Menstrual Cycle In Premenopausal Women Research Articles

Apparent Diffusion Coefficients of Normal Uterus in Premenopausal Women With 3.0-T Magnetic Resonance Imaging

To investigate the apparent diffusion coefficients (ADCs) of the normal uterine zonal structures (myometrium, endometrium, and junctional zone) during different phases of the menstrual cycle among premenopausal women with different age groups. Magnetic resonance (MR) images of 67 healthy women were obtained during the midproliferative and midsecretory phases. They were further divided into 3 age groups: group A (age range, 20-29 years); group B (age range, 30-39 years), and group C (mean age, 44.62 years; age range, 40-49 years). All the women underwent 3.0-T MR scanning twice. The ADC values were compared among each uterine zonal structure and 3 age groups and were calculated between the midproliferative and midsecretory phase. The ADC values among each uterine zonal structures were significantly different from one another (P < 0.001). The ADC values for endometrium in women in their 30s were higher than those in their 20s and in their 30s during the midproliferative and midsecretory phases (P < 0.05), and the ADC values for endometrium in each age groups were lower during the midproliferative phase than those during the midsecretory phase (P < 0.05), but there were no statistical differences in the myometrium and the junctional zone between the 2 phases or among age groups (P > 0.05). These preliminary results suggested that the zone, age, and phase of the menstrual cycle in premenopausal women should be considered when interpreting the ADC values of uterine structures (especially for endometrium).

P5-01-09: Differences in Serum Estradiol and Prolactin Concentrations in Women Who Yield Nipple Aspiration Fluid and Those Who Do Not.

Abstract Introduction: Nipple aspiration fluid, NAF is an important biosample for breast cancer research, but its utility is limited by the fact that the fraction of NAF-yielders varies from 35% to 90% in various studies. NAF yielders (Y) and non-yielders (NY) are known to differ in demographic characteristics, but the systemic endocrine profiles of Y and NY populations have not been studied, and may affect the generalizability of findings in studies of NAF. Methods: A subset of participants from an ongoing case-control study was included (120 cases, 120 controls). Cases are women presenting to the Lynn Sage Breast Center with newly diagnosed unilateral breast cancer, and controls are women presenting to the Lynn Sage Mammography Center who do not have cancer. NAF collection was attempted on all consented subjects; those yielding ≥2 uL NAF were designated as Y and those yielding &amp;lt;2 uL NAF were NY (120 Ys, 120 NYs). Menopausal status, age, race, menstrual cycle phase, mammographic density, and serum hormone levels were also collected. Differences between Y and NY groups were tested using a t-test for age, χ2 for race, and Wilcoxon Sum Rank Test for serum hormone levels. Mammographic density was quantitated using digital or digitized images and the CUMULUS software. Linear regression was used to test the relationship between a logged serum hormone values and if a patient yielded adjusting for phase of menstrual cycle in premenopausal women. Results: Mean ages of Ys and NYs were not different 51.0 and 52.6, respectively (p=0.11). The distribution of Ys by race (Caucasian, African American, other), was not different (χ2 p=0.58). Median serum prolactin concentrations were higher in Ys than NYs for both pre- (7.0 and 2.5 ng/ml) and post-menopausal (5.6 and 2.4 ng/ml) women, respectively (both p&amp;lt;0.01). Median serum estradiol was lower in yielding premenopausal patients only (pre- 90.5 and 64.3 pg/ml p=0.02; post- p=0.59). Stratifying the premenopausal women further into cases and controls, the difference only held for cases and not for controls (p=0.02, p=.033). In the premenopausal patients the regression models suggested that these relationships for estradiol and prolactin remain even after adjusting for phase of the menstrual cycle. No differences in Ys versus NYs were found for progesterone, follicle stimulating hormone, or sex hormone binding globulin. Mammographic density was not different for Ys as compared to NYs for pre- (22% and 20%, p=0.83), but was marginally lower for post-menopausal Ys versus NYs (11% and 15% density; p=0.07). Following stratification of the postmenopausal women into cases and controls, the cases who yielded had significantly lower than NYs (11% and 19% density, p=0.03), but the control Ys and NYs were not different (10% and 11% density, p=0.65). Conclusion: Pre- and post-menopausal women who yield NAF display increased serum prolactin levels, whereas decreased estradiol levels were observed in premenopausal NAF Ys. These findings suggest that NAF yield has systemic endocrine determinants, with implications for biomarker research on NAF samples. Further characterization of Y and NY women is important, along with standardization of methods of NAF collection, since NAF yield varies widely between studies. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-01-09.

