Climacteric Complaints Research Articles

Mastopathie bei partieller testikulärer Feminisierung

We report on a patient with synchrony of mastopathic alterations and incomplete testicular feminization. In the 54-year old patient, typical climacteric complaints as well as mastopathy-associated symptoms occurred. After orchiectomy and subsequent oestrogen substitution, clinical symptoms disappeared.

92059887 Prevalence of climacteric complaints in a representative sample of middle-aged women in Oslo, Norway

92059887 Prevalence of climacteric complaints in a representative sample of middle-aged women in Oslo, Norway

Long-term effect of transdermal hormonal therapy on aspects of quality of life in postmenopausal women

The long-term effect on aspects of quality of life (QoL) of treatment with transdermal oestrogen for 2 weeks followed by transdermal oestrogen/progestogen norethisterone acetate/oestradiol TTS 0.25/0.05 mg/day for the next 2 weeks was investigated in postmenopausal women within the framework of a 1-year seven-centre trial. Of the 136 women who were included (mean age 53 ± 4.8 years), 110 completed the study. Aspects of QoL that are of relevance in the perimenopause and postmenopause were evaluated using the Psychological General Well-Being (PGWB) index, the Women's Health Questionnaire (WHQ) and the Sleep Dysfunction Scale before and after 3 and 9 months of therapy in the oestrogen phase. Climacteric complaints were also assessed by means of the Kupperman Index. Improved well-being, i.e. less anxiety and depression, increased vitality and better self-control ( P < 0.0001) were observed, as well as reduced sleep disturbance ( P < 0.0001). The WHQ showed decreased vasomotor and somatic symptoms, and improved sex life, emotions and cognitive function ( P < 0.0001). Improvement was the same at 3 and 9 months. According to the Kupperman Index, climacteric symptoms were alleviated ( P < 0.0001). Relief of vasomotor symptoms was correlated with improvement in the WHQ ( r = 0.82), the PGWB index ( r = 0.58, P < 0.0001) and sleep ( r = 0.51, P < 0.0001). Because of the absence of a placebo control group, the results must be regarded with caution until confirmed in a placebo-controlled trial.

A new methodological approach to the evaluation of quality of life in postmenopausal women

An approach employing a range of standardized questionnaires, which included the Nottingham Health Profile (NHP), the Psychological General Well-Being (PGWB) index and the Mood Adjective Check List (MACL), was used to assess health-related quality of life (QoL) in conjunction with a study comparing two doses of transdermal oestrogen (50 or 100 μg/24 h) combined with an oral progestogen (5 mg medroxyprogesterone acetate for 14 days each cycle). In addition to the QoL measures, climacteric symptoms were self-rated and also summarized by means of the Kupperman index. In all, 59 women, median age 52 (39–71) years, who completed 4 months of therapy were evaluated. The use of a battery of standardized questionnaires enabled a comprehensive evaluation to be made of perceived health, well-being and day-to-day functioning. Not only was symptomatic relief, e.g. reduced frequency of sweating episodes, sleep disturbance and hot flushes, observed during treatment, but there were also improvements in terms of sleep, energy and emotions. The frequency of health-related problems associated with paid employment, housework, social life, home life and sex life decreased, indicating enhanced ability to take part in daily activities. The PGWB index showed improvement in the subscales representing well-being, anxiety, depression, vitality, health and self-control, while the mood scales indicated that the women experienced less tension and more satisfaction. Although the results of this study need to be further documented on the basis of a placebo-controlled trial, the findings nevertheless imply that the use of a battery of standardized questionnaires optimizes the possibility of evaluating climacteric complaints reliably before and after treatment.

Image of the climacteric woman: a comparison of women attending a university menopause clinic and women participating in a self-help group

The aim of the present study was to find out if there were differences in the image of the climacteric between women visiting the outpatient department of a university clinic because of climacteric complaints and women participating in a self-help group for climacteric women. Furthermore, we investigated the impact of participation in a self-help group on the relationship with the partner. Forty women of each group were matched for civil status, previous hysterectomy with bilateral oophorectomy, and hormone use versus non-hormone use. The tool of the investigation was a self-rating questionnaire with an inventory of age, gynaecological status, number of children still at home, education level, life events during the last 6 months, sports, medication, image of the climacteric, perception of actual life, self-appreciation, vasomotor and nervous complaints, quality of the relationship with the husband and change in this relationship, and finally, sexuality. The data indicate that women seeking primarily a me...

