Physiological Menopause Research Articles

КЛІНІЧНІ ПРОЯВИ КЛІМАКТЕРІЮ У ЖІНОК ІЗ ФІЗІОЛОГІЧНОЮ МЕНОПАУЗОЮ ПРИ ЗАСТОСУВАННІ НЕГОРМО - НАЛЬНИХ ПРЕПАРАТІВ.

<p>Проведено клінічне та лабораторне обстеження пацієнток із фізіологічною менопаузою, з метою<br />визначення нейровегетативних, психоемоційних та обмінно-ендокринних порушень. Представлено результати клінічних<br />проявів клімаксу до та після застосування негормональних препаратів протягом трьох місяців.</p>

Study of Types of Menopause and Post-Menopausal Complications in North Indian Population

Total 90 (Ninety) post menopausal women between 45--60Age were studied, and their types of menopause was classified into three groups (.a)-70 women had normal or physiological menopause. had hot flushes 18(25.7%). Depression and Emotional disturbances 17(24.2%), osteoporosis 13 (18.5%), atrophic vaginitis (vulvo-vaginal atrophy) 12(17%),and urinary incontinence 10(14.2%).(b) 12 women had Menopause due to castration (oophroctomy),surgery and radiation of uterus and ovaries had obesity 5 (41%) depression 3 (25%),osteoporosis 4 (33.3%)(c) 8 women had Early or pre-mature menopause had Diabetic 4 (50%), HIV 2 (25%) and CVS 2 (25%). This menopausal classifications and their post menopausal complications are very much important for Obstetrician and Gynecologist, clinician to treat them with proper medication medico –social workers create awareness among people to prevent secondary infections and take preventive measures caused by post menopause, because menopause is a due to withdrawl of reproductive hormones, hence leads to multiple disorders in normal functions of the body.

Clinical and hormonal status of the women in physiological menopause and with the preserved menstrual function

Estrogenic and progesterone receptors are found not only in the tissues of target organs (uterus, ovaries, breast), but also in other tissues as urethra, bladder, pelvic muscles, brain cells, myocardium, the walls of arteries, bones, skin, mouth, throat, conjunctiva and others. They are involved in maintaining normal life critical systems (nervous, cardiovascular, immune, etc.), determining the cellular synthesis of proteins, lipids, energy complexes, the activity of enzyme systems, basic electrolytes balance and activity of life processes in cells. As a result, the estrogen deficiency in menopause and sometimes in premenopausal period leads for various clinical manifestations of this deficiency in the form of disease states. Often they have a distinct character that is as the basis for the classifying them to separate nosological form – climacteric syndrome that manifests neuro-vegetative, psycho-emotional and metabolic-endocrine complexes of symptoms. The clinical and laboratory examinations in 71 patients of the climacteric age were performed to detect the neuro-vegetative imbalance of hormonal status in women with the preserved menopause and preserved menstrual function. The main group included 42 women with physiological menopause an average age of 45.32 years and postmenopause duration of 2.08 year (subgroup Ia, n = 22) and 4,32 years (subgroup Ib, n = 20); control group included 29 women with retained physiological menstrual cycle an average age of 44.69 years. These women conducted a comprehensive examination, hormonal studies, instrumental examination (ultrasound study of genitals, thyroid and breast, colposcopy). The severity of climacteric syndrome was determined by Kupperman menopausal index in EV Uvarova modification. It was established that intensity of the neurovegetative syndrome symptoms decrease in 6.8% with increasing duration of menopausal. Steroid concentrations and hypothalamic hormones value depending on menopause duration and their levels changes in depending on the hypoestrogenia duration.

