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 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The change of estrogen function, represented by amenorrhea or hot flashes, that results from breast cancer treatment may increase the risk of major depressive disorder in those women undergoing treatment for breast cancer. This pilot study describes the course of menopausal symptoms and the incidence of depression in 21 patients who were likely to become acutely estrogen deficient during treatment for breast cancer. These included women who lost menses during chemotherapy, who suddenly stopped estrogen replacement therapy (ERT), or who started tamoxifen. Eight patients (38%) developed major depressive disorder, the majority within 6 months of starting treatment. Twenty patients (95%) had dysphoria and/or insomnia. Fourteen patients (66%) had hot flashes. While this is only pilot data, these data suggest that breast cancer patients whose treatment precipitates menopausal symptoms should be targeted for diagnosis of depression and treated if diagnosed.
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PMID:Iatrogenic acute estrogen deficiency and psychiatric syndromes in breast cancer patients. 1040 75

In the menopause transition, around 35% of women will seek medical help for menopausal symptoms. At the climacteric, various symptoms such as forgetfulness, anxiety, depressive neurosis, abnormal sensation, hot flush and sleeplessness are often observed due to hypofunction of the ovaries. There is some indication that women become more anxious during times of relatively low level of estrogen and progesterone such as premenstrual syndrome, premenstrual dysphoric disorder, maternity blues and menopausal state. The exact mechanism behind it is still unclear but is probably related to the decrease of ovarian hormones, which may be triggering psychiatric mood disorders. It is known that ovarian hormones act on specific areas of the brain and appear to act as anxiolytics. Certain progesterone metabolites are anesthetic and have antiepileptic and anxiolytic properties. These steroids modulate the type A gamma-aminobutyric acid (GABAA)/benzodiazepine receptor. This may help explain the increased frequency of anxiety disorders and mood disorders in the early postmenopausal period. In addition, estrogen also improves memory and performance in patients with mild Alzheimer's dementia. These effects can be related to amplifying effects of estrogen on excitatory amino acids in the brain. This is suggested that gonadal steroidal hormones seemed to be one of the essential substances for the maintenance of the limbic system and forebrain function which regulated anxiety, mood, memory and cognitive functions in menopausal women.
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PMID:[Menopause and anxiety: focus on steroidal hormones and GABAA receptor]. 1087 12

Menopausal symptoms are important concerns for breast cancer survivors, which may influence daily activities, physical comfort and sexual health. Incidence and severity ratings of menopausal symptoms contribute to our knowledge about menopause in women with cancer, but fail to fully describe the symptom experience. The purpose of this article is to broaden our understanding by describing variation in menopausal symptom distress and how women interpret and manage symptoms within the context of breast cancer. From a larger grounded theory study that explored women's responses to the experience of premature induced menopause within the context of breast cancer, the constant comparative method of analysis was used to generate a detailed contextually grounded description of the menopausal symptom experience in a sample of 27 women with breast cancer who received adjuvant therapy. Women identified a symptom profile of menstrual cycle changes, hot flashes, insomnia, vaginal dryness, dyspareunia, alterations in mood, cognition and libido, and weight gain. The majority of women reported menopausal symptoms but some women were distress free while others reported moderate to severe distress. The context of breast cancer influenced women's response to symptoms and their decision making about menopausal symptom management.
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PMID:The menopausal symptom experience in young mid-life women with breast cancer. 1140 64

