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 Summary

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Hormone Replacement Therapy

The beginning of menopause is marked by the last menstrual cycle. This is the result of declining ovarian func tion and reduced synthesis of estrogens and progesterone. Estrogen production in postmenopausal women is usually only about 10 of that in premenopausal women. Almost no progesterone is synthesized in postmenopausal women. Hormone replacement therapy (HRT) generally refers to the administration of estrogen-progestin combinations. Estrogen replacement therapy (ERT) consists of the use of an estrogen alone, usually in the form of conjugated equine estrogens or an estrogen transdermal patch. The four most common symptoms associated with menopause are vasomotor disorders, or hot flashes urogenital atrophy osteoporosis and psychological disturbances. A varying proportion of women may have one or more of these symptoms. One in four postmenopausal women have osteoporosis. Osteoporosis, a decrease in bone mass, constitutes the most serious effect of menopause. It has been estimated...

Pharmacogenetic Interactions in Hormone Replacement Therapy

Combined estrogen and progesterone therapy, whether in the form of oral contraceptive pills (OCP), in premenopausal, or hormone replacement therapy (HRT), in postmenopausal women, is associated with an increased risk for VTE. Although the absolute risk of pulmonary embolism (PE), or deep vein thrombosis (DVT), is low in healthy young women, users of OCP have a three- to sixfold increased risk of VTE compared with the nonusers (43). Traditionally, the estrogen content has been implicated as the cause for increased VTE risk. However, third generation OCP containing < 50 ug of estrogen and synthetic progesterones, desogertrel or gestodone, are associated with a higher risk of VTE than second generation OCPs containing levonorgestrel and norgestrel, supporting a combined hormonal risk model (44). Based on a recent meta-analysis, the increase risk of VTE among HRT users was estimated to be 2.14, compared with the controls (45). The Women's Health Initiative study randomized 16,1809...

Menopause

Several menopause-related changes in sexual function occur that have been described in the literature diminished sexual responsiveness, dyspareunia, decreased sexual activity, decrease in sexual desire, and a dysfunctional male partner. Sarrel29 described the underlying cause of biological changes that occurred with sexual dysfunction to be estrogen deficiency. The postmenopausal ovary has been shown to be responsible for up to 50 of the testosterone believed to be associated with libido. Many clinicians believe that a combination of both estrogen and testosterone is required to improve female sexual function. The effect of menopause on vaginal physiology has been described. There is a pronounced decrease in pelvic blood flow. This in turn results in a thinning of the vaginal mucosa and loss of the normal microbial environment. With the loss of estrogen, there is change in the integrity of the vaginal tube, making it less compliant for coitus. Lubrication is also compromised because...

The menopause

As a human is unlikely to be self-sufficient until aged 14, the menopause may be thought of as timed to precede death by this number of years. The menopause heralds a sharp drop in oestrogen levels, leading to a loss of subcutaneous fat, an ageing appearance, and thinning of the vaginal mucosa leading to dyspareunia, both of which may lower libido. Freedom from contraception and raised levels of luteinizing hormone-releasing hormone may have the opposite effect. Hallstrom (8) reported on the sexual activity of 586 subjects aged 38 to 54. He found that the loss of libido was due more to the menopause than to age, but social factors also played a part. Hawton et a .(9) selected and age-matched 34 menstruating women with 34 who had ceased. Age had more effect than the menopause. McCoy and Davidson1,' followed 43 women through their menopause and found a slight decrease in interest, coital frequency, and responsiveness.

Continence Abnormalities

Menopause is noted to be a risk factor for the development of altered fecal continence. Some preliminary studies have shown a plethora of estrogen receptors in the sphincters of women, and have shown a subjective improvement in fecal incontinence with estrogen therapy.34'35 Aging is also a significant risk factor for fecal incontinence. The prevalence of fecal incontinence is between 9 and 17 in women 75 years or older. The incidence is higher in women (8 1) probably because of a history of obstetric injury and the loss of estrogen.36

Descriptive Epidemiology

Breast cancer incidence has increased over the past 30 years in the U.S.6 This trend is thought to reflect increased diagnosis due to mammographic screening,7 and perhaps also to secular trends in the prevalence of obesity and hormone replacement therapy (HRT) use by postmenopausal women.8 Over the same period, breast cancer mortality rates have declined, reflecting earlier breast cancer detection and treatment, and improvements in breast cancer therapies.9

Female Sexual Dysfunction

Female sexual dysfunction is a generalized term for abnormalities in the normal female sexual cycle. It is a highly prevalent problem affecting anywhere from 30 to 50 of women in all age groups. The National Health and Social Life survey of 1749 women found that 43 complained of sexual dysfunction.20 Only recently have the problems involved with female sexuality gained recognition by clinicians. There are risk factors associated with female sexual dysfunction including age, menopause, previous surgery, mental and physical health, and availability of a partner.

Biological Explanations For The Sex Ratio In Depression

Direct evidence linking hormone status to depressive disorder has some face validity oestradiol and progesterone seem to modulate the neurotransmitter and neuroendocrine systems, including those involving monamines, and there are transitions in women's lives characterized by hormonal shifts that may also be associated with mood disturbance (childbirth and the menopause).

Preventing AD and future treatments

A number of factors such as non-steroidal anti-inflammatory drugs, hormone replacement therapy, and the antioxidant vitamin E, might be of some use in strategies to prevent AD. Prevention could be primary before any signs of the disease or secondary after some manifestation of the process. Primary preventive measures would have to be directed at either the entire population or to groups at risk (identified by family history or genotype, for example), and therefore would have to be entirely benign and almost cost-free to be acceptable. Secondary prevention, possibly in those with memory impairments not amounting to dementia (minimal cognitive impairment), is a more realistic prospect rendering the determination of the very earliest signs of disease or evidence of a prodromal state a high priority. A biological marker for AD would have immense utility in both clinical practice and in clinical trials. Markers suggested have included platelet membrane fluidity and measurement of amyloid,...

Etiology And Risk Factors

Reports from epidemiological studies of protective effects of certain prescribed medication, non-steroidal anti-inflammatory drugs, hormone replacement therapy (HRT) and cholesterol-lowering therapies are now being investigated in randomized controlled trials. The randomized controlled trial of HRT in postmenopausal women indicated, against expectation, that it increased rather than lowered the incidence of dementia.

Physiologic Correlates Of Malignancy

Cells are required for the repair of defects during ovulation. Hence, ovulatory events could promote tumor progression by stimulating the proliferation of ovarian surface epithelial precursor cells. Consistently, early menarche, late menopause, nulliparity, and the use of fertility-stimulating drugs is associated with increased risk for ovarian carcinoma. In contrast, multiple pregnancies, prolonged breast-feeding, and the use of contraceptives decrease the risk.

Cerebral Blood Flow Changes

A lower incidence of stroke and vascular events in premenopausal women has been well documented, as has an increase in these events in women after menopause.7 Although indirect effects of estrogens on cardiac risk factors such as estrogen's lipid-lowering effect are partially responsible, direct effects of estrogen on the blood vessel wall may play an important role. These direct vascular effects of estrogens may also underlie much of the hormone's neuroprotection after brain injury.