Estrogen Regulation of Duodenal Bicarbonate Secretion and Sex-Specific Protection of Human Duodenum

The reason that women have a lower prevalence of duodenal ulcer is not clear. We investigated whether estrogen regulates human duodenal bicarbonate secretion (DBS) and whether this process accounts for sex differences in the prevalence of duodenal ulcer. We performed an epidemiologic study to correlate duodenal ulcer prevalence with sex and age. Proximal DBS was measured from healthy subjects. Estrogen-receptor expression was examined in human duodenal mucosa by immunoblot and immunohistochemical analyses. Among women, the prevalence of duodenal ulcer was significantly lower than among men. The reduced prevalence was greatest among premenopausal women (20-49 y), who were 3.91- to 5.09-fold less likely to develop duodenal ulcers than age-matched men; the difference was reduced to 1.32-fold or less among subjects aged 60 years or older. Premenopausal (20-29 y), but not postmenopausal (60-69 y), women had significantly higher basal and acid-stimulated DBS than the age-matched men. Basal and acid-stimulated DBS in premenopausal women (20-29 y) were significantly higher than in postmenopausal women (60-69 y), whereas there were no significant differences in basal or acid-stimulated DBS between men who were aged 20-29 years or 60-69 years. Serum levels of estradiol changed in parallel with basal and acid-stimulated DBS during the physiological menstrual cycle in premenopausal women. 17β-estradiol-stimulated DBS was independent of age or sex. Estrogen receptors α and β were detected on plasma membranes and in the cytosol of human duodenal epithelial cells. Estrogen regulates human DBS, which could reduce the risk for duodenal ulcer in women and contribute to sex differences in the prevalence of duodenal ulcer.

A propósito de un caso: falso positivo en pelvis en un estudio PET-TAC debido a una reimplantación ovárica

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography (PET-CT) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After a clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article shows the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relationship with the menstrual cycle of pre-menopausal women.

False positive in pelvis in a PET-CT scan due to ovarian reimplantation: A case report

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography scan (PET-CT scan) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article demonstrates the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relation to the menstrual cycle of premenopausal women.

Optimal Timing of Breast MRI Examinations for Premenopausal Women Who Do Not Have a Normal Menstrual Cycle

The objective of this article is to describe a method for timing breast MRI examinations corresponding to the follicular phase of the menstrual cycle in premenopausal women without cyclical menses, thereby reducing the number of false-positive findings and nondiagnostic examinations. Serum progesterone concentrations corresponding to the follicular phase of a normal menstrual cycle can aid in optimal scheduling of breast MRI examinations for premenopausal women who lack cyclical menses.