Women experiencing gynecological disorders can suffer from a diversity of symptoms and problems. To what extent women are relieved of their physiologically and psychosocially based symptoms by hysterectomy is an important issue. This study aims to evaluate the long-term impact of hysterectomy on such symptoms and to compare the findings with those of a control group. Women with gynecological disorders experienced physiologically based symptoms, such as pelvic pain and urinary incontinence, to a greater degree than did the control group (p < 0.05), whereas bowel function and menopausal symptoms were equally distributed in the two groups. Furthermore, these women experienced psychosocially based symptoms, such as fatigue and insomnia, to a greater degree than the control group (p < 0.05), whereas the groups did not differ in psychological well-being or sexual function. After hysterectomy, however, pelvic pain and sleeping disturbances were alleviated, and the state of energy and urinary function were improved (p < 0.00). Bowel function, menopausal symptoms, psychological well-being, sexual function, and self-perception as a woman were not influenced by the operation. Both 6 and 12 months after hysterectomy, no differences between the patients and the control group were found, except for the tendency of patients not to gain weight after the operation. The symptoms are mostly improved or unchanged after hysterectomy, and additional problems do not seem to follow the operation.
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PMID:Are the physiologically and psychosocially based symptoms in women suffering from gynecological disorders alleviated by means of hysterectomy? 1155 55

Despite continuing evidence of its value, hormone replacement (HR) therapy is used by only a minority of postmenopausal women. Some of this reluctance may stem from concerns about the medicalization of menopause and the labeling of menopause as a state of failure or disease that needs to be treated. These concerns are understandable given the impact of previous efforts to apply erroneous biological models to women's physiology, often to their detriment. Some may assert that current attempts to describe menopause as a state of estrogen deficiency are as wrong as previous explanations that the backing up of menstrual blood required purging and bleeding. However, there is an abundance of research attesting to the value of HR in decreasing such menopausal symptoms as hot flashes and insomnia and in preventing chronic problems, including urogenital atrophy and osteoporosis. In addition, recent research suggests that estrogen may have positive effects on cognition. Questions about HR and breast cancer remain, and several studies have found a small increase in breast cancer among long-term estrogen users. The recent introduction of selective estrogen response modifiers may further increase the safety of HR therapy. Many women worried about breast cancer and other possible estrogenic effects of HR are seeking approaches they consider more natural to managing menopause, turning to such untested remedies as soy supplements and herbs. While awaiting rigorous trials, clinicians can help patients understand the consequences of relying on therapies that have unknown long-term safety and effectiveness.
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PMID:Postmenopausal hormone replacement: historical perspectives and current concerns. 1185 49

Due to the long-term health risks now associated with hormone replacement therapy, many menopausal women are actively seeking alternative treatments. One such alternative is black cohosh (Actaea racemosa, syn. Cimicifuga racemosa), which has been used in the United States for the treatment of gynecologic complaints for more than 100 years. Review of the published clinical data suggests that black cohosh may be useful for the treatment of menopausal symptoms, such as hot flashes, profuse sweating, insomnia, and anxiety. Results from the most recently published trial, however, indicate that black cohosh is not effective for the treatment of menopausal symptoms in breast cancer survivors being treated with tamoxifen. Because the overall quality of the published clinical trials is low, two new randomized, double-blind, placebo-controlled clinical trials are currently underway in the United States. To date, only one standardized black cohosh extract has been tested clinically; the current recommended dose is 40-80 mg per day. At least 4-12 weeks of treatment may be required before any therapeutic benefits may be apparent. Adverse reactions such as nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials. No drug interactions are reported in the medical literature. The estrogenic effects of black cohosh are controversial, and the more recent data indicate that black cohosh extracts may have an anti-estrogenic activity. Owing to potential effects on sex hormones, however, black cohosh should not be administered to children or during pregnancy and lactation.
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PMID:Black cohosh: an alternative therapy for menopause? 1255 11

