Natural Menopause Relief Secrets

Natural Cures For Menopause

Natural Cures For Menopause

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

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Surviving Perimenopause

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

Surviving Perimenopause Overview

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Perimenopause and menopause

Loss of ovarian follicular activity may lead to the common minor mood changes of the perimenopausal period. Minor cognitive and depressive symptoms and vasomotor instability respond well to hormone replacement therapy. Menopause is associated with an increased risk of recurrence of depressive disorders but is not a high-risk time for the new onset of depressive disorders.18 Women who are vulnerable to depression during periods of hormonal fluctuations are likely to experience recurrent depressive episodes during perimenopause and menopause. If such a woman has a depressive episode, then hormone therapy alone is ineffective and a course of antidepressants and or psychotherapy is required.

Hormonal changes at menopause

Estrone, produced by fat, replaces estradiol as the main source of estrogen. HT approximately doubles the estrogen level of a postmenopausal woman. After menopause, progesterone is essentially absent. Another hormone that declines around the time of menopause is testosterone, produced in men as well as in women. In women, the ovaries and the adrenal glands are the major producers of testosterone. The adrenal glands produce dihydroepiandrosterone (DHEA), which is converted to testosterone in peripheral tissues. Testosterone affects the brain, bone, muscle, skin, blood vessels, and vagina and contributes to bone density, strength, energy, hair growth, and libido in women. Levels peak when women are in their twenties and decrease to about half that level when they are in their forties. Ovaries continue producing some testosterone throughout the lifespan. Because estrogen receptors are located throughout the body, menopause affects multiple organ systems (Table 10.2). HT has...

Hormone replacement therapy a preventive therapy that has fallen from favor

Physicians have had to rethink the use of hormone replacement therapy (HRT) for primary and secondary prevention of CHD, given the results of recent studies. The first surprise came with the results of the Hormone Replacement Study (HERS) in postmenopausal women with established vascular disease. This large, randomized clinical trial of combined estrogen and progesterone versus placebo showed that at 6.8 years of follow-up, combined HRT did not reduce the risk of subsequent cardiovascular events in women who already had CHD.58 The HERS trial did not have an estrogen-only arm.

Type 1 diabetes and menopause

The relationship between type 1 diabetes and menopause is even more complex, as menopause in patients with type 1 diabetes may occur at a younger age.24' Genetic factors, including haplotypes found in association with the DR4 haplotype (more common in type 1 diabetes), may increase the risk of early menopause two-fold. The long-term effects of premature menopause, in addition to a shorter time for childbearing, include a higher risk of cardiovascular disease, abnormal lipid profile, and increased risk of osteoporosis. Earlymenopause may occur in women with type 1 diabetes from autoimmune premature ovarian failure (similar to the autoimmune thyroiditis seen more commonly in patients with type 1 diabetes), from peripheral hyperinsuline-mia and hyperandrogenemia seen in polycystic ovary syndrome, and from hypothalamic dysfunction from poorly controlled diabetes. A good menstrual history will help with the early detection of premature menopause in these women.

Psychological aspects of menopause Menopause as a transition

Menopause is a transition encompassing a developmental stage in the lifecycle, during which women gradually adapt to biologic, social, psychological, and spiritual changes that accompany recognized physiologic changes. While women throughout the world experience menopause, diagnosis is often difficult because it canbe made only in retrospect. Along withbiologic changes, significant psychological events occur during mid life, including changing relationships with children, marital instability, widowhood, and the illness or loss of parents. Menopause is a time of transition from childbearing and child-rearing to a time of growth, concentration on marital relationships, and sometimes freedom to travel. It is also a transition to old age, increased risk of illness, disability, and grandparenting. Contrary to medical models of menopause that characterize it as an en-docrinopathy in need ofhormonal treatment, women tend to viewmenopause as a developmental life event, or a rite of passage....

Spiritual aspects of menopause

Spiritual aspects of menopause deal with challenges to a woman's view of herself, her world, and, often, her god. Women's religious and spiritual beliefs play an important role in their views of life and medical illness. In this chapter, spirituality will be defined as beliefs that give meaning to one's life and provide connection to the trascendant.4 Religion will refer to a formal set of sacred beliefs, rituals, and practices. Many clinicians fail to consider the important role that spiritual and religious views play in providing women a context for interpreting life changes and illness. Failure to address spiritual and religious beliefs can frustrate the shared medical decision-making process because of lack of communication about fundamental issues. Physicians should not allow themselves to attempt to influence spiritual or religious views of their patients, but neither should they ignore patients' beliefs used to interpret the world around them.5 Physicians must inquire about...

Menopause and diabetes Type 2 diabetes and menopause

Menopause is defined as the cessation of menses for one year. Erratic menses that may occur before that time is known as perimenopause. As the population ages, estimates suggest that by 2015,45 of all women will be 45 years or older, an age often associated with changes in the menstrual cycle.13 The decrease in endogenous estrogen associated with the onset of menopause can be associated with Evidence regarding the effects on glycemic control of hormone replacement therapy (HRT) used for the management of menopausal symptoms is inconclusive and conflicting. In the Postmenopausal Estrogen Progestin Intervention (PEPI) trial, combination treatment with estrogen plus medroxyprogesterone increased two-hour postprandial glucose levels.16' Other studies have shown that estrogen alone may improve diabetes control in post-menopausal women by decreasing relative androgen levels, since androgens contribute to insulin resistance, as seen in patients with polycystic ovary syndrome.17

Menopause

Women usually stop menstruating at about the age of 45. This is known as the menopause. At this time, nearly all the primary follicles in the ovaries have been released or have become involuted (returned to normal size). Since the primary follicles supply most of the body's estrogen, the cyclic increase and decrease of estrogens cannot occur. Thus, the menstrual cycle is ended. Some women experience various effects (for example, hot flashes, fatigue, anxiety, and irritability) because of the metabolic changes the body is undergoing because of the decreased production of estrogen. The physician may prescribe estrogen therapy to the woman during this time.

Contemporary Endocrinology

Thorner, 2000 Hormones and the Heart in Health and Disease, edited by Leonard Share, 1999 Menopause Endocrinology and Management, edited by David B. Seifer and Elizabeth A. Kennard, 1999 Emile Baulieu, Michael Schumacher, and Paul Robel, 1999 Autoimmune Endocrinopathies, edited by Robert Volp , 1999 Hormone Resistance Syndromes, edited by J. Larry Jameson, 1999 Hormone Replacement Therapy, edited by A. Wayne Meikle, 1999 Insulin Resistance The Metabolic Syndrome X, edited by Gerald M. ReavenandAmi Laws, 1999 Endocrinology of Breast Cancer, edited by Andrea Manni, 1999 Molecular and Cellular Pediatric Endocrinology, edited by Stuart Handwerger, 1999 Gastrointestinal Endocrinology, edited by George H. Greeley, Jr., 1999 The Endocrinology of Pregnancy, edited by Fuller W. Bazer, 1998 Clinical Management of Diabetic Neuropathy, edited by Aristidis Veves, 1998 G Proteins, Receptors, and Disease, edited by Allen M. Spiegel, 1998 Natriuretic Peptides in Health and Disease, edited...

Regular physical activity

Moderate levels of physical activity have significant effects on a woman's health. Burning approximately 150 kilocalories per day or 1000 kilocalories per week leads to a reduction in the risk of coronary heart disease by 50 and of hypertension, diabetes, and colon cancer by 30 .2 After adjusting for covariates such as age, smoking, alcohol use, history of hypertension, and history of high cholesterol, women who are regularly physically active are 50 less likely to develop type II diabetes (relative risk 0.54) than women who are not regularly active.8 Vasomotor and psychosomatic symptoms associated with menopause are also reduced with moderate amounts of activity.6,9 Examples of moderate levels of physical activity are depicted in Table 2.2.

