Natural Menopause Relief Secrets

Women's Midlife Revolution Summit

The Women's Midlife Revolution Summit is an online event that presents a wonderful opportunity for women to learn, bond and share in the privacy of their homes. The interviews of the day will be online viewable for 24 hours for absolutely FREE, starting at 10:00 am. And every day for eleven days, there will be another set of experts videos releasedfor 24 hours for FREE viewing. This will be 11 days packed with knowledge, experience, inspiration, and wisdom as Arnold interviews 22 female professionals, releasing two new interviews per day over this 11-day period. Female nutritionists, doctors, herbalists, holistic therapists, authors, life coaches, entrepreneurs, hormone experts, and physical trainers have all been gathered to lend credence to the joy of seasoned womanhood. Registration is free. You will be required to fill a registration form. After filling the form you will receive an email to click on a link to confirm your participation. Then 3 days before the event starts, you will receive the Playbook for this event, which you can download.You can join the talks easily on your PC, Tablet, Laptop or Cellphone. It is time to shed light on the myths and lies women are told about aging and let women reclaim their power. More here...

Womens Midlife Revolution Summit Summary

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The ageing female reproductive axis II ovulatory changes with perimenopause

Perimenopause, a complex physiological transition for midlife women, begins with changes in experiences many years before cycles become irregular, oestradiol levels decrease or follicle-stimulating hormone levels increase. Erratic and average higher oestradiol levels as well as shorter luteal phase lengths and lower progesterone levels occur during perimenopause. These ovarian changes may be causally related to lower inhibin production but the dynamic prospective inter-relationships within women are not well documented. This review will first define perimenopause and then explore the limited published data on ovulatory characteristics in perimenopause. In addition, it will report preliminary prospective observational data on menstrual cycles and ovulation in initially ovulatory women followed through the perimenopause. Prospective data suggest that ovulation disturbances begin early in perimenopause and increase with irregular cycles. Combined with higher oestradiol levels...

TABLE 987 Etiology of Postmenopausal Bleeding

Hormone replacement therapy is commonly used to relieve symptoms associated with menopause and to reduce the risk of cardiovascular disease. Most therapeutic regimens deliver sequential progestins to induce withdrawal bleeding and protect the endometrium from atypia. Other therapies use continuous administration of estrogen and progesterone to achieve an atrophic endometrium and amenorrhea.12 In patients treated with sequential hormonal therapy, heavy or prolonged bleeding at the end of the cycle or breakthrough bleeding in two or more cycles should be investigated. Of patients on continuous therapy, 40 percent will have abnormal bleeding in the initial 4 to 6 months. There is no acceptable criteria for abnormal bleeding on these therapies, and investigations are warranted if bleeding continues beyond 6 months or recurs after amenorrhea is established. Although bleeding is frequently caused by an unstable or atrophic endometrium, other causes must be considered. Important conditions...

Treatment of menopausal symptoms with estrogen

Estrogen therapy remains the gold standard for relief of menopausal symptoms, and is a reasonable option for most postmenopausal women, with the exception of those with a history of breast cancer, CHD, a previous venous thromboembolic event or stroke, or those at high risk for these complications. Estrogen therapy should be used for shortest duration possible (eg, 6 months to 5 years). 4. Low-dose oral contraceptives. A low-estrogen oral contraceptive (20 pg of ethinyl estradiol) remains an appropriate treatment for perimenopausal women who seek relief of menopausal symptoms. Most of these women are between the ages of 40 and 50 years and are still candidates for oral contraception. For them, an oral contraceptive pill containing 20 pg of ethinyl estradiol provides symptomatic relief while providing better bleeding control than conventional estrogen-progestin therapy because the oral contraceptive contains higher doses of both estrogen and progestin. D. Urogenital changes. Menopause...

Perimenopausal transition

Perimenopause is defined as the two to eight years preceding menopause and the one year after the last menstrual period. It is characterized by a normal ovulatory cycle interspersed with anovulatory cycles. Menses become irregular, and heavy breakthrough bleeding can occur. Some women complain of hot flashes and vaginal dryness. C. Irregular bleeding and menopausal symptoms during this perimenopausal transition may be treated by estrogen-progestin replacement therapy. However, some women still require contraception. In this case, menopausal symptoms may be effectively treated with a low-dose oral contraceptive if the woman does not smoke and has no other contraindications to oral contraceptive therapy. D. The oral contraceptive can be continued until the onset of menopause, determined by a high serum FSH concentration after six days off the pill. Estrogen replacement therapy can be started at this point. II. Menopause occurs at a mean age of 51 years in normal women. Menopause...

Hello Menopause Goodbye Endometriosis

For many women with endometriosis, there's an end in sight it's called menopause, the cessation of menstrual periods. Normally women stop having periods between the ages of 45 and 55 because the ovaries produce less estrogen and progesterone. At menopause, all (or almost all) primordial follicles are used up so eggs can't form. With no follicles or eggs, a woman's body doesn't produce estrogen. As a result, the tissues that normally respond to estrogen (like the endometrium and breast) no longer grow. Because hormones are responsible for the symptoms of endometriosis and because artificially induced menopause (with hormone therapy) often reduces the pain of endometriosis, we can expect menopause to end endometriosis. Although the pain of endometriosis continues into menopause for a small percentage of women, the end of menstrual periods is the end of pain for many women. This change may not happen all at once, but, after months without hormonal stimulation, the endometrial tissue no...

Menopause

Menopause is the final menstruation marking the termination of menses (defined as 6 months of amenorrhea). Menopause is preceded by the climacteric or perimenopausal period, the multiyear transition from optimal menstrual condition to menopause. The postmenopausal period is the time after menopause. Average age of menopause in the United States is about 51 years. Cigarette smoking is the only factor shown to significantly reduce age of menopause (3 years).

Mimicking menopause

Other hormone treatments work in a way similar to negative feedback (they work on receptors), but these treatments work on the pituitary gland (the gland just below the hypothalamus), tricking the body into thinking that it's in menopause. In natural menopause, the symptoms of endometriosis also decrease for several reasons GnRH agonists or antagonists (two classes of drugs) simulate menopause except for one difference Instead of increasing FSH and LH (which leads to more eggs and more hormones ), these medications remove the stimulus to your ovaries by lowering LH and FSH. The result is, ideally, no menstrual cycles, no hormones, and the number-one goal decreased amounts of endometrial tissue and endometriosis.