Tasas de embarazo e implantación de ovodonación, en un solo intento

Objetivos: Conocer las tasas de embarazo e implantación del procedimientos de ovodonación en un solo intento y comparar con los resultados de otros centros. Diseño: Estudio descriptivo, retrospectivo. Lugar: Centro de infertilidad y Reproducción Procrear. Participantes: Pacientes que se sometieron a su primer intento de fecundación in vitro con ovodonacion. Intervenciones: Estudio de la 26 pacientes que se sometieron a su primer intento de fecundación in vitro con ovulación el año 2005. La pacientes que tenían menstruación recibion supresión hipofisiaria el día 21 del ciclo previo, para luego iniciar la preparación endometrial el primer día del ciclo menstrual, sincronizando al ciclo de estimulación ovárica controlada de la donante. Se hizo firmar los consentimientos informados en cada caso y se uso el programa spss12 para el análisis. Principales medidas de resultados: Tasas de embarazo implantación. Resultados: Se revisó 26 ciclos de ovodonación. La edad promedio fue 41,7 ± 3,7 años (rango 32 a 50 años), 20% menor de 40 años y 80% mayor o igual a 40 años. Los diagnósticos fueron 8 (30,8%) con menopausia fisiológica, 17 (65,4%) bajas respondedoras o con reserva ovárica disminuida y 1 (3,8%), enfermedad congénita hereditaria. La preparación del endometrio duró 21,7 ± 6,1 días (rango 12 a 32 días), logrando un grosor endometrial de 11,9 ± 2,9 mm (rango 8 a 19 mm). Se aspiró por donante 11,8 ± 6,4 óvulos (rango 4 a 24 óvulos), fecundándose por paciente 7,7 ± 4,4 óvulos (rango 3 a 18 óvulos); en 2 pacientes se congeló los óvulos, por lo que se realizó ICSI. Se transfirió por paciente 2,8 ± 0,4 embriones (rango 2 a 3 embriones). La transferencia embrionaria se realizó 24 casos (92,3%) en el día 3 y en 2 (7,7%) en el día 5. Se logró una tasa de embarazo de 65,4 (17/26), con una tasa de implantación de 61,5% (16/26); 31,3% (5/16) fue embarazo único, 56,3% (9/16) embarazo gemelar y 12,5% (2/16) embarazo triple. En los 2 casos que se fecundó con óvulos congelados, no hubo embarazo. Conclusiones: La ovodonacion resultó una técnica muy eficaz, con tasa de embarazo en un solo intento de 65,4%, tasa de embarazo clínico de 61,5% y una tasa de implantación de 39,7%: se transfirió un máximo de 3 embriones. El embarazo múltiple resultó elevado, lo que requiere plantear estrategias para disminuirlo, sin afectar la tasa de éxito.

Ageing is the main determinant of haemodynamics and autonomic cardiac changes observed in post-menopausal female rats

The aim of this study was to evaluate and compare the effects of early and physiological menopause on cardiac autonomic parameters in aged female rats. To this end, female Wistar rats (22 and 82 weeks old, N=96) were divided into 4 groups: Young Sham-operated Rats, Aged Sham-operated Rats, Young Ovariectomised (OVX) Rats, and Aged OVX Rats. Young Sham-operated and OVX rats were used as controls. The cardiac autonomic parameters were investigated using different approaches: 1) pharmacological evaluation of the autonomic tonus with methylatropine and propranolol; 2) isolated cardiac contractility with β-adrenergic agonists; and 3) quantification of the mRNA and protein level expression of cardiac β-adrenergic receptors. Among the groups of aged female rats, both the Sham-operated and OVX rats showed higher basal mean arterial pressure and heart rate (HR) values compared to their respective young counterparts. The aged groups also showed a predominance of the sympathetic autonomic component in the determination of HR, whereas the young rats showed a vagal predominance. An assessment of cardiac contractility showed that aged Sham-operated and OVX rats had lower contractile responses following the administration of dobutamine compared to their respective young counterparts. In addition, the aged groups showed higher mRNA and protein expression levels of the β1-adrenergic receptors. In conclusion, our results show that haemodynamic alterations and impairment of the autonomic parameters were similar between the groups of rats subjected to early and physiological menopause. Moreover, these results seem to be due to the ageing process and not ovarian hormone deprivation.

