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Natural Hormone Therapy for Menopause

Mahmud, Khalid

Abstract: Menopausal women are deficient in estrogen, progesterone, and frequently in testosterone and DHEA. Hormone replacement therapy [HRT] in the United States has generally consisted of one or two agents, typically equine estrogen and medroxyprogesterone, with increased risk of heart attack, stroke, dementia and breast cancer [WHI trials]. Bioidentical hormones [chemically identical to endogenous hormones] have gained popularity and can be mixed according to physicians orders by compounding pharmacists in the United States. However, there is little published information about the use of such hormones. This paper reports a 12 plus months follow up on 189 patients who were administered natural estrogen plus progesterone with or without DHEA or testosterone according to a rationalized protocol described below. Ninety-seven percent of the patients experienced varying degrees of symptom control, while three had minimal or questionable benefit. Mental symptoms experienced upon presentation improved in 90% of the patients. Sixty percent of the patients, who had gained weight during menopause, lost an average of 14.8 lbs. [SD 11.98 lbs]. Complications described with traditional HRT did not develop in this group of patients. These findings point out a need for larger controlled trials of similar protocols in the management of menopause

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Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints

Chedraui, Peter; Pérez-López, Faustino; Blümel, Juan Enrique; Hidalgo, Luis; Barriga, José

Abstract: Objective. To determine the association between the metabolic syndrome (METS), and its components, and female sexuality. Methods. Data of sexually active postmenopausal women participating in a METS screening program who filled out the MENQOL tool were assessed. Specifically the sexual domain was analyzed in regard to mean total and item scores. 3rd Adult Treatment Panel (ATP III) criteria was used to identify women with the METS. Results. Two-hundred and six women fulfilled inclusion criteria, with a mean age of 54 ± 6.9 years (median: 54). METS prevalence in this sexually active postmenopausal series was 39.8%. A 52.9% presented abdominal obesity, 35.4% hypertension, 55.8% high triglycerides, 17.5% hyperglycemia and 59.7% low HDL-C. Women with the METS as compared to those without displayed no significant differences in MENQOL sexual scorings. There were also no score differences among those presenting any of the five components of the METS, except women with hyperglycemia that significantly displayed a higher total sexual domain scores, associated to a higher mean score in the decreased libido item. Logistic regression confirmed that women with hyperglycemia were significantly at higher risk for presenting decreased libido and more impaired sexuality. Conclusion. Despite the limitations of this study, as assessed with the MENQOL, hyperglycemia in postmenopausal women screened for the METS was associated to a negative impact in sexuality. More research is warranted in this regard.

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MENOPAUSE, AGEING AND HORMONAL THERAPIES

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The use of HRT and other drugs for prevention and treatment of osteoporosis
Gambacciani M.

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Intervertebral discs and the Menopause and HRT
Brincat M.

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Menopause, ageing and cardiovascular disease
Pines A.

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Menopause, ageing and cognitive function and neurodegenerative disorders
Genazzani A.R.

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INSULIN MODULATES FOOD-RELATED ACTIVITY IN THE CENTRAL NERVOUS SYSTEM

1) J Clin Endocrinol Metab. 2009 Dec 8.

Guthoff M, Grichisch Y, Canova C, Tschritter O, Veit R, Hallschmid M, Häring HU, Preissl H, Hennige AM, Fritsche A.

Context: Previous data suggest a key role of central nervous insulin action in regulating energy homeostasis. Objective: We therefore investigated whether insulin modulates brain responses to food and nonfood pictures in a functional magnetic resonance imaging study.

Design and Patients: Nine healthy, normal-weight subjects underwent two functional magnetic resonance imaging measurements to compare the effects of insulin and placebo administration during a visual recognition task with food and nonfood pictures. Insulin was administered intranasally to raise insulin concentrations in the cerebrospinal fluid without altering systemic effects in the periphery. Metabolic parameters were continuously determined during the experiments.

Main Outcome Measure: We measured the changes in brain activity after intranasal insulin administration. Results: Food pictures were detected faster when compared to nonfood pictures in all conditions without any effect of placebo or insulin. After insulin application, functional magnetic resonance imaging measurements showed a significantly reduced activity in the presence of food pictures compared to placebo in the right and left fusiform gyrus, the right hippocampus, the right temporal superior cortex, and the right frontal middle cortex. The brain activation induced by nonfood pictures remained unaffected by insulin.

Conclusion: We demonstrate that intranasal insulin led to a reduction of activity in brain areas related to object processing and memory and may have an effect on brain activation with regard to the processing of food pictures. This effect might be part of a mechanism that terminates food intake in the postprandial state.

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MANAGEMENT OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN: 2010 POSITION STATEMENT OF THE NORTH AMERICAN MENOPAUSE SOCIETY.

3) Menopause. 2010 Jan-Feb;17(1):25-54.

OBJECTIVE:To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2006 regarding the management of osteoporosis in postmenopausal women.

METHODS:NAMS followed the general principles established for evidence-based guidelines to create this updated document. A panel of clinicians and researchers expert in the field of metabolic bone diseases and/or women’s health was enlisted to review the 2006 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The panel’s recommendations were reviewed and approved by the NAMS Board of Trustees.

RESULTS:Osteoporosis, which is especially prevalent among older postmenopausal women, increases the risk of fractures. Hip and spine fractures are associated with particularly high morbidity and mortality in this population. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures, which is accomplished by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density, and previous fracture as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, government-approved options are bisphosphonates, selective estrogen-receptor modulators, parathyroid hormone, estrogens, and calcitonin.

CONCLUSIONS:Management strategies for postmenopausal women involve identifying those at risk for fracture, followed by instituting measures that focus on reducing modifiable risk factors through dietary and lifestyle changes and, if indicated, pharmacologic therapy.

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