Perimenopause
Climacteric
Menopause
Cyclohexenes
Vinyl Compounds
Menstruation
Menstrual Cycle
Reproductive History
Premenopause
Postmenopause
Longitudinal Studies
Age Factors
Differential association of modifiable health behaviors with hot flashes in perimenopausal and postmenopausal women. (1/149)
OBJECTIVE: To determine the association of modifiable factors, such as smoking, body mass index, and alcohol use, with hot flashes, and to ascertain whether the association with hot flashes varies by menopausal stage. DESIGN: A written survey completed by perimenopausal and postmenopausal women enrolling in a randomized, controlled trial of a menopause risk management program in 1999. Survey items included questions on demographics, health status, and health behaviors. SETTING: A Massachusetts-based health maintenance organization. PATIENTS/PARTICIPANTS: Female members, age 40 to 65, excluding women with chronic conditions precluding study participation, were randomly selected from an automated medical record system. MEASUREMENTS AND MAIN RESULTS: The majority of the 287 postmenopausal and 468 perimenopausal women participating in the study were white, college educated, and nonsmoking. Approximately 30% of both groups reported experiencing hot flashes. Separate multivariable logistic regression models were developed for perimenopausal and postmenopausal women to identify correlates of reporting any versus no hot flashes. After controlling for age, race, oral contraceptive use, hormone replacement therapy use, and depression, correlates of hot flashes in perimenopausal women were body mass index >/=25 kg/m(2) (odds ration [OR], 2.00; 95% confidence interval [CI], 1.28 to 3.12) and alcohol use of 1 to 5 drinks per week (OR, 0.52; 95% CI, 0.31 to 0.86). The only significant correlate of hot flashes in the postmenopausal population was high dietary fat intake (OR, 0.35; 95% CI, 0.15 to 0.81). CONCLUSION: Although study respondents were from similiar sociodemographic groups and received their health care in the same health maintenance organization, modifiable factors associated with hot flashes were different for perimenopausal and postmenopausal women. (+info)Longitudinal study of the inception of perimenopause in relation to lifetime history of sexual or physical violence. (2/149)
STUDY OBJECTIVE: To investigate of the extent to which violence over the life course accelerates the onset of perimenopause, as measured by menstrual changes. DESIGN: Prospective cohort study. SETTING: Boston, Massachusetts. PARTICIPANTS: 603 premenopausal women aged 36-45 years at baseline who completed a cross sectional survey on childhood and adult violence history. MAIN OUTCOME MEASURE: Time to perimenopause, defined as time in months from baseline interview to a woman's report of (1) an absolute change of at least seven days in menstrual cycle length from baseline or subjective report of menstrual irregularity; (2) a change in menstrual flow amount or duration; or (3) cessation of periods for at least three months, whichever came first. MAIN RESULTS: Experience of abuse was associated with delayed onset of menstrual changes indicative of onset of perimenopause. Women reporting childhood or adolescent abuse entered perimenopause about 35% slower than women who reported no abuse (IRR(adj) = 0.65, 95% CI 0.45 to 0.95) after adjusting for age, age at menarche, ever live birth, ability to maintain living standard, smoking, BMI, and depression. There was a similar association among women who reported first abuse during adulthood (IRR(adj) = 0.72, 95% CI 0.28 to 1.80). These findings persisted when the cohort was restricted to non-depressed women (childhood/adolescent IRR(adj) = 0.57, 95% CI 0.36 to 0.90; adulthood IRR(adj) = 0.63, 95% CI 0.23 to 1.77). CONCLUSIONS: This study is the first longitudinal analysis of the timing of perimenopause to show an association with a history of physical or sexual abuse. Further study of the relation between violence and reproductive aging is needed. (+info)Levonorgestrel intrauterine system (LNG-IUS) with conjugated oral equine estrogen: a successful regimen for HRT in perimenopausal women. (3/149)