Gender over the Life Cycle

Postmenopausal women were held in high regard and performed tasks that required purity such as making the war ark that accompanied military expeditions, dancing-singing with the priests and warriors and delivering medicine to the ill during the Green Corn Ceremony. In addition, they brewed ceremonial medicine, nursed wounded warriors, and assisted with the purity rites of high priest. Elderly women, unable to perform heavy labor, helped in the fields by sitting on scaffolds and chasing away animals raiding the crops (Perdue, 1989). Both older women and men helped with the caring and education of children.

TABLE 791 Vomiting and Diarrhea The Gastroenteritis Mnemonic

Acquire data selectively and smartly. Order diagnostic tests according to the differential diagnosis. In the vomiting, premenopausal woman, consider pregnancy high on the differential diagnosis, and rule it in or out with a pregnancy test. Other laboratory tests that may be of assistance are determination of blood urea nitrogen, creatinine, and amylase levels liver function tests determination of blood alcohol and drug levels and urinalysis. Addisonian crisis can present with vomiting, and the laboratory results may show hyperkalemia and hyponatremia. An electrocardiogram can help if the physician is considering the diagnosis of myocardial ischemia. Chest and abdominal radiography can assist in the determination of the presence or absence of pneumoperitoneum, pneumonia, or intestinal obstruction.

What We Do Not Know Longitudinal Cohort Studies

Currently, much is unknown about the long-term effects of contragender hormonal treatment. In light of recent studies on increased breast cancer risk in non-transgendered females due to hormone replacement therapy, it is critical that longitudinal studies are undertaken in the transgender community. Questions of increased risk of breast cancer in MTF transsexuals remain open, as do questions of breast cancer in the FTM transsexual community. Questions of the effect of estrogen on bone mass in this population are also important and go unanswered, as do questions of the effect of estrogen on oral health and the potential to affect cardiovascular problems. Only recently have studies begun to address the issues of excessive smoking in this population. Little is known about the effects of replacing estrogen with testosterone in FTM

Other Inputs of Adipose Tissue on Female Reproductive Ability

Adipose tissue is a significant extragonadal source of estrogen. Conversion of androgen to estrogen takes place in the adipose tissue of the breast and abdomen, the omentum, and the fatty marrow of the long bones. This conversion accounts for approximately one-third of the circulating estrogen of premenopausal women and is the main source of estrogen in postmenopausal women. Men also convert androgen into estrogen in body fat.

Special circumstances

Atrophic epithelium (a normal finding in postmenopausal women) is often characterized by nuclear enlargement, which meets one of the pathologic criteria for ASC. Administration of estrogen (eg, 0.3 mg conjugated estrogen applied as vaginal cream nightly for four weeks 1 8th of the applicator ) causes atypical atrophic epithelium to mature into normal squamous epithelium.

Attenuate activity of the GHRP pathway in older men

GHRP2 is the most effective GHRP-receptor agonist available for investigational use in the human. GHRP2 synergizes with GHRH in stimulating GH secretion in healthy men (Fig. 4), and enhances oestradiol's drive of GH secretion in postmenopausal women (Evans et al 2000, Shah et al 1998a,b, 1999c, 2000). Other clinical studies show that GHRPs exert maximal acute stimulatory effects in mid-to-late puberty when sex-steroid hormone concentrations peak. Moreover, a single i.m. injection of testosterone in boys and brief oestrogen exposure in girls double GH stimulation by a near-maximally effective dose of the GHRP, hexarelin (Loche et al 1997). Thus, sex steroids may modulate GHRP-receptor effector activity in the human, as inferred recently in the postnatal rat and GH-transgenic mouse. Indeed, the promoter of the human GHRP-receptor gene contains a hemioestrogen-responsive element. Thus, we postulate that testosterone could act either pre- or...

Distinctions in the actions of androgen and oestrogen on the GHIGF1 axis

The neuroendocrine mechanisms by which testosterone governs pulsatile GH secretion in the human have remained elusive, in part because of species differences in the nature of androgenic control of the GH IGF1 axis and in part due to the tripeptidyl control of this specialized axis (Giustina & Veldhuis 1998). Moreover, known actions of oestrogen are not necessarily equivalent to those postulated for testosterone. Notably, in clinical studies testosterone, but not oestradiol, consistently stimulates both GH and IGF1 production and elevates (non-pulsatile) GH secretion (Bellantoni et al 1991, Devesa et al 1991, Giustina & Veldhuis 1998, Karlsson et al 1990, Shah et al 1999b, van Kesteren et al 1996, Blumenfeld et al 1992, De Leo et al 1993). Thus, for example, the putative neuroendocrine mechanism of oestrogen's unleashing of GH secretion in postmenopausal women by way of reduced systemic IGF1 feedback cannot be facilely invoked to explicate testosterone's combined stimulation of...

Gonadotropin Releasing Hormone Agonists GnRHa Lupron Synarel Nafarelin Buserelin

GnRHa can also be used as treatment for painful endometriosis. Your reproductive hormones are shut down, your periods stop, and the pain associated with endo-metriosis is gone. When GnRHa is used in this way, your body is transformed into a temporary menopausal state and pregnancy cannot occur during this time. This use of GnRHa is mentioned here because many women with fertility issues suffer from endometriosis. Therefore, it is possible that this treatment may be presented to you as temporary relief to your painful endometriosis symptoms.

Diagnosis of associated coronary stenosis in patients with aortic valve stenosis

Given the limitations of non-invasive techniques, the only method for the definite diagnosis of coronary artery disease is coronary angiography. The risk of coronary angiography is very low in patients with aortic stenosis when there is no associated cardiac catheterisation. Echocardiography-Doppler generally allows an accurate evaluation of aortic valve disease and a haemodynamic evaluation is seldom required. North American guidelines recommend performing coronary angiography in patients with heart valve disease where there is chest pain, objective evidence of ischaemia, decreased left ventricular systolic function, history of coronary artery disease or coronary risk factors (including age).1 The age above which coronary angiography should be systematically performed in the preoperative evaluation of valvar heart disease is difficult to set definitely. North American guidelines recommend coronary angiography in men over 35 years old, in premenopausal women aged over 35 and with...