Aerobic physical training has little effect on cardiovascular autonomic control in aging rats subjected to early menopause

We investigated and compared the effects of physiological menopause (PM) and early menopause (EM) and the adaptations promoted by physical training on the cardiovascular autonomic control of aged rats. Female Wistar rats (N=72) were assigned to 3 groups: control (22weeks old rats, undergoing sham surgery in the 10th week of life), PM (82weeks old rats, undergoing sham surgery in the 10th week of life) and EM (82weeks old rats, undergoing ovariectomy in the 10th week of life). In each group, half of the rats were subjected to swimming training over a period of 10weeks. Sedentary PM and EM groups had higher basal mean arterial pressure (MAP) and heart rate (HR) and lower intrinsic HR compared to the sedentary control group. Physical training reduced MAP in PM group. All trained groups had lower basal HR; however, only control and PM-trained groups showed decreased intrinsic HR. The assessment of cardiac autonomic balance showed that PM and EM sedentary groups exhibited sympathetic predominance compared to control group. After physical training, only EM group presented sympathetic predominance. HR variability (pulse interval) was similar among all sedentary groups. However, control and PM-trained groups showed lower power in low frequency band (LF; 0.2–0.75Hz) and higher power in high frequency band (HF; 0.75–3.0Hz). The analysis of systolic arterial pressure variability revealed that PM and EM sedentary groups had higher LF power. However, PM group showed lower LF power following physical training. Finally, PM and EM groups had a reduction in spontaneous baroreflex sensitivity, that was attenuated by physical training. The overall results suggest that PM or EM promotes similar negative effects on MAP, HR and cardiovascular autonomic control. However, unlike the PM group, physical training was not able to mitigate all negative effects of EM on cardiovascular autonomic control.

Androgen replacement therapy in women

Female androgens are derived from either the adrenal and peripheral conversion of the adrenal sex steroid precursor, dehydroepiandrosterone, or from direct ovarian production. Adrenal insufficiency or bilateral oophorectomy (surgical menopause) result in severe androgen deficiency, which can be clinically associated with impaired libido, drive and energy. Physiological menopause does not necessarily lead to androgen deficiency. The previously suggested definition of female androgen deficiency syndrome, as the concurrent presence of low androgen levels and low libido, is not precise enough and may lead to overdiagnosis. Current replacement options include transdermal testosterone or oral dehydroepiandrosterone treatment, both of which have been shown to result in significant improvements, in particular in libido and mood, while long-term effects on body composition, cardiovascular and cancer risk are less documented. Owing to these concerns, androgen replacement should be reserved for women with severe androgen deficiency due to an established cause and matching clinical symptoms.

Blood Cell Mitochondrial DNA Content and Premature Ovarian Aging

Primary ovarian insufficiency (POI) is a critical fertility defect characterized by an anticipated and silent impairment of the follicular reserve, but its pathogenesis is largely unexplained. The frequent maternal inheritance of POI together with a remarkable dependence of ovarian folliculogenesis upon mitochondrial biogenesis and bioenergetics suggested the possible involvement of a generalized mitochondrial defect. Here, we verified the existence of a significant correlation between blood and ovarian mitochondrial DNA (mtDNA) content in a group of women undergoing ovarian hyperstimulation (OH), and then aimed to verify whether mtDNA content was significantly altered in the blood cells of POI women. We recruited 101 women with an impaired ovarian reserve: 59 women with premature ovarian failure (POF) and 42 poor responders (PR) to OH. A Taqman copy number assay revealed a significant mtDNA depletion (P<0.001) in both POF and PR women in comparison with 43 women of similar age and intact ovarian reserve, or 53 very old women with a previous physiological menopause. No pathogenic variations in the mitochondrial DNA polymerase γ (POLG) gene were detected in 57 POF or PR women with low blood mtDNA content. In conclusion, blood cell mtDNA depletion is a frequent finding among women with premature ovarian aging, suggesting that a still undetermined but generalized mitochondrial defect may frequently predispose to POI which could then be considered a form of anticipated aging in which the ovarian defect may represent the first manifestation. The determination of mtDNA content in blood may become an useful tool for the POI risk prediction.

