in an organ often cause other diseases or symptoms in that organ. In this case it is possible that oestrogens cause other diseases of the endometrium, which have required the women to have dilatation and curettage and so present as possible controls.

Age and Fertility

Female fertility declines gradually during the thirties, and declines steeply after age 40. Women after menopause are infertile. This female fertility profile is a basic fact of life to which male mate choice systems have adapted. Youth is an important cue of fertility. A woman's youth may not have been quite so crucial in the Pleistocene, as long as the woman was still reasonably fertile. If our hominid ancestors had several medium-term relationships in sequence, males need not have been so picky about female age. If the relationship was likely to end after five years as anthropologist Helen Fisher has argued that they usually did in prehistory it would have mattered little whether she was 10 years or 30 years away from menopause.