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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The endometrial histology and endocrinologic and demographic characteristics of 556 asymptomatic postmenopausal women, who attended the menopause outpatient clinic at Ankara Numune Education and Research Hospital were studied before initiating estrogen replacement therapy. Of these women, 486 (87.4%) had atrophic endometrium, 37 (6.65%) had proliferative endometrium, 27 (4.86%) had endometrial hyperplasia without atypia, three (0.54%) had endometrial hyperplasia with atypia and three (0.54%) had endometrial adenocarcinoma on their biopsy specimens. When demographic characteristics of the patients were considered, we found that the patients with endometrial adenocarcinoma and endometrial hyperplasia with atypia had potential risk factors for endometrial pathology such as chronic anovulation, diabetes or hypertension. This study confirms that routine endometrial sampling in asymptomatic postmenopausal women is not warranted, but patients with associated risk factors should be screened for endometrial pathology before starting estrogen replacement therapy.
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PMID:Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women. 1129 27

Polycystic ovary syndrome (PCOS) is classically characterised by ovarian dysfunction (oligomenorrhoea, anovulation and infertility), androgen excess (hirsutism and acne), obesity, and morphological abnormalities of the ovaries (cystic enlargement and stromal expansion). More recently, insulin resistance has been found to be common in PCOS, along with an increased prevalence of other features of the "metabolic syndrome", namely glucose intolerance, type 2 diabetes mellitus, and hyperlipidaemia. Hyperinsulinaemia is likely to contribute to the disordered ovarian function and androgen excess of PCOS. Reducing insulin resistance by lifestyle modifications such as diet and exercise improves endocrine and menstrual function in PCOS. These lifestyle modifications are the best initial means of improving insulin resistance. Metformin, an oral hypoglycaemic agent that increases insulin sensitivity, has been shown to reduce serum concentrations of insulin and androgens, to reduce hirsutism, and to improve ovulation rates. The effect of metformin alone on fertility rates is unknown. Some studies suggest that metformin will reduce total body weight to a small extent, but with a predominant effect on visceral adipose reduction. The effects of metformin on lipid abnormalities, hypertension or premature vascular disease are unknown, but the relative safety, moderate cost, and efficacy in reducing insulin resistance suggest that metformin may prove to be of benefit in combating these components of the "metabolic" syndrome in PCOS. Further properly planned randomised controlled trials are required.
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PMID:Metformin and intervention in polycystic ovary syndrome. Endocrine Society of Australia, the Australian Diabetes Society and the Australian Paediatric Endocrine Group. 1145 23

Hypertrichosis, characterized by increased hair growth located in non-androgen-dependent areas, does not justify the monitoring of hormone levels, conversely to hirsutism, with increased hair growth in androgen-dependent areas of the female genitals. Adult hypertrichosis is iatrogenic (minoxidil, ciclosporine, diazoxide or glucocorticosteroids), of metabolic origin (porphyria), nutritional (anorexia) or paraneoplastic (hypertrichosis lanuoginosa). Metabolic or general assessment can help clinical diagnosis. In non-iatrogenic hirsutism the following must be eliminated: 1) a virilizing tumor (ovarian, adrenal) when confronted with rapid progression or recent hirsutism, plasma testosterone (T)>1.5ng/ml and/or (adrenal tumor) DHEA-sulfate (DHEAS)>700 microgram/dl and associated with hypertension; 2) when confronted with characteristic signs of hirsutism, Cushing's syndrome (post-dexamethasone cortisol), hyperprolactinemia (pooled PRL), or acromegalia (IGF1). Measurement of 17-OH-progesterone at 8 am on the 4th day of the cycle detects the late manifestation homozygous forms of a 21-hydroxylase (21OHD) block. The more frequent forms are: 1) ovarian polymicrocystic or hirsutism-anovulation syndromes without other causes (LH/FSH, T, hyperinsulinemia, sonography); 2) functional adrenal hyperandrogenia (increased DHEAS without organic cause); 3) idiopathic hirsutism. Treatment can be local (discoloration, depilation, diathermo-coagulation, laser). Treatment of hirsutism of organic origin is etiologic. The inhibitory effects of glucocorticosteroids are mediated by 21OHD. The most effective treatments are anti-androgenic: cyproterone acetate, progesterone-like and anti-gonadotropic (contraceptive) agents; and the only product in France officially indicated in hirsutism , spironolactone (anti-mineralocorticosteroid); and flutamide, pure anti-androgen (probably hepatoxic). Finasteride (type II 5 alpha-reductase inhibitor) appears less effective. Estrogen-progestagen-like agents can be associated with anti-androgens. We should also mention the GnRH-agonists, and finally, dietetics and metformine (in cases of insulin-resistance).
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PMID:[Hirsutism and hypertrichosis in adults: investigations and treatment]. 1222 63