Role of Estrogen and Endothelium in Migraine in Young Women

HomeStrokeVol. 40, No. 12Role of Estrogen and Endothelium in Migraine in Young Women Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBRole of Estrogen and Endothelium in Migraine in Young Women Kazushi Tsuda, MD, FAHA Kazushi TsudaKazushi Tsuda Cardiovascular and Metabolic Research Center, Kansai University of Health Sciences, Osaka, Japan Search for more papers by this author Originally published5 Nov 2009https://doi.org/10.1161/STROKEAHA.109.566489Stroke. 2009;40:e705Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: November 5, 2009: Previous Version 1 To the Editor:We read with great interest the recent article by Tietjen and colleagues1 dealing with migraine and endothelial activation in young women. The results of their study demonstrated a strong relation between migraine and endothelium-related biomarkers, including von Willebrand factor activity, high-sensitivity C-reactive protein, and total nitrite/nitrate concentration, in a young, relatively healthy cohort of women. The authors suggest that, in premenopausal women with migraine, there is evidence of increased endothelial activation, a component of endothelial dysfunction. They further propose that an understanding of the role of endothelium in migraine may provide a rationale for multiple avenues for stroke prevention in migraineurs.Numerous studies have shown that estrogen may have beneficial effects on cardiovascular functions. One of the mechanisms underlying the protective effect of estrogen may be the enhancement of nitric oxide production. There is evidence showing that vascular endothelial function is markedly influenced by estrogen and improved by hormone replacement therapy in postmenopausal women.2 In an in vitro study presented earlier, we demonstrated that 17β-estradiol increased membrane fluidity (a reciprocal value of membrane microviscosity) of erythrocytes and improved the rigidity of cell membranes in women through the nitric oxide- and cGMP-dependent mechanism.3 Because abnormalities in membrane microviscosity could cause a disturbance in rheological behavior and microcirculation, these findings indicate that estrogen deficiency might be involved in the pathophysiology of vascular complications in women. On the other hand, it has been demonstrated that endothelial function varied during the menstrual cycle in premenopausal women, suggesting that sex hormone status would have a crucial role in cardiovascular risk and other disease processes in premenopausal women.4 Kawano et al5 also demonstrated a menstrual cyclic variation of myocardial ischemia in premenopausal women. Therefore, we would like to know whether menstrual cycle-related endogenous estrogen status might be associated with the endothelial biomarker levels and the magnitudes of migraine in young women in the study of Tietjen and colleagues. It would be important to assess more precisely the relationships between estrogen status and endothelial function during the menstrual cycle and their contribution to the pathogenesis of migraine in young women.DisclosuresNone.1 Tietjen GE, Herial NA, White L, Utley C, Kosmyna JM, Khuder SA. Migraine and biomarkers of endothelial activation in young women. Stroke. 2009; 40: 2977–2982.LinkGoogle Scholar2 Higashi Y, Sanada M, Sasaki S, Nakagawa K, Goto C, Matsuura H, Ohama K, Chyayama K, Oshima T. Effects of estrogen replacement therapy on endothelial function in peripheral resistance arteries in normotensive and hypertensive postmenopausal women. Hypertension. 2001; 37: 651–657.CrossrefMedlineGoogle Scholar3 Tsuda K, Kinoshita Y, Kimura Y, Nishio I, Masuyama Y. Electron paramagnetic resonance investigation on modulatory effect of 17β-estradiol on membrane fluidity of erythrocytes in postmenopausal women. Arterioscler Thromb Vasc Biol. 2001; 21: 1306–1312.CrossrefMedlineGoogle Scholar4 Williams MR, Westerman RA, Kingwell BA, Paige J, Blombery PA, Sudhir K, Komesaroff PA. Variations in endothelial function and arterial compliance during the menstrual cycle. J Clin Endocrinol Metab. 2001; 86: 5389–5395.CrossrefMedlineGoogle Scholar5 Kawano H, Motoyama T, Ohgushi M, Kugiyama K, Ogawa H, Yasue H. Menstrual cyclic variation of myocardial ischemia in premenopausal women with variant angina. Ann Intern Med. 2001; 135: 977–981.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails December 2009Vol 40, Issue 12 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.109.566489PMID: 19892993 Originally publishedNovember 5, 2009 PDF download Advertisement

The effect of an aromatase inhibitor (AI) on the endometrium and hormones when administered continuously to premenopausal women