Psychosocial determinants of climacteric complaints

A total of 2349 Norwegian women aged 45–55 years, were investigated using postal questionnaires. Associations between menopausal development, psychosocial factors and climacteric complaints were analyzed. Factor analysis of 24 climacteric complaints identified five factors (vague somatic complaints, nervous complaints, mood lability, vasomotor and urogenital complaints) which were analyzed in relation to stage of menopausal development and a number of psychosocial variables. Five types of variable contributed to the variance in the five previously identified factors, viz. style of reacting to menstruation earlier in life, mother's climacteric complaints, negative expectations regarding the menopause, social network, sociodemographic factors, and chronological age. Menopausal development played a modest role in explaining the variance in all except vasomotor complaints, the latter being associated with current cigarette smoking. Traditional sex-role identification was associated with nervous complaints. The authors conclude that hot flushes, excessive sweating and vaginal dryness are the only complaints clearly attributable to menopausal development.

Clinical and endometrial effects of oestradiol and progesterone in post-menopausal women

This study reports the clinical effects in a group of post-menopausal women after 4 months of treatment with 2 mg micronized 17β-oestradiol (E 2) in combination with different doses of micronized progesterone (50, 100 or 200 mg) for 25 days each month. The 30 participants were divided into three groups. All of the subjects tolerated the preparation well and obtained relief from their climacteric complaints. None dropped out because of side effects and no changes were observed in blood pressure, weight or Papanicolaou cytology. Breakthrough bleeding was noted in the first cycle, mainly in the group receiving the lowest dose of progesterone. Endometrial biopsies performed before and after 4 months of treatment showed an atrophic endometrium in most of the women who received 100 mg progesterone and in all of the women on 200 mg progesterone. The results showed that this new combination of 2 mg E 2 and micronized progesterone in different doses was both effective and well accepted.

Efficacy of sustained-release vaginal oestriol in alleviating urogenital and systemic climacteric complaints

In a double-blind, placebo-controlled study, 109 patients suffering from local and vasomotor postmenopausal complaints were randomly assigned to treatment with either depot vaginal suppositories containing 3.5 mg oestriol (E 3) or a placebo. The treatment schedule comprised one vaginal suppository twice weekly for 3 weeks initially, followed by maintenance therapy with one vaginal suppository weekly for the 6-month study period. The effectiveness of the therapy was assessed on the basis of questionnaires (Kupperman index for vasomotor complaints and an original urogenital index for local complaints) and gynaecological examinations which included assessments of vaginal cytology, vaginal pH and Döderlein bacilli. To rule out induced endometrial proliferation, endometrial biopsies were performed in 50 women before and after the study. The vaginal depot (E 3) formulation showed highly significant superiority over the placebo with respect to therapeutic effect on local urogenital complaints and alleviation of vasomotor complaints, including hot flushes. Analysis of the endometrial biopsies indicated that the monotherapy used caused no endometrial stimulation. Taking into account the minimal rate of adverse effects, the 3.5 mg E 3 depot formulation studied represents a useful variant in the range of preparations available for the treatment of post-menopausal complaints.

Substitutionstherapie im Klimakterium: Soll bei hysterektomierten Frauen auf Progestogene verzichtet werden?

The replacement therapy in postmenopausal women is seen to be for transformation of the oestrogen-stimulated endometrium only, which does not apply to hysterectomised women. Because of the influence of estrane on lipids, one often advises against a replacement therapy with progestogens in hysterectomised women. With increasing knowledge of encountered extragenital functions of sexual steroids, the latter is questionable, if natural progesterone is given, which is (said to be) lipid-neutral, performing the function of the progestogens, which is quite more than reproduction only, more efficiently than estrane or gonane. Due to the competitive blocking of aldosterone the effect of progesterone is sodium-diuretic and diuretic, being as important as the therapy of climacteric complaints, as well as the consequence, which is the result of the physiological connection between progesterone and encephalics. Moreover, the effect of the progestogens is to tonicise the vascular system and is linked to a number of intestinal hormones in order to adjust their function. Therefore, progesterone seems to perform a great variety of extragenital functions. Menopausal women should not be deprived of the benefits of these functions within the framework of a replacement therapy.

Prevalence of climacteric complaints in a representative sample of middle-aged women in Oslo, Norway

The prevalence of 24 complaints was surveyed in eight menopausal age groups in a representative sample of 1886 women, 45-55 years of age, drawn from the population register of Oslo, Norway. Although more than one-third had experienced frequent hot flushes, excessive sweating, muscle and joint pains, and sleeping problems, complaints during the climacteric were reported more rarely than in previous studies. The highest prevalences appeared among the 2-3 years postmenopausal women: 45% hot flushes, 33% excessive sweating, 22% vaginal dryness and 10% mood swings. When prevalence among regularly menstruating subjects was used to adjust for the premenopausal level of complaints, the adjusted prevalences were 34% hot flushes, 25% excessive sweating and 18% vaginal dryness. Mood-related complaints showed no relationship with menopausal age. Among the premenopausal women, however, 57% and 55% reported occasional irritability and moodswings respectively. A short literature review indicates that size of prevalence ...

