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flushes. 38 (See figs. 3–1 to 3–5.) The onset of hot flushes was found to be related to decreased estradiol levels (p < 0.01), and the onset of night sweats was related to the change in estradiol level (p < 0.05). 38 Interestingly, breast tenderness was not included in the SWAN study reported above. The SWAN study found that vaginal dryness was related to vasomotor symptoms but did not reach the criteria for inclusion in the factor analysis, and results were not reported by menopausal status. 36 Epidemiological studies have found that only vasomotor and vaginal atrophic symptoms significantly increase as women pass through the natural menopause transition. Longcope et al. 39 also report a significant negative association of hot flushes with estrone and estradiol levels amongst their sample of 241 Massachusetts women followed for 3 years. Thus, a number of epidemiological studies have found FIGURE 3–1 50 that only vasomotor and vaginal atrophic symptoms significantly increase as women pass through the natural menopause transition. Although many theories have been suggested to explain the mechanism of menopausal flushing, none provide a satisfactory explanation. 40 Core body temperature elevations precede the menopausal hot flush and serve as one trigger of this heat loss phenomenon. 41 What is responsible for the core temperature elevation is a matter of speculation. Although vasomotor symptoms are associated with increasing FSH and decreasing estradiol levels, 38,42 it may be that vasomotor symptoms relate to the activity of another substance, in whose absence the activity of the thermoregulatory center is disturbed. 42 This substance may be common to both ovaries and testes and explain the fact that the male flushes after orchidectomy and the woman after ovarian failure. Each hot flush is accompanied by a gonadotrophin-releasing hormone (GnRH) pulse with a consecutive episode of FSH and LH secretion. 43 Because hypophysec- Proportion of Women Bothered by Hot Flushes by Menopausal Status Proportion 1.00 0.75 0.5 0.25 0 Pre Early Peri Late Peri Post +1 yr Post +2 yr Post +3 yr pre = premenopausal early peri = change in menstrual frequency late peri = 3–11 months amenorrhoea post 1 year = 12–23 months amenorrhoea post 2 years = 24–35 months amenorrhoea post 3 years ≥ 36 months amenorrhoea
FIGURE 3–2 Proportion of Women Bothered by Night Sweats by Menopausal Status Proportion 1.00 0.75 0.5 0.25 0 FIGURE 3–3 Pre Early Peri Late Peri Post +1 yr Post +2 yr Post +3 yr pre = premenopausal early peri = change in menstrual frequency late peri = 3–11 months amenorrhoea post 1 year = 12–23 months amenorrhoea post 2 years = 24–35 months amenorrhoea post 3 years ≥ 36 months amenorrhoea Proportion of Women Bothered by Dryness of Vagina by Menopausal Status Proportion 1.00 0.75 0.5 0.25 0 Pre Early Peri Late Peri Post +1 yr Post +2 yr Post +3 yr pre = premenopausal early peri = change in menstrual frequency late peri = 3–11 months amenorrhoea post 1 year = 12–23 months amenorrhoea post 2 years = 24–35 months amenorrhoea post 3 years ≥ 36 months amenorrhoea 51
Page 1:
National Heart, Lung, and Blood Ins
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CHAIRS AND EDITORS Chair and Editor
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Anne McTiernan, M.D., Ph.D. Associa
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Lenore Manderson, Ph.D. Director an
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Michael Mendelsohn, M.D. Director,
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TABLE OF CONTENTS Preface XIII 1 Ex
Page 15 and 16: PREFACE Women’s health and menopa
Page 17 and 18: CHAPTER 1: EXECUTIVE SUMMARY Nanett
Page 19 and 20: TABLE 1-1 Evidence Categories Evide
Page 21 and 22: TABLE 1-2 (continued) Possible Bene
Page 23 and 24: symptom measures, cultural factors,
Page 25 and 26: 5. PHYSIOLOGICAL ROLE OF ESTROGEN A
Page 27 and 28: The atherogenic risk profile of old
Page 29 and 30: • Hormone replacement therapy: Fi
Page 31 and 32: tion of the remaining ridge in area
Page 33 and 34: 9.3.1 Interventions • In many cas
Page 35 and 36: Parkinson’s disease, no overall p
Page 37 and 38: TABLE 1-3 (continued) Sexuality •
Page 39 and 40: CHAPTER 2: THE MENOPAUSE AND AGING
Page 41 and 42: oped and are less prepared to addre
Page 43 and 44: FIGURE 2-4 Diabetes Mellitus. Estim
Page 45 and 46: Sarcopenia, defined as reduced musc
Page 47 and 48: Perimenopause WHO The term “perim
Page 49 and 50: decrease about 2 years before the F
Page 51 and 52: 4.3 Menstrually Defined Menopausal
Page 53 and 54: to be under stress and to hold part
Page 55 and 56: 21 Brincat MP. Hormone replacement
Page 57 and 58: 62 Orentreich N, Brind JL, Rizer RL
Page 59 and 60: CHAPTER 3: SYMPTOMS AND THE MENOPAU
Page 61 and 62: women who may have reached natural
Page 63 and 64: numb-tingling feelings, headaches,
Page 65: (47 percent), problems sleeping (39
Page 69 and 70: tomized hypogonadotropic women expe
Page 71 and 72: 5.1 Exercise It has been suggested
Page 73 and 74: to consume 20-150 mg/day of isoflav
Page 75 and 76: REFERENCES 1 Stewart AL, Hays RD, W
Page 77 and 78: 48 Avis NE, Crawford SL, McKinlay S
Page 79: 92 Albertazzi P, Pansini F, Bonacco
Page 82 and 83: Hällström wrote that the psycholo
Page 84 and 85: countries. Perhaps, as the authors
Page 86 and 87: Beyene used a systematic ethnograph
Page 88 and 89: ange of variables, such as genetic
Page 90 and 91: REFERENCES 1 Gannon L, Ekstrom B. A
Page 92 and 93: 47 George T. Women in a south India
Page 94 and 95: 9. Estrogen and inhibins produced b
Page 96 and 97: HRT) display tissue-selective estro
Page 98 and 99: a partial agonist. In contrast, wit
Page 100 and 101: 3. UROGENITAL TRACT ERα and ERβ a
Page 102 and 103: 4. BONE: DEVELOPMENT AND HOMEOSTASI
Page 104 and 105: in response to estrogen. 106,105 In
Page 106 and 107: lation of sleep, motor behavior, an
Page 108 and 109: 7. HORMONE REPLACEMENT THERAPY: TRA
Page 110 and 111: REFERENCES 1 Jensen EV, Jacobsen HI
Page 112 and 113: 40 Power RF, Mani SK, Codina J, Con
Page 114 and 115: 83 Oursler MJ, Pederson L, Fitzpatr
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125 Gabrielsson BG, Carmignac DF, F
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169 Renier MA, Vereecken A, Buytaer
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FIGURE 6-1 Structural features of E
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ound, the conformation of the recep
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with extremely potent estrogenic ac
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Its potency as an antiestrogen was
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The observation that the degree of
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findings were remarkable because a
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Recently, the use of phage display
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20 Crawley G. Non steroidal estroge
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65 Qu Q, Zheng H, Dahllund J, et al
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in their survey of postmenopausal w
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where over half the world’s popul
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The Danish study of Koster and Gard
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Many studies of sexual interest in
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7. ASSESSING SEXUAL ACTIVITY Clinic