BACKGROUND: This study was designed to assess the long-term efficacy (5 years) of the levonorgestrel-releasing intrauterine system (LNG-IUS) in protecting the endometrium from hyperplasia during estrogen replacement therapy in perimenopausal women. METHODS: Prospective, open, outpatient clinical trial in London and Oxford. Eighty-two women received oral conjugated equine estrogen 1.25 mg daily and LNG-IUS releasing 20 mug levonorgestrel per 24 h. Endometrial biopsy and histological assessment were performed annually. Endometrial thickness was measured by vaginal ultrasonography. RESULTS: Non-proliferative endometrium was present at the end of cycles 12, 24, 36, 48 and 60 in 98.6, 98.6, 95.5, 96.8 and 95.2% of the participants respectively. No endometrial hyperplasias were confirmed throughout a period of 60 cycles. The proportion of amenorrhoeic women increased from 54.4% at 12 cycles to 92.7% at the end of the study. The continuation rate per 100 women at 60 cycles was 79.84 (95% CI 71.0-88.6). CONCLUSIONS: The LNG-IUS with estrogen supplementation in perimenopausal women suppresses endometrial proliferation resulting in amenorrhoea and relieves vasomotor symptoms. The treatment regimen is well tolerated and provides an alternative strategy for perimenopausal women with the likelihood of increasing compliance. (+info)Enlarged squamous cell nuclei in cervical cytologic specimens from perimenopausal women ("PM Cells") : a cause of ASC overdiagnosis. (4/149)
We studied the appropriateness of interpreting squamous cells with enlarged, smooth, bland nuclei in perimenopausal women ("PM cells") as atypical squamous cells (ASCs). Papanicolaou smears (Paps) from 100 women (40-55 years old) with a cytologic interpretation of ASC of undetermined significance (ASCUS) and human papillomavirus (HPV) testing or a biopsy within 6 months were reviewed by 2 observers without knowledge of the biopsy diagnosis or HPV results. Cases in which both reviewers agreed that the Paps were diagnosed more properly as "negative for intraepithelial lesion or malignancy" were compared with cases of "true ASCUS," using histologic squamous intraepithelial lesion and/or a positive high-risk HPV test as a positive outcome (abnormal follow-up). Of 100 cases, 28 were reclassified as benign by both observers. In 15 of these, the original ASCUS interpretation was based on cells with bland nuclear enlargement (2-3 times the area of intermediate cell nuclei), smooth nuclear membranes, and fine chromatin. Abnormal follow-up was identified in 1 (7%) of 15 benign cases but in 30 (42%) of 72 true ASCUS cases (P = .023). PM cells are a significant cause of ASC overdiagnosis in women 40 to 55 years old. Cervical Paps with cells no more atypical than these can be interpreted safely as negative for intraepithelial lesion or malignancy. (+info)Atherosclerotic lesion development in a novel ovary-intact mouse model of perimenopause. (5/149)
OBJECTIVE: Since the unexpected results from the Women's Health Initiative, the possible protective role of estrogen in preventing heart disease in perimenopausal and postmenopausal women is uncertain. This study examined atherosclerotic lesion development in ovariectomized versus follicle-depleted ovary-intact cholesterol-fed female low-density lipoprotein (LDL) receptor-deficient mice. METHODS AND RESULTS: We studied lesion development in LDL receptor-deficient mice that were ovariectomized or follicle depleted with 4-vinylcyclohexene diepoxide (VCD) to induce ovarian failure, then treated +/- exogenous 17beta-estradiol via pellet implant. At 120 days after start of cholesterol feeding, the extent of lesion in aorta and innominate artery was determined. Lesion area in both locations was similar in vehicle control, VCD-treated, and ovariectomized mice. Replacement with 17beta-estradiol caused lesion reduction (P<0.05) in both arterial locations, but it was most efficacious in suppressing innominate lesion area in VCD-treated mice (12.9+/-5.2%) compared with ovariectomized mice (40.0+/-6.04%). CONCLUSIONS: Endocrine status associated with the follicle-depleted ovary influences exogenous estradiol effects during the development of atherosclerotic lesions and, in particular, inhibits lesion progression in the innominate artery. (+info)Ethnic variation in hypertension among premenopausal and perimenopausal women: Study of Women's Health Across the Nation. (6/149)
