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. Read more...

Natural Female Hormone Balance Program Summary

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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). Longitudinal study designs also have provided conflicting results. Women taking part in the in the HRT group of the Postmenopausal Estrogen-Progestin Intervention Trial, a placebo-controlled, randomized clinical trial of 3 years' duration, had an average of 1.2 cm less increase in waist girth and 1.0 kg less weight gain compared with those in the placebo group (Espeland etal., 1997). In another study, WHR remained constant in a group of women taking HRT but increased in a control group over 1 year (Reubinoff etal., 1995). In contrast, a study with a longer...

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...

Pedigree Can Help Distinguish Genetic from Other Risk Factors

A pedigree can be just as useful in determining that a condition is not genetic as in establishing that a condition is inherited in a family. This is particularly true for common complex health conditions such as mental illness, heart disease, and cancer. For example, Jean is a 42-year-old premenopausal woman with unilateral breast cancer. Her mother is healthy at age 65 years, but Jean's maternal grandmother, Pamela, died of breast cancer at age 63. This limited family history may raise your initial suspicion for a familial breast cancer. Yet when you take an extended family history, you find that Jean's mother has three healthy sisters between the ages of 68 and 72 years. You also find that Pamela had two sisters who were cancer free in their mid-70s when they died of heart disease. This negative family history is just as important as the positive family history of cancer in risk assessment and determining cancer screening protocols.

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.

Assessment and other issues

Plasma homocysteine comes predominantly from dietary methionine, although concentrations are sensitive to dietary vitamin B12, folate and pyridoxine, the vitamin co-factors associated with its metabolism (Fig. 3.3). Normal homo-cysteine concentrations are higher in men than in premenopausal women, but increase with age especially after age 60.

Aetiology Pathogenesis

One side it has been described that estrogens have the ability to promote naive B-cell development in mice and to rescue B cells from B-cell receptor-mediated apoptosis while androgens may reduce glandular inflammation on the other side, it appears that estrogens deficiency may accelerate autoimmune exocrinopathy in murine Sjogren's syndrome through fas-mediated apoptosis (Parke, 2000 Ishimaru et al., 1999). The last results indicate that dysfunction of regulatory T cells by estrogens deficiency may play a crucial role on acceleration of organ-specific autoimmune lesions, and estrogenic action further influences target epithelial cells through Fas-mediated apoptosis in a murine model for SS (Ishimaru et al., 1999). Moreover, if it is widely accepted that estrogens promote the expression of autoimmune disease, it is at the same time true that pSS arises more typically in postmenopausal women one explanation may be that sicca complaints, and not the glandular lesion process itself, may...

Effects Of Chromium Supplementation On Human Body Composition And Physical Functions

Volpe et al. 21 also evaluated the effects of Cr(pic)3 added to a controlled exercise program on body composition and some biochemical parameters in obese women during weight loss. Forty-four premenopausal women, aged 27-51 years with a body mass index (BMI) ranging from 27 to 41 kg m2, were matched by BMI then randomized to one of two treatment groups Cr(pic)3 400 g Cr(III) or placebo (Ca2PO4) for 12 weeks. All women participated in the exercise component of the weight loss program, including 30 min of resistance training and 30 min of moderate intensity walking daily, 2 days week. Thirty-seven of the volunteers (84 ) completed the study 20 women in the Cr(pic)3 and 17 women in the placebo group. Neither body composition, determined by using hydrodensitometry, nor sum of the circumferences of the waist and hips were affected by Cr(pic)3 supplementation. Plasma Cr concentration and urinary Cr excretion increased significantly with Cr(pic)3 supplementation. Muscular strength...

Pharmacological Treatments Of Impaired Memory Function

Evidence from animal studies has implicated depletion of nerve growth factor (NGF) as a possible mediator of cholinergic depletion in AD (when NGF is given to animals, cholinergic function is increased). Other approaches have shown some promise in AD, such as oestrogen therapy in post-menopausal women and vitamin E. A range of non-cholinergic techniques are currently being explored, including vasodilators like Hydergine, the so-called nootropics (putative cognitive enhancers such as piracetam) and a range of other compounds (e.g. neuropeptides, opiate antagonists, BDZ inverse agonists, and herbal preparations such as Ginko biloba and ginseng). There are also neurotropic agents, such as oligonucleotides, which are intended to modify biosynthetic pathways involved in the generation of AD pathology. Whether any of these agents have the potential to improve cognitive function in AD is not yet known.