Serum testosterone levels measured by isotope dilution-liquid chromatography–tandem mass spectrometry in postmenopausal women versus those in women who underwent bilateral oophorectomy

Differentiation between subtle changes in low serum testosterone concentrations, common in women and children, is not possible with current commercially available assays. The objectives of the study were to develop a method based on stable isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS) with adequate sensitivity and specificity and to investigate the applicability of this assay in serum samples from pre- and postmenopausal women. For 16 women, testosterone levels were measured in blood samples drawn two years before and after physiological menopause, and for eight women in samples drawn before and after bilateral oophorectomy. Testosterone was extracted from serum, derivatized and analysed on an LC-MS/MS. The developed ID-LC-MS/MS method allowed for specific and reproducible measurement of testosterone. Comparison with stable isotope dilution-gas chromatography coupled to mass spectrometry detection by Deming regression analysis gave a slope of 1.025 and an intercept of 0.055 nmol/L (r = 0.9998). A significant decrease was found in testosterone concentrations before and after bilateral oophorectomy (P = 0.02), whereas no significant difference was found before and after natural menopause (P = 0.4). The ID-LC-MS/MS assay measures serum testosterone with acceptable accuracy and is useful in female samples, supporting the conclusion that the postmenopausal ovary contributes to circulating testosterone. To our knowledge, our analytical method compares favourably to similar published methods in terms of sensitivity. The sensitivity and specificity of this method comply with the reference method for measurement of testosterone in serum samples of women, children and men suffering from hypogonadism and can also be used for men with testosterone in the reference range.

In vitro fertilisation (IVF) with donor eggs in post-menopausal women: are there differences in pregnancy outcomes in women with premature ovarian failure (POF) compared with women with physiological age-related menopause?

This study assessed pregnancy rates and obstetric outcomes in women with premature ovarian failure (Group A) with post-menopausal women > or =40 years (Group B) who had IVF +/- ICSI using donor eggs. This was a retrospective analysis of 54 recipients with either premature ovarian failure or physiological menopause undergoing oocyte donation between 2000 and 2007 at Monash IVF. The average number of stimulated cycles required for a woman in group A and B to deliver a baby was 1.75 and 1.4 respectively. Both groups had high cumulative pregnancy rates; however, there was a statistically significant difference with regards to rates of complications. Oocyte donation in both premature ovarian failure and physiological menopause is highly successful and cumulative pregnancy rate is an important statistic which can be used to inform women seeking this technique. High rates of complications, in conjunction with individual risk-factor analysis needs to be considered when counselling post-menopausal women about oocyte donation.

The influence of physiological and surgical menopause on coronary heart disease risk markers

To investigate the influence of physiological and surgical menopause on serum concentrations of coronary heart disease (CHD) risk markers and sex hormones. Physiological menopausal transition was investigated in two studies. In a longitudinal study, 16 women were followed from 2 years before until 2 years after physiological menopause. In a case-control study, 27 early postmenopausal women were compared with 27 age-matched late premenopausal women. Surgical menopause was investigated in 11 women undergoing a prophylactic bilateral salpingo-oophorectomy. The following parameters were measured: serum concentrations of estradiol, follicle-stimulating hormone, inhibin A, inhibin B, asymmetric dimethylarginine, lipids, leptin, homocysteine, C-reactive protein, and coenzyme Q10, as well as weight and body mass index. After physiological and surgical menopause, serum estradiol and inhibin A and B decreased, whereas follicle-stimulating hormone increased (all P values < 0.01). Serum asymmetric dimethylarginine, total and low-density lipoprotein cholesterol, and leptin concentrations were significantly higher in postmenopausal women compared with premenopausal women (all P values < 0.05). Serum homocysteine concentrations increased significantly during the physiological menopausal transition. Total and low-density lipoprotein cholesterol increased after surgical menopause (both P values = 0.01). None of the other parameters studied were influenced significantly by the menopausal transition. No difference in change in the various CHD risk markers investigated was observed between physiological and surgical menopause. The CHD risk profile was affected unfavorably by both physiological and surgical menopause. Changes in most CHD risk markers were small, despite the substantial changes in hormonal parameters.