Hormone replacement therapy: use patterns in 51-year-old Danish women

A survey based on a postal questionnaire sent to all women born in 1936 living in four Copenhagen suburbs ( n = 597, response rate = 88%) revealed an overall prevalence of hormone replacement therapy (HRT) use of 22% and a cumulative incidence of 37%. This paper describes the use of HRT in this population and the patterns of exposure to treatment. Our results indicate that the use of HRT, particularly combined oestrogen-progestogen therapy, is increasing and is being initiated during the pre-menopause. Climacteric complaints were the main reason for starting treatment; only a minority of the respondents were motivated by prophylactic considerations. Forty percent discontinued treatment, the majority stating that they had done so because of unpleasant adverse reactions or lack of effect.

Haemostatic changes during continuous oestradiolprogestogen treatment of postmenopausal women

To identify changes in haemostatic balance during continuous oestradiol-progestogen treatment, 60 postmenopausal women with climacteric complaints, mean age 55.4 years (range 44-68) were randomly allocated to receive one of four hormone replacement regimens for one year. All four formulations were administered daily and continuously, each contained 2 mg of 17 beta-oestradiol in combination with either norethisterone acetate, 1 mg (group A) or 0.5 mg (group B) or megestrol acetate, 5 mg (group C) or 2.5 mg (group D). No significant changes occurred during treatment within or between the groups in platelet count, fibrinogen and 2-antiplasmin. Activated partial thromboplastin time was shortened (P less than 0.05) in group D and a decline in factor VII activity and antigen (P less than 0.001) and in ATIII activity (P less than 0.05) was noted in group A. Protein C tended to decline in all treatment groups but statistically significant changes were noted only in groups A and C. Two women developed crural thrombosis during the observation period.

Clinical use of oestrogens and progestogens

Oestrogens cure climacteric complaints and prevent the late sequelae of oestrogen deficiency. Prevention of myocardial infarction and of osteoporosis is now the main argument for long-term substitution of oestrogens and progestogens in the post-menopause and leads to a reduction of overall morbidity and mortality in users. Indications, contraindications, some side effects, risk-benefit and cost-benefit considerations are discussed and practical advice for oestrogen medication with regard to doses, preparations and the addition of progestogens is given.

Comparison of two hormone replacement regimens — influence on lipoproteins and bone mineral content

Two hormone replacement therapy regimens were tested in a double-blind clinical trial involving 49 patients. In both cases the oestrogen component was 2 mg oestradiol valerate. This was administered for 21 days and sequentially combined for 10 days with either 0.5 mg norgestrel (Cyclo-Progynova) or 1 mg cyproterone acetate (SH D 461 A). Each treatment cycle was followed by a 7-day tablet-free period. Both regimens proved to be equally effective in alleviating climacteric complaints. However, the low-density-lipoprotein cholesterol lowering effect of SHD 461 A was found to be superior to that of Cyclo-Progynova®. There were no changes in bone mineral content during the one-year treatment period with either combination.

Präoperative Reduktion von Uterusmyomen durch das GnRH-Analogon Goserelin (Zoladex®)

The administration of GnRH analogues is expected to improve treatment by avoiding hysterectomy, since problems connected with the surgical removal of leiomyomata are correlated with their size. In this study the GnRH analogue goserelin in its depot formulation (Zoladex, ICI, Plankstadt) was used for treating isolated leiomyomata of the uterus. All patients were treated for 3 months before myomectomy was performed. The complete regression of a large myoma (206 cm3) was observed in 1 of 11 patients. In 5 cases a reduction in volume of more than 50% was achieved. Ovarian function was suppressed by goserelin, after a short-term stimulation, within 7 +/- 3 days. Serum levels of 17 beta-oestradiol were found to be generally less than 25 pg/ml. All patients reported climacteric complaints, but in no case had therapy to be discontinued. After cessation of goserelin, restoration of ovarian function was observed in all patients.

