Flow-mediated vasodilation and the risk of developing hypertension in healthy postmenopausal women.
(41/121)OBJECTIVES: This study provided the opportunity to assess the relationship between endothelial vasomotor function and incidence of hypertension in a cohort of postmenopausal women. BACKGROUND: Both menopause and hypertension are associated with endothelial dysfunction and are well-known risk factors for atherosclerotic-related disease. METHODS: We conducted a prospective cohort study that began in 1996 on 952 apparently healthy postmenopausal women, age 53 +/- 5 years (range 44 to 60 years), with initially normal levels of blood pressure and no history of hypertension. All participants were followed up for a mean period of 3.6 +/- 0.7 years (range 0.5 to 6.9 years). Endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution ultrasound. RESULTS: During follow-up 112 women developed hypertension. The adjusted relative risk for women with flow-mediated dilation of 3.5 or less (lowest quartile) was 5.77 (95% confidence interval 4.34 to 8.10) versus women with flow-mediated dilation of 5.5 or greater (highest quartile, referent). Each one-unit decrease of flow-mediated dilation was associated with a significant 16% (95% confidence interval 12% to 33%) increase in the multiple-adjusted relative risk of incident hypertension. CONCLUSIONS: These prospective data indicate a significant increase in the relative risk of hypertension with each unit decrease of flow-mediated dilation that is independent of age and baseline systolic and diastolic pressure values. This could suggest that an impaired endothelial vasomotor function precedes and predicts the future development of hypertension in postmenopausal women. (+info)
Bone density-related predictors of blood lead level among peri- and postmenopausal women in the United States: The Third National Health and Nutrition Examination Survey, 1988-1994.
(42/121)Because of the long half-life of lead stored in bone (years), skeletal lead stores may be a source of endogenous lead exposure during periods of increased bone demineralization, such as menopause. To test the hypothesis that postmenopausal bone resorption increases blood lead levels, the authors examined cross-sectional associations of bone density-related factors with blood lead levels among women aged 40-59 years from the Third National Health and Nutrition Examination Survey (1988-1994). Factors related to bone turnover were significant predictors of blood lead level. Bone mineral density was significantly inversely related to blood lead levels in log-linear multivariate models that adjusted for age, race/ethnicity, smoking, education, household income, alcohol use, and residence (urban/rural). With menopausal status added to the model, naturally and surgically menopausal women had adjusted median blood lead levels that were 25% and 30% higher, respectively, than those of premenopausal women (2.0 microg/dl). Current use of hormone replacement therapy was associated with significantly lower adjusted median blood lead levels (1.8 microg/dl) than past use (2.6 microg/dl) and never use (2.2 microg/dl). Lead stored in bone may significantly increase blood lead levels in perimenopausal women because of postmenopausal bone mineral resorption. Attention to factors that prevent bone loss may lessen or prevent this endogenous lead exposure. (+info)
Assessment of women in midlife.
(43/121)BACKGROUND: Midlife is much more than menopause. At the time of their life when women may be experiencing symptoms relating to decreased ovarian function, they are also confronted with a range of physical and psychosocial issues that may affect their wellbeing. OBJECTIVE: This article outlines the range of clinical presentations of women in midlife and discusses assessment of these presentations in the context of the individual woman's life. DISCUSSION: Women in midlife present to doctors for a variety of reasons including information and preventive health, vasomotor or other symptoms of oestrogen deficiency, menstrual disorders, breast disorders, sexual difficulty, relationship and family issues, or mood disorders. Forming an effective doctor-patient partnership to address these issues requires time, empathy, good interpersonal skills, comprehensive and sensitive history taking and examination skills, and a good knowledge of relevant research. (+info)
Menopausal complaints, oestrogens, and heart disease risk: an explanation for discrepant findings on the benefits of post-menopausal hormone therapy.
(44/121)There is a large discrepancy between the findings of observational and experimental studies on the effects of post-menopausal hormone therapy (HT) and coronary heart disease risk. Observational studies, mainly comprising peri-menopausal women, report risk reductions up to 30-50%, whereas the experimental studies, comprising elderly women, do not show coronary protection. Suggested explanations are methodological differences, such as confounding or healthy user bias, incomplete capture of early events, the stage of atherosclerosis at the start of HT, formulation or dose of HT, or early susceptibility to thrombotic events. We propose that the presence of climacteric complaints determines the susceptibility to hormone replacement therapy. Climacteric complaints are the main indication for HT in the population, whereas in the clinical trials women with climacteric complaints were either explicitly excluded or comprised only a minority of the total randomized population. There is some, albeit circumstantial evidence to support this hypothesis. Women with climacteric complaints of sweating not only appear to have lower levels of serum oestradiol, but also lose more bone than women without climacteric complaints. Consequently, sweating episodes may indicate potential benefits from HT. It has also been reported that hot flushes during menopause correlate with a higher level of oxidative stress and an increased cardiovascular reactivity to stressful situations. We suggest epidemiological approaches to test our hypothesis. (+info)
Bowel habits before and during menses in Japanese women of climacteric age: a population based study.