Effects of estrogen and estrogen-progesteron on serum nitric oxide metabolite concentrations in post-menopausal women

Estrogens have some anti-atherosclerotic properties and they influence nitric oxide (NO) production. The aim of this study was to determine NOx levels in post-menopausal women and the effect of estrogen/estrogen-progesteron therapy (ET/EPT) on plasma NO levels. Eighty postmenopausal women (M1) comprising 26 with surgically induced menopause (ET1), mean age 50.9+/-2.9 yr, and 54 with physiological menopause (EPT1), mean age 50.5+/-3.0 yr, were studied. Forty healthy pre-menopausal women, mean age 48.3+/-2.3 yr were the controls (C). The post-menopausal women were treated for 4 months: group ET1 with ET and group EPT1 with EPT. Serum estradiol (E2), FSH, NOx and lipid profile before and after therapy were measured. NOx levels were lower in group M1 than in group C (8.75+/-1.57 vs 10.27+/-2.62, p<0.01) and increased after hormonal therapy (10.65+/-2.38). NOx concentration showed significant positive correlation with E2 (r=0.25, p<0.05). Total cholesterol (240.9+/-43.2), LDL-cholesterol (155.2+/-33.6), triglycerides (124.8+/-54.1), and apolipoprotein B (1.52+/-0.33) were higher in group M1 than in group C (223.1+/-44.3, 133.0+/-38.2, 108.3+/-52.9, and 1.12+/-0.36, respectively), and after ET/EPT they decreased to the values observed in group C. There were no correlations between NO and lipids or apolipoproteins. ET and EPT improve NOx synthesis and endothelial relaxation. Medroxyprogesterone acetate added to E2 does not significantly influence NOx levels.

No room for cancellation, coasting or ovarian hyperestimulation syndrome in oocyte donation cycles

OBJECTIVE: Oocyte donation is an alternative for patients with ovarian failure, repeated IVF failure, diminished ovarian reserve, compromised oocyte quality, physiological menopause and single women. Thus donors sometimes receive high FSH doses in order to induce folliculogenesis and obtain a fairly large number of oocytes/donor. Nevertheless, on some occasions there will be an over-response that may end up in OHSS. The objective of this study is to evaluate if this undesirable situation can be controlled and avoided if final oocyte maturation is induced with a GnRH agonist instead of hCG.

No room for cancellation, coasting, or ovarian hyperstimulation syndrome in oocyte donation cycles

We retrospectively studied 429 IVF donor cycles in which ovulation was triggered with either hCG (175 cycles) or GnRH agonist (254 cycles). Of the donors in whom ovulation was triggered with hCG, 3.2% developed symptoms of moderate (2.2%) or severe (1%) ovarian hyperstimulation syndrome, while none of the IVF donor cycles that were triggered with the GnRH agonist presented ovarian hyperstimulation syndrome, needed coasting, or were cancelled.

Premedication in Supravaginal Uterine Amputation in Menopausal Women

Objective: to study the efficiency of using small-dose estrogens as a component of remedial premedication. Subjects and materials. A hundred and ninety menopausal women were examined. All the patients were divided into a study group and a control one. Group 1 included patients with uterine myoma and menopausal syndrome, which was further divided into two subgroups: Subgroup A comprised patients who as a remedial premedication, along with the standard therapy, received hormonal therapy with oral estradiol in a dose of 2 mg once daily for 7 days. There were no contraindications to the use of these drugs in all the women from this subgroup. Postoperative estrogen therapy was continued in the above doses for a year (as recommended by the International Menopause Committee). Subgroup B consisted of 40 women with menopausal syndrome who received the standard conventional premedication and postoperative therapy. Group 2 included 70 patients with physiological menopause and uterine myoma. Studies were made when remedial premedication was given just before surgery and on discharge from hospital on days 7—8. Results. In the patients with the menopausal syndrome, the level of follicle-stimulating hormone (FSH) was ascertained to be higher than that in women with normal menopause, the level of estradiol was accordingly lower. The differences found in the levels of hormones in the patients depending on the clinical course of a menopausal period allowed the use of hormonal replacement therapy with estradiol in the remedial premedication regimen as both etiologically and pathogenetically founded. On admission, the first stage of psychoemotional testing before remedial premedication revealed impairments of memory, attention, and thinking, as well as high anxiety in all the patients with myoma and menopausal syndrome. There was a significant reduction in long-term memory and memorization. Seven days after preoperative preparation using estradiol, 2 mg/day, there were no short- and long memory disorders and there was stabilization of psychoemotional disorders in most patients. Hemodynamic studies showed that before remedial premedication the patients with abnormal menopause had the following hemodynamics types: hypertensive-hypodynamic dissociation (60.2%) and isolated hypertension (25.2%). In patients with concomitant menopausal syndrome, correction of hemodynamic changes, with the type of central hemodynamics being kept in mind, reduced the frequency of a hypertensive-hypodynamic dissociation and isolated hypertension to 24.7 and 12.0%, respectively. Conclusion. Evaluation of the efficiency of preoperative preparation of patients with concomitant menopausal syndrome may lead to the conclusion that there are benefits of using small doses (2 mg/day) of estrogen for 5—7 days as a component of remedial premedication. By exerting a specific hormonal effect, estrogen therapy promotes psychoemotional stabilization and cardiovascular function normalization. This all reduces the time of preparation of patients for surgery, leads to its favorable course, and decreases the incidence of postoperative complications. Key words: premedication, uterine myoma, menopausal syndrome, psychoemotional disorders, hemodynamics, estrogens, preoperative preparation.