Epidemiology And Classification

Thyroid cancer occurs at all ages but is most common among middle-aged and postmenopausal women and in older men (7). According to reproductive status, the female to male incidence ratio varies, from being almost one in childhood, increasing to three from puberty to menopause, and declining to 1.5 by 65 years of age. Overall death rate is less than 10 (7).

Hormonally Mediated Events

Menopause may cause uncomfortable symptoms in many women and can be controlled to a great extent by HRT. Some of these symptoms, hot flashes, fatigue, and bone thinning (leading to osteoporosis) can intensify symptoms and problems related to MS. Osteoporosis has been linked to the treatment of MS with steroids, and this condition may worsen during the peri-menopausal or menopausal state of life.

Predisposing and trigger factors

Migraine, in particular, is said to be subject to certain physiological and external environmental factors. While predisposing factors increase susceptibility to attacks, trigger factors may initiate them. The two may combine. Attempts to control migraine by managing either are often disappointing. A few predisposing factors (stress, depression, anxiety, menopause, and head or neck trauma) are well recognized but not always avoidable or treatable. Trigger factors are important and their influence is real in some patients, but generally less so than is commonly supposed. Dietary triggers are rarely the cause of attacks lack of food is a more prominent trigger. Many attacks have no obvious trigger and, again, those that are identified are not always avoidable. Diaries may be useful in detecting triggers but the process is complicated as triggers appear to be cumulative, jointly overflowing the threshold above which attacks are initiated. Too much effort in seeking triggers causes...

Disorders of sexual desire

In men, the biological component underlying sexual desire is circulating levels of testosterone and, more specifically, bioactive or free testosterone. Schiavi et al.(23) found that men with hypoactive sexual desire had significantly lower levels of testosterone than matched controls. In women, however, hormone-behavioural relationships are more difficult to identify because baseline levels of androgens are substantially lower and less variable than men's and thus more difficult to measure. Measurement is further complicated in women because endocrine profiles are considerably altered during periods of menstruation, pregnancy, lactation, and the menopause. Schreiner-Engel and Schiavi(24) failed to find significant differences in mean levels of free testosterone in young women with hypoactive sexual desire compared to matched controls.

Psychotherapysexual counselling

Clinician has expanded to include helping men couples, regardless of the aetiology of the dysfunction, make use of these new interventions. Thus, the clinician provides assistance in overcoming the resistances to utilizing medical treatments that may help patients and partners develop a satisfying sexual relationship. (43> Sometimes attitudinal or psychological resistances need to be worked through prior to beginning a medical intervention. If not overcome, these forces can render the best-intentioned treatment efforts ineffectual. The therapist can also help the couple to cultivate a romantic ambience and engage in conversations that will physically and psychologically prepare them to become lovers again. Frequently the therapist can also assist the couple in accepting the changes that may have occurred in their lives, for example menopause, disability, illness, or other life stresses.

[3 Site Specific Fluorescent Labeling of Estrogen Receptors and Structure Activity Relationships of Ligands in Terms of

The estrogen receptor (ER) is a ligand-regulated transcription factor that belongs to the nuclear receptor (NR) superfamily and acts as a dimeric species. There are two subtypes of ER, ERa and ERb, which are both mainly regulated by the endogenous estrogen, estradiol (E2). ER modulation is involved in the development and regulation of reproductive, cardiovascular, and bone health, in addition to controlling various aspects of cognitive function.1 In addition to maintaining homeostasis in many tissues, an excessive activity of ER has been correlated with the development and proliferation of certain breast and uterine carcinomas.2 In clinical settings, ER activity is modulated with exogenous estrogen and antiestrogen ligands as hormone replacement therapy (HRT) and as anticancer agents.3

Clinical Significance

The primary utility of genetic testing for RET mutations is to confirm the diagnosis of MEN2, to provide predictive risk-assessment testing for family members, and to facilitate prenatal diagnosis of MEN2. Early detection of a pathogenic RET mutation improves the prognosis for presymptomatic individuals by offering an opportunity for therapeutic intervention prior to advanced disease, metastasis, or both.45-47 There is reduced morbidity and mortality achieved by increased clinical monitoring, prophylactic thyroidectomy (followed by thyroid hormone replacement therapy plus autotransplantation of the parathyroids), or both.1,37 This can be a very effective treatment to prevent disease metastasis. Resected thyroid tissue from children and adults with positive genetic findings demonstrates C cell hyperplasia or microscopic foci of malignancy in the absence of biochemical screening abnormalities or clinical symptoms.47 Thus, genetic testing for RET mutations is a more sensitive and...

Conclusions And Potential Clinical Relevance

Given the current use of melatonin as a popular over-the-counter jet lag and sleeping aid, it is important to understand the potential for cardiovascular effects in people self-administering melatonin. Possible interactions with estrogen are additional considerations for women taking melatonin during puberty, childbearing years and hormone replacement therapy after menopause. In addition, defining the role of mela-tonin in vascular regulation may lead to novel approaches for treating migraine, stroke and cardiovascular disease.

Estrogen and Progesterone

Estrogen and progesterone may exert a protective effect on the upper airway, preventing premenopausal women from developing sleep apnea (19). The role of hormone replacement therapy (HRT) in sleep-disordered breathing was examined in a cohort of 2852 women who were 50 years of age or older and participated in the Sleep Heart Health Study. The prevalence of sleep-disordered breathing (AHI of 15 or more) among hormone users was approximately half the prevalence among nonusers (19). The inverse association between hormone use and sleep-disordered breathing was evident in various subgroups and was particularly strong among women 50 to 59 years old. An earlier study showed that postmenopausal women had a significantly higher mean AHI compared with premenopausal women, and this significant difference persisted even after adjusting for body mass index and neck circumference (20). The effects of HRT on OSA should be taken into consideration when weighing the risk to benefit ratio of HRT for...

Prescription Drug Data

Both generic and proprietary names are used so the ability to differentiate between product types is available. The total amount of drug dispensed is also entered together with the dosing instructions, thus allowing the duration of any prescription to be calculated. Community prescribing data have been entered for selected medications from January 1989 (notably non-steroidal anti-inflammatory drugs, ulcer healing drugs, lipid-lowering drugs and hormone replacement therapy) and all prescribed medications from January 1993. MEMO now has records of 15 million prescriptions dispensed in Tayside up to December 1996.

Influence of Gender on Arteriolar Function in Hypertension

Females prior to menopause are much less susceptible to hypertension and other cardiovascular diseases than males, indicating that gender has a protective effect in these disorders and that female sex hormones can offset some of the alterations in arteriolar function that may occur with hypertension in males. For example, flow-induced arteriolar dilation is significantly reduced in male spontaneously hypertensive rats compared to females, because of the loss of the nitric oxide (NO)-mediated portion of the response. This impairment of the NO-mediated component of flow induced dilation results in a maintained elevation of wall shear stress in the male rats, suggesting that female sex hormones play an important role in maintaining NO-dependent vasodilator responses and in preserving the regulation of arteriolar shear stress by nitric oxide. Arteriolar dilation in response to increases in perfusate flow is also impaired in isolated gracilis muscle arterioles of ovariectomized female...

