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The symptoms and perceptions of menopause of 60 Australian women were studied, by questionnaire, when they were premenopausal and 10 years later when they were postmenopausal. Menopausal symptoms expected and experienced by the women were compared, fewer women experiencing hot flushes, headache, depression and nervousness and more experiencing insomnia, increase in appetite, abdominal fullness, numbness and muscular problems. The symptoms women thought were due to hormonal changes at menopause were compared. In 1993 more women cited osteoporosis, insomnia, loss of libido, obesity and loss of muscle tone as due to hormone change while fewer cited depression. The premenstrual symptoms and their severity experienced by a woman when she was premenopausal significantly predicts the type and severity of the menopausal symptoms experienced by the woman. The expected menopausal symptoms and their severity cited by a woman also significantly predicts the type of severity of the menopausal symptoms experienced. More premenstrual symptoms predict the menopausal symptoms than those menopausal symptoms the women expected. The expectation menopause will be 'a relief' or 'a nuisance' significantly predicted the overall menopause experience described by the women. Their negative attitudes about doctors' understanding and information available about menopause remained unchanged but they forget menstrual cycle problems over the 10 years. The results suggest a possible physiological basis for premenstrual and menopausal symptoms. Assistance for women with their premenstrual and menstrual cycle symptoms may improve their quality of life at menopause.
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PMID:Changes in Australian women's perception of the menopause and menopausal symptoms before and after the climacteric. 771 63

Epidemiologic studies are important for both understanding and defining rheumatology practice. Controversy still exists over whether the incidence of rheumatoid arthritis is declining, and genetic studies indicate a diversity of HLA haplotypes in rheumatoid arthritis. Large longitudinal osteoarthritis studies have helped define diagnostic criteria and the role of obesity in disease progression. The negative association between osteoarthritis and osteoporosis at specific sites continues to be explored, and the value of long-term estrogen therapy in preventing bone loss has been examined. Both retrospective and prospective population studies have been used to describe the relationship between silicone gel breast implants and connective tissue disease. These and other studies have helped to define the important role of epidemiologic research in the understanding of rheumatic diseases.
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PMID:Epidemiology of the rheumatic diseases. 776 99

The endocrinology of the perimenopause--the time between pre- and postmenopause--is characterized by changes in the metabolism of the steroid hormones caused by increasing insufficiency of the ovaries. Until the age of 48 the concentrations of the estrogens are relatively constant with a median level of 120 pg/ml serum for estradiol and of 75 pg/ml for estrone. Between the age of 49 and 54 the levels decrease to concentrations of 35 pg/ml for estrone and 10 pg/ml for estradiol. In the corresponding time, there is a tenfold rise of the level of FSH. The level remains constant until high age. The decrease of the estrogens causes the menopause in an age of 51 to 52. In the postmenopause the ovaries don't play a role for the concentrations of the estrogens. The concentrations are determined by the conversion of the androgens secreted by the adrenal cortex. The serum concentrations of androstenedione are five times higher than those of testosterone. The function of the adrenal cortex remains until high age; there is no 'adrenopause' comparable to the 'menopause'. The suppression of the adrenal cortex by treatment with corticoids (e.g. for asthma) causes a dramatic decrease of the androgens and consecutively for the estrogens. The lack of estrogens play an important role in the induction of osteoporosis and other disturbances of the late postmenopause, e.g. coronary heart disease. Obese women show in the pre- and the perimenopause more often dysfunctional bleedings caused by anovulation or corpus luteum insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Endocrinological changes in pre- and postmenopause]. 783 30

Seventy-two long-surviving liver transplant recipients were evaluated prospectively, including a baseline allograft biopsy for weaning off of immunosuppression. Thirteen were removed from candidacy because of chronic rejection (n = 4), hepatitis (n = 2), patient anxiety (n = 5), or lack of cooperation by the local physician (n = 2). The other 59, aged 12-68 years, had stepwise drug weaning with weekly or biweekly monitoring of liver function tests. Their original diagnoses were PBC (n = 9), HCC (n = 1), Wilson's disease (n = 4), hepatitides (n = 15), Laennec's cirrhosis (n = 1), biliary atresia (n = 16), cystic fibrosis (n = 1), hemochromatosis (n = 1), hepatic trauma (n = 1), alpha-1-antitrypsin deficiency (n = 9), and secondary biliary cirrhosis (n = 1). Most of the patients had complications of long-term immunosuppression, of which the most significant were renal dysfunction (n = 8), squamous cell carcinoma (n = 2) or verruca vulgaris of skin (n = 9), osteoporosis and/or arthritis (n = 12), obesity (n = 3), hypertension (n = 11), and opportunistic infections (n = 2). When azathioprine was a third drug, it was stopped first. Otherwise, weaning began with prednisone, using the results of corticotropin stimulation testing as a guide. If adrenal insufficiency was diagnosed, patients reduced to < 5 mg/day prednisone were considered off of steroids. The baseline agents (azathioprine, cyclosporine, or FK506) were then gradually reduced in monthly decrements. Complete weaning was accomplished in 16 patients (27.1%) with 3-19 months drug-free follow-up, is progressing in 28 (47.4%), and failed in 15 (25.4%) without graft losses or demonstrable loss of graft function from the rejections. This and our previous experience with self-weaned and other patients off of immunosuppression indicate that a significant percentage of appropriately selected long-surviving liver recipients can unknowingly achieve drug-free graft acceptance. Such attempts should not be contemplated until 5-10 years posttransplantation and then only with careful case selection, close monitoring, and prompt reinstitution of immunosuppression when necessary.
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PMID:Weaning of immunosuppression in long-term liver transplant recipients. 783 42