Data are sparse regarding hypertension prevalence, treatment, and control among some ethnic groups of American women. Furthermore, the effects of ethnicity on hypertension, independent of other factors that vary with ethnicity, are poorly understood. We examined the prevalence of hypertension (defined as systolic > or =140 or diastolic > or =90 mm Hg or receiving treatment), treatment, and control (to <140/<90 mm Hg) in a multiethnic study of premenopausal and perimenopausal women. Stepwise multivariable logistic regression was used to select covariates associated with hypertension. Among 3292 women, 46.9% were white, 28.3% were black, 8.7% were Hispanic, 7.6% were Chinese, and 8.5% were Japanese. Among these 5 ethnic groups, respectively, there was substantial variation in prevalence of normal blood pressure levels (<120/<80 mm Hg; 59.9%, 35.4%, 16.8%, 67.2%, and 63.7%) and hypertension (14.5%, 38.1%, 27.6%, 12.8%, and 11.0%). After multivariable adjustment, hypertension prevalence was 2 to 3x higher among black and Hispanic women but similar among Chinese and Japanese women compared with white women. Among hypertensive participants, prevalence of antihypertensive treatment was highest among blacks (58.9%) and whites (55.2%) and lowest among Chinese (34.4%). Prevalence of control to goal blood pressure levels was highest among whites (43.0%) and Japanese (38.7%) and markedly lower among Hispanic women (11.4%). Compared with whites, black and Hispanic women have significantly higher prevalence of hypertension independent of other factors, whereas Chinese and Japanese women have similar prevalence. Treatment and control rates vary considerably across ethnicities. Greater efforts must be made to improve hypertension awareness, treatment, and control in all middle-aged women, particularly those in ethnic minority groups. (+info)Three-dimensional ultrasonography and power Doppler in ovarian cancer screening of asymptomatic peri- and postmenopausal women. (7/149)
AIM: To determine whether introducing three-dimensional (3D) ultrasonography with power Doppler facilities as a secondary screening test, preceded by annual transvaginal grayscale ultrasonography (TVUS) (followed by transvaginal color Doppler (TVCD) in selected cases) as a primary screening test for ovarian cancer improves the accuracy of ovarian cancer screening studies. METHODS: Annual TVUS was performed on 3,201 peri- and postmenopausal asymptomatic women aged > or =50 years from March 1, 2001 to June 30, 2003. Cystic ovarian lesions in perimenopausal women were routinely reevaluated by TVUS and TVCD at 4-6 week intervals to avoid unnecessary surgical intervention for physiological cysts. Any multiloculated, complex or solid ovarian mass, as well as persistently cystic mass >5 cm in diameter, in which the echo architecture and/or blood flow pattern was not highly suggestive of a benign histology, was categorized malignant. In these cases, TVUS and TVCD findings were obtained in no more than 2 weeks and supplemented by secondary screening, including 3D ultrasonography, and 3D power Doppler, in combination with serum CA 125 determination. After detailed ultrasonographic examination, surgical removal of the tumor and pathohistological classification were completed. RESULTS: Twenty-five patients (0.8%) with persisting ultrasonographic abnormalities after primary and secondary screening underwent surgery to remove the ovarian tumor. Five epithelial ovarian cancers were detected: 3 stage IA, 1 stage IB, and 1 stage IC. Three stage I patients had a palpable abnormality on clinical examination. Furthermore, in three patients with stage I disease, CA 125 serum value was elevated (> or =35 U/mL). Three-dimensional ultrasonography and power Doppler, as well as TVUS findings were indicative of malignancy in all 5 patients with stage I ovarian cancer, whereas TVCD finding was false-negative in 2 patients with stage I disease. Screening test (primary+secondary screening) had the sensitivity of 100%, specificity of 99.4%, positive predictive value of 20%, and negative predictive value of 100%. CONCLUSION: Application of 3D ultrasonography and power Doppler imaging in patients with "positive" standard ultrasound tests (annual TVUS, followed by TVCD in selected cases) represents a novel approach for the early and accurate detection of ovarian cancer through screening. (+info)Diagnostic performance of digital versus film mammography for breast-cancer screening. (8/149)