More than 1 million women are expected to reach menopause each year, many of whom will experience hot flushes and other neuropsychological symptoms that may diminish their quality of life. Hot flushes are the core symptoms that reflect the brain's response to the changing hormonal milieu of the menopause transition, particularly to the rapidly fluctuating and falling levels of estradiol. The physical symptoms of hot flushes and the associated changes in sleep, mood, and cognition will lead many women to seek medical care. It is critical to understand the interrelationship of hot flushes and other neuropsychological symptoms of the menopause transition so that treatment priorities can be established. For example, if sleep disruption explains most daytime neuropsychological problems in women with hot flushes, treating insomnia should be considered a priority. Alternatively, mood, cognition, and quality of life may be disturbed independent of sleep problems. In such a situation, each symptom should be evaluated separately from any assessment of sleep. As recent data from the WHI establish the risks of long-term HRT use, concern about using HRT, even as a short-term intervention, has increased substantially. Although HRT remains the first-line treatment for hot flushes, the WHI findings have drawn attention to nonhormonal treatments of hot flushes and other menopausal symptoms. Growing evidence to support the efficacy of serotonergic antidepressants and other psychoactive medications in the treatment for hot flushes suggests that nonhormonal interventions will prove important alternatives to HRT. As further evidence of the benefits of psychoactive medications for menopausal symptoms is established, the choice between using hormonal and nonhormonal therapies for management of menopausal symptoms will continue to evolve.
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PMID:Assessment and treatment of hot flushes and menopausal mood disturbance. 1456 98

Menopause is a process, either naturally or medically induced, that occurs in nearly all women at some point in life. Some of the most commonly reported symptoms associated with menopause are hot flushes/flashes, fatigue, headaches, irritability, insomnia, and depression. These symptoms overlap with symptoms commonly reported in Traumatic Brain Injury (TBI) as well as postconcussive syndrome. This overlap between symptoms commonly associated with menopause and neuropsychological conditions makes it necessary to have the base rates of these symptoms and conditions available. The purpose of the present review was to consolidate the clinical literature on the most commonly reported menopausal symptoms and to calculate the base rates associated with these symptoms.
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PMID:A review of symptoms commonly associated with menopause: implications for clinical neuropsychologists and other health care providers. 1458 9

While symptom distress can alter the cancer experience, it is difficult to define and measure. This study's aims were (1) to determine whether the McCorkle Symptom Distress Scale (SDS) or the Rhodes Adapted Symptom Distress Scale (ASDS) was the more accurate measure of symptom distress in women with breast cancer; (2) correlate both scales with a visual analogue scale (VAS) measuring anxiety, a symptom frequently reported clinically; (3) determine tool preference; and (4) establish when during the first cycle of chemotherapy the highest levels of symptom distress were experienced. One hundred twenty women were recruited and measurement of symptom distress (SDS and ASDS) and anxiety (VAS) taken at the start of chemotherapy (Time 1), at the nadir (Time 2), and at the end of the cycle (Time 3). Both instruments were highly correlated and detected change over time; none was correlated with the VAS anxiety scale. Symptom distress scores were generally low, with fatigue, appearance, insomnia, and concentration causing the greatest distress. Other factors like functioning, body image, and menopausal symptoms cited as contributors to symptom distress levels were not measured and could account for low scores and perhaps suggest that symptom distress may not be accurately measured in today's women with early-stage breast cancer.
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PMID:Measurement of symptom distress in women with early-stage breast cancer. 1525 72

Since the publication of the results of the Women's Health Initiative that described the risks of hormone replacement therapy, many women are actively seeking alternative treatments for menopausal symptoms. Black cohosh (Actaea racemosa, syn. Cimicifuga racemosa) is one such alternative that has been used in the US for over 100 years. To date only two cimicifuga extracts have been tested clinically, and the current recommended dosage is 40-80 mg/day. Review of the published clinical data suggests that cimicifuga may be useful for the treatment of menopausal symptoms, such as hot flashes, profuse sweating, insomnia, and anxiety. However, the methodology used in most of the trials is poor and further clinical assessment of cimicifuga is needed. In terms of safety, transient adverse events such as nausea, vomiting, headaches, dizziness, mastalgia, and weight gain have been observed in clinical trials. A few cases of hepatotoxicity have been reported, but a direct association with the ingestion of cimicifuga has not been demonstrated. The most recent data suggest that cimicifuga is not estrogenic.
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PMID:Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms. 1589 23


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