Menopause, Hormone Replacement Therapy

Menopause is a systemic endocrine transition, not unlike the hormonal shifts seen in thyroid or adrenal insufficiency. And yet it’s rarely treated with the same medical urgency. Menopause involves a sustained loss of hormones essential to bone, brain, vascular, and immune health. It’s time to move beyond outdated generalizations and toward a conversation grounded in clarity, clinical relevance and preventive healthcare. All hormone therapies are not created equal. Modern bioidentical formulations using transdermal estradiol and micronized progesterone demonstrate a safer, more physiologic profile than the WHI’s oral synthetic combination. Personalization, precision and timing are the key to optimal menopausal care. More generally, this article demonstrates how to systematically identify paradigmatic thinking errors in medicine.

Menopause: Amenorrhea, particularly in women under the age of 45, necessitates a careful and systematic differential diagnosis to exclude reversible or pathological causes before menopause can be confirmed. While menopause is typically diagnosed clinically in women aged 45 years or older presenting with characteristic symptoms, younger women require more detailed assessment to rule out other etiologies. Pregnancy remains the most common cause of secondary amenorrhea and should always be excluded first. Other potential causes include anatomic abnormalities such as Asherman’s syndrome and chronic endometritis, hypothalamic-pituitary-gonadal (HPG) axis dysfunction secondary to factors like stress, chronic illnesses, nutritional deficiencies, and pituitary disorders, as well as primary ovarian insufficiency, polycystic ovarian syndrome, and ovarian neoplasms. Proper clinical evaluation, supported by laboratory and imaging studies, ensures accurate diagnosis and guides appropriate management. Early identification of treatable conditions is essential to optimize reproductive health outcomes and prevent complications.

Objective. To investigate the flow velocity waveform changes of the hepatic and renal arteries in women with surgical menopause who received hormone replacement therapy versus those who did not. Methods. Eighty women who had undergone surgical menopause were divided into 2 groups. The first group (n = 38) consisted of patients who did not receive estrogen treatments after surgery; patients in the second group (n = 42) did receive treatments. The hepatic and renal arteries of patients in both groups were examined by duplex Doppler ultrasonography before the commencement of hormone replacement therapy and after 2 years of treatment, and the pulsatility indices were calculated. Results. No significant differences were detected in the renal and hepatic artery pulsatility indices of patients in the estrogen treatment group (group 2) before and after total abdominal hysterectomy and bilateral salpingo-oophorectomy (P > .05). No significant differences in preoperative and postoperative hepatic arterial pulsatility indices were detected among patients in group 1 (P > .05). Renal artery pulsatility indices measured before and after total abdominal hysterectomy and bilateral salpingooophorectomy did show a statistically significant difference in group 1 (P < .001). In addition, a statistically significant difference was detected before and after surgery in both groups when pulsatility indices were measured at the second-year control dose. Conclusions. Hepatic arterial pulsatility indices are not affected in postmenopausal women, but renal artery pulsatility indices rise to some extent in women not receiving hormone replacement therapy.

Phytoestrogens are diphenolic compounds that are present in several plants eaten by human beings. Soybeans and flaxseed are particularly abundant source of phytoestrogens. When ingested in relatively large amounts, phytoestrogens have been shown to have significant estrogen agonists / antagonists effects in animals and humans. There is epidemiological, laboratory and clinical evidence which indicates that phytoestrogens, like certain selective estrogen receptor mudulators, have an antiproliferative effect on the breast, and positive effects on the lipoprotein profile and bone density. They might also improve some of the climacteric symptoms. This evidence is critically reviewed, and the possible benefit of dietary intervention with phytoestrogen-rich food for woman's health is discussed.

El avance de la medicina ha incrementado la esperanza de vida al nacer y el crecimiento de la población mayor a 60 años, siendo cada vez mayor las mujeres en etapa de menopausia. Objetivo: Estudiar la calidad de vida (CV) en pacientes menopáusicas con y sin terapia de reemplazo hormonal. Método: Se estableció una investigación de tipo comparativa y aplicada, con diseño no experimental, contemporáneo transeccional y de campo, donde se incluyo una muestra de 200 pacientes con diagnóstico de menopausia. Se les aplicaron los cuestionario de CV SF-36 y el Menopause Rating Scale (MRS). Resultados: Hubo diferencias significativas (p<0,05) en cuanto al dolor físico y altamente significativas (p<0,01), respecto a los síntomas somáticos, psicológicos y urogenitales en las pacientes no tratadas vs las del grupo que recibió TRH. Conclusión: Las pacientes bajo TRH perciben una mayor CV específica respecto a las pacientes que no la reciben, presentando síntomas somáticos o psicológicos menos severos.