Variation In Prescribing And Medication Compliance

Prescribing may vary by patient factors that are independent of need or disease severity. For example, the variation of use of hormone replacement therapy by socio-economic status independent of need (Evans et al., 1997a). Compliance to labelled medication direction or therapy is a related issue. By assessing how patients collect dispensed medication, in terms of numbers of prescriptions dispensed and intervals between them, and linking to outcome data sets, patient compliance or non-compliance to medication can be studied. For example, a study in diabetes showed that adolescents in Tayside who have brittle diabetes are often non-compliant with insulin (Morris et al., 1997b).

Clinical evaluation of PMS

The differential diagnosis includes hypothyroidism, anemia, perimenopause, drug and alcohol abuse, and affective disorders. Common alternative diagnoses in patients complaining of PMS include affective or personality disorder, menopausal symptoms, eating disorder, and alcohol or other substance abuse. A medical condition such as diabetes or hypothyroidism, is the cause of the symptoms in 8.4 , and 10.6 have symptoms related

Ovulation suppression

Ovarian suppression with GnRH agonists induces menopause. PMS symptoms will be relieved, but patients experience menopausal side effects, including irritability, insomnia, hot flashes, and vaginal dryness. To prevent osteoporosis, add-back therapy with estrogen and progesterone is required.

Therapeutic options

Contraindications to hormone replacement therapy Family or individual history of breast cancer estrogen dependent neoplasia undiagnosed genital bleeding and a history of or active thromboembolic disorder. B. Hormone replacement therapy should be considered to relieve vasomotor symptoms, genital urinary tract atrophy, mood and cognitive disturbances, and to prevent osteoporosis and cardiovascular disease. It also may be considered to help prevent colon cancer, Alzheimer's disease, and adult tooth loss.

Hereditary Breast Ovarian Cancer

Not, however, eliminate the risk for primary peritoneal cancer, which is estimated to range from 1.9 to 10.7 .85 Furthermore, premenopausal women choosing this option must consider the long-term consequences of surgically induced menopause. Similarly, prophylactic mastectomy does not completely eliminate the risk of subsequent breast cancer, although a recent retrospective review of 2,029 women who had elected the procedure for a variety of reasons estimates a greater than 90 reduction in risk.86 This finding was supported by a prospective study of BRCA1 2 carriers in which no breast cancers were observed in the 76 women who underwent prophylactic mastectomy.87 This consideration occurs most commonly among women from high-risk families or those with known BRCA1 2 mutations who are making treatment choices for their first primary breast cancer, given the increased rate of second cancers in the same breast as well as the contralateral breast in that setting. Another indication for the...

Schizophrenia and paranoid disorders

When viewed across the lifespan, the incidence of schizophrenia shows strong age-group differences. (33) In males, the incidence rises steeply in adolescence, reaching a peak in the early twenties and then steadily declines to old age. Females show a similar rise in young adulthood with a subsequent drop, but there is also a second peak around the time of menopause. This second peak may occur because oestrogen delays the onset of schizophrenia in some vulnerable women. In younger adults, males have a higher incidence of schizophrenia, whereas in later life females have the higher incidence.

Hormonal Influences on the Pelvic Floor

Reproductive hormones, especially estrogen, have a significant impact on pelvic floor function. Hormonal changes that occur during a woman's lifespan impact many aspects of female physiology. With the onset of menopause, it becomes evident that estrogen sensitivity is greatest in the central nervous system and the genital tissues. The most frequently occurring initial symptoms of estrogen deprivation include hot flushes, mood changes, and emotional irritability. These central nervous system symptoms are promptly reversible with systemic estrogen replacement. More prolonged duration of estrogen deprivation will lead to other known consequences such as osteoporosis and urogenital atrophy. It is estimated that 80 of postmenopausal women have hot flushes, and that not all women will develop osteoporosis. However, urogenital atrophy occurs universally. Interestingly, many women with urogenital atrophy are asymptomatic.1 Many treatments are currently available for prevention of and therapy...

Chapter References

McCoy, N and Davidson, J. (1985). A longitudinal study of the effects of menopause on sexuality. Maturitas, 7, 203-10. 19. Sherwin, B., Gelfand, M., and Brender, W. (1985). Androgen enhances sexual motivation in females a prospective cross-over study of sex steroid administration in the surgical menopause. Psychosomatic Medicine, 47, 339-51.

Symptomatology of Urogenital Atrophy

We require a greater understanding of the natural history and symptomatology of urogenital atrophy. Although the occurrence of urogenital atrophy is universal after menopause, most women are asymptomatic. In a recent trial,we attempted to correlate the symptoms of urogenital atrophy with objective assessment of urogenital atrophy severity.1 We found no significant correlation between atrophy symptomatology and objective assessment tools such as maturation index, vaginal pH, or visual examination. It is thus unclear why some women become highly symptomatic of their urogenital atrophy, whereas others remain completely asymptomatic.

Hormonal Impact on Colorectal Function

Very few data are available regarding the impact of estrogen deprivation after menopause on colorectal function. Many of the changes in colorectal function, such as increased incidence of hemorrhoids and weakening of the anal sphincter are thought to be age-related, rather than caused by hormonal changes. However, estrogen receptors have been found in the external anal sphincter, and there is some anecdotal evidence that local estrogen therapy may be useful in the treatment of hemorrhoids.8

Few Words Regarding Womens Health Initiative

Recent reports regarding the adverse effects of combination hormone replacement therapy found during the Women's Health Initiative (WHI) trial have further fueled the controversy regarding the usage of estrogen therapy in postmenopausal women. The WHI is a National Institutes of Health-funded study beginning in 1993 evaluating the influence of postmenopausal management on cardiac disease, breast and colon cancer, and fractures. The study intervention groups included a low-fat diet group, calcium and vitamin D supplementation group, conjugated equine estrogens-alone group, combined conjugated equine estrogens and medroxyprogesterone acetate group, and a placebo group. The findings reported in 2002 demonstrated an increased risk of deep venous thrombosis, stroke, myocardial infarction, and breast cancer in women in the combination estrogen progestin group. There was a reduction in colon cancer and risk of bone fractures. The adverse changes were only seen in the combination hormonal...

Prevalence Of Overweight And Obesity

The observed association between obesity and colorectal cancer is generally more consistent and stronger for men than for women and for colon cancer than for rectal cancer.33 Some studies found that WHR is a strong predictor (of the same strength as BMI) of colorectal cancer risk, especially for women.36,42,44,52-55 The association is also generally stronger and more consistent for cancer of the distal colon than the proximal colon.36,39,40,52,54-58 A meta-analysis of 13 studies on BMI and colon cancer found that the observed associations were of similar strength for cohort and case-control studies, and that the pooled estimates were statistically significant for both male and female but larger for men than for women.34 Excess weight early in life appears to be at least as important as recent excess weight in relation to colorectal cancer risk.40,45,54,56,58 One large population-based case-control study found that estrogen modifies the association between BMI and colon cancer risk...