Vertical Mammaplasty The Era of Maturity

Development of our knowledge in areas other than surgical techniques deserves interest, for example, vascular anatomy in relation to surgery breast content, which varies with menstrual cycle, parity, age, weight, and heredity capacity for lactation, which combines hereditary and hormonal factors variable fat degeneration after menopause and so on. Let us hope that the interest will increase with time, just as it did for vertical mammaplasty.

Subsyndromal Depressive Symptoms SSD

Depression and Menopause The prevalence of depressive disorders does not seem to increase during menopause 74 . However, further investigation may be needed 75 . Negative beliefs about menopause and experiencing a longer than usual menopause are associated with an increased risk of developing a depressive disorder.

Diet as therapy Menopausal symptom control

With fewer women taking hormone replacement therapy due to recent evidence, more women are looking for alternatives to control menopausal symptoms, particularly hot flushes. Several possibilities have been promoted for this, with a variety of depth of evidence. Soy products contain estrogen-like compounds called isoflavones. These are converted in the liver to substances similar to selective estrogen receptor modulators (SERMs) and have both agonist and antagonist activity at estrogen receptors. Intake of soy protein may therefore be helpful in the short-term (two years or less) treatment of hot flushes associated with menopause (evidence level C). Soy intake in the longer term may reduce serum cholesterol and protect against osteoporosis (evidence level C). Dietary soy intake may differ in biological activity from isoflavones in supplements (Table 3.2).2,3 Redclover contains isoflavones similar to those found in soy products. There is conflicting evidence as to whether red clover has...

Developmental issues for the midlife woman

Women in the USA are presented with two predominantly negative scripts of the mid-life experience. One script is of a medicalized focus on menopause as a time of transition from a healthy, estrogen-rich time of life to the stage of inevitable health decline, with an attendant increased risk of heart disease and osteoporosis. The other readily available scenarios are social descriptions of an empty nest, abandonment for the woman, or that of a useless, used-up fertility has-been.1 Both of these views are in contrast with the repeated observations that women feel better about menopause, and themselves, after having traversed it.2,3 Considerable sociocultural variation in attitude toward the experience of menopause exists.4,5 Yet, overall, women have positive associations with mid life as a time to take stock and renew. Primary care providers have the opportunity to explore these beliefs with their patients and educate them about what is actually known about wellbeing during mid life.

Implications for work with midlife women

The medical orientation of training has been to approach life stages that are marked by biological events, such as birth and menopause, as pathological 2 Dennerstein, L., Smith, A. and Morse, C. Psychological well-being, mid-life and the menopause. Maturitas 1994 20 1-11. 3 Avis, N. E. and McKinlay, S. M. A longitudinal analysis of women's attitudes toward the menopause results from the Massachusetts Women's Health Study. Maturitus 1991 13 65-79. 4 Sampselle, C. M., Harris, V., Harlow, S. D. and Sovers, M. Midlife development and menopause in African American amd Caucasian women. Health Care Women Int. 2002 23 351-63. 5 Adler, S. R., Fosket, J. R., Kagawa-Singer, M., et al. Conceptualizing menopause and midlife Chinese American and Chinese women in the US. Maturitas 2000 35 11-23. 7 Hunter, M. S. and O'Dea, I. Perception of future health risks in mid-aged women estimates with and without behavioral changes and hormone replacement therapy. Maturitas 1999 33 37-43.

Studies in Seventh Day Adventists

Breast cancer was not strongly associated with intake of animal products in the mortality study. After taking into account age at menarche, age at first pregnancy, age at menopause, relative weight, and education, increasing consumption of meat, milk, cheese, and eggs was unrelated to fatal breast cancer risk.23

Hormonal fluctuations

Women have more erratic fluctuations in their hormonal status compared with men. Estrogens and progesterone rise to high levels during pregnancy, only to drop abruptly postpartum as prolactin levels elevate. Perimenopause is now recognized as a unique physiological entity, with dropping levels of estrogen and an even greater loss of progesterone as ovulationbecomes inconsistent. The perimenopausal state can last years before menopause. Based on the results of small studies, the perimenopausal state appears to have unique, albeit perhaps transient, effects on sexual health and functioning. An interview survey of 124 perimenopausal women found that the age group centering around 49 years did not have sexual difficulties in desire, response, or satisfaction in their sexual life, whereas a subset of women with very low estradiol levels tended to have reduced coital activity.19 In a study of 43 perimenopausal women who kept daily records of menstrual cycles and sexual activity, a negative...

Initiation Of Folliculogenesis And Preantral Follicle Growth

Apoptotic cell death occurs in oocytes and granulosa cells of both primordial follicles and growing follicles. Members of the Bcl2-related protein family play either positive or negative roles in regulating apoptosis (45,46) (see Chapter 6). Bcl2 and BclxL protect against apoptosis, while Bax, which can heterodimerize with Bcl2 and BclxL, counters their protective effect and promotes cell death when overexpressed. Bax is expressed in granulosa cells and oocytes, and plays a critical role in regulating ovarian-cell death 6-wk old Bax-deficient mice have three times more primordial follicles than controls and one-half the number of atretic primordial follicles. This difference in the rate of follicu-lar-pool depletion results in the presence of growing, functional follicles at 640 d of age. Despite the presence of growing follicles, no corpora lutea or pregnancies have been seen in these very old mice. Ovulation could be induced by injection of exogenous gonadotropins, indicating that...

Environmental factors

Problem drinking in mid-life women is associated with marital disruption, children leaving home, and not having employment outside the home. Other risk factors are a failure to adapt to aging, heavy spousal drinking, drinking alone at home, and abuse of prescribed psychoactive drugs.29 Perimenopause is a time of increased psychological and physical vulnerability for some individuals, which may be related to concurrent changes in the reactivity of the hormonal stress system.

Medical consequences of longterm alcoholism Harmful effects

Many studies report that moderate to heavy alcohol consumption increases the risk for breast cancer.35 A meta-analysis involving more than 150 000 women with and without breast cancer showed an increased relative risk of breast cancer of 1.32 (95 CI 1.19-1.45) for an intake of 35-44 g of alcohol per day. The relative risk increased by 7.1 for each additional 10 g day alcohol-intake.36 The investigators concluded that if the observed relationship is causal, then about 4 of the breast cancers in developed countries are alcohol-related. A prospective cohort study of approximately 45 000 postmenopausal women has shown that the relative risk is doubled when alcohol consumption is combined with hormone replacement therapy.37 In contrast, smoking has little or no independent effect on the risk of developing breast cancer.36

The Role of Sex Age Hormonal Status and Ethnicity on the Biology of Breast Cancer

A role for female sex hormones in breast cancer has long been suspected because women are far more susceptible than men. Early menarche and late menopause, which lengthen the period of exposure to sex hormones, increase the risk for breast cancer. The age at which a woman has her first child, the number of pregnancies, and whether she breast feeds may also be risk factors and are related to hormonal status. The amount of breast tissue available may be a factor, but small-breasted women are at similar risk to those with large breasts.