OBJECTIVE: Objective was to characterize the effect of high dose anastrozole (ANZ) on the endometrium and endogenous hormones over a single complete menstrual cycle in premenopausal women. DESIGN: Multi-center, placebo-controlled, randomized clinical trial. MATERIALS AND METHODS: Female volunteers 25 - 45 years of age were randomized to ANZ or placebo (PBO) (19/group). Treatment was for 26 consecutive days. After obtaining informed consent, subjects were ineligible if they had pre-existing endometrial pathologies or significant concurrent illnesses. Subjects received initial dose of blinded medication on Cycle Day 2; subjects randomized to ANZ, received a loading dose of 20 mg and then 10 mg/day. Endometrial thickness was measured at each visit and assessed at a central reading laboratory. Blood samples were collected and hormone levels were assayed at a central laboratory. Clinic visits corresponded to Cycle Days 2, 6, 8, 12, 15, 21, and 27. Analyses of variance and covariance were used to assess for treatment effects. RESULTS: Demographic characteristics were similar for both groups. Both groups had similar endometrial thickness at the start of treatment (ANZ group = 5.19 mm; PBO group = 5.53 mm) and no significant differences were observed at any time point. Mean E2 levels were comparable between the two groups at the start of the treatment (ANZ =42.5 pg/ml and PBO = 45.9 pg/ml). ANZ treatment significantly suppressed peak E2 levels during the cycle by approximately 40% (ANZ =70.1 pg/ml vs. PBO =123.1 pg/ml; p<.05). There were no apparent affects of continuous ANZ on any other sex steroid or gonadotropins. No safety differences were observed. CONCLUSIONS: This is the first known trial in which high dose ANZ was administered to premenopausal women for an entire menstrual cycle. While ANZ significantly suppressed endogenous E2, the magnitude of this suppression was not sufficient to effect endometrial thickness. No other effects on endogenous hormones were obtained.

The Pattern of Growth Hormone Delivery to Peripheral Tissues Determines Insulin-Like Growth Factor-1 and Lipolytic Responses in Obese Subjects

The Pattern of Growth Hormone Delivery to Peripheral Tissues Determines Insulin-Like Growth Factor-1 and Lipolytic Responses in Obese Subjects

Vascular Endothelial Estrogen Receptor α Is Modulated by Estrogen Status and Related to Endothelial Function and Endothelial Nitric Oxide Synthase in Healthy Women

ABSTRACT Context and Objective Estrogen receptor α (ERα), a potent transcription factor expressed in vascular endothelial cells, plays a key role in regulating vascular function and health. We determined whether vascular endothelial cell expression of ERα is influenced by estrogen status and is related to vascular endothelial function in healthy women. Methods ERα protein expression was measured (quantitative immunofluorescence) in endothelial cells from peripheral veins of 16 healthy, premenopausal women during the early follicular (EF) and late follicular (LF) phases of the menstrual cycle and 17 estrogen-deficient postmenopausal women. Endothelial-dependent dilation (EDD; brachial artery flow-mediated dilation) and endothelial nitric oxide synthase (eNOS) expression and activation were also measured in a subgroup of women. Results In premenopausal women (n = 10), ERα expression was 30% lower (P &amp;lt; 0.001) during the EF (low estrogen) compared with the LF (high estrogen) phase of the menstrual cycle. In postmenopausal women, ERα expression was 33% lower (P &amp;lt; 0.001) compared with the LF phase of the menstrual cycle in premenopausal women. ERα expression was strongly related (r = 0.67; P &amp;lt; 0.001) to EDD, which was reduced in postmenopausal women. ERα abundance was positively related to expression of eNOS (r = 0.54; P = 0.009; n = 21) and ser1177 phosphorylated eNOS (r = 0.59; P = 0.006; n = 20). Conclusions These results provide the first evidence that expression of ERα in vascular endothelial cells is modulated by estrogen status and may be a key determinant of vascular endothelial function in healthy pre- and postmenopausal women. ERα expression may influence vascular endothelial function in women by affecting protein levels and activation of eNOS.

Vascular Endothelial Estrogen Receptor α Is Modulated by Estrogen Status and Related to Endothelial Function and Endothelial Nitric Oxide Synthase in Healthy Women