Preparation For Pregnancy

Menstruation continues in most women until about age 50. At this time, a woman no longer ovulates. Most of a woman's follicles have either matured and ruptured or degenerated. Without follicles, the ovaries cannot secrete enough estrogen and progesterone to continue the menstrual cycle, and menstruation ceases. This stage is called menopause (MEN-uh-PAWZ).

Multipurpose Databases

Failure of clarity at this stage could doom the study from the onset. Investigators interested in a particular hypothesis can often be mesmerised by the apparent abundance of information available to them. They should keep in mind that it is crucial to restrict themselves to appropriate comparisons. Thus if one is looking at the effect of, say, hormone replacement therapy on osteoporosis, the relevant outcome measure available in such databases is generally a fracture. However, not all fractures are relevant. Indeed, most are irrelevant to the hypothesis, as they will have an obvious and sufficient cause, such as a road traffic or other accident, an underlying neoplasm or pre-existing bone disease. Similarly, not all exposures to hormones are relevant. For example, it would seem unlikely (biologically implausible) that a single prescription for such treatment would be relevant to the outcome of interest. Trained epidemiologists are used to thinking of chance, bias and confounding as...

Reproductive and Developmental Toxicology Carole A Kimmel PhD Judy Buelke Sam

Gametogenesis Males And Females

Reproductive senescence occurs with advancing age, depletion of oocytes, and loss of normal ovarian cycling. As indicated earlier, agents that enhance atresia of oocytes may produce early depletion and untimely reproductive senescence. The long-term consequence of early menopause is an increased risk of a number of associated diseases, including heart disease and osteoporosis. Cigarette smoking has been shown to reduce the age at onset of menopause by as much as 2 years (42). In addition, Mattison and Thorgeirsson (43) showed that benzo a pyrene, which occurs in tobacco smoke, can kill oocytes in mice. 2.4 Male Reproduction

Estrogen and Lupus Human and Animal Studies

Tion of these immune complexes triggers inflammation, culminating in widespread tissue damage (Abdou et al., 1981). Gender is a strong risk factor for SLE since this disease primarily affects women in the reproductive years and the female-to-male susceptibility ratio can be as high as 13 1 (Rider and Abdou, 2001). SLE has been associated with situations where levels of gonadal hormones are changing such as during pregnancy, postpartum period, menopause, and during estrogen administration. The first onset of the disease is unlikely to occur before puberty or after menopause. Pregnancy has been associated with flares of lupus (Wilder, 1998). SLE disease activity fluctuates with the menstrual cycle (Bruce and Laskin, 1997) and lessens after menopause (Mok et al., 1999). The flares of lupus have been reported to increase during in vitro fertilization when levels of female hormones, particularly estrogen, are clinically manipulated (Guballa et al., 2000). Further, although not unequivocal,...

Mechanisms Underlying Low Grade Inflammation During Aging

A second potential mechanism resides in endocrine changes during aging. In aging, dysregulation of secretion of hormones that come under the regulation of the HPA axis may occur. This may have impact on the regulation of cortisol secretion. Cortisol is important as an anti-inflammatory agent. The effect of aging on glucocorticoid (GC) sensitivity of pro-inflammatory cytokine production was examined in elderly men, testosterone-treated elderly men, and young controls. Stress-induced increases in cortisol did not differ significantly between experimental groups, but GC sensitivity increased significantly in young controls and testosterone-treated elderly men, whereas a decrease was found in untreated elderly men. As the increase in GC sensitivity after stress serves to protect the individual from detrimental increases of pro-inflammatory cytokines, the disturbed mechanism in elderly men may result in enhancement of inflammation. The decrease in sensitivity is linked to decreased...

The Molecular Basis Of The Tissue Specificity Of Brca1associated Tumors

In addition to dysregulated transcriptional activity of ERa, prolonged estrogen exposure is also a well-documented risk factor for breast cancer (68, 74-78). Ovaries, specifically ovarian granulosa cells, are the primary source of estrogen in premenopausal women. This explains why early menarche and late menopause are associated with increased risks of breast cancer (79). Aromatase (Cyp19) is expressed in a restricted number of steroidogenic tissues including ovaries. The enzyme catalyzes the conversion from androgen to estrogen, the rate-limiting step in estrogen biosynthesis (80). Recently published work from our laboratories suggests that expression of BRCA1 in ovarian granulosa cells is inversely correlated with that of aromatase during steroidogenesis (81). Importantly, small interfering RNA (siRNA)-mediated knockdown of BRCA1 or its partner BARD1 resulted in elevated aromatase expression and its enzymatic activity in ovarian granulosa cells (81). In an independent study, Dubeau...

Pharmacologic Therapy Of Obstructive Sleep Apnea Drugs that Increase Respiratory Drive See Also Chapter

The prevalence of sleep apnea increases after menopause, suggesting that female hormones may play a protective effect on sleep-disordered breathing (83). Medroxyprogesterone (Cycrin , Provera ) is a respiratory stimulant and has been used to treat OSA by increasing central neural drive to the pharyngeal muscles. Strohl et al. (84) demonstrated improvement in 4 9 patients with OSA in an uncontrolled study of note, three of the four subjects who improved were hypercapnic suggesting that they may have had an element of obesity-hypoventilation syndrome in addition to OSA. Subsequent studies, however, have not been as impressive, with mild to no improvement of OSA after treatment with progesterone (85,86), even in postmenopausal women (87). Furthermore, the combined use of estrogen and progesterone does not appear to be effective (88).

Reproductive Endocrine Function Ovarian Dysfunction

Alkylator therapy (e.g., busulfan, melphalan, or thiotepa) are at particularly high risk of developing ovarian failure (Thibaud et al. 1998 Sklar 1999). Furthermore, even if female patients recover ovarian function after treatment is completed, a significant proportion of these patients are at risk of experiencing premature menopause in the future (Byrne et al. 1992). Radiation-induced ovarian failure is also common in female cancer survivors. As with chemotherapy, pre-pubertal ovaries seem to be more resistant to damage from irradiation than post-pubertal ovaries. Radiation doses above 1000-2000 cGy can, however, cause irreversible ovarian damage in young girls (Stillman et al. 1981 Wallace et al. 1989a) therefore, young females who receive abdominal, pelvic, or spinal irradiation for tumors such as neuroblastoma have a high risk of ovarian failure (Shalet et al. 1976 Stillman et al. 1981 Wallace et al. 1989a Wallace et al. 1989b). Moreover, we can extrapolate that the concomitant...

On Adult Presentations

Diminishes with time, however, and both sexes achieve a similar incidence by age 50 (43). A study of OSA incidence and its risk factors found the risk for sleep apnea in men increased only marginally with age, while it increased very significantly in women the OR (confidence interval) for increased AHI per 10-year increase was 2.41 in women (1.78-3.26) and only 1.15 (0.78-1.68) in men (43). A study of Hong Kong women found a 12-fold rise in the prevalence of sleep apnea in women between the fourth and sixth decades (31). There is a large amount of literature to support the role of menopause in modulating this increased risk for sleep apnea in women around the age of 50 (44-46). In general, men and women are present with the same constellation of sleep-related symptoms and complications (47). Women with OSA may be slightly older, more obese, more likely to use sedatives, and complain of insomnia and depression (48).