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None of these studies evaluated the
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estrogen-androgen group during the
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REFERENCES 1 Sarrel PM, Whitehead M
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52 Utian WH. The true clinical feat
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140
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outes of administration and differe
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FIGURE 8-2 Change in Age-Adjusted D
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fied as overweight or obese. 32 The
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TABLE 8-1 148 Guide to Risk Reducti
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TABLE 8-1 (continued) 150 Recommend
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TABLE 8-1 (continued) 152 Recommend
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Interesting differences in atherosc
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similar effects in both patients wi
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a lowering of triglycerides, 140 an
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may account for a substantial propo
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associated with an independent prot
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eases preoperatively. Quality of li
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excess risk of 6-18 per 10,000 per
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REFERENCES 1 NHLBI Morbidity and Mo
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36 Samaras K, Hayward CS, Sullivan
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79 Collins P, Rosano GM, Jiang C, L
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121 Mäkelä S, Savolainen H, Aavik
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162 Clarke S, Kelleher H, Lloyd-Jon
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201 Rahimtoola SH, Bennett AJ, Grun
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243 Varas-Lorenzo C, Garcia-Rodriqu
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7. A connection between menopausal
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3. PATHOGENESIS OF FRACTURE Fractur
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Diagnosis of osteoporosis according
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density and has a favorable effect
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How should this information be inco
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emergence of proved treatment alter
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Data on the relation between skelet
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REFERENCES 1 Osteoporosis Preventio
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42 Gluer CC. Quantitative ultrasoun
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85 Ettinger B, Pressman A, Silver P
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130 Jeffcoat MK, Lewis CE, Reddy M,
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1. INTRODUCTION Perimenopausal wome
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for breast cancer are at increased
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findings on biopsy in women with an
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thra. Patients typically describe l
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Biofeedback: Used in conjunction wi
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There has been one systematic revie
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ence in pelvic organ prolapse. The
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21 Ferenczy A. Endometrial carcinom
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65 Wyman JF, Fantl JA, McClish DK,
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222
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1. INTRODUCTION Worldwide, breast c
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difficult to compare because of com
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Although HRT has been related to an
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cyclic use and 2.9 (95 percent CI 2
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TABLE 11-3 Selected Studies on Horm
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TABLE 11-3 (continued) Thus, a stro
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TABLE 11-4 236 Cohort Studies on Ho
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TABLE 11-5 238 Case-Control Studies
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TABLE 11-5 (continued) 240 Adjustme
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When the same women in NSABP were r
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REFERENCES 1 Pisani P, Parkin DM, B
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47 Day NE. Epidemiology: the role o
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93 Rodriguez C, Patel AV, Calle EE,
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139 Parazzini F, La Vecchia C, Negr
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1. INTRODUCTION Menopause is associ
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inverse relation with nonverbal mem
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ease decreased significantly with i
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of households selected to be repres
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standard antipsychotic drugs increa
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5. FUTURE NEEDS • Explore the pos
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19 Berman KF, Schmidt PJ, Rubinow D
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64 Lerner A, Koss E, Debanne S, Row
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114 Smith R, Studd JW. A pilot stud
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162 Klein BE. Lens opacities in wom
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patients with strong personal convi
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Therefore, convincing evidence of t
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3.1.1 Risk Factors Many factors are
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278 lower dosages of estrogen will
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• Diabetes: Women with diabetes b
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Lipids and lipoproteins • LDL cho
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284 persists but is less steep in w
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5.2.3 Pharmacotherapy Breast Cancer
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• There is no clinical trial evid
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Sirtori CR, Pazzucconi F, Colombo L
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Hansson L, Zanchetti A, Carruthers
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Dementia and Mental Health Forette
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CRP C-reactive protein CT computed
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PTCA percutaneous transluminal coro
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U.S. DEPARTMENT OF HEALTH AND HUMAN
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