Obesity is the major nutritional problem affecting industrialised society. According to a recent ISTAT survey, 41% of men and 19% of women in the Italian population suffer from obesity. Obesity is a complex pathological entity with a multiform and often indeterminable etiology. Studies of natural and adopted children and twins suggest that a clear hereditary, constitutional predisposing factor is present in obesity which interacts with environmental conditions. The genetic factor is also suggested by the statistical finding that if neither parent is obese, then only 7-10% of their children will be obese, whereas if one parent is obese, 40-50% of children will probably become obese, and if both parents are obese as many as 70-80% of children will be obese. The risks related to obesity can be broadly categorised as mechanical and metabolic. The former include arthrosis, osteoporosis, degenerative diseases affecting the joints and bone matrix, muscular hypotrophy and respiratory deficits. The major metabolic risks include hypercholesterolemia, altered glycoregulation and hyperuricemia. From an obstetric point of view, apart from the fact that obesity is often associated with sterility, excess weight can often lead to sometimes dramatic complications during pregnancy, involving major risks for both mother and fetus. From a gynecological point of view the links between obesity, tumours and menopause are well known.
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PMID:Obesity: internal medicine, obstetric and gynecological problems related to overweight. 787 28

The accuracy of a bioelectrical impedance analysis (BIA) was examined by comparison with a dual energy X-ray absorptiometry (DXA) to measure the body composition. The subjects consisted of 52 patients (21-78y.) with chronic renal failure (32 cases), osteoporosis (6 cases) and diabetes mellitus with obesity (14 cases). Bioelectrical impedance between hand and leg was measured by a body composition analyzer (Model BIA-BC-3, RJL) with a four-electrode system. One pair of current supply and detector electrode was attached to the right hand and another pair was to the leg. The total fat mass measured by BIA was well correlated with the value by DXA (r = 0.959, p < 0.01). The total fat mass by BIA was also correlated with the fat mass in the arms (r = 0.863), fat mass in the legs (r = 0.911), and fat mass in the trunk (r = 0.920) by DXA. The correlation rates were p < 0.01. These correlation coefficients were lower than the correlation rate of the total fat mass measured by DXA. The total lean mass measured by BIA was well correlated with the value by DXA (r = 0.963, p < 0.01). It was correlated with the lean mass in the arms (r = 0.899), lean mass in the legs (r = 0.929), and lean mass in the trunk (r = 0.906) by DXA, but these values were lower than the correlation rate of the total lean mass obtained by DXA. These findings suggest that BIA is a safe and simple method for analyzing the body composition of the total fat mass and the total lean mass, and total body composition is reflected more clearly than regional body composition.
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PMID:[A comparative study of a bioelectrical impedance method and dual energy X-ray absorptiometry for body composition analysis]. 799 20

Obesity offers protection against osteoporosis in older women. The mechanisms are not well understood, but relate in part to increased aromatization of adrenal androgens to estrone in peripheral fat and muscle tissue. Two hundred and one white and 77 black women previously reported to be free of skeletal disease and to have normal bone mass had measurements of total body bone mineral (TBBM), fat mass (TBFM), and lean mass (TBLM) performed by dual energy x-ray absorptiometry. Serum estrone, androstenedione, and dihydroepiandrostenedione sulfate were measured on the same day. Body weight, body mass index, TBFM, and TBLM were all significantly higher in the black women. However, proportionately, there were no differences in body composition between the two groups. This suggests that the black women were not more obese despite their greater body mass index, and that future studies on the health impact of obesity in older black women should take this into consideration. Despite the greater TBFM and TBLM in the black women and no difference in serum androstenedione levels, the serum estrone level was not higher in the black women, and the higher bone mass in blacks was not related to serum estrone. In both ethnic groups, TBBM was significantly related to body weight (white, r = 0.80; black, r = 0.85; P < 0.001 for both). Both TBFM and TBLM were significantly related to TBBM in both ethnic groups. Serum estrone was significantly related to all measures of body mass in the white women, but to no measures of body mass in the black women, indicating apparent differences in the metabolism of estrone between older white and black women.
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PMID:Body composition and gonadal steroids in older white and black women. 807 60