Tumors of the Lacrimal

Epidemiology Keratoconjunctivitis sicca as a result of dry eyes is one of the most common eye problems between the ages of 40 and 50. As a result of hormonal changes in menopause, women are far more frequently affected (86 ) than men. There are also indications that keratoconjunctivitis sicca is more prevalent in regions with higher levels of environmental pollution.

Testicle Shrinkage Treatment

Very Small Testicular Size

If you are approaching menopause, discuss your options for hormone replacement therapy (HRT). Menopausal symptoms, your potential for developing osteoporosis, and your risk for developing cardiovascular disease should be part of this discussion.

Using Serum Igf1 As A Surrogate Endpoint Biomarker Of Developing Primary And Secondary Breast Cancer

This effect was investigated further in a phase III drug trial using fenretinide (a synthetic retinoid). The trial looked at whether the administration of the drug could reduce the risk of contralateral and recurrent ipsilateral breast cancer in treated breast cancer patients between ages 30 and 70. Fenretinide which inhibits cell growth and induces apoptosis was shown to reduce the risk of secondary breast malignancy in premenopausal women by 35 . Incidentally, this reduction in risk corresponded to a reduction in circulating IGF-1 which was observed one year after drug administration only in premenopausal women but not in postmenopausal women (51). The observed modulation of IGF-1 by Fenretinide together with its clinical effects of secondary cancer risk suggests that a decline in IGF-1 levels may at least partially account for its chemopreventive activity. A 2 * 2 randomised trial of fenretinide and low dose tamoxifen and another randomised trial involving fenretinide and women on...

Upper Airway During Wakefulness

Breathing is markedly increased in men (98,116). Explanations of these gender-related differences are multi-factorial and include differences in body fat distribution, hormones, control of breathing, upper airway dimensions, and abnormalities in the upper airway mechanics. Investigators have compared normal males and females using acoustic reflection, cephalometry, CT, and MRI and have found many anatomical differences. Women have been shown to have a smaller upper airway (52,117), smaller neck size (118,119), more fat distributed to the lower body and extremities (peripheral fat distribution) (120-122), smaller airway soft tissue structures volume (17,122,123), and shorter upper airway length (17). The differences listed above are not widely established findings except for body fat distribution. Men with OSA have demonstrated a more collapsible upper airway during non-rapid eye movement (NREM) sleep when compared to BMI-matched women with OSA (125). Inconsistent data exist with...

The Association Between Serum Igf1 And Breast Cancer Risk

The first prospective study on this relationship was performed by Hankinson et al. (18) who carried out a case-control study by retrospectively measuring serum IGF-1 on blood samples collected from 397 women who subsequently developed breast cancer against 620 age-matched controls. The results showed that when looking at the overall group, there was no relationship between serum IGF-1 and risk of developing breast cancer. However, on sub-analysis based on menopausal status, there was a significant association between elevated serum IGF-1 and breast cancer risk in women who were premenopausal at the time of blood collection (50). A subsequent larger case-control study by Schernhammer et al. involving 800 breast cancer patients and 1,129 age-matched controls also showed that serum IGF-1 levels were modestly associated with an increased breast cancer risk among premenopausal women only (45, 51). Other studies have confirmed that this risk was not present in postmenopausal women with high...

Beef pork lamb and vealTotal fat grams

Research shows that a person's risk of developing heart disease and diabetes is greatly increased when fat is distributed above the waist, such as the abdomen area. Males tend to gain weight in the waist which places them at greater risk than females, who tend to gain weight below the waist. Sometimes this is called the apple or the pear referring to the shape of the body. The apple shape is not exclusively male. The hormonal changes of menopause tend to cause a shift of weight from the hips to the waist. In addition, women after the age of menopause are at increased risk of heart disease, like males. I am going through menopause. Is this preventing me from losing weight Humans tend to gain weight as they age. This is due to a number of factors including a changing set point, a change in muscle mass, a change in fat distribution and often a decrease in physical activity. Menopause generally occurs around the age of 50, which is the time when all of these factors come into play....

Antidepressants and Female Sexual Dysfunction

Selective SSRI medications may effectively combat the FSD associated with the SSRI. It is also important to recognize that FSD may present with many of the same symptoms as depression, such as poor energy and lack of interest. We have seen numerous patients who were misdiagnosed as having depression, and placed on SSRI drugs (making their FSD worse ), when in fact the primary problem was FSD. Successful management of the underlying cause of the FSD (e.g., hormone replacement therapy for androgen insufficiency syndrome) has allowed many women to stop using antidepressant medications and regain a normal sex life.

Primary Sex Organs Ovaries

About 2 weeks after an ovum is released, if it is not fertilized, menstruation occurs. Menstruation involves the loss of all but the basal layer of the endometrium. This process includes bleeding. It first occurs at puberty and lasts until menopause (45-55 years of age). After menopause, pregnancy is no longer possible.

Growth hormone deficiency

Growth hormone deficiency is probably the most common endocrine expression of hypopituitarism. Acquired growth hormone deficiency in adulthood results in reduced muscle strength and exercise capacity, reduced thermoregulation and sweating ability, subnormal kidney function, decreased lean body mass and bone mineral density, abnormal thyroid hormone, lipid, and carbohydrate metabolism, myocardial dysfunction, and impaired social well being, and it leads to increased mortality due to cardiovascular disease (De.Boer.et.al 1995). Growth hormone replacement therapy in growth-hormone-deficient adults improves these symptoms.

Potential Risk Factors

Menopause Postmenopausal women are more likely to have UI than premenopausal women. Evidence that atrophy of the urogenital mucosa can be reversed with estrogen suggests that estrogen loss contributes to the problem. However, the literature is inconsistent in describing the role of menopause and estrogen loss as significant contributors. Rekers et al.21 compared premenopausal women with postmenopausal women and found no significant difference in the prevalence of UI between the two groups. Another study found that women who experience surgical menopause had a higher rate of UI (36 ) compared with those who experience natural menopause (22 ).22 The role of hysterectomy is controversial. Some studies have shown significant association between UI and hysterectomy, as well as oophorectomy. Brown et al.23 explained this association by the fact that hysterectomy may disturb the musculofascial attachments of the bladder to the surrounding pelvic wall, and oophorectomy results in surgical...

Sexual Function after Pelvic Surgery

Pelvic surgery to correct prolapse may affect sexual function for a number of reasons including narrowed vaginal canal, poor lubrication, and fear of urinary incontinence. Some studies suggest that sexual dysfunction can occur up to 20 of the time after surgery for prolapse or incontinence. It is thought that the vaginal dissection may lead to pelvic floor neuropathy affecting the pudendal nerve, which subsequently affects vaginal sensation and orgasm. Hysterectomy has been associated with sexual dysfunction. It is thought that removal of the cervix alters the upper portion of the vaginal canal and causes a neuropathy, which is the source for dyspareunia as well as anor-gasmia. However, studies in the literature are conflicting as to the exact cause of sexual dysfunction after hysterec-tomy.22 Another possible cause for dyspareunia is poor estrogenization of the vaginal mucosa in those women who undergo surgical menopause at the time of a hysterectomy. Techniques used to repair the...