Etiology of gender differences

In a predisposed individual, life events can trigger depression. Women are more likely than men to report a stressful life event in the six months prior to a major depression and may be more vulnerable to developing depression after stressors.5 Many mid-life women face a cluster of potential triggers, such as divorce, relationship issues, loss or illness of parents, retirement employment issues, concerns over adolescent and adult children, financial stress, domestic violence, and health concerns, including menopause.6

Clinical presentation

Overt symptoms during a routine physical exam, and may disclose depressive symptoms only if she feels safe and confident that the physician can provide effective help. Physicians are five times more likely to recognize depression if psychiatric symptoms are mentioned early in the interview and if no physical illness is detected.8 Awareness of gender differences in depression can facilitate diagnosis (Table 7.1). Women may present at certain times, such as premenstrually, during perimenopause, and during exogenous hormone therapy, because of hormonal triggers of depression. Women tend to have a more chronic pattern of depressive illness than men and to express more symptoms of appetite weight changes, sleep disturbances, psychomotor retardation, guilt, panic, anxiety, and somatization (especially pain syndromes).9

How The Sleep Of Women Differs

Even greater attention has been paid to conditions distinctive in women, notably changes in their reproductive hormones and related developmental status. Menarche, the menstrual cycle, pregnancy, and menopause all have been found to have effects on sleep quality and quantity. (Much of this research has been done by Kathryn Lee, PhD, a nurse with the Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, and her associates Lee, McEnany, & Zaffke, 2000 Lee, Zaffke, & McEnany, 2000 Baratte-Beebe & Lee, 1999.) The end of the reproductive years in a woman is marked by menopause when the production of progesterone and estrogen begin to fall and eventually remain low. One of the consequences, hot flashes during sleep, is reported by over a third of women. They contribute to an increase of brief arousals during sleep. In extreme cases, severe hot flashes can result in hundreds of awakenings per night. Even a moderate level can result in...

Prevention of chronic disease

Table 10.2 Signs and symptoms from hormonal changes at menopause Figure 10.1 Disease rates for women on hormone replacement therapy (HRT) of estrogen plus progestin or placebo. Annual cases per 10 000 women. (From the Writing Group for the Women's Health Initiative investigators.)

Risks of hormone therapy

L., LeBlanc, E. et al. Postmenopausal Hormone Replacement Therapy for Primary Prevention of Chronic Conditions. Summary of the Evidence. Accessed August 21, 2002. Source Nelson, H. D., Humphrey L. L., LeBlanc, E. et al. Postmenopausal Hormone Replacement Therapy for Primary Prevention of Chronic Conditions. Summary of the Evidence. Accessed August 21, 2002. Of the studies that suggest a benefit, most demonstrate a decreased risk or delay in onset of AD in postmenopausal women using HT (primary prevention) but no effect of estrogen on the clinical course of AD in women with mild to moderate established disease (secondary prevention).38 Other studies, such as that of Seshadri and colleagues,39 demonstrate no benefit in AD prevention with over ten years of HT use. A more recent prospective study40 reported a decreased incidence of AD in women who used HT for ten or more years. These women did not display the anticipated increased gender risk of AD. Their...

The choice to use hormoneestrogen therapy

At the present time, excess adverse effects appear to outweigh benefits from the use of combination HT to prevent chronic disease.48 HT is not protective against cardiovascular disease and may increase its risk. The American Heart Association,49 the American College of Obstetricians and Gynecologists (ACOG),50 and the North American Menopause Society (NAMS)51 recommend against the use of HT for primary or secondary prevention of cardiovascular disease. Both ACOG and NAMS recommend caution if HT The principle indication for EPT and ET is the management of menopausal symptoms in women without established CHD, breast (or other hormonal-dependent) cancer, thrombosis, or riskfactors for these conditions, especially if the menopausal symptoms have not responded to alternative strategies. NAMS recommends that the primary indication for EPT or ET is the treatment of menopausal symptoms.53 ET markedly improves menopause-related symptoms, such as hot flushes, hot disordered sleep, and vaginal...

Discontinuing hormone therapy

There are no evidence-based recommendations to guide discontinuation of HT. Women who did not have menopausal symptoms prior to starting HT appear to have few if any symptoms when it is discontinued. Similarly, there are no data on whether or how to taper use, although many clinicians will reduce a dose and maintain the woman at that dose for one to two months before decreasing again. Alternatively, some clinicians change to a different formulation of estrogen (i.e. from oral to transdermal) as part of the process.

Types of estrogenprogestin therapy and estrogenalone therapy

All forms of estrogen are equivalent in treating menopausal symptoms such as hot flushes and vaginal dryness. Oral estrogens generally improve lipid panels favorably, particularly by increasing the high-density lipoprotein (HDL) cholesterol. In some women, however, oral estrogens may raise serum triglyceride levels.

The Reproductive Years

The time between menarche and menopause, during which reproduction is possible, spans a period of almost 40 years in women. Although the presence of menstrual bleeding is often equated with the ability to conceive, establishing a pregnancy actually depends on the presence of a normal ovarian cycle (i.e., a normal ovulatory menstrual cycle). If vegetarianism affected women's reproduction, it would necessarily affect the characteristics of the ovarian cycle. To provide background information for an examination of this issue, the normal ovarian cycle will be described, as will subclinical and clinical disturbances of the cycle and their potential impact on reproduction. This will be followed by a discussion of the effects of various dietary and non-dietary factors on cycle characteristics, and finally, by a review of the available literature assessing whether differences exist between vegetarians and non-vegetarians. The normal ovulatory cycle described above does not invariably occur...

The Menopausal Transition

Menopause signals the end of child-bearing capacity, and is also associated with changes in susceptibility to various chronic diseases, including breast cancer, heart disease, and osteoporosis.66 Differences in age at menopause between vegetarian and omnivorous women, should they exist, could be associated with differences in chronic disease patterns between these groups. Furthermore, some women experience unpleasant symptoms during menopause (vasomotor symptoms such as night sweats and hot flushes, mood swings, insomnia, weight gain, headaches, and fatigue),67 and these symptoms have been observed to differ among women in different cultures.67,68 Whether dietary variables contribute to these differences in symptom experiences has not been clearly established, but there is speculation that they could.68-70 Some of these dietary differences may also exist between vegetarian and omnivorous women. Accordingly, after defining and describing the menopausal transition, available research on...

Implications for Current Breast Cancer Investigations

Clinical and epidemiological studies have revealed a close association between breast-cancer risk and the cyclical exposure of the mammary gland to ovarian sex steroids that occurs during the premenopausal years (reviewed in 151). This correlation is further substantiated by the fact that inhibition or reduction of such steroidal exposure, (e.g., after oophorectomy, and in late menarche and early menopause), has been demonstrated to markedly reduce breast-cancer risk (152-155). The increase in breast cancer observed with advancing age (Fig. 10) is currently hypothesized to arise from ovarian sex-steroid-induced proliferation of the mammary epithelial cell, which allows for the occurrence and aggregation of genetic changes throughout the reproductive years that result in breast cancer in later life (156). With a primary correlate of breast-cancer risk linked with the cyclical exposure of the mammary epithelial cell to ovarian sex steroids, breast-cancer prevention treatments based on...