Objectives: The study has evaluated bone health status among post-menopausal women in a public hospital of Malaysia. Materials and Methods: A total of 116 post-menopausal women, who met the criteria, participated in this study. The purposive sampling method was used to achieve the criteria of participants. Results: This cross-sectional study revealed that more than half of the respondents (52.6%, n=61) had osteopenia; whereas, 47.4% (n=55) of the respondents had osteoporosis. There was a significant correlation between the age and menopausal years with the bone health status (i.e. P=0.004 and P=0.028, respectively) in postmenopausal women. Conclusions: Menopausal women experienced deterioration of bone mineral density (BMD) with advancing age and menopausal years.

Context: The complexity in critical patient management and polypharmacy, raise the need for support from a clinical pharmacist to optimize drug therapies. Aims: To evaluate the clinical pharmacist participation in an Adult Intensive Care Unit in a local context where the practice is not well established. Methods: The study was conducted in a teaching hospital. Consisted of two stages a retrospective in which were collected of pharmacotherapy follow-up during a period of two years and a prospective phase of observational and cross-sectional character, which picked up the clinical history of patients and pharmaceutical interventions. These pharmaceutical interventions were evaluated by two intensive care physicians and two external pharmacist, using a default score to each one of these, the degree of concordance was obtained using the kappa coefficient. Results: In the retrospective phase were collected 182 patients, who were performed a total of 750 interventions, of which 99.7% was ...

Objective: The incidence of vasomotor crises during the climacterium varies in women across different populations, and phytoestrogen consumption seems to play an important role in this problem. The aim of this study was to determine whether intervention with soy (dietary, extract, or concentrate), as compared with placebo, reduces the incidence of hot flashes in climacteric women. Methods: Only published, randomized, placebo-controlled clinical trials were selected, with a 12-week duration of intervention, having selected postmenopausal women affected with hot flashes attributed to the climacterium (without cancer background). The intervention to be evaluated was soy, as Bsoy dietary supplement,[ Bsoy extract,[ or Bisoflavone concentrate[ (genistein or daidzein). The results were expressed as the number of hot flashes, average score of vasomotor symptoms, or average percent reduction in hot flashes within a time unit (day, week, or month). Results: Nineteen studies were analyzed. The minimum heterogeneity was observed in the Bisoflavone concentrate[ group. In the Bextract[ and Bdietary supplement[ groups, heterogeneity reached an intermediate level, I 2 = 42% and 59.73%, respectively. The overall result showed a standardized mean difference of j0.39 (95% CI, j0.53 to j0.25) in favor of soy as well as j0.45 (95% CI, j0.64 to j0.25), j0.51 (95% CI, j0.79 to j0.22), and j0.20 (95% CI, j0.46 to j0.06) for the Bconcentrate,[ Bextract,[ and Bdietary supplement[ subgroups, respectively. Conclusions: Although the overall combined results and the results by subgroups (according to the type of supplement used) showed a significant tendency in favor of soy, it is still difficult to establish conclusive results given the high heterogeneity found in the studies.

Se presentan los resultados de una encuesta realizada a los médicos internos de la Facultad de Medicina de la Universidad de Antioquia, en el segundo semestre de 1997. El proyecto se realizó con el doble propósito de construir conocimiento sobre el tema del climaterio femenino un tema determinado.Se utilizó el censo y las técnicas de encuesta y escala Lickert para indagar sobre variables socioculturales, demográficas y de carácter científico/técnico. Se encontró que el nivel de conocimientos, medido por la &quot;nota&quot;, fue de 2.85 + 0.83; la actitud frente a la terapia fue baja en el 44% y alta en el 40%. Como se había previsto en la hipótesis, la relación entre actitudes y conocimientos fue directa, pero la asociación con variables sociodemográficas no pudo determinarse debido a la homogenidad de la población.

Existen, dentro del Sistema Nacional de Salud consultas especializadas con el objetivo de tratar a las pacientes insertadas en el climaterio en las que se le orientan tratamientos y conductas a seguir por la mujer con la ayuda de la familia. Generalmente las feminas asisten buscando la ayuda que necesitan en los farmacos, convencidas de que estos seran la unica solucion a sus molestias. Una de las orientaciones, asociada a los medicamentos es la realizacion de ejercicios fisicos de manera general los que, en la mayoria de los casos, no son realizados por la mujer debido a la falta de orientacion profesional unido a otros factores sociales. En el siguiente trabajo proponemos la conformacion de grupos especializados de mujeres en la etapa climaterica, dirigidos por un especialista en Ginecologia en conjunto con un profesional de la Cultura Fisica quienes orienten ejercicios fisicos dosificados segun las caracteristicas y patologias propias de cada una de las mujeres. Consideramos esta...