Corticosteroids are commonly used in combination with cyclosporine in clinical kidney recipients, and administered indefinitely to many patients. Long-term administration of steroids is associated with a number of serious side effects including hypertension, obesity, hyperlipidemia, diabetes mellitus, cataract, osteoporosis, infection, moon face, and so on. A disturbance of growth is also a serious problem in pediatric patients. It is therefore desirable to discontinue the administration of steroid in renal allograft patients. For the withdrawal of steroid, it is quite important to thoroughly inhibit the recipient immune responses during the induction phase of immunosuppression without any serious adverse effect, that the patient may not retain immunological memories against donor antigens for a long period. Thus, we have been performing extensive immunosuppressive therapy using quadruple drugs, that is, DSG, cyclosporine, mizoribine, and prednisolone, during the early stage after kidney transplantation for withdrawal of prednisolone during the maintenance stage. Up to now, 19 recipients were treated with this protocol. In these patients, 8 were completely discontinued on the steroid and have been maintaining excellent graft function 9.2 to 32 months after transplantation, and 2 were reduced on the steroid to 5 mg. The present protocol may contribute greatly toward the quality of life in renal recipients.
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PMID:Deoxyspergualin. Mode of action and clinical trials. 810 31

Few family planning specialists are examining the potential bone-protective effects of oral contraceptives (OCs) in premenopausal and perimenopausal women. Osteoporosis is a major public health problem worldwide, as reflected in its associated morbidity and mortality and economic impact. For example, more than 25 million people in the US have osteoporosis, which costs society $7-10 billion each year. These costs are largely due to the more than 1.3 million fractures each year. The 250,000 hip fractures are responsible for the highest personal and societal cost. 12-20% of women with a hip fracture die within 2-3 months of the fracture. At least 50% need assistance with daily activities. Clinicians and public health specialists are not putting their energy into developing strategies that may preserve bone density in the premenopausal and perimenopausal years. More emphasis is needed on such strategies, since menopause is the time when bone loss accelerates. Clinicians do stress hormone replacement as a preventive therapy, but this is restricted to postmenopausal women. Extensive research and development of lower-dose OCs and data on appropriate screening of women with risk factors (e.g., smoking, obesity, and hypertension) demonstrate that healthy, nonsmoking women can use OCs safely and effectively throughout most of their reproductive years. Perhaps OC use can provide women the noncontraceptive benefit of maintenance and build up of bone mass up to menopause.
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PMID:Rational use of oral contraceptives in the perimenopausal woman. 812 Aug 61

As the hypothalamic gonadotropin-releasing hormone (GnRH) pulse generator is an integrator of hormonal, metabolic, and neural signals, it is not surprising that the function of the hypothalamogonadal axis is subject to the influence of a large array of environmental factors. Before puberty, the central nervous system (CNS) restrains the GnRH pulse generator. Undernutrition, low socioeconomic status, stress, and emotional deprivation, all delay puberty. During reproductive life, among peripheral factors that effect the reproductive system, stress plays an important role. Stress, via the release of corticotropin-releasing factor (CRF), eventually triggered by interleukin 1, inhibits GnRH release, resulting in hypogonadism. Effects of CRF are probably mediated by the opioid system. Food restriction and underweight (anorexia nervosa), obesity, smoking, and alcohol all have negative effects on the GnRH pulse generator and gonadal function. Age and diet are important determinants of fertility in both men and women. The age-associated decrease in fertility in women has as a major determinant chromosomal abnormalities of the oocyte, with uterine factors playing a subsidiary role. Age at menopause, determined by ovarian oocyte depletion, is influenced by occupation, age at menarche, parity, age at last pregnancy, altitude, smoking, and use of oral contraceptives. Smoking, however, appears to be the major determinant. Premature menopause is most frequently attributable to mosaicism for Turner Syndrome, mumps ovaritis, and, above all, total hysterectomy, which has a prevalence of about 12-15% in women 50 years old. Premature ovarian failure with presence of immature follicles is most frequently caused by autoimmune diseases or is the consequence of irradiation or chemotherapy with alkylating cytostatics. Plasma estrogens have a physiological role in the prevention of osteoporosis. Obese women have osteoporosis less frequently than women who are not overweight. Early menopause, suppression of adrenal function (corticoids), and thyroid hormone treatment all increase the frequency of osteoporosis. Aging in men is accompanied by decreased Leydig cell and Sertoli cell function, which has a predominantly primary testicular origin, although changes also occur at the hypothalamopituitary level. Plasma testosterone levels, sperm production, and sperm quality decrease, but fertility, although declining, is preserved until senescence. Stress and disease states accelerate the decline on Leydig cell function. Many occupational noxious agents have a negative effect on fertility.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Environment, human reproduction, menopause, and andropause. 824 11


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