Dideoxycytidine ddC See zalcitabine dideoxyinosine ddl See didanosine

People with HIV are usually advised to take a multiple vitamin-mineral supplement that supplies the basic level of nutrients most important to body function. Many nutritionists believe that additional supplements are necessary. Symptoms that may be related to nutrient deficiencies and may be reversible with appropriate supplementation include serious fatigue, memory loss or other cognitive dysfunction, skin problems, neuropathy, weight loss, loss of the senses of smell or taste, appetite loss, muscle pain or cramps, digestive problems, night blindness, canker sores, constipation, depression anxiety, menstrual cramps, and menopausal problems. Many other symptoms in people living with HIV may be related to nutrient deficiencies.

Some Resolution To The Controversy

A recent study has overcome many of these limitations and, thus, provides a clearer view of the effects of Cr(III) supplementation on body weight and composition 40 . Eighty-three premenopausal women were matched by BMI and randomized in a double-blind study to receive one of three treatment groups Cr(III) supplement with 200 g (analyzed value 190 g) Cr(III) as Cr(pic)3, picolinic acid (equivalent to that in the matched Cr(pic)3 1700 mg), and placebo (lactose). After assessment of individual energy needs, the women consumed only food and beverages provided for 12 weeks. The study tested the hypothesis that Cr(III) supplementation decreases body weight and alters body composition when energy intake is constant. Body weight was maintained within 2 of admission values. Body composition, determined at admission and 4 weeks by using dual X-ray absorptiometry, did not change significantly. Thus, under the conditions of constant energy intake, supplemental Cr(III) neither affected body...

Monitoring health outcomes

For the moment it is a fact of life that the measurement of process is usually our best mechanism for predicting rather than measuring outcome and thus quality of care, but it does require that we measure quality by degree of adherence to very clearly defined and agreed standards. Unfortunately, these are only available in a limited number of clinical instances. For example, the percentage of premenopausal women with node-positive breast cancer receiving chemotherapy or the percentage of patients with myocardial infarction receiving thrombolysis within a set time. Medical managers need to make clear judgments about the validity of the criteria that are going to be used as gold standards of quality. This in turn leads back not only to the validity of EBM as a process but also to an awareness that bureaucratisation of the process can lead to the original measure being misrepresented or inappropriate. For example, concerning the management of breast cancer, when breast conserving surgery...

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...

Additional Reading

Estimation of risk of osteoporotic fracture in postmenopausal women. J. Musculoskelet. Neuronal. Interact. 4 50-63, 2004. Hammett-Stabler, C. A. The use of biochemical markers in osteoporosis. Clin. Lab. Med. 24 175-97, 2004. Mahakala, A., Thoutreddy, S., and Kleerekoper, M. Prevention and treatment of postmenopausal osteoporosis. Treat. Endocrinol. 2 331-45, 2003.

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.

Definition of Disease

Ovarian carcinoma is the leading cause of death from gynecologic cancer in the United States, and is responsible for 5 of all cancer deaths. The median age at diagnosis is 60 years. The lifetime risk of ovarian cancer is approximately 1 . Risk factors for epithelial ovarian cancer include nulliparity and family history of ovarian cancer. A family history of ovarian, breast, endometrial, or colon cancer may indicate a familial cancer susceptibility syndrome. The most common inherited ovarian cancer susceptibility syndrome involves mutations in BRCA1 and BRCA2. Carriers of BRCA1 mutations have a cumulative lifetime risk of ovarian cancer that approaches 44 . Patients are at risk for hereditary ovarian and breast cancer if they have one of the following (1) premenopausal breast or ovarian cancer, (2) breast cancer diagnosed before age 50 with a first- or second-degree relative with breast or ovarian cancer diagnosed before age 50, (3) breast cancer at any age with two or more family...

Differential Diagnosis

The differential diagnosis of ovarian cancer is the same as for an adnexal mass. In a premenopausal patient, pelvic inflammatory disease, tuboovarian abscess, appendiceal abscess, hydrosalpinx, physiologic ovarian cysts, mature cystic teratomas, endometriomas, leiomyomas, benign ovarian masses, and malignant ovarian tumors should be considered. In a postmenopausal patient, there is a greater chance of malignancy. Additional diagnoses in a postmenopausal patient include diverticular abscesses and vascular aneurysms. The workup of a patient with an adnexal mass generally includes a complete history and physical, transabdominal and transvaginal ultrasonography, and determination of serum CA-125. Results of these tests should be interpreted relative to the patient's reproductive status. In premenopausal women, the sensitivity of CA-125 concentrations is low, so this test should be interpreted with caution. In this population, imaging, along with a complete history and physical, will yield...