Introduction: in order to promote activities to improve the quality of life, the vasomotor, psychosocial, physical and sexual display, typical of the perimenopausic period and the conducts of self care, in a group of women above 40 years of age that work at a University were evaluated. Materials and methods: descriptive study. 30 volunteer women participated and answered three different instruments: Sociodemographic characterization survey, questionnaire to evaluate the quality of life of Mencol and measuring scale of conducts of self care. A uni-varied analysis was done, using the Epiinfo 2002. Results: women between the ages of 40 and 55, married (70%) all had children, in the majority they were teachers (80%). The majority perceived with greater intensity the sexual manifestations of the menopause. The self care and promotion and prevention were moderate. Conclusions: each woman expressed their menopause in a particular manner, and it should be treated in an individual manner. It is required to promote activities o self care.

Objective-Our purpose was to determine the advantage of early treatment (before ovariectomy) on a preventive basis of an ethyl acetate extract of Erythrina lysistemon (EL) on menopausal signs, an extract which has previously shown estrogenic activity by acting through the oestrogen receptors. Methods-Female Wistar rats aged 1-1.5 month were randomised in groups and treated respectively from 28 days before ovariectomy to 84 days after. The fasting lipids levels, glucose tolerance, bone and uterine weight, uterine and vaginal epithelial height were determined at days 0, 28, 56 and 84; whereas body weight was determined every forth night. Results-Oral administration of 200mg/kg/d of EL significantly increased HDL-cholesterol and LDL-cholesterol levels on days 0 and 28 and decreased them at days 56 (70%) and 84 (48.27%) compared to untreated ovariectomized rats. It also significantly increased bone weight. Further, EL at day-56 controlled glucose intolerance; but it failed to do so at day-84 and significantly increased blood glucose level. At day 0, EL significantly decreased uterine weight of animals as well as E1. In contrast 28 days after ovariectomy, EL significantly increased uterine weight (36.43%), uterine (19.71%) and vaginal (31.76%) epithelial height with a more advance vaginal cornification compared to controls. Conclusion-These results suggest that oral administration of 200mg/kg/d of EL 28 days before ovariectomy prevented bone loss. EL had a transient effect on glucose intolerance. However EL significantly increased HDL-cholesterol and decreased TG levels.

We determined the effect of conjugated equine estrogen plus medroxyprogesterone acetate on calcium content of aortic atherosclerotic lesions in oophorectomized adult New Zealand rabbits submitted to a cholesterol rich diet. Five groups of 10 animals each were studied: G1 = control, G2 = cholesterol diet only, G3 = diet plus conjugated equine estrogen (0.625 mg/day); G4 and G5 = diet, conjugated equine estrogen (0.625 mg/day) plus medroxyprogesterone acetate (5 and 10 mg/day, respectively). Mean weight varied from 2.7 ± 0.27 to 3.1 ± 0.20 kg (P = 0.38) between groups at the beginning and 3.1 ± 0.27 to 3.5 ± 0.20 kg (P = 0.35) at the end of the experiment. Cholesterol and triglyceride levels were determined at the time of oophorectomy, 21 days after surgery (time 0), and at the end of follow-up of 90 days. The planimetric method was used to measure plaque and caryometric method for histopathologic examination of the aorta. Calcium content was determined by the method of von Kossa. A similar increase in cholesterol occurred in all treated groups without differences between them at the end of the study. Groups G4 and G5 had smaller areas of atherosclerotic lesions (2.33 ± 2.8 and 2.45 ± 2.1 cm 2 , respectively) than the groups receiving no progestogens (G2: 5.6 ± 4 and G3: 4.6 ± 2.8 cm 2 ; P = 0.02). The relation between lesion area and total aorta area was smaller in groups treated with combined drugs compared to the groups receiving no progesterone (G4: 14.9 ± 13 and G5: 14.2 ± 13.4 vs G2: 35.8 ± 26 and G3: 25 ± 8 cm 2 , respectively; P = 0.017). Oral conjugated equine estrogen (0.625 mg/day) plus medroxyprogesterone acetate (5 or 10 mg/day) provoked a greater reduction in atherosclerotic plaque area and calcium content in treated groups, suggesting a dose-dependent effect.

