ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Perimenopause refers to the time period around menopause. The clinical goal of perimenopause therapy is to optimize the woman's health during and after this transitional period. However, clinical trial data are insufficient to establish evidence‐based treatment standards regarding the diagnosis and treatment for both acute and chronic symptoms and conditions of perimenopausal women. Accordingly, The North American Menopause Society (NAMS) sought to develop a consensus opinion on clinical approaches to perimenopause.Design:NAMS held a closed conference of experts in the field to review the current literature, share clinical experience, and make recommendations about how to help women achieve optimal health throughout perimenopause. The proceedings of the conference were used to assist the NAMS Board of Trustees in developing this consensus opinion of the Society.Results:On the basis of the conference proceedings, NAMS established the following recommendations for the treatment of perimenopausal women: (1) The annual health examination is valuable in the perimenopausal woman and should include comprehensive screening for physical and psychological problems as well as for appropriate lifestyle counseling. (2) Sufficient clinical data exist to provide recommendations for developing management plans for acute perimenopausal symptoms, as well as counseling for potential chronic diseases related to postmenopause. (3) The importance of individualized screening and management approaches for each woman is evident, as is the need for including the woman in the management decision‐making process. (4) Because clinical research data on women in perimenopause are limited, healthcare providers may consider extrapolating data on postmenopausal women, as well as relying on clinical experience when considering management options. (5) Management of perimenopausal symptoms may include doing nothing (many symptoms may be self‐limiting) or recommending a combination of treatments.Conclusions:Although perimenopause is largely unstudied, many therapeutic approaches to the management of perimenopause disturbances exist, both prescription and nonprescription. NAMS established these consensus opinions to be a resource for clinicians when designing a healthcare plan for a perimenopausal woman. The perimenopausal woman's health and quality of life can be maintained and improved through preventive care, lifestyle modifications, early diagnosis of disease or increased risk for disease, and interventions when appropriate. However, more research is needed in all areas concerning perimenopausal women. (Menopause2000;7:5‐13. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Menopause, an understudied, normal biological process in middle‐aged women, is associated with loss of fertility and increased risk for osteoporosis and cardiovascular disease. Appropriate animal models allow in‐depth investigation of biological mechanisms that underlie the increased risk for adverse health events in menopausal women. Although some species of older female nonhuman primates experience a menopause‐like condition, with cessation of reproductive cycles, decreased bone density, and perhaps an increased risk for atherosclerosis, several factors restrict their usefulness for research (e.g., expense of purchase and care, relatively small numbers of animals available, risk for disease transmission to humans, limited facilities for experimentation). Thus, it may be useful to consider nonprimate animal species as potential models for pathophysiological changes associated with loss of reproductive function.Design:A workshop was convened in June 1998 at the National Institutes of Health to explore the suitability of nonprimate animal species in this context. The focus of this workshop was on middle‐aged, ovariectomized females of various laboratory animal species and the ability of exogenous estrogen to reverse pathophysiological changes in the skeleton, cardiovascular system, and thermoregulatory control mechanisms in these species.Conclusions:Of the species considered (mice, rats, dogs, rabbits, pigs, and sheep) and because of the limitations of relatively small amounts of research in ovariectomized, middle‐aged animals for most of these species, mice (largely because of transgenic technology) have the potential to be good models for the effect of ovariectomy and estrogen replacement on associated bone and cardiovascular changes. Rats are an excellent model for bone but a poor model for the cardiovascular system changes associated with loss of reproductive function. Usefulness of the pig, which is usually considered to be a good model for the human cardiovascular system, is limited by the dearth of information available on ovariectomized mature pigs in cardiovascular and bone studies, sensitivity of bone density to dietary calcium, the difficult‐to‐manage size of regular pigs, and the relatively high cost of minipigs. Rabbits show good potential as a cardiovascular model despite the limited numbers of studies and the difference from