Estrogen receptor alpha (ER alpha), a potent transcription factor expressed in vascular endothelial cells, plays a key role in regulating vascular function and health. We determined whether vascular endothelial cell expression of ER alpha is influenced by estrogen status and is related to vascular endothelial function in healthy women. ER alpha protein expression was measured (quantitative immunofluorescence) in endothelial cells from peripheral veins of 16 healthy, premenopausal women during the early follicular (EF) and late follicular (LF) phases of the menstrual cycle and 17 estrogen-deficient postmenopausal women. Endothelial-dependent dilation (EDD; brachial artery flow-mediated dilation) and endothelial nitric oxide synthase (eNOS) expression and activation were also measured in a subgroup of women. In premenopausal women (n = 10), ER alpha expression was 30% lower (P < 0.001) during the EF (low estrogen) compared with the LF (high estrogen) phase of the menstrual cycle. In postmenopausal women, ER alpha expression was 33% lower (P < 0.001) compared with the LF phase of the menstrual cycle in premenopausal women. ER alpha expression was strongly related (r = 0.67; P < 0.001) to EDD, which was reduced in postmenopausal women. ER alpha abundance was positively related to expression of eNOS (r = 0.54; P = 0.009; n = 21) and ser1177 phosphorylated eNOS (r = 0.59; P = 0.006; n = 20). These results provide the first evidence that expression of ER alpha in vascular endothelial cells is modulated by estrogen status and may be a key determinant of vascular endothelial function in healthy pre- and postmenopausal women. ER alpha expression may influence vascular endothelial function in women by affecting protein levels and activation of eNOS.

Bone turnover marker profile in relation to the menstrual cycle of premenopausal healthy women

To explore the bone turnover marker profile during the menstrual cycle of premenopausal women. This was a noninterventional study. Levels of bone turnover markers, including serum C-terminal telopeptide of type I collagen (sCTX), bone-specific alkaline phosphatase, osteocalcin, procollagen type 1 N propeptide, and urinary N-terminal telopeptide of type I collagen, were measured in blood and urine samples during one menstrual cycle. Levels were expressed as raw test results and percent change from serum luteinizing hormone peak. Differences in mean levels of bone turnover markers between menstrual phases and subphases were examined. Fifty-five women comprised the per-protocol population. Mean sCTX values were 0.48 ng/mL during the follicular phase (FP), 0.47 ng/mL at serum luteinizing hormone peak, and 0.43 ng/mL during the luteal phase (LP). Additionally, the mean percent change from luteinizing hormone peak varied from +4.35% during the FP to -5.11% during the LP (P = 0.0014). Mean sCTX levels during the early and through mid FP were significantly higher than levels during the mid and late LP. The pattern for urinary N-terminal telopeptide of type I collagen was similar to that of sCTX but not statistically significant. There was a statistically significant tendency for procollagen type I N propeptide levels to be lower during the FP relative to the LP. Levels of osteocalcin and bone-specific alkaline phosphatase did not vary significantly during the menstrual cycle. Levels of some bone turnover markers varied during the menstrual cycle. A statistically significant change in sCTX (9.46%) occurred between the FP and LP of the menstrual cycle.

Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast cancer.

Recent studies have suggested that the timing of surgery in relation to the menstrual cycle might influence survival of premenopausal women with operable breast cancer. The data of 96 premenopausal patients who underwent primary surgery for operable breast carcinoma between 1975 and 1988 were analysed. At 10 years, disease-free and overall survival rates of patients whose initial surgery was 1-12 days after the starting date of the last menstrual period (follicular phase) were significantly poorer compared with survival of those who underwent operation more than 12 days after the last menstruation (luteal phase) (disease-free survival rate 40 versus 72 per cent, P = 0.002; overall survival rate 40 versus 79 per cent, P = 0.001). These differences in survival remained significant in a second analysis based on the menstrual phase at the time of both initial and definitive operation. Menstrual phase had the greatest impact on the survival of patients with positive axillary nodes (P = 0.009). Prospective studies are required to elucidate the relationship between the timing of all surgical procedures during the menstrual cycle and survival.

Models of breast cancer growth and investigations of adjuvant surgical oophorectomy.