This study describes the profile and attitudes, knowledge and expectations of patients with postmenopausal osteoporosis. Subjects and methods: Epidemiological and cross-sectional study carried out in Spain. Participating patients were aged over 45 years and receiving treatment for postmenopausal osteoporosis. Data on personal and family medical

Objective— The objective was to compare the effects of tibolone and hormone therapy (HT) on lipid profile, vasodilation, and factors associated with inflammation and hemostasis. Methods and Results— Fifty-three women received micronized progesterone (MP, 100 mg) with conjugated equine estrogen (CEE, 0.625 mg) or tibolone (2.5 mg) daily for 2 months, with a 2-month washout period. Compared with HT, tibolone significantly reduced total cholesterol ( P &lt;0.001), triglyceride ( P &lt;0.001), and HDL cholesterol ( P &lt;0.001) levels as well as triglyceride/HDL cholesterol ratios ( P &lt;0.001) but not LDL cholesterol levels. Tibolone significantly improved flow-mediated brachial artery dilator response to hyperemia from baseline values ( P &lt;0.001) by a magnitude similar to that found with HT ( P =0.628). Compared with tibolone, which showed no changes, HT significantly increased high-sensitivity C-reactive protein (hsCRP, P =0.030) and reduced antithrombin III ( P &lt;0.001). HT an...

Objective: The present study was undertaken to investigate the possible existence of an endogenously generated circadian rhythm in endothelial function in women and whether this rhythm is altered after the menopause. Methods: Healthy non smoking women (11 pre-menopausal and 13 postmenopausal women) were studied during a 22 h period under constant routine conditions; endothelium-dependent (flow-mediated dilation (%FMD)) and-independent (glyceryl-trintrate (GTN)-mediated) function was assessed every 2 and 4 h, respectively, by high-resolution ultrasound of the brachial artery. Results: %FMD and %GTN was significantly higher in pre-menopausal women (9.9 ± 1.0%FMD (mean ± S.E.M.); 18.2 ± 1.8%GTN; P < 0.01) compared with postmenopausal women (6.5 ± 0.5%FMD; 11.5 ± 1.6%GTN). A significant day-night variation in %FMD was observed pre-menopausal women (day 9.2 ± 0.8%; night 10.4 ± 1%; P < 0.05) with an attenuated rhythm in postmenopausal women (day 6.8 ± 0.6%; night 6.0 ± 0.4%). Conclusions: The findings show a circadian rhythm in %FMD in pre-menopausal women, which disappears after the menopause. The reduction in %FMD and an absence of a day-night variation in %FMD in postmenopausal women may have important implications for the incidence of coronary heart disease in women after the menopause.

Does menopause hormone therapy reduce the risk of chronic diseases? The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.

La osteoporosis es una enfermedad crónica no transmisible con factores de riesgo como sedentarismo, consumo de tabaco y alcohol, e ingesta de dieta no balaceada. Objetivos: Establecer la relación entre el estilo de vida saludable y la prevención de la osteoporosis en la mujer climatérica sin patología asociada. Métodos: Análisis descriptivo comparativo con diseño no experimental, transversal y correlacional, en muestra formada por 80 mujeres climatéricas en tratamiento de osteoporosis y 80 mujeres climatéricas sin diagnóstico de osteoporosis, con características sociodemográficas similares. Para recopilar la información se utilizó una encuesta semiestructurada validada en el estudio. Para el análisis estadístico se aplicaron las pruebas de Mann-Whitney y McNemar, según correspondiera. Resultados: Las mujeres con osteoporosis eran más sedentarias e ingerían menores cantidades de calcio que las mujeres sin el diagnóstico médico de la patología, de igual manera han utilizado en menor extensión terapia de reemplazo hormonal. En el grupo de mujeres con osteoporosis fue factor de riesgo para la enfermedad el consumo de tabaco pero no el de alcohol. Conclusiones: Tener un estilo de vida saludable durante el climaterio es una estrategia útil para prevenir la osteoporosis en el climaterio, puesto que en este estudio se detectaron como factores de riesgo en esta población: el estado nutricional enflaquecido, el no realizar actividad física y el ser sedentaria, tener antecedentes de consumo de tabaco y su consumo actual, el consumo insuficiente de calcio dietario y/o su uso terapéutico por periodos menores a un año.

El avance de la medicina ha incrementado la esperanza de vida al nacer y el crecimiento de la población mayor a 60 años, siendo cada vez mayor las mujeres en etapa de menopausia. Objetivo: Estudiar la calidad de vida (CV) en pacientes menopáusicas con y sin terapia de reemplazo hormonal. Método: Se estableció una investigación de tipo comparativa y aplicada, con diseño no experimental, contemporáneo transeccional y de campo, donde se incluyo una muestra de 200 pacientes con diagnóstico de menopausia. Se les aplicaron los cuestionario de CV SF-36 y el Menopause Rating Scale (MRS). Resultados: Hubo diferencias significativas (p<0,05) en cuanto al dolor físico y altamente significativas (p<0,01), respecto a los síntomas somáticos, psicológicos y urogenitales en las pacientes no tratadas vs las del grupo que recibió TRH. Conclusión: Las pacientes bajo TRH perciben una mayor CV específica respecto a las pacientes que no la reciben, presentando síntomas somáticos o psicológicos menos severos.