What do we need from a screening test

A suitable screening test requires both high sensitivity and specificity. Women who have a positive screen require further investigation, often in the form of exploratory surgery. It is therefore imperative to maximize specificity in order to obtain a high positive predictive value, and to decrease the number of false-positive screens. In the general population, a specificity of 99.6 is required to achieve a positive predictive value of 10 (Jacobs and Oram, 1988). However, because of the much higher incidence of the disease in the familial group, a lower specificity may achieve the same positive predictive value. It is important to note, however, that, unlike in the general population, 60-75 of women undergoing screening for familial ovarian cancer are premenopausal. This results in an increased false-positive rate with both ultrasound and CA125 screening.

What screening tests are in use

Of the ovarian tumour markers, the most extensively studied is CA125. It is an antigenic determinant on a high-molecular-weight glycoprotein that is recognized by the mouse monoclonal antibody, OC125, developed using an ovarian cancer cell-line as an immunogen. CA125 was first discovered in 1981 (Bast et al.). Levels are raised in 50 of stage I ovarian tumours and in 90 of stage II ovarian tumours (Zurawski et al., 1988). CA125 levels may also be raised in a range of other physiological and pathological conditions, which may be gynaecological or non-gynaecological, benign or malignant (Table 14.1). This can cause particular problems in screening the high-risk population. Many of these women are premenopausal and the CA125 level may fluctuate with the menstrual cycle or maybe elevated by such conditions as endometriosis. Specificity using CA125 as a screening tool can be improved using serial determinations over time (Einhorn et al., 1992). An algorithm has been developed in...

Skin Disorders Affecting The Nipple And Breast

Paget's disease is an uncommon neoplastic disorder that usually begins at the nipple and spreads outward, secondarily involving the areola. This is an important distinction, since benign skin conditions begin on the areola. The appearance ranges from that of an eczema-like erosion of the nipple to a red, raw surface, with a copious, clear discharge. Both the areola and nipple have chronic, moist eczematous changes. Paget's disease is estimated to occur in 1 to 2 percent of breast cancers.4 Most cases are diagnosed in postmenopausal women. Unfortunately, early symptoms, such as an itching or burning sensation of the nipple, may be subtle and may have been present for years before the diagnosis is made. Paget's disease is usually unilateral. Patients may note a small crusted area, with staining of the clothing, or an overt serous or bloody discharge from the nipples. Dermatologic changes of the nipple and areola progress slowly. In later cases, there may be a sharply demarcated area on...

Courtship and Marriage

A special feature of marriage among the Nandi is the possibility of woman-woman marriage. If a post-menopausal woman has no sons to inherit her house-property, she may use house-property cattle to pay bridewealth for a newly initiated woman who becomes her wife (the older woman is the husband). The wife has sexual relations with men of her own choosing, or the female husband arranges a sexual partner for her. Children born to the wife regard the female husband as their father, and the sons become heirs of the house-property. The relationship between the female husband and her wife is not sexual. The female husband is said to become a man, and she is required to give up sexual intercourse with men. An alternative solution to the same problem involves a daughter going through a marriage ceremony with the center pole of her mother's house. She then lives at home with her mother, has sex with self-chosen partners, and her sons count as heirs of the house.

Iiifigo staging systems

Although cervical cancer is staged clinically, the results of surgical staging can be used for treatment planning. The staging procedure can be performed through a laparotomy (transperitoneal or extraperitoneal) or laparoscopically. Surgical staging allows for a complete pelvic and paraaortic lymphadenectomy. Nodal tissue obtained at the time of surgery can detect microscopic disease. Staging offers an opportunity to resect bulky metastatic lymph nodes and allows for individualization of the radiation field. In premenopausal women, oophoropexy can be done at the same time to protect the ovaries from radiation damage.

Treatment of earlystage Iblla carcinoma

Radical surgery leaves the vagina in more functional condition, while radiation therapy results in a reduction in length, caliber, and lubrication of the vagina. In premenopausal women, ovarian function can be preserved with surgery. The surgical approach also provides the opportunity for pelvic and abdominal exploration and provides better clinical and pathologic information with which to individualize treatment.

Relative Status of Men and Women

In principle, men are the authorities over every aspect of life. Even in their own compounds, women are supposed to defer to men and offer them unquestioning obedience. The husband controls all the family resources, and ideally his wife should donate her mahar to him as well. Nonetheless, women can have considerable influence over men as behind-the-scenes advisors and instigators, and a wise man confers with his wife about household expenditures and other matters of mutual interest. Eventually, successful postmenopausal women can even gain some of the public deference due to men.

Mineral And Phytate Concentrations And Ratios

Fractional Calcium Absorption from Calcium Carbonate as Influenced by Calcium Load and Phytate Calcium Molar Ratios in Healthy Premenopausal Women.3 TABLE 13.1. Fractional Calcium Absorption from Calcium Carbonate as Influenced by Calcium Load and Phytate Calcium Molar Ratios in Healthy Premenopausal Women.3

Table 42 Symptoms and signs of thyrotoxicosis

With the development of the third generation TSH assays the diagnosis of sub-clinical hyperthyroidism has become more precise. Patients with subclinical hyper-thyroidism are usually asymptomatic or have very subtle symptoms with normal free T4 and T3 levels and a low serum TSH level. Subclinical hyperthyroidism may be associated with increased bone turnover and accelerated bone loss, a significant problem in postmenopausal women who become susceptible to osteoporotic bone fractures. It has also been associated with adverse cardiac consequences such as atrial fibrillation, cardiac hypertrophy, congestive heart failure and aggravation of ischemic heart disease.

Gonadotropins Follistim GonalF Bravelle [FSH and Repronex Menopur [FSH and LH

The other category is called urinary-based gonadotropins because these medications are made from the purified urine of menopausal women. Urinary-based gonadotropins fall into two types. The first type is almost as pure as the recombinant FSH and is sold under the brand name of Bravelle. The second type comprises nearly equal parts of FSH and LH. Brand-name examples of this type of gonadotro-pin are Repronex and Menopur. Some doctors prefer the pure FSH product, whereas others believe that LH helps the ovulation process.

Susceptibility and chemoprevention Molecular Pathways

Signaling by growth factors such as insulin-like growth factor (IGF), vascular endothe-lial growth factor (VEGF), transforming growth factor beta (TGF-b), and EGF represents an important area of focus in cancer initiation and development. Increased signaling through IGF can inhibit apoptosis (likely by upregulating the protein kinase Akt and the transcription factor NF-kB) (17), and some correlation exists between high circulating blood levels of IGF and the risk of premenopausal breast cancer (18). Epithelial growth factor, signaling through its receptors epidermal growth factor receptor (EGFR) and HER-2 neu plays a significant role in stimulating cell proliferation in the mammary gland (19). Vascular endothelial growth factor expression is regulated by NF-kB as well as cyclooxygenase and lipoxygenase metabolites of arachidonic acid (AA), and signaling it increases the growth and migration of endothelial cells that leads to vascularization of growing tumors (20). In contrast, TGF-b...