Cancer And Phytoestrogens

Therefore the association of high body mass index (BMI) with increased risk may not be through increasingly dense mammographic patterns in postmenopausal women due to the increase of fatty tissue in the breast.23 High-risk patterns and high BMI, although both risk factors, are negatively confounding.24 Thus, the reduced occurrence of dense patterns with increasing age is consistent with the mammographically dense tissue being replaced by fatty tissue after menopause.23 In the Shanghai breast cancer study soyfood intake was associated with a decreased risk of breast cancer.25 The study included 1459 cases and 1556 age-matched controls. Women in Shanghai had levels of soy intake considered high i.e., soy consumption was at least once a week. The women with the highest consumption had a 30 reduced risk of breast cancer with stronger reduction for ER-positive subjects compared to subjects who were ER negative. In this situation there was even greater reduction among women with a...

Breast cancer screening

The aim of screening for this disease is to identify pre-invasive disease or invasive disease before dissemination (through the lymphatics or blood). There is no evidence that simple breast self-examination is an effective means of screening for breast cancer. X-ray mammography is the most sensitive technique for detecting breast cancer and is also the most specific. Mammography is most sensitive once involution of the breast tissue has occurred (i.e. once the menopause has taken place). The test is less sensitive in women with dense breasts that is those with predominantly glandular tissue or residual stromal tissue.

Adverse Effects Of Treatment With Thyroid Hormone

In patients with longstanding hypothyroidism and those with ischemic heart disease, rapid correction of hypothyroidism may precipitate angina, cardiac arrhythmias, or other adverse effects. For these patients, replacement therapy should be started at low initial doses, followed by slow titration to full replacement as tolerated over several months. If hypothyroidism and some degree of adrenal insufficiency coexist, an appropriate adjustment of the corticosteroid replacement must be initiated prior to thyroid hormone replacement therapy. This prevents acute adrenocortical insufficiency that could otherwise arise from a thyroid hormone-induced increase in the metabolic clearance rate of adrenocortical hormones.

Humana Press

Thorner, 1999 18. Menopause Endocrinology and Management, edited by David B. Seifer and Etienne-Emile Baulieu, Paul Robel, and Michael Schumacher, 1999 15. Autoimmune Endocrinopathies, edited by Robert Volp , 1999 14. Hormone Resistance Syndromes, edited by J. Larry Jameson, 1999 13. Hormone Replacement Therapy, edited by A. Wayne Meikle, 1999 12. Insulin Resistance The Metabolic Syndrome X, edited by Gerald M. Reaven

Other exposures

Other exposures account for 5 or less of the cancer burden. Occupational exposures have been linked with lung, bladder, and haematopoietic malignancies. Breast cancer has consistently been associated with early age at menarche, late age at first birth, and late age at menopause with relative risks of the order of 2.0 or less. Parity is associated inversely with endometrial and ovarian cancer.

Reproductive Factors

At the time of menopause, age-specific incidence rates of breast cancer slow markedly, and the rate of increase in the postmenopausal period is only about one sixth the rate of increase in the premenopausal period. In their study, Tri-chopolous and colleagues18 found that women who experienced natural menopause (defined as cessation of periods) before age 45 had only one half the breast cancer risk of those whose menopause occurred after age 55.

Exogenous Hormones

More recently, Marchbanks et al.78 report null findings from the large Women's CARE study (Women's Contraceptive and Reproductive Experiences) that included more than 9000 subjects recruited in five U.S. sites. Although they found case subjects had significantly lower parity, older ages at first birth, higher reports of family history of breast cancer, later age at menopause, and less use of hormone replacement therapies, they found no significant association between current OC use (RR 1.0 95 CI 0.8 to 1.3) or former use (RR 0.9 95 CI 0.8

Atrophy

As modern medicine continues to improve, life expectancy will continue to increase. It has been estimated that, there are currently more than 25 million women who will live 30 years beyond menopause. Menopause by definition is an estrogen-deficient state resulting in physiological changes to many female organs. The urogenital organs, including the urethra, bladder, vagina, and vulva, are highly estrogen dependent. Blood flow to the pelvis is also estrogen dependent. Without an appropriate estrogen level, urogenital atrophy will develop. This means that 100 of women who enter into the menopausal state will develop atrophy of the urogenital system. the normal sex response cycle, leading to dyspareunia. In addition, there is increased incidence of vaginal and urinary tract infections. The signs as well as the symptoms of atrophy probably begin before a woman completes the transition into menopause. However, the degree of estrogen deficiency that results in an atrophic state is unknown to...

Vagina

Histologically, the vaginal wall is composed of three layers. The most superficial layer is stratified squamous epithelium. The middle layer is the lamina propria and consists of collagen and elastin. The lamina propria contains no glands. Vaginal lubrication is via a transudate from the vessels, cervix, and from the Bartholin's and Skene's glands. Coursing through the lamina propria are small blood vessels. The innermost layer is the muscularis that consists of smooth muscle. The histology of the vaginal layers may change with menopause.

Utilising The Data

When new data become available from purpose-designed studies it is important that they are reviewed in the context of the existing data. An assessment should be made as to whether and how the new evidence changes the previous evaluation, focusing particularly on the strength of the evidence for a drug-related association and possible approaches to prevention. In the latter respect, detailed analysis of the data to identify possible risk factors for the hazard is important. Suppose that a rare hazard has been identified along with several risk factors. It may well be that the benefits of the medicine are clearly sufficient to outweigh the hazard overall but not in particular individuals with risk factors for the outcome. An example of this would be venous thromboembolism (VTE) with hormone replacement therapy (HRT). The risk of VTE is two to three times greater in users than non-users of HRT (Castellsague et al., 1998), i.e. there is an increased relative risk. However, the probability...

Clinical Evaluation

The first step in the diagnostic work-up is identification of the problem. Unfortunately, few women volunteer any history of FSD, and therefore information should be actively elicited as part of the routine medical history. A simple approach for a clinician could be,Many woman report that once they reach menopause, they experience changes in sexual function Have you noticed any changes in your sexual function or desire The idea is to offer an open-ended question and opportunity for the patient to realize 1) she is not alone, 2) you are interested in helping her, and 3) successful treatments are available. Various questions regarding the length of time since the onset of sexual dysfunction, libido issues, ability to become sexually aroused, poor lubrication, ability to achieve orgasm, and dyspareunia should be asked to further classify the sexual dysfunction (e.g., hypoactive sexual desire disorder). Any history of abuse should be elicited. The history should also include any...

Involve Your Family

Your loved ones may be puzzled by your failing memory and may not connect it with the same demyelinating process that has you walking with a cane and going to the bathroom every half hour. Family members and friends need to be educated concerning the realities of cognitive dysfunction and MS. Without accurate information, those around you may attribute your cognitive changes to stress, depression, age, menopause, stubbornness, laziness, or any of a myriad of other mistaken notions.