(45/121)A good deal of data are available on the bowel habits of pre-climacteric females during menstruation. Few studies have examined the same subject in females of climacteric age but who are still menstruating, so the present study was undertaken to examine the bowel habits in menstruating females in this age group. Subjects (n = 246) were residents of a city in northern Japan, aged from 45 to 55 years old and who were still menstruating. Their every-day state of defecation and fecal characteristics were assessed with regard to four parameters: bowel movement frequency, defecation state, fecal appearance and fecal consistency. Based on a perfect match to these four criteria, the subjects were assigned to two groups, the normal group and the constipation group, and changes were assessed by enquiring how their bowel habits differed immediately before and during menses compared with their usual state. Immediately before menstruation, in the constipation group feces became harder and looser in 22.1% and 13.7%, respectively, compared with 8.7% and 9.5% in the normal group. On the other hand, during menstruation in the constipation group, feces became harder and looser in 11.6% and 16.8%, respectively, compared with 5.7% and 8.9% in the normal group. In other words, the constipation group showed a greater change immediately before and during menstruation compared with the normal group, though the differences were not significant. Our data thus suggest that the changes in the bowel habits of women of climacteric age at menstruation are greater for those suffering from constipation than those who are not. (+info)
Acupuncture for treatment of climacteric syndrome--a report of 35 cases.
(46/121)OBJECTIVE: To evaluate the effects of acupuncture for treatment of climacteric syndrome. METHODS: The 65 cases in this series were randomly assigned to the acupuncture group (N=35) and the control group (N=30), with the former treated by acupuncture and the latter by medication respectively. The therapeutic effects were evaluated by means of the clinical outcome, improvement in the symptom scores and the results of radioimmunoassays. RESULTS: In the acupuncture group, 12 cases were cured, 16 cases markedly effective, and 6 cases improved, the total effective rate being as high as 97.14%. The decrease in the symptom scores, and especially the elevation of the decreased E2 level and the decrease of the increased FSH and LH levels, demonstrated that acupuncture therapy was superior to medication. CONCLUSION: Acupuncture for regulating the mental activities and reinforcing the kidney is an effective therapy for climacteric syndrome. (+info)
Climacteric symptoms and quality of life: validity of women's health questionnaire.
(47/121)OBJECTIVE: To evaluate the reliability and validity of the Portuguese version of the Women's Health Questionnaire. METHODS: In order to evaluate the Women's Health Questionnaire (WHQ), an analytical cross-sectional study was carried out at the women's menopause outpatient clinic of a university hospital in Sao Paulo, Brazil. There were studied 87 women in perimenopause or menopause, defined as experiencing at least one year's absence of menstrual flow. The following variables were collected: demographic data, clinical variables (Kupperman index and correlate numeric scale) and quality of life indexes (SF-36 and utility). RESULTS: The WHQ proved to be a questionnaire easily translated into Portuguese and well-adjusted to Brazilian women. The internal consistency of the overall WHQ was excellent (Cronbach alpha =0.83; 95% CI: 0.71-0.91). Test-retest reliability was also excellent (intraclass correlation coefficient [ICC]=0.92; 95% IC: 0.86-0.96) and had good absolute agreement (0.84; 95% CI: 0.71-0.92). A satisfactory clinical validity was observed. The construct validity was corroborated by clear associations with others scales. A good index of responsiveness after the intervention was reached. CONCLUSIONS: The Portuguese version of the WHQ is of easy and fast administration and understanding. Its measuring properties were related, allowing its use in the evaluation of Brazilian climacteric women's quality of life for various purposes. (+info)
Current alcohol use is associated with a reduced risk of hot flashes in midlife women.
(48/121)AIMS: To examine the relation between current alcohol use, estradiol, estrone, and testosterone levels, and hot flashes in midlife women using a case-control study design. METHODS: Cases were midlife women (45-54 years) who reported ever experiencing hot flashes. Controls were midlife women (45-54 years) who reported never experiencing hot flashes. Each participant completed a questionnaire and provided a blood sample that was used to measure estradiol, estrone, and testosterone levels by enzyme-linked immunosorbent assay. RESULTS: The results indicate that current alcohol use (at least one day per month) was significantly associated with a reduced risk of hot flashes compared to non-use of alcohol, independent of age and smoking habits. The hot flashes experienced by current alcohol users were less severe and less frequent than those experienced by non-users of alcohol. Further, current alcohol users had similar levels of estradiol, estrone, and testosterone compared to non-users of alcohol. CONCLUSIONS: These data suggest that current alcohol use is associated with a reduced risk of any, severe, and frequent hot flashes in midlife women by a mechanism that may not include changes in sex steroid hormone levels. (+info)