Middle Age and Old Age

As a general rule, a woman improves her relative status and rank as a consequence of her husband's attaining pumo'on, middle age, and pilabthir, old age. However, the greatest increase in status for a woman comes about after reaching menopause. Following menopause, a woman has more freedom to move about her village. In contrast with an old man who has increasing restrictions, an old woman has fewer restriction and limitations than she did as an adolescent or during her childbearing years. An old woman no longer shares food with those women younger than she but only with women of commensurate status. A Yapese woman who has reached old age and who comes from an important estate is respected by her younger relatives, both male and female, and her opinions in estate matters carry weight.

Cardiovascular Disease

In ischemic heart disease, there is a very marked gender difference Women die 10-15 yr, later than men and the death rate in women increases exponentially after the age of 50. In case of artificial menopause, the risk for atherosclerosis is two to three times higher than a menopausal age of 50 yr. The mortality figures for coronary heart disease vary from 50 to 200 per 100,000 inhabitants (male more than female) and for cerebrovascular disease, 100 per 100,000 inhabitants (female more than male). Fasting homocysteine levels are lower in women than in men. Levels of homocysteine show a positive association with age for both sexes. In the postmenopausal age category, female post-methionine-load homocysteine levels surpass the levels of men. Elevation of homocysteine (> 80th percentile of controls) appeared to be at least as strong a risk factor for vascular disease in women as in men, even before menopause. For post-methionine-load homocysteine, there is a 40 stronger association with...

Diagnostic evaluation

It is reasonable to pursue a period of observation in a premenopausal woman with an adnexal mass if the mass is not clinically suspicious on ultrasonography. Adnexal masses that are mobile, purely cystic, unilateral, less than 8 to 10 cm in diameter, and have smooth internal and external contours by ultrasound are highly unlikely to be malignant and can be followed for two months the majority of physiologic cysts will regress during this time. E. The threshold for surgical intervention is lower in postmenopausal women those with cysts greater than 3 cm should undergo exploratory surgery, laparotomy, or laparos-copy.

Gender and Religion

Beliefs about purity and pollution explained Cherokee attitudes toward menstruation, childbirth, and menopause. They believed that the periodic contact with blood was powerful and dangerous. During menstruation blood was outside its appropriate place in the body and women had to take precautions such as retiring to menstruation huts, not participating in ceremonial activities, avoiding contact with the sick, or performing normal tasks. Cherokees believed that the power of blood would neutralize all the treatments of medicine people. Husbands also had regulations to observe, such as dancing behind others in ceremonial occasions and not having intercourse (Perdue, 1998).

Clinical Implications of Thiazide Diuretics

These effects have been ascribed to its hypocalciuric action 13 , which causes calcium retention and reduces the turnover of bone. However, in many postmenopausal women and elderly subjects, urinary calcium excretion may be low due to impaired intestinal calcium absorption 13 . They may therefore

National Osteoporosis Foundation

Measurement of BMD is recommended for all women 65 years and older regardless of risk factors. BMD should also be measured in all women under the age of 65 years who have one or more risk factors for osteoporosis (in addition to menopause). The hip is the recommended site of measurement.

Metabolic and Nutritional Disorders

Metabolic diseases may affect the skeleton. A condition of too little bone, osteoporosis, has three major causes (1) disuse atrophy (2) a decrease in anabolic hormones, especially in postmenopausal women, and (3) an increase in catabolic hormones, such as androgens or corticos-teroids. Affecting the weight-bearing vertebrae predominantly, the bones are thin, light, and weak, and pathologic fractures can occur, causing kyphosis (hunchback), or scoliosis (lateral curvature of the spine), and loss of stature.

Clinical Features

The patient should be examined carefully for the presence or absence of hernias and abdominal or pelvic masses. Rectal and pelvic examinations are necessary. In addition to detecting the presence or absence of an obstructing rectal mass, rectal examination also enables the physician to ascertain whether there is fecal impaction. Anal fissures are also detected during the rectal examination. In addition, rectal examination allows the physician to determine whether the stools are bloody. Guaiac-positive stools can be seen in both functional constipation and constipation resulting from colon cancer. With constipation resulting in fecal impaction, rectal mucosa often ulcerates, forming stercoral ulcers on the rectal walls, which yield guaiac-positive stools. With constipation caused by tumor, stools are also often guaiac positive. Constipation and new ascites in postmenopausal women should prompt evaluation for ovarian or uterine carcinoma. Signs of hypothyroidism may also...

Analytical strategies

The groups can be defined on time, such as the summer college class of freshmen, or defined on specific requirements (e.g., fire fighters or workers, menopausal women, retired men aged 50 to 55). Thus, people are enrolled into a cohort and baseline data are collected on factors of interest to the study, such as their lifestyle and exposure to the substance. The range of people enlisted in prospective studies can be from 100 to 100,000, and as time passes, some individuals will develop the disease of interest.

Clinical Conditions in Reproductive Age Females

LEIOMYOMAS Leiomyomas (fibroids) are benign tumors of muscle cell origin and are the most frequently occurring pelvic tumor. They are found in one of four white women and in one of two black women.10 Commonly, there is more than one fibroid present. The etiology of leiomyomas is unclear, and theories include the proliferation from a single muscle cell from a small embryonic rest or a defined region of tissue with a higher level of estrogen receptors. They decrease in size during menopause, and enlargement is seen early in pregnancy and, in some cases, OCP use. Up to 30 percent of patients with leiomyomas experience pelvic pain and abnormal bleeding. Acute pain is rare, but severe pain may be experienced with torsion or degeneration. Degeneration is a result of rapid growth and loss of blood supply. This is almost exclusively seen in early pregnancy. The diagnosis of leiomyoma is made on physical examination. A mass or commonly multiple masses are palpable. In patients with acute...