MPO Polymorphisms

Two polymorphisms have been identified in the promoter region of the MPO gene, 463G A and 129G A, which reduce MPO enzyme activity in neutrophils, with the 463G A showing gender- and age-specific effects (122). Examination of women on hormone replacement therapy revealed an association of the lower-activity 463A allele and increased progression of atherosclerotic lesions (123), and examination of men found increased fibrotic lesions associated with the 463A allele in men under the age of 53 years (124). In studies of brain infarction, an association with outcome rather than cause was reported, with patients with G-129 allele showing larger brain infarction, and patients with G-463 allele demonstrating worse short term functional outcome (125).

Lingual Thyroid

Ectopic lingual thyroid is a rare developmental anomaly due to failure of the thyroglossal duct to migrate cau-dally from the foramen caecum 13 . It is seen in females about four times more frequently than males and usually presents in middle age. The lingual gland is seen in the base of the tongue, deep to the foramen caecum. It is often asymptomatic, but may cause dysphagia, dyspho-nia or dyspnoea. Symptoms may coincide with puberty, pregnancy or the menopause due to hyperplasia secondary to raised levels of thyroid-stimulating hormone. In addition, any of the diseases involving the conventional thyroid gland, including inflammatory conditions, adenomas and carcinomas, can affect the ectopic thyroid tissue.

Blood Pressure

Between men and women and is therefore protective against hypertension. This is further supported by the observation that after menopause, when plasma estrogen concentrations are low, a woman's risk for hypertension is equal to that of men at a similar age.56 It follows then that natural plant estrogens such as soy isoflavones may have similar beneficial effects on blood pressure. In this section, we discuss the few published studies about the effects of soy and soy isoflavones on blood pressure.

Hypopituitarism

Hypopituitarism is when multiple pituitary hormone secretion is diminished. It can be due to either gland destruction or inadequate stimulation by factors that regulate pituitary functioning. Common causes of hypopituitarism are pituitary adenomas, hypothalamic tumours, metastatic carcinoma (especially breast and bronchus), and cerebral trauma and haemorrhage 73) Other causes include vascular disorders, immunological conditions, and a variety of congenital anomalies. Clinical manifestations depend on which hormones are deficient signs and symptoms are those of the individual deficiency states described previously. Other signs that may be present when there is hypopituitarism include headache, visual loss, and radiographically discovered sella enlargement. Treatment of patients with hypopituitarism involves hormone replacement therapy and surgery when accessible lesions are present. (73>

Vitamins

Rapola et al. found that beta-carotene significantly increased the number of fatal heart attacks among men with previous heart attack who smoked.8 Without a good explanation of why this effect has been observed, it would be safest to advise smoking patients who have known heart disease to avoid beta-carotene and other vitamin A supplementation completely for the time being. However, an epidemiological study suggests that a diet rich in beta-carotene may lower a woman's risk of breast cancer after menopause, so a complete avoidance of beta-carotene supplementation for everyone is certainly not being recommended at this time.9 Further research may be needed to determine if supplemented beta-carotene is significantly less desirable than dietary beta-carotene. Certainly, as a general rule, supplemented nutrients can never be as desirable as dietary nutrients.

Osteoporosis

Bone loss in women accelerates at the onset of menopause on average at a rate of approximately 3 per year for the first 5 years and 1 per year thereafter. Hip fractures frequently occur 15-25 years after menopause and result from the reduced bone mass. Other fractures associated with osteoporosis include fractures of the vertebrae, distal forearm, and proximal humerus. E. Genitourinary symptoms. Withdrawal of estradiol during menopause results in thinning of the mucosal layer. The vaginal and urethral mucosa appear pale, dry, and flattened. These changes are associated with vaginal dryness, dyspareunia, atrophic vaginitis, urethritis, and urinary incontinence. Use of systemic estrogen replacement or local estrogen creams and urethral suppositories can reverse these changes.

Breast cancer

An increased risk of breast cancer has been associated with the extended duration of endogenous estrogen exposure such as that which occurs with early menarche, late menopause, and obesity. 2. Some evidence suggests a small increase in breast cancer risk after 10-15 years of estrogen supplementation. No consistent link between hormone replacement therapy and breast cancer has been found. Because women with prior breast cancer have an increased risk for a second primary breast cancer, close surveillance is warranted.

Completed suicide

As at all ages, more old men commit suicide than old women. In the United States the ratio is as high as 4 to 1.(23> Rates in men show a more or less linear increase with age, but those in women tend to fall after the menopause. As mentioned above, suicide incidence (at any age) can vary quite considerably from country to country, and there is some evidence to suggest that older men who emigrate retain the incidence of their country of origin rather than the one to which they go. (24>

Vaginal Atrophy

Upon initiation of local hormone replacement therapy, there is a prompt revascularization of the vaginal and ure-thral mucosa. This can be clinically detected within 6 weeks of initiation of local estrogen therapy. As might be expected, vaginal irritative symptoms (i.e., tingling, itching) may occur during the initiation of the neovascularization process. These symptoms are typically short-lived.

Levothyroxine Sodium

Levothyroxine sodium (Levothroid, Synthroid, Levoxine) is the sodium salt of the naturally occurring levorota-tory isomer of T4. It is the preparation of choice for maintenance of plasma T4 and T3 concentrations for thyroid hormone replacement therapy in hypothyroid patients. It is absorbed intact from the gastrointestinal tract, and its long half-life allows for convenient once-daily administration. Since much of the T4 is deiodi-nated to T3, it is usually unnecessary to use more expensive preparations containing both T4 and T3.The aim is to establish euthyroidism with measured serum concentrations of T4,T3, and TSH within the normal range.

Liothyronine Sodium

Liothyronine sodium (Cytomel) is the sodium salt of the naturally occurring levorotatory isomer of T3. Liothy-ronine is generally not used for maintenance thyroid hormone replacement therapy because of its short plasma half-life and duration of action. The use of T3 alone is recommended only in special situations, such as in the initial therapy of myxedema and myxedema coma and the short-term suppression of TSH in patients undergoing surgery for thyroid cancer. The use of T3 alone may also be useful in patients with the rare condition of 5'-deiodinase deficiency who cannot convert T4 to T3.

Health needs

People with mental retardation need to have access to regular health screening.(35) In later life, women at risk of osteoporosis should be offered hormone replacement therapy. Pictorial health education materials are available to help health-care professionals provide information about illness, medical procedures, and treatment to people with limited verbal communication.*3.6)

Conclusions

Soy appears to have weak estrogenic activity when taken after menopause but may block the effects of more potent estrogens (thereby reducing breast cancer risk) when used before menopause. It can reduce menopausal symptoms but is less effective than estrogen in this regard. Although long-term high soy diets Black cohosh may reduce menopausal symptoms, and it appears safe and well tolerated for at least a 6-

Endometrial Cancer

Incidence rates rise steadily 5 to 10 years prior to menopause and peak at age 65-70. Except in Japan where the death rates have doubled since 1970, especially among younger women, worldwide there is a decreasing mortality rate due to endometrial cancer. Early detection is considered the likely reason for improved survival 3, 40 . Cited as the best-recognized risk factor. This exposure may be exogenous (estrogen-only HRT) or endogenous, due to low parity, polycystic ovary syndrome, estrogen-secreting tumors, early menarche or late menopause 3, 41 . However, MRI staging accuracy is diminished when uterine zonal architecture has been distorted, e.g. by fibroids or when the junctional zone is not present, as can be the case among women after menopause. Moreover, in very early stages of endometrial carcinoma, the MRI findings are non-specific 49 . Ciatto et al. 55 followed 2 240 asymptomatic women after menopause as well as 1 220 women with abnormal uterine bleeding (AUB). For...