Se presentan los resultados de una encuesta realizada a los médicos internos de la Facultad de Medicina de la Universidad de Antioquia, en el segundo semestre de 1997. El proyecto se realizó con el doble propósito de construir conocimiento sobre el tema del climaterio femenino un tema determinado.Se utilizó el censo y las técnicas de encuesta y escala Lickert para indagar sobre variables socioculturales, demográficas y de carácter científico/técnico. Se encontró que el nivel de conocimientos, medido por la &quot;nota&quot;, fue de 2.85 + 0.83; la actitud frente a la terapia fue baja en el 44% y alta en el 40%. Como se había previsto en la hipótesis, la relación entre actitudes y conocimientos fue directa, pero la asociación con variables sociodemográficas no pudo determinarse debido a la homogenidad de la población.

The onset of menopause is unique to every woman with varying symptoms which have implications on health and well-being. This study evaluated the perception, knowledge and beliefs about menopause and the prevalence of climacteric symptoms. The study was a cross-sectional survey of 280 menopausal women aged 45 years and older in the Accra Metropolis of the Greater Accra Region of Ghana. Data on socio-demographic characteristics, knowledge, beliefs and experience of menopausal symptoms were collected using a semi-structured questionnaire. Anthropometric data on weight, height, % body fat and MUAC were also taken. All data were analyzed using SPSS version 16.0 and presented as means and frequencies. Predictors of menopausal symptoms were determined by logistic regression. The mean age of onset of menopause was (48±2.9) years with 98.2% having some knowledge of the signs and symptoms of menopause. The most frequently reported menopausal symptoms by the women were: night sweats (83.2%), h...

El periodo del climaterio es una etapa de transición en la vida de la mujer caracterizada por cambios físicos, psicológicos y sociales. Es una etapa dinámica marcada por la repercusión de los cambios hormonales, principalmente por la paulatina disminución de los estrógenos. La presente revisión bibliográfica describe las características generales del periodo, cambios que ocurren y aspectos a educar en las mujeres durante el climaterio y la postmenopausia, con el propósito de dar una visión actualizada de esta etapa que permita planificar cuidados específicos. Las estrategias educativas planteadas se presentan organizadas en etapas, según la problemática de la mujer en este periodo.

Whereas in the placebo Hormonin randomisation the readings are 78.3mmHg and 78.6mmHg. There was no statistical significant difference. The same was found for 24 hour systolic, sleep systolic and diastolic readings. The urinary nitrite+nitrate creatinine ratios and WBC were not si~i~c~tly effected by treatment. Ho~onin increased serum levels of HDL (~~0.05) and reduced those of LDL (~'0.01). The fibrinogen levels were significantly lower on active treatment (pQ.05). There was no adverse effect of Hormonin in these hype~ensive women. The changes in other cardiovascul~ risk factors were in general benefcial and similar to those described normotensive women.

OBJETIVO: Establecer el nivel de conocimiento y aceptación de la terapia de reemplazo hormonal en las pacientes mayores de 39 años que acuden a consultorio externo, DISEÑO: Estudio transversal, descriptivo, en el Servicio de ginecología del Hospital Nacional Cayetano Heredia entre los meses de febrero y abril de 1995. SUJETOS: 212 pacientes. RESULTADOS: 84% estaban en climaterio o menopausia, los síntomas más reconocidos fueron del tipo neuropsiquiátrico. Tenía conocimiento de la existencia de tratamiento, el 72%, sólo 6% usaba TRH. El 97% acepta hormonoterapia y el 61% mostró disposición a recibirla de por vida: sin embargo, solo 25% tenía conocimiento de los beneficios. Se encontró temor al sangrado y a la gestación en 37% y 58%, respectivamente. Se evidenció que las pacientes de mayor instrucción tenían menor conocimiento de los beneficios de TRH y recibieron mayor información. CONCLUSION: Las pacientes que reciben TRH tienen más conocimientos de los beneficios de la hormonoterap...