Metabolic effects of continuous estradiol-progestin therapy in postmenopausal women : Obstet. Gynecol. 73/5 I (754–758)/1989

Sixty postmenopausal women with climacteric complaints were randomly allocated to four treatment groups. Without interruption, each patient was given one tablet daily containing 2 mg 17 beta-estradiol along with either norethisterone acetate 1 mg and 0.5 mg or megestrol acetate 5 mg and 2.5 mg. Blood samples were obtained before treatment and then after 1, 4, and 12 months of treatment. Serum was analyzed for cholesterol and triglycerides in serum and for cholesterol in the ultracentrifugally separated lipoprotein fractions of very low-density lipoproteins, low-density lipoproteins, and high-density lipoproteins. Significant reductions of serum cholesterol were found in all treatment groups except for that given 2.5 mg megestrol acetate. After 1 and 4 months of treatment, low-density lipoprotein cholesterol decreased 7-22%, whereas high-density lipoprotein cholesterol was reduced by 2-16% in the four groups. No significant differences could be demonstrated among the groups in low-density lipoprotein cholesterol or high-density lipoprotein cholesterol during treatment, as assessed by analysis of variance. Thus, cholesterol metabolism was equally influenced by both progestin types. Accordingly, the clinical efficacy and acceptance would decide the preparation to be advocated for women in need of hormone replacement therapy.

Carbohydrate metabolism during hormonal substitution therapy

Oestrogens and progestogens are known to influence glucose tolerance. Impairment of glucose tolerance is seen in particular among users of progestogens with androgenic properties. Dydrogesterone is frequently used as the progestogen adjunct during oestrogen substitution therapy for the management of climacteric complaints in post-menopausal women. However, no detailed data have been published concerning its effects on carbohydrate metabolism. In this study, 20 healthy post-menopausal women received equine oestrogens at a dose of 0.625 mg/day for 2 mth, following which dydrogesterone was added cyclically (20 mg/day for 12 days/mth) over a period of 6 mth. Oral glucose tolerance tests were performed before and after each treatment regimen. In relation to the concentrations observed after oestrogen was given alone, dydrogesterone induced only a small increase in blood insulin values which was not statistically significant. The effect was similar to that produced by endogenous progesterone, which is known to be of no clinical significance.

Comparison of four continuously administered progestogen plus oestradiol combinations for climacteric complaints

International Journal of Gynecology & ObstetricsVolume 28, Issue 4 p. 391-391 Citations from the literature gynecological endocrinology Comparison of four continuously administered progestogen plus oestradiol combinations for climacteric complaints T Sporrong, T SporrongSearch for more papers by this authorM Hellgren, M HellgrenSearch for more papers by this authorG Samsioe, G SamsioeSearch for more papers by this authorLA Mattsson, LA MattssonSearch for more papers by this author T Sporrong, T SporrongSearch for more papers by this authorM Hellgren, M HellgrenSearch for more papers by this authorG Samsioe, G SamsioeSearch for more papers by this authorLA Mattsson, LA MattssonSearch for more papers by this author First published: April 1989 https://doi.org/10.1016/0020-7292(89)90623-1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume28, Issue4April 1989Pages 391-391 RelatedInformation

Psychosomatic aspects of females in the climacteric. The climacteric--psychosomatics--personality structure

In this experimental study, the feelings of climacterium in two groups of menopausal women were compared (a test group with climacteric complaints vs a control group without complaints). 70 patients were given a questionnaire: EWL by Janke and Debus, FPI and Giessen-test. The evaluation of the socio-economic data exhibited the fact, that patients in the group with complaints took more drugs than the other group and were more inclined to weight gain. Gynecological data showed significant differences in the beginning and the experience of menstruation. Psychological tests of the group with complaints showed a lack of self-assurance and increased anxiety. These women had also a tendency toward psychosomatic disorders and were less assertive in their social contacts. The discriminant analysis of menopausal and personality variables classified the women equally into the group with complaints compared to the control group.

Analysis of the climacteric syndrome

The climacteric syndrome (CS) was investigated in a large sample of women (over 4000) who spontaneously attended the Menopause Clinic at the University of Bologna between 1976 and 1986. The participants selected had received no hormonal replacement therapy for at least 6 mth or any other drug for at least 3 mth previously. They were all free from any disease that could influence any of the CS symptoms. The frequency of 12 symptoms considered typical of the CS was investigated. The interrelationships between these symptoms were determined as well as the frequency of the occurrence of individual symptoms in association with various climacteric complaints. The results indicated (a) that the CS is not uniform but both variable and individual, (b) that the frequency of its constituent symptoms remains high in advanced fertile age and the advanced post-menopause, (c) that the symptoms are preferentially interlinked, (d) that many, but not all, symptoms exhibit a differentiated pattern during the course of the natural and surgical menopause/age progression, and (e) that hot flushes and sweating, and to some extent insomnia and headache, are menopause-dependent.