Postmenopausal Bleeding

A patient is considered to be in menopause after 12 continuous months of cessation of menses and elevated gonadotropins. Menopause usually occurs at approximately 52 years of age. Postmenopausal bleeding is anv bleeding that occurs after menopause. Risk Factors. These include obesity, hypertension, and diabetes mellitus. Other risk factors include nulliparity, late menopause, and chronic anovulation conditions, such as polycystic ovarian (PCO) disease. Negative histology. If the endometrial sampling reveals atrophy and no evidence of cancer, then the patient can be assumed to be bleeding from atrophy and can be treated with hormone replacement therapy. With hormone replacement therapy estrogen and progesterone should be given to the patient. If .estrogen is given alone the risk of

Pharmacological Management Estrogens

The ability of sex hormones to induce physiological changes of the lower urinary tract during the menstrual cycle, pregnancy, and menopause is the rational for using these agents pharmacologically to Estrogens are used either systemically or topically. Side effects may include an increased risk for gynecological malignancies, fluid retention, depression, nausea, vomiting, elevated blood pressure, gallstones, and cardiovascular effects such as stroke and myocardial infarction. However, in addition to the aforementioned benefits of improved voiding function, hormone replacement therapy confers an overall benefit in mortality as compared to nontreated patients (24). Topical vaginal application through direct placement or vaginal implants are preferable because of the decreased systemic absorption and preferential local uptake (25). When mild atrophic changes of the vaginal epithelium are noted on pelvic examination despite systemic estrogen replacement, additional topical vaginal therapy...

Modification of Genetic Risk Caused by Environmental Factors

Before age twelve, does not have children or has her first child after age thirty, does not breastfeed her children, or undergoes menopause after age fifty-five. The correlation appears to be with the number of ovulatory cycles the woman undergoes in her lifetime. The period between menarche and first pregnancy, during which time the breast tissue is developing, appears to be most sensitive to environmental insults, possibly because rapidly dividing cells have the highest probability of incorporating mutations. It is thought that events initiating breast cancer may occur during this time, but that the promotional events necessary for the disease to be expressed occur over years. Menopausal women with an intact uterus require the addition of progesterone or synthetic progestins to an HRT (hormone replacement therapy) regimen to prevent estrogen-induced endometrial hyperplasia and possibly cancer. For years doctors and scientists believed the drugs caused a slightly elevated risk of...

Role of Diet in Preventing Breast Cancer

Many physicians take a guarded view of the benefits of dietary supplements. Since the FDA does not regulate the industry adequately, there are concerns as to the purity of these products, the true concentrations of active ingredients (if they are active), their side effects, and potentially dangerous contaminants. There are also concerns that their actions, if any, may be due to a placebo effect. Specific effects cannot legally be put on labels. Some of these products have potentially dangerous interactions with conventional medicines. Some, however, may be beneficial. For example, most physicians recommend dietary supplements of calcium for peri-menopausal and post-menopausal women to help prevent osteoporosis. Soy byproducts known as isoflavones act as phytoestrogens (phyto plant) and may eliminate some of the discomforts of menopause while not stimulating proliferation of breast tissue.

Randomized Trial of UAE

Both to improve generalizability, and to speed enrollment, this RCT should involve multiple sites throughout the country. Data elements to be collected should encompass all those factors which panelists unanimously agreed were key to advancing knowledge in this field. Power calculations for these outcomes are shown in Table 6. Panel members agreed that data should be collected for a three to five year period following enrollment to ensure adequate information on premature menopause experienced by women enrolled in the trial.

Diabetes complications

Cardiovascular disease remains the major cause of morbidity and mortality for all patients with diabetes. Women with diabetes are five times more likely to develop coronary artery disease than women without diabetes.33 The protective effect of female gender against cardiovascular disease before menopause is not true for any woman with diabetes. Presentation of heart disease may be atypical in the woman with diabetes. Fatigue, decreased exercise tolerance, or dyspepsia may be anginal equivalent symptoms in the woman with diabetes.34 Routine evaluation with exercise stress testing may have up to a 54 false-positive rate in women, so other cardiac evaluations, such as a stress nuclear perfusion study or stress echo, may be necessary. Small-vessel disease is common in diabetes therefore, revascularization procedures may be more difficult in women with diabetes. Risk-factor modification, including smoking cessation, aspirin use, blood pressure control (with consideration of an...

Treatment of Breast Cancer

Surgery is usually followed by an additional (adjuvant) therapy. A lumpectomy is usually followed by a course of radiation to destroy undetected cancer cells that may have been left behind in the breast, chest wall, or lymph nodes and that have the potential to metastasize. Some lumpectomy and most mastectomy patients also receive chemotherapy in which toxic drugs are given orally or by IV to block DNA synthesis or division of cancer cells (table 5.3). Although the drugs target tumor cells, they are not specific and affect all rapidly dividing cells such as those in hair follicles, intestinal lining, and bone marrow. That is why chemotherapy causes such unpleasant side effects as hair loss, vomiting, and low blood cell counts. Chemotherapy may also cause premature menopause and infertility. Chemotherapy is usually given in cycles, with each period of treatment followed by a period of recovery. The total course of treatment can span three to six months. Side effects usually vary with...

Summary And Conclusions

Reports of UAE in the lay press have generated considerable enthusiasm, suggesting that demand for a non-surgical (albeit still invasive) treatment of myomata would be high (Gilbert,1999). The prevalence of symptomatic fibroids, the apparent high demand for a new treatment, and the rough equivalence of outcomes among UAE, hysterectomy, and myomectomy suggest that controlled trials of these treatments would be feasible, ethical, and desirable. The expert panel concluded that beginning a properly designed randomized, controlled trial would be crucial in establishing the comparative risks and benefits of UAE, hysterectomy, and myomectomy. The panel further believed that the validity of such a trial would be enhanced by careful measurement of several short and long term outcomes. Key short term outcomes which the panel agreed should be included were death, reoperation (e.g. hysterectomy for infection following UAE), and operative injury. Long term outcomes similarly identified included...

When Women Stop Having Periods

The menopause or climacteric is the time in a woman's life when the menstrual periods stop coming. After menopause, she can no longer bear children. In general, this 'change of life' happens between the ages of 40 and 50. The periods often become irregular for several months before they stop completely. There is no reason to stop having sex during or after the menopause. But a woman can still become pregnant during this time. If she does not want to have more children, she should continue to use birth control for 12 months after her periods stop. When menopause begins, a woman may think she is pregnant. And when she bleeds again after 3 or 4 months, she may think she is having a miscarriage. If a woman of 40 or 50 starts bleeding again after some months without, explain to her that it may be menopause. During menopause, it is normal to feel many discomforts anxiety, distress, 'hot flashes' (suddenly feeling uncomfortably hot), pains that travel all over the body, sadness, etc. After...

Risk factors and etiology

The risk factors linked with cervical cancer include infection with certain subtypes of HPV, multiple sexual partners, sexually transmitted diseases, low socioeconomic status, and smoking.20 Estrogen use, including hormone replacement therapy, is not a risk factor for cervical cancer and in fact may be protective.21

The Need for Emotional Support

Physicians and others who care for breast cancer patients are becoming more sensitive to quality-of-life issues. An important part of breast cancer therapy is emotional support both for the patient and for the family. Many women feel a deep sense of loss following mastectomy and even lumpectomy, and need the support that can be provided by professional counselors. Chemotherapy often causes hair loss, induces premature menopause, and may cause serious mood swings that affect not only the patient but also her loved ones. Many medical centers now provide integrated services including physicians, surgeons, nutritionists, and social workers as part of a team. Patients often have supportive family members and friends, or may be part of a religious group or other organization that provides support sessions and religious healing services. A diagnosis of cancer is a life-altering event even if the prognosis for long-term survival is excellent.

Risk factors for ovarian cancer

The risk of ovarian cancer has been linked to overall number of lifetime ovulations, with increasing risk among women of low parity and late menopause and decreasing risk in women using oral contraceptives and in women of high parity. The overall lifetime risk in the general population is 1.6 . These risk factors are unlikely to be of help to the clinician for purposes of screening. However, historical information can be of benefit in delineating women at higher risk for ovarian cancer.