Premature ovarian failure

Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea). It is a heterogeneous disorder affecting approximately 1% of women <40 years, 1:10,000 women by age 20 and 1:1,000 women by age 30. The most severe forms present with absent pubertal development and primary amenorrhea (50% of these cases due to ovarian dysgenesis), whereas forms with post-pubertal onset are characterized by disappearance of menstrual cycles (secondary amenorrhea) associated with premature follicular depletion. As in the case of physiological menopause, POF presents by typical manifestations of climacterium: infertility associated with palpitations, heat intolerance, flushes, anxiety, depression, fatigue. POF is biochemically characterized by low levels of gonadal hormones (estrogens and inhibins) and high levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea). Beyond infertility, hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis. Heterogeneity of POF is also reflected by the variety of possible causes, including autoimmunity, toxics, drugs, as well as genetic defects. POF has a strong genetic component. X chromosome abnormalities (e.g. Turner syndrome) represent the major cause of primary amenorrhea associated with ovarian dysgenesis. Despite the description of several candidate genes, the cause of POF remains undetermined in the vast majority of the cases. Management includes substitution of the hormone defect by estrogen/progestin preparations. The only solution presently available for the fertility defect in women with absent follicular reserve is ovum donation.

Effects of oestradiol and oestroprogestin on erythrocyte antioxidative enzyme system activity in postmenopausal women

Data concerning the relationship between sex steroid hormones and the cellular antioxidative enzyme system are controversial. We investigated the effects of oestradiol deficiency after menopause and the influence of transdermal oestradiol therapy (ET) and hormonal (oestradiol plus medroxyprogesterone) replacement therapy (HT) on erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT). GSH and selenium (Se) concentrations were also estimated. Serum lipid peroxide (LPO) levels were measured as an indicator of free-radical production and lipid peroxidation. The study group consisted of 80 postmenopausal women, divided into two subgroups: 26 women with surgically induced menopause (ET1) and 54 women with physiological menopause (HT1). Forty premenopausal healthy volunteers were controls (C group). LPO was higher in postmenopausal women and decreased after both ET and HT. GSH-Px and GSH were lower in the postmenopausal groups but increased significantly after both types of therapy. Se concentrations did not differ significantly among the groups. CAT activities were similar in all groups and decreased after ET and HT. SOD activities in postmenopausal women were similar to those in the C group and did not change significantly after treatment. The administration of natural oestrogens to postmenopausal women diminishes oxidative stress and increases antioxidative cell potency.