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 Light Urinary Incontinence

Stress and urge urinary incontinence become more common with age. Stress incontinence is characterized by accidental spurts of urine following abdominal pressure (coughing, laughing, sneezing, lifting). Urge incontinence is characterized by an urge to urinate and the rapid loss of urine (sometimes in significant amounts) prior to controlled micturition. Sufferers may have a combination of stress and urge incontinence. Some women begin experiencing light incontinence after having delivered children for others, the onset is postmenopausal. In Western Europe, reported prevalence of stress incontinence ranges from 40 to 60 urge incontinence ranges from 7 to 20 , and mixed stress and urge incontinence ranges from 20 to 50 (172-174). In North America and Western Europe, women cope with light incontinence in various ways. In a Swedish study of post menopausal women, 4 of respondents (18 of stress incontinence sufferers) had urine loss sufficient to necessitate either the wearing of a...

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.

Treatment and Outcome

Hypertension and other factors that might promote atherosclerosis (the common age-related arterial narrowing) must be extremely well controlled in these patients who have suffered widespread damage to their arteries. Antiplatelet therapy should probably be continued for life. Anti-OSTEOPOROSIS treatment may be used to protect against the effects of the corticosteroids, especially in postmenopausal women. Infection is a concern in patients receiving powerful immuno-suppression drugs as described above and should be promptly treated. With modern treatment approximately 70-80 percent of patients can be expected to be alive five years after diagnosis.

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.

Digitonin See saponin

Dihydroepiandrosterone DHEA Predominant androgen secreted from the adrenal cortex, an intermediate in androgen and estrogen biosynthesis. Can be converted to sulphate (DHEA-S) the predominant plasma form, which can in turn be converted to potent androgens and estrogens. Considered to play an important immunomodulatory role, and the decline in DHEA levels with age correlates with reduced immune competence. Administration especially to postmenopausal women is claimed to bring benefit, especially in bone mineralization. Has been shown to have tumour suppressive and antiproliferative effects in rodent tumours.

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,...

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...

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. Vulvar epithelial thickness is at its highest in the reproductive...

Cyclic Vulvovaginitis Candida Vaginitis Pruritus Vulvae

There have long been indications that the incidence of Candida vaginitis is hormone dependent (2,33). Thus, a Candida infection is observed more frequently in pregnant women than in nonpregnant women. The use of ovulation inhibitors, in particular, those with a high estrogen content, also increases the risk of an infection. In postmenopausal women who do not use estrogen replacement therapy, the incidence is low. Relapses of a Candida infection with pruritus vulvae occur frequently in the luteal phase prior to the onset of menstruation. Kalo-Klein and Witkin demonstrated an inhibition of the cellular immune response to C. albicans during this phase, which they attributed to variations in the progesterone and estradiol levels (33). However, even independent of the menstrual cycle, patients with relapsing Candida vaginitis were shown to have a reduced Candida-specific T cell reaction. In vitro, both a reduced T cell proliferation and a reduced interferon-gamma secretion were...

Vitamin K status and health 3211 Adults

A number of adult intervention studies have been carried out, particularly on postmenopausal women, which have shown vitamin K to be effective in reducing ucOC in serum. Takahashi et al (2001) used 89 osteoporotic patients with vertebral fractures, 24 patients with hip fractures, 43 pre- and 48 post-menopausal Japanese women. They gave either a daily dose of 45 mg vitamin K2 alone or vitamin K2 plus1 mg 1-a hydroxyvitamin D3 or vitamin D alone. After four weeks of treatment with vitamin K alone or vitamin K plus D, ucOC was significantly decreased, but was not changed in those who received vitamin D alone. There was a disproportion of ucOC intact OC in postmenopausal women and those with hip or vertebral fractures, vitamin K and vitamins K plus D markedly decreased the ratio of ucOC intact OC to approximately 80 , but vitamin D did not decrease the ratio. This work confirmed previous studies (Plantalech et al, 1990 Douglas et al, 1995 Schaafsma et al, 2000). The first intervention...

Alternatives to Tamoxifen

Buzdar et al. stressed the effectiveness of anastro-zole (1 mg respectively 10 mg day) as long ago as 1996. They state that the effects are similar to those of megestrol acetate, which was in trial at the same time. Anastrozole was even effective in postmenopausal women with advanced breast cancer that had progressed during tamoxifen therapy. 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. In a double blind randomized trial Domber-nowsky et al. (1998) demonstrated that the aroma-tase inhibitor letrozole has a dose-dependent effect and is more effective and better tolerated than me-gestrol acetate (Table 12) in the treatment of post-menopausal women with...