BACKGROUND: Film mammography has limited sensitivity for the detection of breast cancer in women with radiographically dense breasts. We assessed whether the use of digital mammography would avoid some of these limitations. METHODS: A total of 49,528 asymptomatic women presenting for screening mammography at 33 sites in the United States and Canada underwent both digital and film mammography. All relevant information was available for 42,760 of these women (86.3 percent). Mammograms were interpreted independently by two radiologists. Breast-cancer status was ascertained on the basis of a breast biopsy done within 15 months after study entry or a follow-up mammogram obtained at least 10 months after study entry. Receiver-operating-characteristic (ROC) analysis was used to evaluate the results. RESULTS: In the entire population, the diagnostic accuracy of digital and film mammography was similar (difference between methods in the area under the ROC curve, 0.03; 95 percent confidence interval, -0.02 to 0.08; P=0.18). However, the accuracy of digital mammography was significantly higher than that of film mammography among women under the age of 50 years (difference in the area under the curve, 0.15; 95 percent confidence interval, 0.05 to 0.25; P=0.002), women with heterogeneously dense or extremely dense breasts on mammography (difference, 0.11; 95 percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausal or perimenopausal women (difference, 0.15; 95 percent confidence interval, 0.05 to 0.24; P=0.002). CONCLUSIONS: The overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer is similar, but digital mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women. (ClinicalTrials.gov number, NCT00008346.) (+info)Perimenopause is a term used to describe the phase before menopause where the ovaries gradually begin to produce less estrogen. It's also sometimes referred to as the "menopausal transition."
This stage can last for several years, typically starting in a woman's mid-40s, but it can begin in some women as early as their mid-30s or as late as their early 50s. During this time, menstrual cycles may become longer or shorter, and periods may be lighter or heavier.
The most significant sign of perimenopause is the irregularity of periods. However, other symptoms such as hot flashes, sleep disturbances, mood changes, and vaginal dryness can also occur, similar to those experienced during menopause.
Perimenopause ends after a woman has gone 12 months without having a period, which marks the start of menopause.
The climacteric, also known as perimenopause or menopausal transition, is a phase in a woman's reproductive life characterized by various physiological and hormonal changes that occur as she approaches menopause. The term "climacteric" comes from the Greek word "klimakter," which means "ladder" or "rung of a ladder."
During this phase, which typically begins in a woman's mid-to-late 40s and can last for several years, the production of estrogen and progesterone by the ovaries starts to decline. This decline in hormone levels can lead to a variety of symptoms, including:
* Irregular menstrual cycles
* Hot flashes and night sweats
* Sleep disturbances
* Mood changes
* Vaginal dryness and discomfort during sexual activity
* Decreased libido
* Urinary frequency or urgency
* Memory and cognitive changes
The climacteric is a natural phase of a woman's life, and while some women may experience significant symptoms, others may have few or no symptoms at all. Hormone replacement therapy (HRT) and other treatments are available to help manage the symptoms of the climacteric for those who find them disruptive or bothersome.
Menopause is a natural biological process that typically occurs in women in their mid-40s to mid-50s. It marks the end of menstrual cycles and fertility, defined as the absence of menstruation for 12 consecutive months. This transition period can last several years and is often accompanied by various physical and emotional symptoms such as hot flashes, night sweats, mood changes, sleep disturbances, and vaginal dryness. The hormonal fluctuations during this time, particularly the decrease in estrogen levels, contribute to these symptoms. It's essential to monitor and manage these symptoms to maintain overall health and well-being during this phase of life.
Cyclohexenes are organic compounds that consist of a six-carbon ring (cyclohexane) with one double bond. The general chemical formula for cyclohexene is C6H10. The double bond can introduce various chemical properties and reactions to the compound, such as electrophilic addition reactions.
Cyclohexenes are used in the synthesis of other organic compounds, including pharmaceuticals, agrochemicals, and materials. Some cyclohexene derivatives also occur naturally, for example, in essential oils and certain plant extracts. However, it is important to note that pure cyclohexene has a mild odor and is considered a hazardous substance, with potential health effects such as skin and eye irritation, respiratory issues, and potential long-term effects upon repeated exposure.
