ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveAn elevated risk of urinary tract infections (UTIs) in postmenopausal women has been attributed to an increase in the vaginal pH. Estrogen replacement therapy (ERT) helps restore the vaginal milieu and may have a beneficial effect on risk of infection. Studies examining the association between ERT and UTIs have been inconsistent. We conducted a nested case control study to clarify this relationship in women aged 45–89.DesignFor each case, we selected up to five control women, matched by year of birth. We used pharmacy records to classify women as new users, past users, ongoing users (past and new users), and never users of ERT. There were 254 cases and 1,268 controls.ResultsThe risk ratio for UTI was 1.02 [95% confidence interval (CI) 0.74, 1.40] for any use versus never use, after adjustment for health care utilization. The risk ratio for the association between new use and UTI was 1.13 (95% CI 0.46, 2.77). For ongoing users the risk ratio was 1.08 (95% CI 0.76, 1.54), whereas the risk ratio for past use was 0.77 (95% CI 0.39, 1.48).ConclusionsOur results do not support a protective effect of ERT on the risk of UTIs.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveWe studied whether oral administration of ipriflavone, a synthetic derivative of naturally occurring isoflavones, could prevent bone loss occurring shortly after menopause.DesignFifty-six women with low vertebral bone density and with postmenopausal age less than five years were randomly allocated to receive either ipriflavone, 200 mg three times daily, or placebo. All subjects also received 1,000 mg elemental calcium daily.ResultsVertebral bone density declined after two years in women taking only calcium (4.9 ± 1.1%, SEM,p= 0.001), but it did not change in those receiving ipriflavone (-0.4 ± 1.1%, n.s.). A significant (p= 0.010) between-treatment difference was evidenced at both year 1 and year 2. At the end of the study, urine hydroxyproline/creatinine excretion was higher in the control group than in the ipriflavone group, as compared to no difference at baseline. Five patients taking ipriflavone and five taking placebo experienced gastrointestinal discomfort or other adverse reactions, but only one and four subjects, respectively, had to discontinue the study.ConclusionsIpriflavone prevents the rapid bone loss following early menopause. This effect is associated with a reduction of bone turnover rate.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveOne of the mechanisms currently proposed to explain the cardioprotective effect of hormone replacement therapy (HRT) is the antioxidative property of estrogens. Considering that HRT involves the administration of an estrogen, usually combined with a progestin and sometimes with an androgen, we investigated the following in vitro: (1) the effect of estradiol, progesterone, and testosterone on the oxidation of low density lipoprotein; (2) the possible pro-oxidative effect of progesterone and testosterone on native low density lipoprotein; and (3) the possible modification of the antioxidant effect of estradiol on low density lipoprotein induced by progestins.DesignLow density lipoprotein was isolated from blood samples obtained from 20 untreated postmenopausal women and divided in multiple aliquots, each containing 0.5 mg LDL protein. In Protocol 1 (n= 10) different doses of estradiol, progesterone, and testosterone ranging from 0 to 26 μg/ml were tested inducing oxidation with 15 μM copper sulfate. In Protocol 2 (n= 6) we studied the rate of oxidation of low density lipoprotein incubated with progesterone or testosterone without any oxidative induction. In Protocol 3 (n= 10) we studied the concomitant effect of 15 μM estradiol with four separate progestins (progesterone, medroxyprogesterone acetate, norethindrone, and norgestrel) in different doses (0, 5, 15, and 50 μM). After incubation for 4 h at 37°C, malonaldehyde was measured as a marker of low density lipoprotein oxidation. The results were expressed in mean ± SD.ResultsProtocol 1: Estradiol induced a dose-dependent decrease in malonaldehyde generation, from a baseline of 61.8 ± 30.2 nmol/mg protein to 11.6 ± 7.1 nmol/mg protein at the highest dose of estradiol tested (p< 0.0001). Progesterone or testosterone did not modify malonaldehyde generation. Protocol 2: Progesterone and testosterone did not show pro-oxidative action. Protocol 3: Estradiol 15 μM alone induced a 35% decrease in malonaldehyde generation, from a baseline of 75.4 ± 25.4 to 49.3 ± 18.8 nmol/mg protein (p< 0.0001). Norgestrel and norethindrone did not modify the antioxidant effect of estradiol (p> 0.05). Progesterone and medroxyprogesterone acetate induced a further reduction of malonaldehyde concentration to 37.2 ± 20.8 and 38.6 ± 18.2 nmol/mg protein, only at the highest dose tested (p< 0.02 andp< 0.01, respectively).ConclusionsOur results demonstrate that, in contrast with the potent antioxidant effect of estradiol, progesterone and testosterone did not show any pro- or antioxidant effect on low density lipoprotein in vitro. Furthermore, progestins did not counteract the antioxidant effect of estradiol in vitro.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe purpose of this prospective study was to investigate the association of breakthrough bleeding with circulating estradiol levels and obesity in postmenopausal women receiving hormone replacement therapy.DesignFifty postmenopausal women receiving 0.625mg conjugated estrogen with 2.5 mg medroxyprogesterone acetate were included in the study. Patients are recalled at 1st, 5th and 9th weeks for the measurements of the serum estradiol levels.ResultsTwenty women (40%) had a bleeding episode within 9 weeks of therapy. Of the 25 women who had abody mass index (BMI) of >25, 13 (52%) had bleeding. Of the 25 women who had a BMI of < 25, 7 (28%) had bleeding. There was a trend toward a relation between BMI and breakthrough bleeding, although the relation did not achieve significance (p= 0.14). Serum estradiol levels of both bleeders and nonbleeders remained similar throughout the study. Endometrial histology revealed proliferative endometrium in two cases and secretory endometrium in one case at baseline; two cases of proliferative endometrium were found during bleeding. The remaining samples revealed atrophy.ConclusionsNo relation was found between serum estradiol levels and breakthrough bleeding. Nevertheless, increased BMI may have an impact on breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe purpose of this research was to discover and describe the meaning of and attitudes toward menopause in midlife Chinese women in Taiwan. How these women learned about menopause was also explored.DesignQuestionnaires were distributed to a convenience sample of 208 Chinese women aged 35 to 55 living in Taiwan; 168 responded. Qualitative data were analyzed using content analysis. Percentage and chi-square were used to examine the quantitative data.ResultsThe findings revealed that 154 (91.7%) women perceived menopause as a natural phenomenon. No statistically significant differences in attitude toward menopause were found between women grouped by different menopausal levels, by use or not use of hormones, or by religious preference. Some women described menopause as, “no longer young, getting old.” Others described menopause as, “wisdom and maturation,” “a symbol of achievement,” and “a time to start enjoying life.” Sixty-eight (40.5%) of the sample indicated they obtained menopausal information from friends and printed materials such as books, newspapers, and magazines.ConclusionsStudy findings indicate that Chinese women in Taiwan perceive menopause in a positive and holistic way. Culturally sensitized Western practitioners can utilize this study's findings to more appropriately individualize care for Chinese midlife women.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study examined the impact of the Women's Health Exchange (WHE), a program aimed at educating women about menopause and estrogen replacement therapy, on patient continuance with Estraderm®, a transdermal estrogen replacement medication.DesignThe prescription database of Express Scripts, Inc., a pharmacy benefits management company serving a large, nationwide insured population, was used for the study. All study subjects had one or more claims for Estraderm between 2/1/95 and 8/31/95. The intervention group consisted of 299 WHE enrollees, and the control group comprised a random sample of 1,513 patients who had not enrolled in WHE.ResultsA multivariate Cox regression model found that older age, longer prior length of Estraderm use, progestin use, and patronage of a mail-order pharmacy were associated with increased continuance. Controlling for these factors and for HMO enrollment and copay amount, the likelihood of discontinuing Estraderm was significantly lower for WHE enrollees compared to non-WHE enrollees. Sensitivity analyses tested the effects of preexisting differences between the WHE and control group subjects on study findings. Even when WHE enrollees were compared with control subjects having similar medication costs, disease severity, or continuance with chronic medications, WHE enrollment was associated with an increased length of Estraderm therapy.ConclusionsThese findings suggest that patient education programs may improve continuance with transdermal hormone replacement therapy for patients with a prescription benefit.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe purpose of this study is to examine the influence of Sociodemographic characteristics, reproductive hormones, and body composition on symptoms reported by generally well midlife women.DesignThe design was a 24-cell, randomly selected quota sample, stratified by four occupations that varied in professional status, two races, and three age groups. One hundred fifty-three women, aged 35 to 69, who worked 20 or more hours a week, who were not on hormone replacement therapy, who were not pregnant, and who did not have a hysterectomy prior to the age of 53 participated in the study. Data were collected at 10 employment sites. Symptoms were assessed by a 22-item symptom index. Serum hormone levels of estradiol and follicle stimulating hormone (FSH) were drawn for each woman, and body composition was assessed by body mass index (BMI).ResultsChi-square tests showed that significantly more White women than Black women experienced nervous tension, loss of urine, and vaginal dryness. Analyses of variance showed that women experiencing hot flashes had significantly higher FSH levels, lower estradiol levels, and higher BMI than women not experiencing this symptom. Estradiol (odds ratio 0.988) and BMI (odds ratio 1.094) were significant predictors of experiencing hot flashes when entered into a stepwise logistic regression with age and FSH level as covariates.ConclusionsFindings suggest that symptoms experienced by midlife women are consistent across races, and that interventions targeting weight reduction may improve hot flashes experienced by midlife women.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe purposes of this study were to (1) validate components of a decision process regarding adoption of hormone therapy and (2) compare the decision processes women used with respect to their evaluation of decision quality.DesignA sample of women participating in a population-based study of midlife women's health participated in individual in-depth interviews.ResultsContent analysis of 30 recorded interviews provided evidence that each component of the decision process (precontemplation, contemplation, commitment, critical evaluation, and continuance) was replicated. Few additional codes were identified, and these could be subsumed under the phases of the original decision model.ConclusionsWomen's self-reported statuses on a screening questionnaire corresponded to the stages of the decision model coded from their interviews. What women actually decided to do (use hormone therapy or something else) was not associated with their decision process. Satisfaction with the decision, uncertainty about the decision, and other factors related to the decision were independent of the decision phases.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveAging, sleep, and breast cancer are important concerns of postmenopausal women. There now is evidence that melatonin, the hormone secreted by the pineal gland, may have a role in the regulation of various human biological processes including sleep, tumor growth, and perhaps aging. The current knowledge concerning these questions is briefly and critically reviewed.ConclusionsMelatonin might be implicated in menopause-associated processes such as insomnia, breast cancer, and general aging. Its beneficial effect on sleep has been demonstrated in controlled clinical trials, however, “melatonin replacement therapy” for all postmenopausal women is currently unjustified.

ISSN:1072-3714    

出版商:OVID    

年代:1998

数据来源: OVID