Prophylactic oophorectomy at the time of hysterectomy

Experience onset of menopausal symptoms within one to two years.41 A significant portion of these women also experience decreased bone density.42 This consideration makes oophorectomy more attractive in women aged 40 years or older and seeking hysterectomy for other conditions.

Management options in BRCA12

Reduction of anxiety has been associated strongly with an interest in prophylactic oophorectomy in genetic counseling programs, independent of actual risk classification.62 Conflicting information is available regarding the psychological impact of prophylactic oophorectomy. A prospective study of women in a familial cancer clinic compared women who did and did not undergo prophylactic oophorectomy it found significant reduction in ovarian cancer anxiety and a high degree of satisfaction with the decision to undergo the prophylactic procedure.63 Another small study compared utilized responses to the Short-Form (SF)-36 Health Status Questionnaire and the General Health Questionnaire (GHQ) women undergoing oophorectomy for prevention scored poorer functioning on the role-emotional and social functioning subscales, with a trend to report more menopausal symptoms, and reported higher scores on the GHQ. There were no significant differences in the groups with respect to cancer worry or...

Obstetrics and Gynecology

The answer is b. (Seidel, 4 e, pp 508-512.) Women between the ages of 30 and 55 may develop benign cyst formation of the breasts or fibrocystic breast disease. Patients typically state that the symptoms worsen premenstrually or as they approach menopause (decreased progesterone). Physical examination often reveals bilateral lumpy and tender breasts. Mammography shows dense breast tissue. Mastitis is most com- 459. The answer is b. (Fauci, 14 e, p 2102.) The patient is presenting with symptoms of normal menopause, which may include hot flashes, urinary frequency, dysuria, urinary incontinence, vaginal dryness, vaginal itchiness, and dyspareunia. Patients also have amenorrhea. Patients may become anxious or depressed during this time, but there is no evidence that personality or mood changes are due to menopause. 462. The answer is a. (DeCherney, 8 e, pp 668-669.) The most common cause of postmenopausal vaginal bleeding is atrophic vaginitis (with or without trauma). Endometriosis...

Xylocaine Infiltration For Marsupialization

A 55-year-old postmenopausal female presents to her gynecologist for a routine exam. She denies any use of hormone replacement therapy and does not report any menopausal symptoms. She denies the occurrence of any abnormal vaginal bleeding. She has no history of any abnormal Pap smears and has been married for 30 years to the same partner. She is currently sexually active with her husband on a regular basis. Two weeks after her exam, her Pap smear comes back as atypical glandular cells of undetermined significance (AGUS). What is the next most appropriate step in the management of this patient

Decreased arousal andor plateau

As with increasing erectile difficulties with age alone, there are age-related changes in vaginal lubrication for women. Sildenafil is beneficial to women experiencing arousal difficulties during perimenopause and should be considered a treatment option.33 Additionally, nitric oxide - required for cGMP and subsequent vasocongestion - is believed to be androgen-sensitive, heightening the possible benefits of androgen supplementation to enhance arousal.

Is Livergen Suitable For Three Months Pregnancies

The answer is b. (Braunwald, 15 e, pp 2194, 2232-2234.) Post-menopausal women not on estrogen replacement should achieve a daily intake of calcium at 1200 mg of elemental calcium. The average woman in the United States receives 600 to 700 mg from diet alone. The current recommendation is that women consume 1200 mg oral calcium supplement in two or three divided doses. Although fluoride is an osteoclast inhibitor, early studies revealed an increased fracture rate with fluoride supplementation for prevention or treatment of osteoporosis. Fluoride does not have a proven role in the prevention or treatment of osteoporosis. The current exercise regimen recommended is weight-bearing activities such as walking, dancing, tennis, or jogging three to five times per week. This patient is not performing adequate weight-bearing exercise. There is no indication at this time that the patient should restart hormone replacement therapy without further diagnostic testing. If this patient is...

Jo Ann Rosenfeld

Despite the fact that there are more women than men at every age, this time of change is poorly studied and understood for women (Figure 1.1). Many large population studies have not included women, have included only a few women, or have not reported data by gender. Few studies have examined this age group. The change to adolescence, adulthood, and elder has been well examined and researched. Each of these ages has their own specialists (obstetrician gynecologist or geriatrician). However, the middle ages are often neglected. Menopause is not a disease, a definite time, or a curse. Its needs, challenges, and effects on women's health are not understood well. Familial and social stresses may be challenging or overpowering, as the woman has to redefine herself within society, employment, and her family. These women must not be viewed either as finished or unimportant simply because they are finished with childbearing and or approaching menopause, nor must they be considered pre-elderly....

The History

Risk factors that can lead to the progress of vascular disease such as smoking, diabetes, hypertension, and hyperlipidemia are ascertained in the history. Additionally, an adequate exercise history should be elicited. One question that elucidates the rate-limiting organ system is how far patients can walk, and what stops them (leg pain, shortness of breath, chest pain, etc.). It is also important to know if the patient is taking hormonal medications such as oral contraceptives or hormone replacement therapy. These medications can predispose to venous and occasionally arterial thrombosis. It is during the history taking that a physician can begin to address many of these risk factors. By recruiting antismoking clinics or eliciting the help of diabetes and cardiac specialist physicians, a surgeon can improve a patient's overall health both pre-and postoperatively.

Adequate calcium

Menopausal women are at increased risk for osteoporosis, especially if they are Caucasian and or thin. Cigarette-smoking and a positive family history increase the risk. While taking adequate calcium during the bone-building years (before age 30) is essential, calcium intake in later years is still important to slow the bone mineral loss that inevitably happens after menopause.

Hormone Therapy

Hormone replacement therapies (HRT) based exclusively on oestrogens increase the risk of endometrial cancer, to the extent that there is a tendency to prescribe oestrogen and progesterone HRT except in hysterectomized women. There are reports indicating a two- to fourfold increased risk of DVT in women on HRT 9, 15 this should be taken into account when evaluating menopausal women. It should also be kept in mind that a large number of epidemiological studies conclude that Asian women, because of their diet rich in soy, reach the menopause in better condition than Occidental women and have a lower incidence of undesirable effects. Moreover, and despite the large number of published reports focusing on isoflavones (a Medline search of the term iso-flavones yields over 7500 citations), there is no mention in the literature of an increased risk of thrombosis linked to the uptake of these components of soy.

Role of Environment

Same risk as other Americans if they move to the United States. This observation and others suggest a role for environmental factors in the development of the disease. Scientists have studied the effects of exposure to many environmental and dietary factors that might contribute to the increasing incidence of breast cancer in Western countries. They have examined the effects of dietary fat, air and water pollutants, pesticides, radiation, alcohol, stress, oral contraceptives, hormone replacement therapy, and even abortions. They have also studied the effects of chemicals known as xenoestrogens, environmental chemicals that behave like estrogens. Organochlorines, for example, are common pollutants that exhibit estrogenic activity. These chemicals include PCBs, organic components of industrial waste that may leak into the water table. To date, none of the studies has revealed a specific environmental cause for breast cancer.