OBJECTIVES: To establish knowledge of Peruvian women on climacteric and menopause and their attitude towards hormonal therapy. DESIGN: Transversal, descriptive study based on a survey in different regions of Peru. SUBJECTS: Women over 39 years old. RESULTS: High parity, stable union dependent, housewife, and low grade of education were found. Fifty-four percent of patients define menopause by absence of periods, 51,8% by presence of symptoms, and 47,3% do not identify the cause; 86% know symptomatology, specially hot flushes and neuropsychiatric symtions, and 67,3% present them; 70,5% know about treatment, only 14,9% receive it, 90% wish to receive it, but only 57,3% would accept hormones; 38,2% are afraid of hormones and 69,5% are afraid to conceive if vaginal bleeding returns; 75,6% believe government participation is necessary and 68,7% wish more information on hormonal replacement therapy benefits. Most women think physical exercise, low salt and fat ingestion, and no smoking ar...

Objective: To determine the effect of tibolone treatment on brachial artery pulsatility index (PI), resistance index (RI), and flux-mediated dilation (FMD) in postmenopausal Mexican women. Method: The FMD, PI, and RI of the right brachial artery were measured in 19 postmenopausal women before and after they received a hyperemic stimulus, first at baseline and then following a 6-month treatment with 2.5 mg of tibolone per day. Statistical analysis was performed using the t test. Results: The mean ± SD age was 52.2 ± 3.9 years; time since menopause was 24.6 ± 16.7 months; and treatment duration was 5.7 ± 2.0 months. Compared with prestimulus measurements, a significant poststimulus increase in arterial diameter and a significant decrease in PI were observed at baseline. Compared with prestimulus measurements, a significant poststimulus increase in arterial diameter and a significant decrease in both PI and RI were observed post-treatment. Conclusion: Tibolone treatment had a favorable effect on brachial artery responses to hyperemic stimuli.

We investigated the estrogen-like properties of the methanol extract of Erythrina abyssinica in ovariectomized rats. Climaterix was induced in female rats by surgically removing the ovaries. Data loggers implanted in the abdominal cavity during the procedure recorded core temperatures at predetermined time intervals for 72 h. 6 h after the onset of temperature recording, animals were treated with estrogen (1 mg/kg), methanol extract of Erythrina abyssinica (200 mg/kg) or an equivalent volume of 5% ethanol. Rats treated with extract had significantly fewer hot flashes (171 ± 11 vs. 264 ± 21) which were of shorter duration (683 ± 137 min vs. 1935 ± 345 min) compared to untreated animals. Treated animals had lower core temperature during periods of high activity indicating that the methanol extract of E. abyssinica reduced frequency and duration of hot flashes.

Summary A surrogate FRAX® model for Pakistan has been constructed using age-specific hip fracture rates for Indians living in Singapore and age-specific mortality rates from Pakistan. Introduction FRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the International Society for Clinical Densitometry and International Osteoporosis Foundation have recommended the development of a surrogate FRAX model, based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country. Objective This paper describes the development and characteristics of a surrogate FRAX model for Pakistan. Methods The FRAX model used the ethnic-specific incidence of hip fracture in Indian men and women living in Singapore, combined with the death risk for Pakistan. Results The surrogate model gave somewhat lower 10-year fra...

We assessed the effects of estrogen on vascular dilatory and other homeostatic functions potentially affected by nitric oxide (NO)-potentiating properties in type II diabetic postmenopausal women. BACKGROUND There is a higher cardiovascular risk in diabetic women than in nondiabetic women. This would suggest that women with diabetes do not have the cardioprotection associated with estrogen. METHODS We administered placebo or conjugated equine estrogen, 0.625 mg/day for 8 weeks, to 20 type II diabetic postmenopausal women in a randomized, double-blinded, placebo-controlled, cross-over design. RESULTS Compared with placebo, estrogen tended to lower low-density lipoprotein (LDL) cholesterol levels by 15 Ϯ 23% (p ϭ 0.007) and increase high-density lipoprotein (HDL) cholesterol levels by 8 Ϯ 16% (p ϭ 0.034). Thus, the ratio of LDL to HDL cholesterol levels significantly decreased with estrogen, by 20 Ϯ 24%, as compared with placebo (p ϭ 0.001). Compared with placebo, estrogen tended to increase triglyceride levels by 16 Ϯ 48% and lower glycosylated hemoglobin levels by 3 Ϯ 13% (p ϭ 0.295 and p ϭ 0.199, respectively). However, estrogen did not significantly improve the percent flow-mediated dilatory response to hyperemia (17 Ϯ 75% vs. placebo; p ϭ 0.501). The statistical power to accept our observation was 81.5%. Compared with placebo, estrogen did not significantly change E-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, monocyte chemoattractant protein-1 or matrix metalloproteinase-9 levels. Compared with placebo, estrogen tended to decrease tissue factor antigen and increase tissue factor activity levels by 7 Ϯ 46% and 5 Ϯ 34%, respectively (p ϭ 0.321 and p ϭ 0.117, respectively) and lower plasminogen activator inhibitor-1 levels by 16 Ϯ 31% (p ϭ 0.043). CONCLUSIONS The effects of estrogen on endothelial, vascular dilatory and other homeostatic functions were less apparent in type II diabetic postmenopausal women, despite the beneficial effects of estrogen on lipoprotein levels.