primates in coronary artery structure. Although rabbits are the smallest species known to have Haversian bone remodeling processes, the limited number of bone studies in ovariectomized rabbits is confounded by effects of dietary calcium. Although there are virtually no studies on the cardiovascular system of the ovariectomized dog, bone studies that have been conducted suggest that it is a poor model for the menopausal human. Furthermore, the role of estrogen in bone and cardiovascular physiology is difficult to interpret because of the limitation of two estrus cycles per year in the dog. The sheep seems to be a promising large animal model for the bone and cardiovascular systems, but more research is needed. Of the species examined for estrogen effects on vasomotor symptoms (guinea pig, mouse, rat, and monkey), only rats and monkeys show evidence of hot flashes associated with loss of reproductive function. (Menopause2000;7:14‐24. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To assess whether the plasma concentrations of calcitonin gene‐related peptide (CGRP), neuropeptide Y (NPY), or neurokinin A (NKA) increase during hot flushes in postmenopausal women with vasomotor symptoms.Design:Eight postmenopausal women (age range = 49‐63 years) with vasomotor symptoms were included. During 1 day, repeated blood samples were taken between and during flushes; four samples were taken during each flush. The samples were analyzed for CGRP, NPY, and NKA using radioimmunoassay technique.Results:The serum concentrations of CGRP and NPY increased significantly‐73% and 34%, respectively‐during the flushes (p= 0.018;p= 0.028), whereas the concentrations of NKA did not change significantly.Conclusions:CGRP and NPY may be involved in the mechanisms that cause vasomotor symptoms. (Menopause2000;7:25‐30. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:The rate and severity of hypertension increase dramatically after menopause. Complications seem to be more frequent and marked in hypertensive patients with greater blood pressure (BP) variability, and antihypertensive treatment does not easily reduce this variability. The effect of hormone replacement therapy (HRT) on BP and its variability is not well understood in moderate to severe hypertension, but estrogen may have calcium channel‐blocking properties. Cardiovascular events occur more frequently in the morning, likely in part because of a rise in BP.Design:We prospectively studied 34 postmenopausal women with treated hypertension (mean age = 53 years) and receiving a cyclic combination of estradiol and norgestrel for 19 weeks with 24‐h ambulatory BP monitoring.Results:Mean daily BP and its variability decreased significantly with HRT (149.3 ± 6.1 mm Hg vs. 140.3 ± 8.5 mm Hg [p< 0.001]; diastolic: 95.4 ± 4.7 mm Hg vs. 92.4 ± 7.2 mm Hg [p< 0.05]). There was also a significant decrease in the early morning BP values after HRT (154.0 ± 6.9 mm Hg vs. 145.6 ± 11.0 mm Hg [p< 0.001]; diastolic: 98.0 ± 4.8 mm Hg vs. 95.1 ± 10.0 mm Hg [p< 0.05]). Subjects who were taking calcium channel blockers (n= 11) had only half the reduction in 24‐h systolic BP compared with those who were not taking calcium channel blockers (5.3 mm Hg vs. 10.5 mm Hg), and the reduction in those who were taking calcium channel blockers failed to reach statistical significance.Conclusions:Our results demonstrate that HRT may have a role in decreasing the severity of hypertension, and the mechanism of its action might be through calcium channels. (Menopause2000;7:31‐35. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To evaluate serum leptin levels in postmenopausal women who are receiving hormone replacement therapy (HRT) and postmenopausal women who are not receiving HRT with similar body mass index (BMI) to determine whether estrogens exert effects on leptin secretion.Design:Cross‐sectional, prospective study comparing serum leptin levels in premenopausal women, postmenopausal women who were not receiving HRT (group A), and postmenopausal women who were receiving HRT (group B).Results:Serum leptin levels were significantly higher in group A in comparison to group B and control women (15.82 ± 6.6 ng/ml, 8.14 ± 4.17 ng/ml, and 10.12 ± 5.48 ng/ml, respectively;p< 0.05). Total fat mass (FM) was found to be significantly higher in untreated postmenopausal women in comparison to the other two groups (22.66 ± 2.79 kg vs. 19.14 ± 3.39 kg vs. 18.98 ± 3.82 kg;p< 0.05). No significant difference was observed in weight, height, BMI, blood pressure, or glucose levels among the three groups. A linear correlation between BMI and serum leptin levels as well as between total FM and serum leptin levels was observed in all groups. No correlation was found between serum leptin levels and months from menopause and months of HRT.Conclusions:Our results show that serum leptin is increased in untreated postmenopausal women, possibly as a consequence of the increase in FM, and that HRT reduces serum leptin levels to premenopausal values. These data need further investigation by a broader longitudinal study. (Menopause2000;7:36‐41. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The purpose of this study was to describe bone resorption activity using a biochemical marker according to the categories of age, menopausal status, and selected drug/supplement use in middle‐aged and elderly community‐based women.Design:This was a cross‐sectional study that assessed urinary cross‐linked N‐telopeptide of type I collagen (NTx) and used self‐report data to group women as premenopausal (Pre), perimenopausal (Peri), postmenopausal without hormone replacement therapy (Post), and postmenopausal with hormone replacement therapy (HRT).Results:Mean NTx values were found to be significantly different by group and controlling for age (p= 0.001), with post hoc tests showing all pairwise group comparisons as significantly different (p= 0.001), except that the Pre and HRT groups were not significantly different. Both the Peri and the Post NTx levels were significantly higher than the Pre and the HRT groups'. NTx values in the Peri group varied with age—the youngest Peri women were similar to Pre women, and the oldest Peri women were similar to Post women. Significantly lower NTx levels were found only in the Post (p= 0.009) and HRT (p< 0.001) groups using diuretics compared with nonuse and only in the HRT group using calcium supplements compared with nonuse (p= 0.006). No differences by thyroid use were found. With a biochemical marker, the results showed that bone resorption activity differences could be demarcated in women according to age, estimated menopausal stage, and selected drug/supplement use.Conclusions:These results support the usefulness of NTx assessment for indicating bone resorption activity and therefore the potential for osteoporosis or for monitoring the efficacy of antiresorptive therapies. (Menopause2000;7:42‐52. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The purposes of this study were to (1) examine whether ovarian volume differs by age and menopausal status in healthy women; (2) evaluate whether ovarian volume could be a sensitive and specific predictor of menopausal status; and (3) assess whether ovarian volume is affected by cigarette smoke, oral contraceptives (OCs), and hormone replacement therapy (HRT).Design:Each participant (527 women) completed an extensive in‐home interview that assessed age, menopausal status, smoking history, OC use, and HRT use. Each participant also received a transvaginal ultrasound that measured ovarian volume. Geometric means for ovarian volume were compared between premenopausal and postmenopausal women usingttests. Tests for trends were conducted using linear regression analyses.Results:Ovarian volume declined with age (p≤ 0.0001) and also differed by menopausal status; postmenopausal women had smaller ovarian volumes than premenopausal women of the same age (p≤ 0.0001). Ovarian volume was not associated with smoking history or HRT use. However, it was significantly smaller in current users of OCs compared with past users of or those who never used OCs (p≤ 0.0001). Ovarian volume was a sensitive and specific predictor of postmenopausal status.Conclusions:The data suggest that age, menopausal status, and OC use may be determinants of ovarian volume. They also suggest that ovarian volume may be useful for predicting menopausal status in women. (Menopause2000;7:53‐61. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:As female life expectancy increases, women spend a greater proportion of their life in menopause. Menopausal women may benefit from preventive treatments, such as hormone replacement therapy, and are more likely to use medical treatments if they have access to information about menopause. The purpose of this study was to identify women's needs with respect to learning about menopause.Design:A 20‐question survey was administered anonymously to 116 women during outreach programs. Data were separated and evaluated by race and level of education.Results:A significant association was found between access to information about menopause and both race and education level. Being African American or having less than a college education was associated with a twofold risk (p< 0.01) for not having a source of menopause information. A significant relationship was found between a woman's rating of her current knowledge of menopause and access to source of information (p= 0.03); women who did not have an information source felt the least knowledgeable about the subject. Women varied in the ways in which they are comfortable with learning about menopause. Different groups of women seemed to prefer different methods of learning about menopause.Conclusions:Both level of education and race are associated with a woman's ability to obtain information about menopause. To enhance women's understanding of health during menopause, information must be readily available. This information should be presented to women through educational programs that are designed to meet the needs of varied groups of adult women. (Menopause2000;7:62‐67. © 2000, The North American Menopause Society.)

ISSN:1072-3714    

出版商:OVID    

年代:2000

数据来源: OVID