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.

Inhibitors of mTOR Clinical Trials

CCI-779 Phase II Randomized Study of Neoadjuvant CCI-779 Followed by Radical Prostatectomy in Patients With Newly Diagnosed Prostate Cancer Who Have a High Risk of Relapse CCI-779 Phase II Randomized Study of Letrozole With or Without CCI-779 in Postmenopausal Women With Locally Advanced or Metastatic Breast Cancer CCI-779 Phase II Study of CCI-779 in Patients With Locally Advanced or Metastatic Pancreatic Cancer

Other nutritional changes 1471 Antinutrients

Phytoestrogens in soy and other foods may protect post-menopausal women from osteoporosis and heart disease and protect men against prostate and other testosterone-dependent cancers. Extrusion can transform soy into food products with broad appeal for consumers, but processing effects on soy isoflavones and other phytoestrogens should be evaluated for any products for which health effects are intended. Blends of soy protein concentrate and cornmeal (20 80) were processed under different extrusion conditions (Mahungu et al, 1999). Increasing barrel temperature caused decarboxylation of isoflavones, with increased proportions of acetyl derivatives, but total isoflavones also decreased.

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...

Universal precautions In 1985 the centers for

Urinary tract infection (UTI) Infections of the urinary tract are usually caused by bacteria, such as Escherichia coli, which travel from the colon to the urethra and bladder (and occasionally to the kidneys). Low resistance, poor diet, stress, and damage to the urethra from childbirth, surgery, catheteriza-tion, and so on can predispose individuals to infection. often a sudden increase in sexual activity triggers symptoms. UTIs recur frequently in males and females. Pregnant women are especially susceptible (pressure of the growing fetus keeps some urine in the bladder and uterus, allowing bacteria to grow), as are postmenopausal women (because of hormonal changes). older men are susceptible due to benign enlarged prostates. This can cause obstruction of the urethra and lead to infection. The incidence and severity of UTIs in HIV-positive people

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.

Prevalenceepidemiology

Joint Contractures And Scleroderma

Systemic scleroderma appears worldwide and affects all races. Women overall are affected approximately three times as often as men and even more often during the late childbearing and early menopausal years. Although, no strong racial predilection has been reported, certain incidence data suggest, that blacks have a higher risk of developing the disease than whites. The annual incidence has been estimated to be between 0.6 and 19 cases

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

Diagnosis of Iron Overload

Transferrin saturation is the most sensitive indicator of iron overload, and screening guidelines recommend a transferrin saturation cutoff of 45 . However, testing should be repeated, by convention on a morning fasting sample, and in the absence of recent ingestion of iron supplements, to improve specificity. If TS is repeatedly elevated, other conditions that can cause increases in serum iron and TS, including oral or parenteral iron supplementation, acute hepatitis, and aplastic anemia, are excluded. While elevated serum ferritin ( 200 mg L in premenopausal women and 300 mg L in men and postmenopausal women) is not as sensitive as TS for iron overload, if 1000 mg L, evidence of hepatic injury is more likely to be observed on examination of a liver biopsy. However, ferritin can be elevated in other conditions such as infections, inflammations, and liver disease.

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,...

Hot Flashes and Abdominal Pain

During a routine physical examination, a 45-year-old woman complained to her gynecologist of a 3-month history of transient burning sensations in her face and chest that would last for a few minutes, and then pass. She stated that she experienced these hot flashes between 7 and 8 times per day, and often they disrupted her sleep. She had no other physical complaints, and she denied any menstrual cycle irregularities. To determine whether she was menopausal, the physician ordered a serum follicle stimulating hormone (FSH) test which was 10.9 IU L (premenopausal reference interval 1-10 IU L) on day three of the patient's menstrual cycle. Suspecting the woman's symptoms were due to perimenopausal transition, her doctor prescribed venlafaxine (a selective serotonin reuptake inhibitor), to minimize her hot flashes.