Population Groups at Risk of Vitamin K Deficiency

As noted previously, some older people, especially postmenopausal women, seem to be at increased risk of developing marginal vitamin K deficiency, which manifests itself, for instance, by an increased percentage of undercarboxylated osteocalcin (ucOC) in the circulation. The sequelae of such marginal deficiency, and in particular its implications for bone health, are currently the subject of considerable research effort (Table 2). Several epidemiological cross-sectional studies have noted an association between higher vitamin K intakes and higher bone mineral density or lower fracture risk. One study reported that a subgroup of postmenopausal women who were 'fast losers' of calcium responded to vitamin K supplements by reduced calcium and hydroxyproline excretion. Although vitamins D and K have distinct functions in calcium absorption, and its distribution, deposition, and excretion, there is evidence that synergistic interactions can occur between them, and that both can affect the...

Physical Examination

Older patients with a history of pelvic pain and bleeding should undergo a full gynecologic examination. Degenerative changes to the lumbar spine and hips may make the traditional lithotomy position difficult. Alternatively, the patient may be examined supine with knees flexed and legs dropped to the side, or lying on her side with the lower arm behind her back and thighs flexed (the Sims position). A small speculum (e.g., a 1- to 1.5-cm Pederson) should be used if the vulva and vagina appear atrophic. Physicians must remember that the vaginal walls may become adherent in individuals who are not sexually active, and a gentle digital examination may be required to ensure that a speculum examination is possible. Vaginal examination is generally well tolerated in women who are on estrogen replacement. Documentation of the size, shape, and mobility of the uterus is especially important when making a diagnosis in this population. Ihe normal ovary should not be palpable 5 years after...

Growth Factor Signaling

Production of IGF occurs both systemically and locally. Growth hormone regulates the levels of IGF generated by the liver, the major site of IGF production. Increased serum levels of IGF are critical for the proper maintenance of terminal end bud structures in the mammary gland. The role of IGF in prevention of or susceptibility to breast cancer stems largely from correlative evidence in human studies and direct evidence in rodent studies. Epidemiological studies analyzing possible roles for IGF in breast cancer have indicated that premenopausal women with serum IGF levels in the highest quartile have an increased incidence of breast cancer. Conversely, well established protective therapies such as tamoxifen, fenretinide, and caloric restriction are associated with a decrease in IGF serum levels. However, the most convincing evidence that high IGF levels and signaling may be related to breast cancer is obtained from genetically defined rodent models with alterations in the IGF...

Channel Functions And State Functions

It is unlikely that there will be a one-to-one relationship between any of these modulatory pathways and specific cognitive or comportmental domains. In general, however, the activation of these modulatory pathways provides a mechanism for augmenting the neural responses to novel and moti-vationally relevant events, facilitating their storage in memory, enhancing their access to on-line processing resources, sharpening the attentional focusing they elicit, and increasing their impact on consciousness. These projections are in a position to alter the tone, coloring, and interpretation of experience rather than its content. In addition to cholinergic and monoami-nergic receptors, many areas of the cerebral cortex, especially components of the limbic system, also contain receptors for estrogen, testosterone, and other steroids. Alterations in the circulating level of these hormones, as in puberty or menopause, could influence behavioral states in a manner analogous to the effect of the...

Biomedical Realities Constructing Diseases

Sociolinguistic and narrative studies of Biomedicine take discourse as a central topic in terms of education (Good, 1994) and therapeutics (Labov & Fanshel, 1977 Mattingly, 1999). Biomedical communication patterns, physician silence, and aspects of a discourse of practitioner error have been investigated, as well as the discourse on medical competence (Bosk, 1979 DelVecchio Good, 1995 Paget, 1982), and the logic and semantic load of patients' discourse (Good, 1994 Kleinman, 1988b Mattingly, 1999 Young, 1995). Physician discourse also serves to construct the patient not only as body part, but also in terms of social identity (e.g., implicative age, race, gender or gender categories). Such constructions have strong consequences for treatment (Gaines, 1992c, 1992d Good, 1994 Gordon & Paci, 1997 Lindenbaum & Lock, 1993) for example, physicians often create probabilistic scenarios about patients that guide diagnosis and treatment (e.g., this 50-year-old white female patient with...

Monitoring Response to Treatment and Assessing Residual Disease

Monitoring chemotherapy response of breast cancer with DCE-MRI. 44-year old post-menopausal woman with a 4 cm, grade 3 invasive ductal cancer of the right breast with palpable ipsilateral axillary nodal enlargement. Rows depict T2-weighted anatomical images, early (100 seconds) subtraction images, transfer constant, relative blood volume (rBV) parametric images and relative signal intensity time curves (ROIs in whole tumour-green, normal tissue-red and fat-blue) at identical slice positions before and after two cycles of FEC (5-Fluorouracil, Epiru-bicin, Cyclophosphamide) chemotherapy. Transfer constant map (colour range 0-1 min-1) and relative blood volume (colour range 0-500 AU). With treatment, a reduction in the size of individual lesions is seen with a reduction in relative blood volume and transfer constant. This patient had a complete clinical and radiological response to treatment after 6 cycles of chemotherapy with pathology showing microscopic residual disease...

Risk as Self Governance

Medicalization of female middle age, and in particular the end of menstruation, commenced early in the 19th century but it was not until the 1930s, after the discovery of the endocrine system, that menopause came to be represented in North America and Europe as a disease-like state characterized by a deficiency of estrogen. In order to sustain this argument, the bodies of young pre-menopausal women must be set up as the standard by which all female bodies will be measured. Post-menopausal, post-reproductive life can then be understood as deviant. This expert knowledge is buttressed through comparisons made with human populations where post-menopausal life is less common, and with primate populations in which post-reproductive life is very unusual. The arguments of biological anthropologists that older women are essential to the survival of highly dependant human infants and their mothers in early hominid life are ignored. Moreover, it is argued erroneously that women have lived past...

TABLE 901 Etioloqic Aqents in Uncomplicated Urinary Tract Infection

Depending on its pH and chemical constituents, urine is generally a good culture medium. Factors unfavorable to bacterial growth are a low pH (5.5 or less) a high concentration of urea and the presence of organic acids derived from a diet including fruit juice and methionine, a breakdown product of ingested protein that enhances acidification of the urine. A thin film of urine remains in the bladder after voiding. An intact bladder mucosa removes organisms from the film, probably by the production of organic acids by the mucosal cells and not by antibody formation or phagocytosis. Incomplete bladder emptying renders this mechanism ineffective and is responsible for the increased frequency of infection in patients with a neurogenic bladder, and in postmenopausal women with bladder or uterine prolapse. The latter group also has marked changes in vaginal microflora due to lack of estrogen, with loss of lactobacilli and increased colonization by E. coli.