Androgen therapy in women

Androgens in women either derive from direct ovarian production or from peripheral conversion of the adrenal sex steroid precursor, dehydroepiandrosterone, towards active androgens. Therefore, loss of adrenal or ovarian function, caused by Addison's disease or consequent to bilateral oophorectomy, results in severe androgen deficiency, clinically often associated with a loss of libido and energy. Importantly, physiological menopause does not necessarily lead to androgen deficiency, as androgen synthesis in the ovaries may persist despite the decline in estrogen production. However, the definition of female androgen deficiency, as recently provided by the Princeton consensus statement, is not precise enough and may lead to over-diagnosis due to the high prevalence of its diagnostic criteria: androgen levels below or within the lower quartile of the normal range and concurrent sexual dysfunction. Importantly, physiological menopause is not necessarily associated with androgen deficiency and therefore does not routinely require androgen therapy. Current replacement options include transdermal testosterone administration or dehydroepiandrosterone treatment, both of which have been shown to result in significant improvements, in particular in libido and mood, while effects on body composition and muscular function are not well documented. It is important to keep in mind that the number of randomized controlled trials is still limited and that currently none of the available preparations is officially approved for use in women. Currently, androgen replacement should be reserved for women with severe androgen deficiency due to an established cause and matching clinical signs and symptoms.

Manifestations of somatic disturbances in early postmenopause in women after physiological and surgical menopause

The most common secondary manifestations of menopause are clinical manifestations of estrogen deficiency. They could be early and late. The aim of this study was to compare manifestations of somatic disturbances in early postmenopause in women after physiological and surgical menopause. This prospective study included 60 women, age 41-55 years, divided into two groups: physiological (30 of them) and surgically induced menopause. For every subject a special evidence list, consisting of the disease history questions, physical and gynecology examination as well as dates about physiological variables (arterial tension, height, weight, and body-mass index) and laboratory examination was formed. The values of arteriol blood pressure, body height, body mass, body mass index (BMI), and lipid status were determined and gynecological examinations were performed in each patient. The most frequent symptoms in both groups were vasomotor ones. Headache was the more intensive sign in the group after induced menopause. Extrasistolyc heart excursion was a common symptom in both study groups. Arterial tension, regardless of the type of menopause, was in the physiological range. The frequent organic signs of menopause, more intensive in the group after induced menopause, were genitourinary and skin atrophy. An analysis of the BMI showed that the women in both groups were obese (BMI > 25). The lipids analysis confirmed the predomination of hyperlipoproteinemia type IIa in the group with physiologic menopause and type IIb after induced menopause. The dominant signs of menopausal syndrome were vasomotor and bone-joint symptoms, more frequent in the group after induced menopause. There were no statistically significant differences between the study groups according to the genitourinary atrophy and other signs of aging. Menopausal hormonal changes, regardless of the way of menopause developing, increase the risk for hyperlipoproteinemia. The frequency of somatic signs in early post menopause is typically higher after induced menopause. More intensive follow-up in patients after surgical removing of the ovaria is necessary in order to improve the quality of life in these patients.

Effects of raloxifene therapy on plasma renin and aldosterone levels and blood pressure in postmenopausal women

Objective. Blood pressure, which generally increases after menopause, is one of the best tools to characterize cardiovascular disease. The renin–aldosterone system plays a role in determining cardiovascular risk and the role of estrogen in the regulation of angiotensinogen gene expression and serum levels is well known. Raloxifene can induce endothelium-dependent vasodilation without affecting endothelium-independent vasorelaxation. The aim of the study was to investigate the effects of raloxifene on the renin–aldosterone system and blood pressure in postmenopausal women.Designs. Forty women, 54–59 years of age, in physiological menopause for 6 months to 4 years, were enrolled in the study and treated with raloxifene 60 mg/day for 6 months. All had blood pressure less than 130/85 mm Hg at the start of the study. The women were divided into two groups: the first (group A; 20 women) with normal blood pressure and the second (group B; 20 women) with previous high blood pressure treated with antihypertensive drugs, not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.Results. No significant changes in plasma renin activity (PRA) or plasma concentrations of aldosterone were observed between the two groups after 6 months of raloxifene use. There was a slight reduction in PRA (11±4% for group A and 13±5% for group B) and in plasma levels of aldosterone (3.6±0.5% and 4.6±0.5%, respectively) with respect to basal values, but neither change was statistically significant.Conclusions. The results of the present study show that raloxifene at 60 mg/day dose is well tolerated and has no clinical impact on blood pressure, PRA or aldosterone in postmenopausal women.