"Vinyl compounds" is not a term used in medical definitions. It is a term used in chemistry and materials science to refer to a group of chemicals that contain carbon-based molecules with a vinyl group, which is a functional group consisting of a double bond between two carbon atoms, with one of the carbons also being bonded to a hydrogen atom (-CH2=CH-).
Vinyl compounds are used in various industrial and consumer products, including plastics, resins, adhesives, and coatings. Some vinyl compounds, such as polyvinyl chloride (PVC), have been used in medical devices and supplies, such as intravenous (IV) bags, tubing, and blood vessel catheters. However, the use of PVC and other vinyl compounds in medical applications has raised concerns about potential health risks due to the release of toxic chemicals, such as phthalates and dioxins, during manufacturing, use, and disposal. Therefore, alternative materials are being developed and used in medical devices and supplies.
Menstruation is the regular, cyclical shedding of the uterine lining (endometrium) in women and female individuals of reproductive age, accompanied by the discharge of blood and other materials from the vagina. It typically occurs every 21 to 35 days and lasts for approximately 2-7 days. This process is a part of the menstrual cycle, which is under the control of hormonal fluctuations involving follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone.
The menstrual cycle can be divided into three main phases:
1. Menstruation phase: The beginning of the cycle is marked by the start of menstrual bleeding, which signals the breakdown and shedding of the endometrium due to the absence of pregnancy and low levels of estrogen and progesterone. This phase typically lasts for 2-7 days.
2. Proliferative phase: After menstruation, under the influence of rising estrogen levels, the endometrium starts to thicken and regenerate. The uterine lining becomes rich in blood vessels and glands, preparing for a potential pregnancy. This phase lasts from day 5 until around day 14 of an average 28-day cycle.
3. Secretory phase: Following ovulation (release of an egg from the ovaries), which usually occurs around day 14, increased levels of progesterone cause further thickening and maturation of the endometrium. The glands in the lining produce nutrients to support a fertilized egg. If pregnancy does not occur, both estrogen and progesterone levels will drop, leading to menstruation and the start of a new cycle.
Understanding menstruation is essential for monitoring reproductive health, identifying potential issues such as irregular periods or menstrual disorders, and planning family planning strategies.
The menstrual cycle is a series of natural changes that occur in the female reproductive system over an approximate 28-day interval, marking the body's preparation for potential pregnancy. It involves the interplay of hormones that regulate the growth and disintegration of the uterine lining (endometrium) and the release of an egg (ovulation) from the ovaries.
The menstrual cycle can be divided into three main phases:
1. Menstrual phase: The cycle begins with the onset of menstruation, where the thickened uterine lining is shed through the vagina, lasting typically for 3-7 days. This shedding occurs due to a decrease in estrogen and progesterone levels, which are hormones essential for maintaining the endometrium during the previous cycle.
2. Follicular phase: After menstruation, the follicular phase commences with the pituitary gland releasing follicle-stimulating hormone (FSH). FSH stimulates the growth of several ovarian follicles, each containing an immature egg. One dominant follicle usually becomes selected to mature and release an egg during ovulation. Estrogen levels rise as the dominant follicle grows, causing the endometrium to thicken in preparation for a potential pregnancy.
3. Luteal phase: Following ovulation, the ruptured follicle transforms into the corpus luteum, which produces progesterone and estrogen to further support the endometrial thickening. If fertilization does not occur within approximately 24 hours after ovulation, the corpus luteum will degenerate, leading to a decline in hormone levels. This drop triggers the onset of menstruation, initiating a new menstrual cycle.
Understanding the menstrual cycle is crucial for monitoring reproductive health and planning or preventing pregnancies. Variations in cycle length and symptoms are common among women, but persistent irregularities may indicate underlying medical conditions requiring further evaluation by a healthcare professional.
Reproductive history is a term used in medicine to describe the past experiences related to reproduction for an individual. This can include information about pregnancies, including the number of pregnancies, outcomes (such as live births, miscarriages, or stillbirths), and any complications that arose during pregnancy or childbirth. It may also include details about contraceptive use, menstrual history, sexually transmitted infections, and any reproductive health issues or surgeries.