The risks of steroidal contraception as reviewed by the Central Medical Committee of the International Planned Parenthood Federation in April 1970 are presented and discussed. The causal relationship between the use of steroidal contraceptives and thromboembolic disease is accepted, but the complication is considered very rare. It is recommended that oral formulations containing less than 50 micrograms of estrogen be used wherever possible, but for those women who need a higher estrogen content, it is still responsible to prescribe it. No adequate evidence has been obtained linking steroidal contraception in any relationship with cancer or fetal abnormalities. Estrogen administration possibly produces an adverse change in the quantity and quality of milk and the duration of lactation. Rare cases of jaundice and hypertension appear to be sometimes associated with oral contraceptive use and are easily reversible. Changes in glucose tolerance and serum lipids appear to occur under steroidal administration and are reversible. It is possible that those women with a history of irregular menstruation prior to taking the pill may experience prolonged anovulation after ceasing pill use. Mental changes reported due to oral contraceptives are highly subjective in nature and difficult to evaluate. It is concluded that the pill is highly effective as a method of family planning and is a significant factor in world health presenting no risks that justify discontinuation of its use.
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PMID:Use of steroidal contraception justified. 1225 54

Obesity is a risk factor for women in both pregnancy and contraception. Obesity per se does not cause sterility, but problems in gonadotropic function can arise during periods of rapid weight gain in bulimic episodes. Dysovulation is more common in such cases than amenorrhea. In established obesity, anovulation may occur, as demonstrated by the temperature curve and hormonal levels, but it is usually due to other factors such as ovarian polycystic syndrome or Cushing's syndrome. The main problems of obesity during pregnancy are carbohydrate metabolic disorders and hypertension. In 1 study, hypertension was found in 42.4% of pregnancies of obese women vs. 5.84% in controls; 22% of cases were severe, with blood pressure over 160/100. Carbohydrate metabolic difficulties were found in 11.8% of obese subjects vs. 1.2% of controls. The main consequence of maternal obesity on the child is macrosomy; occurring in 21.3% of births vs. 5.8% in controls. 5.1% of births to obese women are postmature vs. .7% in controls. The rate of cesareans for obese women is high. Improved fetal prognosis in pregnancies of obese women requires increased clinical surveillance for signs of hypertension or excessive weight gain and laboratory monitoring of glucose metabolism every month or even every 2 weeks. A sonogram should be done to detect macrosomy. A careful diet of 1200-1500 calories per day is recommended. 40% should be protein and 30% lipid. Rapid-absorption sugars should be excluded. Oral contraceptives appear to cause weight gain because estrogen stimulates the appetite and progestins have an anabolizing action. If weight gain exceeds 3 kg, a low dose pill and a restrictive diet should be recommended. OCs should be terminated if weight gain continues, and anomalies of glucose or lipid metabolism should be ruled out. Obesity constitutes a relative contraindication for use of combined OCs. Combined OCs may aggravate the obesity. Obesity on the other hand is a risk factor for cardiovascular accidents in OC users. IUDs are preferred for multiparous obese women. Nulliparas and multiparas with absolute contraindications to IUDs can use low-dose OCs if there are no other cardiovascular risk factors, no weight gain, and blood pressure and lipid and glucose metabolism are checked every 6 months. If these conditions cannot be met, the use of condoms or spermicides is recommended.
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PMID:[The obese woman: pregnancy and contraception]. 1228 89

Polycystic ovary syndrome (PCOS) is a frequent disease, characterized by disturbed ovarian function with hyperandrogenism. Anovulation is secondary to an absence of follicular dominance. Apart from a primary ovarian defect, insulin resistance is observed in PCOS women, even in the absence of overweight. This insulin resistance could be secondary to a defect in the insulin transduction pathway, mainly by a defect in receptor phosphorylation. It enhances hyperandrogenism as it increases ovarian androgen production. Therefore treating insulin resistance by weight loss or drugs reducing insulin resistance might improve fertility of PCOS women. Metformin has been shown to reduce ovarian production, enhance ovulatory cycles and in some cases increase fertility. However, there are few randomized studies on large numbers of patients to prove an effect on pregnancies as well as on the occurrence of early pregnancy loss. There are currently no recommendation on dose and duration of metformin treatment. It is noteworthy that metformin has no authorization in France to be prescribed apart from diabetic patients' care. Considering the medical care of PCOS women, the cardiovascular risk needs to be taken into account. Therefore hypertension, dyslipidemia and diabetes must be treated in those women who need to be followed carefully all over their life.
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PMID:[Insulin resistance and polycystic ovary syndrome]. 1271 82