Beneficial And Adverse Effects Of Phytoestrogens In Humans

The bulk of the available data on the effects of phytoestrogen on humans is mostly from postmenopausal women, and in particular on the effects on hot flushes. Data are beginning to emerge on the effect of phytoestrogens in bone, but very little is known about the effects of these compounds on the uterus and breast. This information is urgently required to allow evaluation of long-term safety of these compounds, particularly in view of long-term treatment of postmenopausal women for the prevention of osteoporosis. Very little is known about the therapeutic potential of phytoestrogen in men. To date, six randomized studies (Murkies et al., 1995 Albertazzi et al., 1998 Washburn et al., 1999 St Germain et al., 2001 Kotsopoulos et al., 2000 Knight et al., 2001) have investigated the effect of soy or other pulses on incidence and severity of hot flushes in perimenopausal and postmenopausal women (Table 4.1). Some of the studies utilized soy as whole grains, some in flour form. Other studies...

Dietary data in Europe European surveys

Eligible subjects were generally drawn from the general population, residing in a given geographical area. In some countries different sampling frames were used in order to ensure a good participation rate and complete follow-up this did not seriously violate the sampling scheme of a cohort study. According to the study protocol, men over 40 years and women over 35 years of age were recruited. The lower age limit for women was selected to ensure a sufficient number of subjects for investigating risk factors for premenopausal cancers. The upper age limit of the cohort is less precisely defined and varies between 60 and 74 years, depending on the study centre.

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.

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.

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 of...

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...

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.

Bottom

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.

Hormones

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. Researchers from the WHIMS group reported in 2003 that combination estrogen-progestin therapy (Prempro) not only failed to improve memory in postmenopausal women but actually doubled the women's risk for dementia. Research in 2004 established that estrogen therapy by itself was also associated with an increased incidence of dementia. The Women's Health Initiative found that estrogen...

Conclusions

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.

Niacin

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...

Calcium

Plements in preventing osteoporosis, the weight of evidence points towards a role for calcium deficiency in its genesis and for calcium therapy in its prevention and management, at least in postmenopausal women (Heaney, 2001). Increases in bone mineral density (BMD) have been observed following calcium supplementation in young, as well as in elderly subjects. However, although dietary calcium does play a major role in optimisation of bone mineralisation it is by no means the only factor involved (Prentice, 1997).

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...

Menses

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.

Candidate Variables

Although not using our categorisation, Sauerbrei, Royston, Bojar et al. (1999) imply for non-metastatic breast cancer that nodal status is the only Level-In variable associated with prognosis. In contrast Level-Query is attached to tumour size, tumour grade, histological type, oestrogen (ER) and progesterone receptor (PR), menopausal status and age despite many investigations of their respective roles. They also point out that more than 100 Level-New factors have been proposed at various times.

Lead

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.

Anatomy of the Vulva

Escutcheon Mons Pubis

Histologically, the labia minora are composed of dense connective tissue, erectile tissue, and elastic fibers. Unlike the labia majora, they do not contain adipose tissue. The skin of the opposed surfaces of labia minora has numerous sebaceous glands but no hair follicles or sweat glands. Among women of reproductive age, there is significant variation in the size of the labia minora. They are relatively more prominent in children and postmenopausal women.

Wbccount

More recently, Margolis et al. (175) from the WHI Research Group reported a higher WBC count to be associated with an increased risk of CV events and mortality among 66,261 postmenopausal women aged 50-79 years, enrolled at 40 centers, who were free of CHD and cancer at baseline. Compared with women with WBC counts in the bottom quartile (2.5-4.7 x 109 L), women in the top quartile (6.7-15.0 x 109 L) had a more than twofold increased risk for CHD death (HR 2.36 95 CI 1.51-3.68 ), after multivariable adjustment for traditional CV risk factors and aspirin and hormone use. Women in the top quartile of the WBC count also revealed a 40 increase in the risk for nonfatal MI, a 46 increase in the risk for stroke, and a 50 increase in risk for total mortality, independent of other risk factors. In addition, the potential additive value of WBC count to CRP in predicting risk was evaluated in a subgroup of the WHI cohort, showing that women with both higher CRP levels and WBC count were nearly...

Policosanol Alcohol

This dietary supplement made from alcohols extracted from sugarcane shows promise as a cholesterol-lowering agent. Though we're not sure exactly how it works, policosanol alcohol seems to block the production of cholesterol. Trials have shown it lowers LDL levels moderately in people with diabetes, postmenopausal women, the elderly, and those with familial hypercholesterolemia, the genetic disorder that causes high cholesterol. That said, most of the trials have been done by one group of scientists, and there haven't been as many long-term, independent clinical trials on policosanol alcohol as I would like to see before recommending it wholeheartedly. And more important, no one knows if poli-cosanol's beneficial effects actually translate into lower incidents of heart attacks and strokes.

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