Clinical observations of the natural history of breast cancer and its response to a variety of therapeutic interventions have contributed to changing concepts about the growth and metastatic spread of this disease. Increased attention has been given to tumor cell dormancy and the occurrence of greatly delayed metastatic disease development, which has been important to rethinking therapy. Although gene profiling of breast tumors recently has highlighted the importance of individual tumor characteristics in patients' prognosis, considerable data also support the concept of breast cancer as a problem of macro- and microenvironmental regulatory imbalance and dynamic chaos. Observations of unexpectedly large survival benefits from adjuvant surgical oophorectomy done in the luteal phase of the menstrual cycle in premenopausal women are consistent with an interpretation that extratumoral interactions in the host environment are important in prognosis. These observations also suggest that a treatment paradigm shift from an exclusive focus on cell kill and specific tumor cell molecular targets to one focused also on broad host regulatory control may be useful. Clinical trials and laboratory mechanistic investigations based on these data and observations can determine the potential impact of therapeutic interventions targeting host system macro and micro tumor cell environments.

Gender, Estrogen, and Schizophrenia

Most of the evidence to support an association between estrogen and psychosis is indirect and comes from clinical studies of gender differences in schizophrenia and from studies of fluctuating levels of psychopathology in different phases of the menstrual cycle. Our data, as well as those of other investigators, suggest a significantly later age at onset of schizophrenia in women than in men. There is somewhat more direct evidence from animal studies indicating that estrogen modulates dopamine systems in a manner similar to neuroleptics, although there are some inconsistencies in the literature. Few studies have examined the effects of estrogen administration in conjunction with neuroleptics on psychotic symptoms. We present a case report of a postmenopausal woman with schizophrenia who had an improvement in positive symptoms with estrogen replacement therapy. Long-term double-blind treatment studies are needed to investigate the effects of estrogen on psychotic symptoms in women with schizophrenia.

Screening for androgen deficiency in women: methodological and interpretive issues

Objective: To appreciate the problems in obtaining and interpreting androgen levels in women. Design: Review of the literature to compare various laboratories and methods of analysis of serum androgens. Patient(s): Normal control populations culled from the literature to compare with patients previously reported on by us; data from our laboratory quality control compared with data from the literature. Result(s): Investigators and laboratories disagree as to the best methods of measuring testosterone (T) levels in women. Measuring DHEAS levels is much less controversial. Conclusion(s): Serum T levels should be measured in the morning hours and during the middle third of the menstrual cycle in premenopausal women. DHEAS levels may be measured at any time. Androgens decrease with age, but age-related levels are not accurate because current control populations have never been screened for sexual dysfunction. Such control populations need to be obtained.

Summaries for patients. Blood flow to the heart varies during the menstrual cycle in premenopausal women with heart disease.

Summaries for Patients4 December 2001Blood Flow to the Heart Varies during the Menstrual Cycle in Premenopausal Women with Heart DiseaseSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-11-200112040-00004 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What is the problem and what is known about it so far?In ischemic heart disease, blood vessels that supply the heart muscle become blocked. If blood flow to an area of heart muscle is blocked for a prolonged period, that area of heart muscle dies and is replaced by scar tissue, a condition commonly known as a heart attack. Blockages in blood flow that do not last long enough to cause the death of heart muscle can cause a type of chest pain known as angina. Before menopause, women are much less likely than men of similar age to ... Author, Article, and Disclosure InformationAffiliations: The summary below is from the full report titled “Menstrual Cyclic Variation of Myocardial Ischemia in Premenopausal Women with Variant Angina.” It is in the 4 December 2001 issue of Annals of Internal Medicine (volume 135, pages 977-981). The authors are H Kawano, T Motoyama, M Ohgushi, K Kugiyama, H Ogawa, and H Yasue.Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine. Previousarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMenstrual Cyclic Variation of Myocardial Ischemia in Premenopausal Women with Variant Angina Hiroaki Kawano , Takeshi Motoyama , Masamichi Ohgushi , Kiyotaka Kugiyama , Hisao Ogawa , and Hirofumi Yasue Correction: Blood Flow to the Heart during the Menstrual Cycle Metrics Cited byWomen's Health LiteratureWatch 4 December 2001Volume 135, Issue 11Page: I-61KeywordsAnginaBlood flowBlood vesselsCardiovascular therapyEstrogensHeartHormonesIschemiaMenstrual cycleMyocardium ePublished: 4 December 2001 Issue Published: 4 December 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Effects of estrogen therapy on arterial resistance and pulsatility in postmenopausal women.