Other Causes of Hyperhomocysteinemia

Premenopausal women tend to have lower plasma homocysteine than men of similar age, and homocysteine levels tend to rise in women after the menopause. Hormone replacement therapy reduces homocysteine back to premenopausal levels. Moreover, homocysteine decreases in male to female transsexuals, and increases in female to male transsexuals, primarily related to the estrogen and androgen regimens that such individuals respectively follow. Taken together, these observations strongly suggest an influence of sex hormones on homocysteine metabolism, though the mechanisms are not well understood.

New Trends in the Study of Biomedicine

Midwifery (see Davis-Floyd, Cosminsky, & Pigg, 2001) and menopause (e.g., Lock, 1993) all of which have been intensely biomedicalized. Many of its latest works focus on Biomedicine's new reproductive technologies (NRTs), which have expanded exponentially in recent years, from the birth of the world's first test-tube baby in 1978 to current attempts at human cloning.

Vegetarian Diets Ethics and Health

Some nutritionists claim that people with high metabolic needs, like pregnant or lactating women and children, face significantly higher risks of nutritional deficiency if they exclude both meats and dairy products from their diets. They claim, for instance, that (1) it is difficult for vegan women to get enough iron because iron from nonmeat sources is less efficiently absorbed than the iron available in meat (iron deficiency is a problem for women because menstruation removes iron from their systems monthly), (2) vegans cannot get enough vitamin B12 (deficiencies of which cause severe neurological damage) because the vitamin is produced by microorganisms in the digestive tracts of animals, and (3) it is particularly difficult for women to get enough calcium from a dairy-free diet (osteoporosis, a condition characterized by brittle bones, is a serious problem for postmenopausal women).

Clinical consequences of the decline in activity of the hormonal systems

Andropause In most women, the period of decline in oestrogens during menopause is accompanied by vasomotor reactions, depressed mood, and changes in skin and body composition (increase in body fat and decrease in muscle mass). In the subsequent years, the loss of oestrogen is followed by a high incidence of cardiovascular disease, loss of bone mass and cognitive impairment (Lindsay et al 1996). Only recently has it become evident that oestrogens may not only play an important role in regulating bone turnover in women, but also in men. Smith et al (1994) described a male with a homozygous mutation in the oestradiol receptor gene who, even in the presence of normal T levels, had unfused epiphysis and marked osteopenia, along with elevated indexes of bone turnover. A few studies now have demonstrated significant relations between serum (bioavailable) oestradiol levels and bone mineral density in elderly men (Khosla et al 1998).

Nutrients in the soil in the absence of permanently cultivated fields hotcold health systems See humoral medicine human

Non-biomedical realms (e.g., pregnancy, birth, menopause, exercising). medical pluralism. In contrast to indigenous societies, which tend to exhibit a more-or-less coherent medical system, state or complex societies have an array of medical systems a phenomenon generally referred to by medical anthropologists, as well as medical sociologists and medical geographers, as medical pluralism. medium. Part-time religious practitioner who is asked to heal and divine while in a trance.

Ovarian ablation and GnRH analogs

Few data have been reported on the comparison between different methods of ovarian ablation. A couple of randomized studies have compared surgical with medical ablation in premenopausal women with metastatic breast cancer the results were inconsistent but both trials were closed prematurely because of poor accrual, thus leaving the question unresolved 63 . The reversibility of the effect upon discontinuation of treatment represents the major advantage but also a potential limit of medical castration, questioning the optimal duration of the treatment. Studies using GnRH analogs as a means of obtaining ovarian ablation have investigated treatment for 2-5 years in different populations, by age and risk of recurrence and concomitant treatments, but no direct comparison between different duration has yet been performed 63 . In premenopausal women with advanced ER positive breast cancer, ovarian ablation yielded a response rate up to 60 . A meta-analysis of the small randomized trials which...

Fat Distribution and Disease Risk

Since fat distribution is correlated with age as well other risk factors for disease, such as smoking, alcohol consumption, physical activity, and menopause in women, it is important to control for the effects of these variables in order to obtain an estimate of the independent effect of central obesity on morbidity. The impact of some of these correlates of fat distribution may be subtle and unlikely to seriously distort relationships between fat patterning and disease. However, age, the ultimate risk factor for disease and death, is sufficiently highly correlated with fat distribution to result in substantial distortion. Similarly, cigarette smoking is related adequately strongly to fat patterning and to various diseases and outcomes to make analyses that do not adjust for smoking difficult to interpret.

Changes in Calcium Metabolism during the Life Span

Menopause begins a period of bone loss that extends until the end of life. It is the major contributor to higher rates of osteoporotic fractures in older women. The decrease in serum estrogen concentrations at menopause is associated with accelerated bone loss, especially from the spine, for the next 5 years, during which approximately 15 of skeletal calcium is lost. The calcium loss by women in early menopause cannot be prevented unless estrogen therapy is provided. Calcium supplements alone are not very helpful in preventing postmeno-pausal bone loss. Upon estrogen treatment, bone resorption is reduced and the intestinal calcium absorption and renal reabsorption of calcium are both increased. Similarly, amenorrheic women have reduced intestinal calcium absorption, high urinary calcium excretion, and lower rates of bone formation (compared to eumenorrheic women). In both men and women, there is a substantial decline in intestinal absorption of calcium in later life.

Cultural Construction of Gender

Bamileke believe that males and females differ in their anatomy and reproductive capacity, in their relative strength, and in their emotionality. In terms of reproduction, men contribute substance to the making of a new fetus (usually termed water, the same word used for semen, but occasionally termed blood). If the child is born in wedlock, it is said to physically resemble its father. Women likewise contribute substance (usually identified as blood but occasionally as water) to the new being, as well as actively forming the fetus through their transformational (cooking) skills during gestation. Women further form the child through breast-feeding. Women are responsible, through both inheritance of traits and child-rearing practices, for the personality of the child. Women are considered to be physically less strong than men, but to have greater endurance. Bamileke women are still expected to display considerable physical strength and fortitude, especially in their agricultural...