Risk Factors

While the link between environment and breast cancer remains unclear, a number of factors that increase the risk of developing the disease have been identified. The most important risk factor is age (table 1.1). A woman younger than fifty years, with no other risk factors, has only a 2 percent risk of developing the disease. In contrast, if she lives beyond eighty-five years, her risk is 12.5 percent. Other major risk factors include the age of menarche (first menstrual period), parity (number of pregnancies), whether she breast-fed her children, and age at menopause. These factors suggest a strong role for hormones, especially estrogens, in developing breast cancer. Use of hormone replacement therapy (HRT) over many years also increases risk, as may obesity and heavy ingestion of alcohol.

Relational aging

The many roles women fulfill in the family and culture may transition over the mid-life years. There is no distinct orderly sequence for this series of transitions, because they are dependent upon the individual woman's life circumstances. Shifting demographics in modern Western culture have altered norms for ages of partnering, marriage, childbearing or choosing not to have children, and entering or leaving the workplace. As a woman enters the mid-life years, she may progress in orderly fashion through several transitions of job stabilization or promotion, launching children, menopause, caring for aging parents and caring for an aging partner. However, there maybe significant mixing of these lifecycle events at any one given period of time.

Importance

Sexuality is much more then sexual behavior. Sexuality is an important part of one's health, quality of life, and general wellbeing. Sexuality is an integral part of the total person, affecting the way each individual - from birth to death - relates to herself, her sexual partner(s), and every other person.1 This time of life can and should be a tremendously positive time for women in regards to sexual health. How a woman successfully navigates sexual health risks depends on the complexity of how she defines herself and her sexuality in relationship to aging, menstruation, childbearing capability, success with overcoming challenges of her past, and the quality of intimate partnership(s). Risks to sexual health can include unplanned pregnancy, the physiologic changes of transition into and through menopause and with aging, the increased probability of chronic illness and its medical and surgical treatment, abuse in any form, and sexually transmitted infections.

Inherited

Factor V Leiden, also known as activated protein C resistance (APCR), results from a point mutation in the factor V gene, leading to a loss of protein C cleavage sites (Ouriel et al., 1996). The consequence of this is impaired activation of protein C. The most common presentations are VTE and fetal loss. It usually does not result in arterial thrombosis unless other risk factors are also present, for example smoking. Homozygotes have an 80-fold increased risk of DVT, and heterozygotes have much less. Many patients with factor V Leiden remain asymptomatic, and about 60 of those who present with thrombosis have another risk factor such as use of oral contraceptives (OCs) or hormone replacement therapy (HRT). The overall risk of VTE is 3 to 7 . levels of these factors. Hormone replacement therapy and pregnancy are also implicated in raised levels of these factors. Patients on HRT or OC and with elevated factor VIII levels have a 10-fold increased risk of VTE compared to those without...

Developmental tasks

Case a 54-year-old woman presents with a nine-month history of amenorrhea, hot flushes, difficulty sleeping, and edgy mood. She reports that her mother, sisters, and friends have shared with her how difficult going through the change had been for them. She has read about recent study results raising concerns regarding hormone replacement therapy and cardiovascular risks, but she has also heard that hormones can help to reduce the signs of aging. She is divorced and had launched her final child from home this past summer. She has enjoyed rearranging the house but is not sure how she will spend her time as she gets closer to finishing this project. In a Danish study aimed at exploring whether women have any positive experiences in relation to the menopause, a questionnaire was sent to a random sample of 51-year-old women.5 Of 393 women who answered an open-ended question, the total number of replies with a positive content was 268. Concrete positive descriptions included relief that...

Psychosocial issues

A qualitative study of 11 women during mid life, exploring their sense of confusion, found that most notable were their comments about negative societal views of aging and lack of health-related information on physical and physiological changes of midlife.10 The most relevant factors influencing a woman's quality of life during the menopausal transition are her previous emotional and physical health, her social situation, her experience of stressful life events (particularly bereavements and separations), and her beliefs about the menopause. There are considerable cultural differences in the reporting of vasomotor symptoms, which may be explained by the meaning ascribed to them, the value of older women in societies, and dietary, lifestyle, and genetic differences. Those who seek medical help for menopausal problems report more physical and psychological problems. These women are more likely to be under stress and to hold particular beliefs about the menopause. These personal and...

The empty nest

In a study on depression, anxiety, and the empty nest syndrome in 222 peri-menopausal and menopausal women with a mean age of 47.7 years (102 of whom were at menopause), disturbed attitudes toward sexuality were the main factors associated with emotional symptoms.14 Depending on how the woman has defined herselfin relationship to her children, the time when children leave the home can provide greater time for her to pursue self-interests and to put greater emphasis on her relationship with her partner. With single women, it maybe a time to think about establishing a relationship again. The greater complexity to her definition of self, the less negative impact the empty nest will have on her sexual identity. Additionally, the quality of the relationship might be tested at this stage. If she and her partner sacrificed their relationship to raise their children, then they will need to become reacquainted with each other.

Body image

How a woman defines her sexuality in relationship to her uterus and ovaries, menstrual cycle, and or fertility status can affect the intensity ofher griefreac-tion, to menopause body image, and self-esteem. How she adapts to wrinkles and other visible changes of age - such as reframing age spots as experience spots - can determine how she transitions through ego integrity versus despair. biology that warrants the prevalent image of sexless, neutered, loveless aging. For many aging people, sexual desire, physical love, and sexual activity continue to be integral parts of their lives, and intimacy is expressed, in addition to intercourse, through closeness, touching, and body warmth. In essence, caring and gentleness in loving activities may be more important. Cessation of sexual activity is not associated with menopause, and many women, freed from the risk of conception, seek intercourse and report heightened sexual satisfaction.

Summary

Including increase in difficulty for single women to find consistent partners in their age group. Clinicians are encouraged to raise the topic of sexual health and to assist mid-life women as they make their transitions through menopause, and with aging partners, supporting this phase of life as a prime period and the notion that these women are valued for their history and wisdom and unique beauty that mid life and beyond has to offer. 5 Hvas, A. Positive experiences in connection with menopause. Ugeskr. Laeger 2002 164 2614-17. 6 Avis, N. Perception of the menopause. Womens Eur. Menopause J. 1996 3 80-84. 7 Locke, M. Menopause Lessons from anthropology. Psychosom. Med. 1998 60 41019. 11 Hunter, M. S. Predictors of menopausal symptoms psychosocial aspects. Baillieres Clin. Endocrinol. Metab. 1993 7 33-45. 13 Avis, N., Stellato, R., Crawford, S., Johannes, C. and Longcope, C. Is there an association between menopause status and sexual functioning J. Am. Geriatr. Soc. 1972 20 151-8. 21...

Lipoprotein a [Lpa

The circulating levels of Lp(a) are largely genetically determined therefore, it is difficult to influence this variable. Nicotinic acid can lower Lp(a) levels but compliance may be a problem because of side-effects (e.g. flushing). Correcting hypothyroidism or administering hormone replacement therapy may also lower Lp(a) levels. Since the risk attributed to Lp(a) is influenced by the LDL-C level, it may be that the overall risk of a vascular event can be decreased by aggressively lowering the LDL-C levels (e.g. with a statin 7 ).

Remodelling

The sex hormones (oestrogens, androgens and progestins) are essential in maintaining proper coupling during bone remodelling. Oestradiol and oestrone are the predominant circulating sex hormones in premenopausal women, while testosterone predominates in men. However, androgens and oestrogens circulate in both men and women and there is evidence that these hormones affect bone homeostasis in both sexes. In women, when oestrogen levels fall following menopause, circulating androgens may have significant influences on bone metabolism (Oursler et al., 1996).