The hypothesis of this study was that changes in arterial determinants of afterload due to static muscular contraction can be modified, in postmenopausal women, by estrogen replacement therapy. Two groups of 14 postmenopausal and 15 premenopausal women were enrolled. Hemodynamic changes induced by right handgrip were recorded between days 7 and 10 of the menstrual cycle in premenopausal women. The same recordings were performed in postmenopausal women, before and after receiving transdermal estrogen replacement therapy for 8 days. Handgrip was performed at 50% of maximal voluntary contraction and maintained until exhaustion. Arterial pressure and blood velocity were recorded in the resting hand with photoplethysmographic and Doppler techniques. Indices of arterial elasticity and resistance were calculated. In postmenopausal women, these indices increased during effort only slightly less after therapy than before, if the mean values and statistical significance were considered, but the most evident effect of therapy was a decrease in interindividual differences in the effort induced changes. This means that, after therapy, increases in arterial resistance and elasticity indices were appreciably prevented mainly in those postmenopausal women who, before therapy, showed the greatest increases. Differences due to therapy were negligible in postmenopausal women in whom, before estrogen replacement, increases in elasticity and resistance indices during effort were similar to those obtained in premenopausal women. After therapy, no differences were found in resting conditions in any of the investigated cardiovascular parameters. Estrogen replacement did not appreciably affect changes in some arterial afterload-related indexes during handgrip, if the average values were considered in a group of postmenopausal women, but uneven and unpredictable peaks in individual responses were cut off, with a better predictability of the responses to sustained muscular contractions, as well as of the related risk factors.

Sex hormone levels correlate with the activity of cytokine-secreting cells in vivo.

This work examines the correlation between serum levels of oestrogen, progesterone and dehydroepiandrosterone sulphate (DHEA-S) and the number of human peripheral blood cells actively secreting interleukin (IL)-2, IL-4, IL-6, IL-10, tumour necrosis factor-alpha (TNF-alpha) or interferon-gamma (IFN-gamma) in vivo. Simultaneous assessment of serum hormone levels and cytokine-secreting cell activity throughout the menstrual cycle showed that the number of peripheral blood mononuclear cells (PBMC) able to secrete IL-4 in response to stimulation correlated significantly (P < 0.0001) with oestrogen levels and fluctuated with the menstrual cycle in pre-menopausal women. The activity of IFN-gamma-secreting cells, on the other hand, varied as a function of serum DHEA-S levels in pre-menopausal women (P < 0.0001). Similarly, the number of cells secreting IFN-gamma in men correlated with serum DHEA-S levels (P < 0.001). In contrast, post-menopausal women had fewer cells actively secreting cytokines and the activity of these cells did not correlate with sex hormone levels. These results suggest that sex hormones may modulate cytokine production in vivo and contribute to gender-related differences in normal and pathological immune responses.

TIMING OF SURGERY WITH REGARD TO THE MENSTRUAL CYCLE IN WOMEN WITH PRIMARY BREAST CANCER

There is sufficient evidence to support both the hormonal influence on the outcome of breast cancer surgery and the SDA hypothesis. The SDA model produces a paradigm shift in the understanding of the natural history of breast cancer. It offers opportunities to try modifying a tumor's biological potential for metastasis (e.g., by tamoxifen, progesterone, antiprotease, or angiostatin) in the neoadjuvant setting. It continues to support the beneficial effects of detection and surgery early in the natural history of disease. It would be worthwhile to plan a trial comparing standard practice (unplanned surgery as the patient enrolls) with surgery during the luteal phase of the menstrual cycle in premenopausal women. Another possibility, based on studies of circulating progesterone, would be to compare primary progesterone treatment (for 4 to 10 days before surgery) with standard practice. Such a trial of primary progesterone is already under way, conducted by the Indian Breast Group. More than 200 patients have enrolled so far. The details of the trial are available from Clinical Research Secretariat, Tata Memorial Centre, Parel, Mumbai, India (e mail: tmho3@bom2.vsnl.in).