Life Span and the Aging Process

The aging process causes many changes, both visible and invisible. In humans, these changes take several forms. In the first two decades of life, from birth to adulthood, aging involves physical growth and maturation and intellectual development. These changes are fairly noticeable and relatively swift compared to the rest of the life span. After reaching physical maturity, humans begin to show subtle signs of physical aging that grow more pronounced over time. Long-term exposure to sunlight and the outdoors may begin to toughen the skin and produce wrinkles on the face and body. The senses change Sight, hearing, taste, and smell become less acute. Gradual changes in the eye cause many older adults to need glasses to read. Hair begins to thin and turn gray. Individuals with less active lifestyles often begin to gain weight, particularly around the waist and hips. Beginning in their 40s (or, rarely, in their late 30s), many women experience menopause, which marks the end of...

Removing your ovaries

Some women don't want to risk losing all their natural hormones. One ovary can provide plenty of natural hormones to prevent menopausal symptoms with the potential problems of osteoporosis and other menopausal problems. The only major difference with an oophorectomy is the removal of the ovarian hormones and the short- and long-term effects of no estrogen. If both ovaries are gone, essentially all the estrogen and progesterone producers are gone too. This absence of estrogen can cause menopausal symptoms within a few days of the surgery and may last for a variable amount of time, from months to years. Symptoms usually abate eventually. If they don't, your doctor may prescribe hormone replacement, depending on your overall health history, such as history of heart disease or cancer. If surgery removes only one ovary, the other ovary may shut down for some time. As a result, a woman may have the same menopausal symptoms for the short term. In almost all cases, the remaining ovary begins...

Colorectal Cancer Background and aetiology

In 1972, Burkitt described the relationship between diet and incidence of bowel cancer he hypothesised that a diet rich in fibre was associated with regular bulky stools and reduced bowel carcinogenesis, perhaps by reducing exposure of colonic mucosa to dietary carcinogens. It does seem likely that the combination of high fibre and low fat may be protective against bowel cancer. Protection against colorectal carcino-genesis is also derived from dietary supplements of calcium and folate and evidence from the Nurses Health Study (North America) suggested that oestrogen in the form of hormone replacement therapy (HRT) lowers the incidence of colorectal neoplasia. There has been interest in the potential influence of non-steroidal anti-inflammatory drugs in colorectal carcinogenesis. Cyclooxygenase (COX)-2 inhibition appears to have potent effects on the colonic mucosa, increasing apoptosis and reducing cellular proliferation. It is also likely that these drugs function through...

Investigating The Aging Brain

One relatively recent set of findings illustrates this problem particularly well. Several studies have shown that the female sex hormone estrogen may affect neurons so that higher hormonal levels improve learning and memory. Moreover, some research suggests that estrogen may protect against Alzheimer's disease. Therefore, when women go through menopause, they could show a decline in cognitive function due to reduced estrogen levels, and thus, there will be a sex-based aging difference. For those women at risk for Alzheimer's disease, there may be a further insult on neuronal function. Estrogen replacement therapy, more common now than in previous years, may ameliorate these effects. Whether or not these specific findings hold up as research continues, this illustration shows the complex interactions involving aging changes, sex, cognitive alterations, and disease risk factors that can confound experimental studies of aging and that can affect our ability to define what healthy aging...

Micronutrient Deficiency

In older adults reduced cutaneous synthesis and enteric absorption of vitamin D increases the risk of vitamin D deficiency. Reduced renal responsiveness to parathormone is an added risk factor. At least 500IUday_1 of vitamin D are required to prevent significant osteoporosis in postmenopausal women. Institutionalized patients with reduced exposure to sunlight are at higher risk of vitamin D deficiency due to reduced cutaneous synthesis. The role of calcium supplementation in the prevention of osteoporosis is also well accepted. Additional evidence suggests that inadequate dietary calcium consumption may play a role in the genesis of colorectal cancer and hypertension.

Folate Deficiency And Chromosome Instability

Folate and or B12 deficiency in humans has been long associated with chromosomal instability and multiple chromosomal aberrations. Early cytogenetic studies of folate- or B12-deficient human lymphocytes or marrow cells revealed multiple chromosomal breaks and gaps, decondensed chromosomes, premature centromeric division, and centromeric spreading (31,32). Chronic folate deficiency is manifested in a futile cycle of uracil misincorporation during DNA replication and repair (5,6,12,33). Uracil misincorporation stems from a block in the folate-dependent methylation of dUTP to dTTP, resulting in the misinsertion of uracil in place of thymine (5,34). The misincorporation of uracil for thymine per se is not a premutagenic lesion because the DNA polymerase will insert the correct adenine base opposite either thymine or uracil (5,35). However, the presence of an active uracil glycosylase leads to site-specific abasic sites and single-strand breaks that represent significant premutagenic...

Endogenous Formation of Choline Moiety as Phosphatidylcholine

SNPs (single nucleotide polymorphisms) in humans may exist and, if so, would influence dietary requirements for choline. In mice in which this gene is knocked out, the dietary requirement for choline is increased and they get fatty liver when eating a normal choline diet. Estrogen induces greater activity of PEMT perhaps explaining why premenopausal women require less choline in their diets. In addition to formation of choline, this enzyme has an essential role in lipoprotein secretion from the liver.

Medicalized Identities and Conditions

Social science critiques of medicalization, whether associated more closely with labeling theory and the social control of deviance, or with Foucaldian theory and the relationship of power to knowledge, have documented the way in which identities and subjectivity are shaped through this process. When individuals are publicly labeled as schizophrenic, anorexic, infertile, menopausal, a heart transplant, a trauma victim, and so on, transformations of subjectivity are readily apparent (Ablon, 1984 Becker, 2000 Estroff, 1993 Kaufman, 1988). At times medicalization may function to exculpate individuals from responsibility for being sick, and individuals may then actively participate in this process (Lock, 1990 Nichter, 1998).

Regulation of Metabolism

As discussed below, alterations in homocysteine metabolism also occur after menopause, in diabetes, and in hypothyroidism. These observations suggest that hormones, including estrogen, insulin, thyrox-ine, and thyroid-stimulating hormone, may directly or indirectly affect homocysteine metabolism. As for oxidative stress, the mechanisms by which these hormones affect homocysteine metabolism are poorly understood.