This information is often collected by healthcare providers to help assess fertility, plan for future pregnancies, identify potential risks, and provide appropriate care and management of reproductive health conditions. It's also used in research and public health to understand trends and disparities in reproductive outcomes.
Premenopause is not a formal medical term, but it's often informally used to refer to the time period in a woman's life leading up to menopause. During this stage, which can last for several years, hormonal changes begin to occur in preparation for menopause. The ovaries start to produce less estrogen and progesterone, which can lead to various symptoms such as irregular periods, hot flashes, mood swings, and sleep disturbances. However, it's important to note that not all women will experience these symptoms.
The official medical term for the stage when a woman's period becomes irregular and less frequent, but hasn't stopped completely, is perimenopause. This stage typically lasts from two to eight years and ends with menopause, which is defined as the point when a woman has not had a period for 12 consecutive months. After menopause, women enter postmenopause.
Postmenopause is a stage in a woman's life that follows 12 months after her last menstrual period (menopause) has occurred. During this stage, the ovaries no longer release eggs and produce lower levels of estrogen and progesterone hormones. The reduced levels of these hormones can lead to various physical changes and symptoms, such as hot flashes, vaginal dryness, and mood changes. Postmenopause is also associated with an increased risk of certain health conditions, including osteoporosis and heart disease. It's important for women in postmenopause to maintain a healthy lifestyle, including regular exercise, a balanced diet, and routine medical check-ups to monitor their overall health and manage any potential risks.
Longitudinal studies are a type of research design where data is collected from the same subjects repeatedly over a period of time, often years or even decades. These studies are used to establish patterns of changes and events over time, and can help researchers identify causal relationships between variables. They are particularly useful in fields such as epidemiology, psychology, and sociology, where the focus is on understanding developmental trends and the long-term effects of various factors on health and behavior.
In medical research, longitudinal studies can be used to track the progression of diseases over time, identify risk factors for certain conditions, and evaluate the effectiveness of treatments or interventions. For example, a longitudinal study might follow a group of individuals over several decades to assess their exposure to certain environmental factors and their subsequent development of chronic diseases such as cancer or heart disease. By comparing data collected at multiple time points, researchers can identify trends and correlations that may not be apparent in shorter-term studies.
Longitudinal studies have several advantages over other research designs, including their ability to establish temporal relationships between variables, track changes over time, and reduce the impact of confounding factors. However, they also have some limitations, such as the potential for attrition (loss of participants over time), which can introduce bias and affect the validity of the results. Additionally, longitudinal studies can be expensive and time-consuming to conduct, requiring significant resources and a long-term commitment from both researchers and study participants.
"Age factors" refer to the effects, changes, or differences that age can have on various aspects of health, disease, and medical care. These factors can encompass a wide range of issues, including:
1. Physiological changes: As people age, their bodies undergo numerous physical changes that can affect how they respond to medications, illnesses, and medical procedures. For example, older adults may be more sensitive to certain drugs or have weaker immune systems, making them more susceptible to infections.
2. Chronic conditions: Age is a significant risk factor for many chronic diseases, such as heart disease, diabetes, cancer, and arthritis. As a result, age-related medical issues are common and can impact treatment decisions and outcomes.
3. Cognitive decline: Aging can also lead to cognitive changes, including memory loss and decreased decision-making abilities. These changes can affect a person's ability to understand and comply with medical instructions, leading to potential complications in their care.
4. Functional limitations: Older adults may experience physical limitations that impact their mobility, strength, and balance, increasing the risk of falls and other injuries. These limitations can also make it more challenging for them to perform daily activities, such as bathing, dressing, or cooking.
5. Social determinants: Age-related factors, such as social isolation, poverty, and lack of access to transportation, can impact a person's ability to obtain necessary medical care and affect their overall health outcomes.
Understanding age factors is critical for healthcare providers to deliver high-quality, patient-centered care that addresses the unique needs and challenges of older adults. By taking these factors into account, healthcare providers can develop personalized treatment plans that consider a person's age, physical condition, cognitive abilities, and social circumstances.
Menopause