Type I osteoporosis

This syndrome manifests in women typically between 50 to 75 years of age, and results from an acceleration of cancellous bone loss after the menopause. About one in five postmenopausal women will develop type I osteoporosis unless treated. Within the first 1 to 5 years after the onset of menopause, the rate of cancellous bone loss is two to six times the pre-menopausal rate of about 1 per year, but it gradually returns to the pre-menopausal rate about the 10th year after onset of menopause (Krall & Dawson-Hughes, 1999). There is only a slight corresponding increase in cortical bone loss. Fractures occur most commonly in the distal radius (forearm) and the spinal vertebrae. The Osteoporosis in post-menopausal women is due to the dramatic decrease in oestrogen production that accompanies menopause this is evident by the well-established efficacy of hormone replacement therapy (Lindsay, 1993). The accelerated phase of bone loss is associated with increased osteoclastic resorption and...

Yd Audi Form Mole

Discussion The most common type of breast cancer. Approximately one in nine women in U.S. will develop breast cancer. Risk factors includc family history, early menarche, late menopause, obesity, exogenous estrogens, atypical hyperplasia of breast, and breast cancer in the opposite breast.

Hormones

Estrogens certainly improve hot flushes.64 Doses as low as 20 mg transdermal estrogen have been demonstrated to reduce the severity of symptoms. HT should be used only if menopausal symptoms are troublesome, alternatives are not acceptable or effective, and the woman is informed fully of the risks.

Osteoporosis

Both observational studies and RCTs demonstrate HRT has positive effects on bone density, regardless of whether the woman already has osteoporosis. The effect on fracture incidence varies there was no reduction in hip, wrist, vertebral, or total fractures with HRT in the HERS study, but the WHI reported reductions for hip and vertebral fractures, although these were not statistically significant. The best evidence suggests that HRT decreases the risk of vertebral fractures in the first decade after surgical menopause, the risk of non-vertebral fractures in early postmenopausal women, and the risk of vertebral fractures in women with established osteoporosis. However, HT may confer its maximum protective effect on bones if used for only three years. A subgroup of women in the Postmenopausal Estrogen Progestin Interventions (PEPI) trial who used HRT for three years and then discontinued it did not experience a dramatic drop in bone mineral density. Women using HT beyond three years may...

The future

Women will continue to live an increasing proportion of their lives post-menopause, and greater numbers of women will be in this stage of life. Addressing symptomatic issues and preventing chronic disease will remain www.4women.gov owh North American Menopause Society www.menopause.org 2 Porter, M., Penney, G., Russell, D., Russell, E. and Templeton, A. A population based survey of women's experience in the menopause. Br. J. Obstet. Gynaecol. 1996 103 1025-8. 3 Brett, K. M. and Madans, J. H. Use of postmenopausal hormone replacement therapy estimates from a nationally representative cohort study. Am. J. Epidemiol. 1997 145 536-45. 5 Utian, W. and Boggs, P. The North American Menopause Society 1998 menopause survey, part I postmenopausal women's perceptions about menopause and midlife. Menopause 1998 6 122-8. 6 US Preventive Services Task Force. Recommendations and rationale hormone replacement therapy for primary prevention of chronic conditions. www.ahcpr.gov clinic 3rduspstf hrt...

Oral contraceptives

Women may use hormonal therapy into their fifties and menopause, if they have no contraindications and are not smokers.8 However, menopause will then need to be diagnosed, because the woman will continue to cycle, even when menopausal, if she is still taking OCPs. After age 50, a follicle stimulating hormone (FSH) level should be obtained on the fifth to seventh afternoon of her week on placebos (withdrawal bleeding week). If her FSH level is 25 IU dl or more, she is menopausal and should stop her OCP. She may still have a withdrawal bleed.8

Future Perspectives

In addition to its proposed role in the nervous system, progesterone has been implicated to have a physiological role in cardiovascular biology. Premenopausal women have a significantly lower risk (ratio 1 10) of cardiovascular disease than men of equivalent age. However, this protection diminishes in the postmenopausal woman. At age 75, the incidence is essentially the same in both sexes, with cardiovascular disease the leading cause of mortality morbidity in women by age 60 (reviewed in 196). Because natural and surgical (bilateral oophorectomy) menopause accelerates the development In the case of bone homeostasis, inappropriate bone loss that occurs as a result of the onset of menopause is known to be associated with contemporaneous decreases in serum estrogen levels, as evidenced by the beneficial effects of estrogen replacement therapies in reversing this effect (212). Interestingly, with the addition of progesterone to such hormonal replacement therapies, a number of biochemical...

Special tests

Women who receive bone density screening have better outcomes (improved bone density or fewer falls) than women who are not screened. The US Preventive Services Task Force suggests that the primary argument for screening is that postmenopausal women with low bone density are at increased risk for subsequent fractures of the hip, vertebrae, and wrist, and that interventions can slow the decline in bone density after menopause.22 The presence of multiple risk factors (age > 80 years, poor health, limited physical activity, poor vision, prior postmenopausal fracture, psychotropic drug use, and others) is a stronger predictor of hip fracture than low bone density.22 The patient who is asymptomatic and has only one or two risk factors can benefit from BMD screening. Indications for BMD screening are outlined in Table 14.2.

Calcitonin

Treatment should be continued until pain is controlled, followed by tapering of medication over four to six weeks. Calcitonin decreases further bone loss at vertebral and femoral sites in patients with documented osteoporosis, but it has a questionable effect on fracture frequency.31 Calcitonin prevents trabecular bone loss during the first few years of menopause, but it is unclear whether it has any impact on cortical bone.29

Items 388390

A 51-year-old G3P3 presents to your office with a 6-month history of amenorrhea. She complains of debilitating hot flashes that awaken her at night she wakes up the next day feeling exhausted and irritable. She tells you she has tried herbal supplements for her hot flashes, but nothing has worked. She is interested in beginning hormone replacement therapy, but is hesitant to do so because of its possible risks and side effects. The patient is very healthy. She denies any medical problems and is not taking any medication except calcium supplements. She has a family history of osteoporosis. Her height is 5 ft, 5 in. and her weight is 115 lb. 388. When you counsel the patient regarding the risks and benefits of hormone replacement therapy, you tell her that which of the following is a documented risk of HRT (estrogen and progesterone) d. Hot flushes can begin several years before actual menopause

Chemoprevention

Recent five-year clinical trials of the anti-estrogen compound tamoxifen indicated that chemoprevention may be an effective method of preventing breast cancer in high-risk individuals (including lobular carcinoma in situ, and those with mutated BRCA1 or BRCA2 genes). However, as I indicated above, tamoxifen is not without its own risk. It may lead to endometrial hyperplasia or cancer or cause thromboses. It also causes temporary premature menopause, with all the associated discomforts, and some patients develop resistance to the drug. New studies are under way comparing tamoxifen to a similar drug, raloxifene (Evista ), that may have similar beneficial effects with fewer side effects.

Epidemiology

Applying American Diabetes Association (ADA) diagnostic criteria to those aged 40-74 years, the prevalence of diabetes (both diagnosed and undiagnosed) in the USA rose from 8.9 in 1976-1980 to 12.3 in 1988-1994.2 In a cohort of US adults aged 25-74 years, who were followed from 1971 to 1993, the 5.1 of subjects who had diabetes experienced 10.6 of the observed mortality. Median life expectancy was eight years lower for those aged 55-64 years with diabetes and four years lower for those aged 65-74 years with diabetes.3 In addition to the high rates of diabetes and associated mortality, mid-life women should be concerned about diabetes because of the implications for management of menopause. This chapter will examine the diagnosis, prevention, and management of diabetes in mid-life women.