Worldwide, breast cancer is the most common malignant neoplasm and the second most common cause of cancer death in women. This malignancy is recognized to be estrogen-dependent and due to this feature, hormone replacement therapy is regarded as potentially dangerous in breast cancer survivors who seek relief of their menopausal symptoms. Whereas hot flashes are detected in nearly half of postmenopausal women with a relatively high frequency and severity, botanic sources of estrogens have been proposed as an alternative treatment. Nevertheless, estrogenic properties of these compounds suggest possibility of stimulating cancer recurrence or worsening prognosis in survivors. As well, effects in improving vasomotor climacteric changes is controversial. Many studies have considered the subject, some focusing on efficacy of phytoestrogens for control of menopausal symptoms, and others discussing effects of these compounds on breast cancer outcome in terms of survival or recurrence. The present article is a concise review of the effects of consumption of phytoestrogens on menopausal symptoms, namely hot flashes, and breast cancer recurrence and mortality in survivors of the disease. Overall, the major part of the current existing literature is in favor of positive effects of phytoestrogens on breast cancer prognosis, but the efficacy on menopausal symptoms is probably minimal at the best.

Con el fin de establecer si la Terapia de reemplazo hormonal (TRH) esta relacionada con los cambios en la memoria a corto plazo (silabas sin sentido) y la atencion (auditiva y visual), se seleccionaron 50 mujeres menopausicas de tres servicios de ginecologia de la ciudad de Bogota. La investigacion se llevo a cabo comparando dos grupos apareados por pares de 25 mujeres cada uno, cuya diferencia principal consistio en que uno de ellos recibia TRH y el otro no. Los resultados de las pruebas aplicadas mostraron la relacion entre la TRH y el desempeno en memoria y atencion medidos, en el sentido de que se encontraron diferencias significativas en los indicadores de estos procesos cognoscitivos entre el grupo de mujeres que recibian TRH y el grupo sin TRH. Esta investigacion apunta en la direccion del papel de los estrogenos en los procesos cognoscitivos. Finalmente, se sugiere considerar el desarrollo de tecnicas que incidan en estos procesos, para mejorar la calidad de vida de las muje...

Objective: Several reviews have evaluated the clinical evidence relating isoflavone treatment to the relief of menopausal hot flash symptoms. The majority of these reviews included a variety of isoflavone sources, often without discriminating between the identities of individual isoflavones contained in the study product. An evaluation of published studies using wellcharacterized isoflavone-containing supplements was conducted to determine whether the observed effects, or lack thereof, were attributable to differences in the composition of isoflavones in study products. Design: Eleven studies that met the inclusion criteria were stratified according to specific isoflavone composition. Results: All 11 studies contained similar total isoflavone doses. In five studies, involving a total of 177 treated participants, the study product provided more than 15 mg genistein (calculated as aglycone equivalents) per treatment. Each of these five studies consistently reported a statistically significant decrease in hot flash symptoms. In the six studies involving a total of 201 treated participants that provided less than 15 mg genistein per treatment, only one reported a statistically significant decrease in hot flash symptoms. Thus, the reduction in hot flashes was related to genistein dose, not total isoflavone content of the treatments. Conclusion: Reports concluding that isoflavone supplements do not significantly reduce hot flash symptoms may be incorrect. The lack of discrimination between individual isoflavones contained in heterogeneous isoflavone mixtures from differing sources can be misleading when designing studies, interpreting results, and conducting reviews. In light of these observations, evaluation of isoflavone effects should focus greater attention to the specific composition within supplements in future studies.