Polycystic ovary syndrome has been viewed primarily as a gynecologic disorder requiring medical intervention to control irregular bleeding, relieve chronic anovulation, and facilitate pregnancy. A large body of evidence has demonstrated an association between insulin resistance and polycystic ovary syndrome. The former condition has an established link with long-term macrovascular diseases such as type 2 diabetes mellitus, hypertension, and atherosclerotic heart disease, consequences that also are observed in women with polycystic ovary syndrome. In addition, chronic anovulation predisposes women to endometrial hyperplasia and carcinoma. The purpose of this review is to examine the clinical course of this syndrome, which spans adolescence through menopause, and suggest a simple and cost-effective diagnostic evaluation to screen the large numbers of women who may be affected. Therapy, which should be individualized, should incorporate steroid hormones, antiandrogens, and insulin-sensitizing agents. Weight loss by way of reduced carbohydrate intake and gentle exercise is the most important intervention; this step alone can restore menstrual cyclicity and fertility, and provide long-term prevention against diabetes and heart disease. Treatment alternatives should be directed initially toward the most compelling symptom. Longitudinal care is of paramount importance to provide protection from long-term sequelae.
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PMID:Current perspectives in polycystic ovary syndrome. 1531 31

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder with widespread systemic manifestations affecting 5-10% of women of reproductive age. The accompanying insulin resistance and hypeinsulinemia mark this syndrome as a prediabetic state, with high incidence of impaired glucose tolerance, gestational diabetes, and overt diabetes. Other metabolic and biochemical changes, such as hypertension and dyslipidemia, increase the risk of cardiovascular disease. Fertility may also be impaired due to anovulation, impaired implantation, and higher rates of spontaneous abortions. All of these effects may also be related to hyperinsulinemia. Metformin, as insulin-sensitizing drug, is being evaluated for its potential long-term disease-modifying effect, such as prevention of diabetes. Its use may also help restore spontaneous ovulation and improve menstrual cyclicity, improve the success rate of induction of ovulation with clomiphene citrate and FSH, and decrease the high rate of ovarian hyperstimulation and early pregnancy loss. Nevertheless, these new exiting potential benefits of metformin should be evaluated in large randomized controlled studies, and clinicians must counsel women appropriately before the initiation of metformin therapy.
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PMID:Insulin resistance and metformin in polycystic ovary syndrome. 1526 44

Polycystic ovary syndrome (PCOS) affects mostly young women causing chronic anovulation, hyperandrogenism, hirsutism and obesity with android pattern. The prevalence of the metabolic syndrome (abnormal glucose metabolism, dyslipidemia, hypertension and increased waist circumference) in PCOS is not defined although both have a common etiologic factor: insulin resistance. This retrospective study from medical records examined the presence of obesity and features of the metabolic syndrome in women with PCOS. The metabolic syndrome was defined as presence of two or more of the following signs: abnormal glucose metabolism, hypertriglyceridemia, low HDL, and hypertension. Thirty nine records of patients with PCOS were reviewed. The mean age was 29.4 years and the body mass index was 36 kg/m2. Hypertriglyceridemia was present in 43%, low HDL in 71%, hypertension in 36%, impaired glucose tolerance in 10% and diabetes mellitus type 2 in 37%. The metabolic syndrome was identified in 44% of sampled women with PCOS. These findings indicate that women with PCOS are at increased risk of diabetes mellitus type 2 at a young age. PCOS patients have higher prevalence of the metabolic syndrome than the rest of the population and thus are at increased risk of cardiovascular disease even if they don't develop diabetes mellitus type 2.
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PMID:Association between the polycystic ovary syndrome and the metabolic syndrome in Puerto Rico. 1632 83

Malnutrition is a major problem in developing countries, and obesity and eating disorders are increasingly common in developing as well as developed countries. The reproductive axis is closely linked to nutritional status, especially undernutrition in the female, and inhibitory pathways involving detectors in the hind brain suppress ovulation in subjects with weight loss. Recovery may occur after minimal reacquisition of weight because energy balance is more important than body fat mass. Anorexia nervosa and bulimia nervosa affect up to 5% of women of reproductive age causing amenorrhoea, infertility and, in those who do conceive, an increased likelihood of miscarriage. Obesity can affect reproduction through fat cell metabolism, steroids and secretion of proteins such as leptin and adiponectin and through changes induced at the level of important homeostatic factors such as pancreatic secretion of insulin, androgen synthesis by the ovary and sex hormone-binding globulin (SHBG) production by the liver. WHO estimates that 9 to 25% of women in developed countries are severely obese, and obese mothers are much more likely to have obese children, especially if they have gestational diabetes. Obesity-associated anovulation may lead to infertility and to a higher risk of miscarriage. Management of anovulation with obesity involves diet and exercise as well as standard approaches to ovulation induction. Many obese women conceive without assistance, but pregnancies in obese women have increased rates of pregnancy-associated hypertension, gestational diabetes, large babies, Cesarean section and perinatal mortality and morbidity. Among contraceptors, the fear of weight gain affects uptake and continuation of hormonal contraceptives, although existing trials indicate that any such effects are small. For all methods of hormonal contraception, weight above 70 kg is associated with increased failure rates.
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PMID:Nutrition and reproduction in women. 1644 60


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