Legumes

Intense research over the past decade has shown that soybean has health-promoting properties and may be useful in lowering the risk of heart disease, cancer, osteoporosis, menopausal symptoms, and other problems. Soy is now available in many different kinds of foods such as tofu, soy D. Help for Menopause and Bone Loss Soy products are being studied for their potential use as hormone replacement therapy during menopause. Japanese women who regularly consume soy products report less frequent and fewer hot flushes and other menopausal symptoms than American and European women who do not eat soy products. A 3-month clinical trial observed a beneficial effect of soy protein on the frequency of hot flushes in postmenopausal women.104 Italian researchers observed a significant decrease in the average number of hot flushes experienced by postmenopausal women taking 60 g of soy protein isolate daily for 12 weeks. In a double-blind, placebo-controlled study, the women taking soy experienced a...

Signs and symptoms

In mid life, type 2 diabetes is the most common type of diabetes. The diagnosis of type 2 diabetes is based on symptoms of hyperglycemia and the measurement of elevated blood-glucose readings. The classic symptoms of significant hyperglycemia include polyuria, polydipsia, weight loss, polyphagia, and blurred vision. Hyperglycemia may also cause fatigue, vaginitis, or other non-specific symptoms, which maybe attributed to menopause. If the onset of hyperglycemia is gradual, then there may not be any symptoms, thus delaying the diagnosis of diabetes.

Uses Of Estrogen

In cases where there is insufficient estrogen present, the woman can suffer various conditions (like dryness of the vagina). The lack of sufficient estrogen in the woman's body could be attributed to surgery (removal of the ovaries), to menopause, or to other conditions. In such cases, the physician might elect to prescribe estrogen therapy to provide the needed estrogen.

Partial Orchidectomy

Partial orchidectomy may be considered in patients with a tumor in a solitary testis or bilateral tumors. The advantage is that it may allow the patient to avoid hormone replacement therapy and, in some cases, to preserve fertility. In a series of 73 men who underwent partial orchidectomy for testicular cancer (primarily seminoma), 85 avoided the need for subsequent hormone replacement. In 82 of patients there was associated carcinoma in situ (CIS) treated with local irradiation (18 Gy). One patient died of systemic tumor progression. There were no local recurrences in the men with CIS who received radiotherapy. There were four local recurrences in patients not irradiated, but all were treated successfully with inguinal orchidectomy. Of 10 men who postponed radiotherapy for fertility reasons, five fathered a child after organ-sparing surgery 6 . The procedure does require specialist expertise, and patients should be referred to a center with experience with partial orchidectomy....

Hormonal therapy

Recent studies provide a link of hormone replacement therapy (HRT) to ovarian cancer, but these findings are inconsistent. Oral contraceptive pills (OCPs) have been well-documented to decrease the risk of ovarian cancer. The protective effect continues for many years following their discontinuance. Since OCPs suppress gonadotropin secretion, this mechanism of action might also be supposed to provide a benefit in menopausal HRT.

Items 485487

A 60-year-old white female presents for an office visit. Her mother recently broke her hip, and the patient is concerned about her own risk for osteoporosis. She weighs 165 lb and is 5 ft, 6 in. tall. She has a 50-pack-year history of tobacco use. Medications include a multivitamin and levothyroxine 50 M-g d. Her exercise regimen includes mowing the lawn and taking care of the garden. She took hormone replacement therapy for 6 years after menopause, which occurred at age 49. d. Restarting hormone replacement therapy d. Use of hormone replacement therapy

Estrogen

Other studies examined the risk of developing or dying with AD. In a cohort of approximately 300 post-menopausal women, the odds of developing AD were increased in women who did not receive ERT (odds ratio 1.82). Duration of estrogen use was not discussed. The population had a relatively high prevalence of vascular dementia 175 . In another cohort of almost 9000 women in a retirement community, earlier age of menarche and longer estrogen use were associated with lower mortality rates from AD and a lower risk of developing AD (odds ratio of 0.65). A methodological limitation of the study was reliance on death certificates for AD diagnosis, reducing diagnostic sensitivity 176 . In the Baltimore Longitudinal Study of Aging, almost 500 women were followed for 16 years and approximately half were estrogen users. The relative risk of developing AD in estrogen users was 0.46 177 . In the Italian Longitudinal Study of Aging, estrogen use was lower among the women who developed AD after...

Anatomy Vulva

The mons pubis is a mound of skin-covered subcutaneous fatty tissue overlying the pubic bone. It is continuous with the subcutis of the anterior abdominal wall superiorly and the labia majora posteriorly. The mons becomes covered with coarse hair and the amount of fat increases at puberty. These gradually decrease after menopause. Vestibule of the Vagina. The vestibule is the medial (central), mucosa-covered part of the vulva. On embryologic, anatomic, and architectonic grounds, the correct term is vestibule of the vagina'' not vulvar vestibule,'' as sometimes appears in the literature (2). The vestibule is composed of loose fibroelastic and smooth muscular tissue without fat. The boundaries of the vestibule are Hart's lines laterally, the hymenal ring medially, the frenulum of the clitoris anteriorly, the fourchette posteriorly, and Colles' fascia deeply. The vestibule contains the urethral meatus and vaginal opening in the midline. The ostia of the greater vestibular...

Items 355356

A 57-year-old woman presents to the office because of vaginal bleeding. She had her menopause at age 50. She does not use hormonal replacement therapy. Her last periodic health examination was one year ago. The physical and pelvic examinations are nomal. Which of the following is the most likely diagnosis

Items 402407

A 59-year-old G4P4 presents to your GYN office complaining of losing urine when she coughs, sneezes, or engages in certain types of strenuous physical activity. The problem has gotten increasingly worse over the past few years, to the point where the patient finds her activities of daily living compromised secondary to fear of embarrassment. She denies any other urinary symptoms such as urgency, frequency, or hematuria. In addition, she denies any problems with her bowel movements. Her prior surgeries include a tonsillectomy and appendectomy. She has adult-onset diabetes and her blood sugars are well controlled with oral glucophage. The patient has no history of any gynecologic problems in the past. She has four children that were delivered via spontaneous vaginal deliveries their weights ranged between 8 and 9 lb. She is currently sexually active with her partner of 25 years. She has been menopausal for 4 years and has never taken any hormone replacement therapy. Her height is 5 ft,...

Urethral Caruncle

Caruncles, which probably represent ectropion of the distal posterior urethra (76), may be related to the hypoestrogenic milieu of menopause. They appear as red polypoid protrusions from the urethra. Histologically, the diagnosis is usually clear cut. The lesion has a polypoid or papillary configuration and is lined by sometimes hyperplastic squamous or transitional cells. There are abundant vessels and inflammatory cells in the stroma, with an appearance of granulation tissue however, Young et al. (77) have described an unusual variant containing atypical stromal cells mimicking a lymphoma or sarcoma (Table 41).

History

Frequency, duration, severity, and bother and exacerbating or relieving factors. It is important to note whether the onset of the symptom occurred after a specific event such as surgery, childbirth, menopause, or with the use of a new medication. Any prior treatments by other physicians for their symptoms and the resultant outcome should also be noted. Specific questions about childhood and adolescent voiding troubles or problems with toilet training should be asked. to LUTS, including irritative symptoms of frequency and urgency, as well as incontinence. If the patient is postmenopausal, it is important to note whether the patient is being treated with hormone replacement therapy. Careful questioning regarding a history of endometriosis and gynecological malignancy should be performed.