Phytoestrogens

Those found in soy products, as a potential alternative to the synthetic estrogens in HRT (24,36,42,43). Together with lig-nans, coumestans, flavones, and flavanones, isoflavones belong to the larger group of nonsteroidal phytoestrogens. Interest in phytoestrogens has been fueled by observational studies showing a lower incidence of menopausal symptoms, osteoporosis, cardiovascular disease, and breast and endometrial cancers in Asian women who have a diet rich in soy products. Consistent with epidemiological studies are the findings that soy phy-toestrogens prevent mammary tumors and bone loss in rodents and atherosclerosis of coronary arteries in monkeys. Soy protein relieves hot flashes in postmenopausal women and attenuates bone loss in the lumbar spine of perimenopausal women. Furthermore, a high intake of dietary phytoestrogens is associated with a lower incidence of cancers of the colon, breast, and prostate. Isoflavones and other phytoestrogens have been considered to exert...

Gonadotropins

LH and FSH are pituitary hormones secreted in pulsatile fashion approximately every 2 hours. In women before menopause, this pattern is superimposed on much larger changes that occur during the normal menstrual cycle. FSH is released in substantial amounts during the follicular phase of the menstrual cycle and is required for proper development of ovarian follicles and for estrogen synthesis from granulosa cells of the ovary. Most LH secretion occurs in an abrupt burst just before ovulation. LH is required for progesterone synthesis in luteal cells and androgen synthesis in thecal cells of the ovary. FSH stimulates spermatogenesis and synthesis of androgen-binding protein in Sertoli cells of the testes. LH stimulates testosterone production from Leydig cells. Production of LH and FSH is controlled by gonadotropin-releasing hormone (GnRH) from the hypothalamus and by feedback control from target organs through steroids and multiple forms of a protein, in-hibin.

Cervical Cancer

Squamous carcinomas usually arise from the squamo-columnar junction whose position varies with age. Before puberty and after the menopause it is situated inside the endocervical canal. At puberty, oestrogen influenced cervical eversion occurs, followed by squamous cell metaplasia, which has the potential to de-differentiate into squamous cell carcinoma. Adenocarcinomas arise within the endocervical canal and are more likely to remain occult, delaying clinical presentation.

Regulatory Theories

Among women taking estrogen-progestin pills. In 2006, multiple clinical studies showed that breast cancer rates in the United States dropped in 2003, consecutive to a drastic reduction in the use of hormone replacement therapy. Some of the numbers came from the National Cancer Institute's surveillance database, which uses cancer registries around the country to project national incidence and death rates.

Allergy

Skin and blood tests may be required to find the source of an allergy. For chronic hives, check with a physician that the thyroid is functioning properly and that there are no antithyroid antibodies present. Thyroid hormone replacement therapy may be necessary. Although they may be necessary in acute situations, commercial antihis-tamines merely suppress allergy symptoms and can cause drowsiness and depression. Vitamin C is a natural antihistamine. For hives and itching, a colloidal oatmeal product or cornstarch added to the bath can relieve symptoms.

Cancer

For women, breast and reproductive cancers can be caused by high levels of estrogen in the blood. Estrogen stimulates cell reproduction. Contributing to estrogen in the body are birth control pills and hormone replacement at menopause. Meat, poultry, and dairy foods may contain traces from animals that have been given the hormone for growth and pesticides and industrial pollutants contain what are called xenoestrogens or foreign estrogens.

Insomnia

As we age, the body requires less sleep. Natural progesterone may be helpful for PMS and menopause-related sleeplessness as a hormone imbalance can cause irritability and sleep disturbances. Exercise in the late afternoon or early evening can promote better sleep. Mela-tonin is only effective if there is a deficiency or body levels are low.

Prophylactic Surgery

Prophylactic oophorectomy may be performed laparoscopically on an outpatient basis in the vast majority of women, with low morbidity and mortality. However, aside from perioperative risks and issues associated with early menopause, patients should be carefully counseled that the procedure might not be entirely protective. Because primary peritoneal cancer has been reported to occur in 0.8-11 of high-risk women even after prophylactic oophorectomy (67,181-183) thorough exploration of the pelvic and abdominal cavity should be performed at the time of surgery. Also, complete meticulous histological assessment of the ovaries should be performed, in order to exclude the presence of occult malignancy, which has been reported to occur in 2-4 of women undergoing prophylactic oophorectomy (181,184-186). Given the documented increased risk of fallopian tube carcinoma in women with BRCA1 and BRCA2 mutations, the surgeon should take care to remove the entire fallopian tube. Without performing...

Minerals

Calcium is the most abundant mineral in the body. Ninety-eight percent is found in the bones, 1 in teeth, and 1 in other tissues. When the body is at rest, calcium is pulled out of the bones to be used elsewhere, establishing the importance of daily adequate intake of the mineral and of exercise. Calcium helps regulate nerve transmissions and along with magnesium, is important for cardiovascular health. If muscles do not have enough calcium, they cannot contract or if contracted, do not relax, which results in cramps. The mineral is good for relaxation and improves the quality of sleep. During the hormonal shifts of menopause, the dominance of the parathyroid hormone causes calcium to be removed from bone resulting in osteoporosis.

Female Athlete Triad

The decreased levels of female hormones during amenorrhea can lead to calcium loss from the bones and increase the likelihood of developing osteoporosis later in life. Osteoporosis is a major cause of bone fractures in the elderly. Bone density throughout the adult lifespan is greatly impacted by the amount of bone formed prior to the early thirties. Therefore, amenorrhea and eating disorders in young adults can negatively affect bone health for life. Prior to menopause, a healthy diet (including adequate calcium intakes) and the performance of weight bearing activities are the two factors that have the greatest positive influence on bone health (see Chapters 3, 4, 5, and 7).

Menstrual Problems

Endometriosis develops when cells from the lining of the uterus migrate outside the uterus. These cells still respond to the monthly hormonal cycles and release blood during menses. However, the blood has nowhere to go and so the area becomes inflamed and painful. Uterine fibroids are benign muscle tumors produced when estrogen activity is high as they depend on estrogen for growth. They appear in pre-menopausal women and shrink at menopause and in the absence of estrogen replacement therapy. They do not turn malignant. Birth control pills add to estrogen levels in the body. Symptoms of uterine fibroids include a feeling of fullness, frequent urination, and heavy and cramping menstruation.