The aim of this study was to evaluate the effectiveness of a pharmaceutical grade isoflavone supplement (Inoclim ®) 40 mg per capsule of soy extract rich in daidzin and genistin) on the number of hot flashes and night sweats in menopausal African women. This open, prospective, multicenter study involved 140 menopausal women with climacteric symptoms (i.e., a minimum of five hot flashes and/or moderate to severe night sweats per day). These patients received a daily 40-mg supplement of soy isoflavone contained in an Inoclim ® capsule (Laboratoire Innotech International, France). The dose was increased to two capsules per day when there were more than five hot flashes or when the women could not sleep because of night sweats. The patients were followed up over a 4-month period and data were analyzed using EPI-Info TM version 3.5.1. The outcome measure was fewer hot flashes and night sweats. The mean daily number of episodes of hot flashes was 5.7 at baseline and 1.8 at week 16, corresponding to a decrease of 68.4% (n = 93 patients at baseline and n = 66 at 16 weeks). The mean number of daily episodes of night sweats was 3.7 at baseline and 0.8 at week 16, corresponding to a decrease of 78.4% (n = 127 patients in the first week and n = 73 at 16 weeks). Over 80% of patients took a single one 40 mg capsule per day. The percentage of patients who adhered to the prescription was more than 95% during the 4-month follow-up period. These results confirm the effectiveness of a pharmaceutical grade isoflavone supplement (40 mg, rich in genistin and daidzin) on vasomotor symptoms in menopausal women.

Existen, dentro del Sistema Nacional de Salud consultas especializadas con el objetivo de tratar a las pacientes insertadas en el climaterio en las que se le orientan tratamientos y conductas a seguir por la mujer con la ayuda de la familia. Generalmente las feminas asisten buscando la ayuda que necesitan en los farmacos, convencidas de que estos seran la unica solucion a sus molestias. Una de las orientaciones, asociada a los medicamentos es la realizacion de ejercicios fisicos de manera general los que, en la mayoria de los casos, no son realizados por la mujer debido a la falta de orientacion profesional unido a otros factores sociales. En el siguiente trabajo proponemos la conformacion de grupos especializados de mujeres en la etapa climaterica, dirigidos por un especialista en Ginecologia en conjunto con un profesional de la Cultura Fisica quienes orienten ejercicios fisicos dosificados segun las caracteristicas y patologias propias de cada una de las mujeres. Consideramos esta...

Use of food supplements-containing phytoestrogens among postmenopausal women is rapidly increasing. Although phytoestrogens are often perceived as safe, evidence for overall positive risk-benefit profile is still inconclusive. The chance to buy them by user&#39;s initiative does not facilitate surveys on their prevalence and pattern of use. The aim of this study was to describe the pattern of use and self-reported positive and negative perceptions of phytoestrogens in post-menopausa. A questionnaire was administered to women who were buying food supplements containing phytoestrogens in 22 pharmacies located in the Bologna area (400,000 inhabitants). Questionnaire was structured into 3 sections: (a) socio-demographic information, (b) pattern of use, (c) positive and negative perceptions. Data on 190 peri- and post-menopausal women (aged 38-77) were collected. Women stated to use phytoestrogens to reduce hot flushes (79%), insomnia (15%), mood disturbances (14%) and prevent osteoporos...

SUMMARY. This study aimed to evaluate the safety and efficacy of a novel protocol of transdermal Hormone Replacement Therapy (HRT) based on a nanostructured formulation of Estriol (0.1 %) + Estradiol (0.25 %) restoring serum levels and relieving menopausal symptoms. We evaluated 122 women with mean age of 56.88 (± 6.27) as part a longitudinal prospective study on post-menopausal women with natural menopause, received in the right forearm a transdermal formulation of (EE) daily for 60 months. Clinical parameters including the degree of satisfaction with symptomatic relief, serum concentrations of estradiol, weight, blood pressure, and bilateral mammography BI-RADS were compared between the baseline and five years after treatment. New evidence regarding this HRT protocol was assessed. The transdermal nanoformulation estradiol improved clinical parameters. Satisfaction with treatment was 92 %. Serum concentrations of estradiol changed significantly after treatment (p &lt; 0.05). Weight...

El avance de la medicina ha incrementado la esperanza de vida al nacer y el crecimiento de la población mayor a 60 años, siendo cada vez mayor las mujeres en etapa de menopausia. Objetivo: Estudiar la calidad de vida (CV) en pacientes menopáusicas con y sin terapia de reemplazo hormonal. Método: Se estableció una investigación de tipo comparativa y aplicada, con diseño no experimental, contemporáneo transeccional y de campo, donde se incluyo una muestra de 200 pacientes con diagnóstico de menopausia. Se les aplicaron los cuestionario de CV SF-36 y el Menopause Rating Scale (MRS). Resultados: Hubo diferencias significativas (p<0,05) en cuanto al dolor físico y altamente significativas (p<0,01), respecto a los síntomas somáticos, psicológicos y urogenitales en las pacientes no tratadas vs las del grupo que recibió TRH. Conclusión: Las pacientes bajo TRH perciben una mayor CV específica respecto a las pacientes que no la reciben, presentando síntomas somáticos o psicológicos menos severos.