Endocrine abnormalities and bone loss in women

This phase begins at menopause, can be prevented by oestrogen replacement, and almost certainly results from the cessation of ovarian function. Oestrogen acts through high affinity oestrogen receptors in osteoblasts and osteoclasts to restrain bone turnover, and when this restraint is lost at menopause, overall bone turnover increases and resorption increases more than formation. In addition, the increased activity of osteoclasts and their prolonged lifespan lead to trabecular plate perforation and to loss of structural elements, thus weakening bone out of proportion to the loss of bone density. The high rate of bone resorption increases skeletal calcium outflow, which leads to a partial suppression of parathyroid hormone (PTH) secretion and compensatory increases in urinary calcium excretion (Riggs et al 1998). The reason for the cessation of the rapid phase of As the rapid bone loss phase subsides, serum levels of PTH increase progressively throughout the remainder of life. Markers...

Female Reproductive Tract

Folliculogenesis begins in fetal life. Primordial germ cells multiply by mitosis. They begin to differentiate into primary oocytes and enter meiosis between the 11th and 20th weeks after fertilization. Primary oocytes remain arrested in prophase of the first meiotic division until meiosis resumes at the time of ovulation, which may be more than four decades later for some oocytes. Meiosis is not completed until the second polar body is extruded at the time of fertilization. Around the 20th week of fetal life, about 6 to 7 million oocytes are available to form primordial follicles, but the human female is born with about only 300,000 to 400,000 primordial follicles in each ovary. Oocytes that fail to form into primordial follicles are lost by apoptosis. The vast majority of primordial follicles remain in a resting state for many years. In a seemingly random process, some follicles enter into a growth phase and begin the long journey toward ovulation, but the vast majority of developing...

Evidence From In Vivo Studies With Humans

A folic acid depletion repletion study (baseline 195 g d depletion 5 wk 65 g d repletion 4 wk 111 g d followed by 20 d of > 280 g d) of nine postmenopausal women in a metabolic unit showed a significant increase in micronucleus frequency in lymphocytes following depletion and a decrease following repletion micronucleus frequency in buccal cells decreased after the repletion phase (27). The depletion phase in this study also resulted in increased DNA hypomethylation, increased dUTP dTTP ratio, and lowered NAD levels in lymphocytes (28). Other studies have shown that global DNA methylation in lymphocytes or colonic tissue is influenced by the extent of folate intake. The depletion-repletion study performed by Jacob et al. (28) with postmenopausal women in a metabolic unit showed more than a 100 increase in DNA hypomethylation after 9 wk on low-folate diet (56-111 g d) and a subse

Ageing stress and the brain

In 1988 Joseph Meites described a neuroregulatory theory of ageing, emphasizing the integrative role of the nervous system for neuroendocrine axes and circadian rhythms (Meites 1988). As the brain aged, Meites proposed, so would the hypothalamus age, leading to menopause, andropause, somatopause and dysregulated circadian rhythms. Meites tested pharmacological strategies to augment hypothalamic neurotransmitter function, which he found could reverse these 'biomarkers of ageing', a result that comports with the age-associated decline of hypothalamic monoamine neurotransmitter systems (Rodriguez-Gomez et al 1995). Though it can be modified by recent insights, the general perspective of Meites that we endocrinologists are also neuroscientists remains valid. Ageing of the brain is an important factor in overall ageing and mortality.

Changes in circulating androgens

The significance of changes in androgen secretion is a neglected area of female reproductive ageing. One important study has documented a 50 fall in circulating total and free testosterone concentrations in normal regularly cycling women between the ages of 20 and 40 (Zumoff et al 1995). This has been postulated to reflect declining levels of adrenal androgen precursor secretion. Across the menopausal transition itself, studies from the authors' laboratory indicate that there is no significant change in the circulating concentrations of total testosterone, whilst there is a fall in sex hormone binding globulin and an increase in free androgen index (Burger et al 2000b). Studies from other investigators suggest that there may be a further increase in circulating androgen levels in the late 50s and 60s (Laughlin 2000). The precise consequences of these changes in androgen for womens' health in general are unknown. On the other hand, loss of androgen as may occur following ovariectomy...

Endocrine abnormalities and bone loss in ageing men

Except after orchiectomy, men do not have an equivalent of the rapid phase of bone loss that women experience following menopause. After accounting for the absence of this phase, the patterns of late bone loss and of the increases in serum PTH and bone resorption markers in ageing men are virtually superimposable upon those occurring in women (Riggs et al 1998). In the past, it has been difficult to attribute male bone loss to sex steroid deficiency because men do not have an equivalent of menopause, and because serum total testosterone levels FIG. 3. Changes in serum testosterone (T) in ageing men. The left panel shows that serum total testosterone decreases only slightly in ageing men. Total T (P < 0.001), bioavailable T (P< 0.001). The right panel shows the changes in serum bioavailable testosterone, which decreased progressively with ageing. Values for premenopausal (Pre) and postmenopausal (Post) women are given for comparison. Error bars represent SEM. (With permission from...

Choice And Definition Of Problems To Be Studied

Using only a particular discipline's established methods may result in approaches that fail to reveal sufficient information about the problem being explored. This may be a difficulty for research surrounding medical problems particularly important to the elderly, women, men of color, and homosexual males. Pregnancy, childbirth, menstruation, menopause, lupus, sickle-cell disease, AIDS, and gerontology represent healthcare issues for which the methods of one discipline are clearly inadequate.

Disorders of Galactose Metabolism Clinical Manifestations

Ovarian atrophy appears to be an important manifestation of galactose toxicity, with clinical and biochemical evidence of ovarian dysfunction present in nearly all affected females. The basis of the toxicity has not been defined. The consequences of the gonadal dysfunction range from failure of pubertal development, through primary amenorrhea to secondary amenorrhea or premature menopause (75-76 of affected females). Although gonadal function has been described as early as infancy based on elevations of follicle stimulating hormones

Nutritional Value of Fish and Shellfish Introductory Remarks

Recent research found that eating just one serving a week of fish decreased the risk of developing dementia by 30 . Eating fatty fish several times a week may also lower the risk of developing prostate cancer by as much as half. A Swedish study of 3500 postmenopausal women eating two servings of fatty fish a week found that they were 40 less likely to develop endometrial cancer than those eating less than one-fourth of a serving a week.

Neuroendocrine Effects of Alcohol

The development of female secondary sexual characteristics in men (e.g., gynaecomastia and tes-ticular atrophy) generally only occurs after the development of cirrhosis. In women, the hormonal changes may reduce libido, disrupt menstruation, or even induce premature menopause. Sexual dysfunction is also common in men with reduced libido and impotence. Fertility may also be reduced, with decreased sperm counts and motility.

The genesis of chromosome abnormalities

Enters meiosis produces four spermatozoa the process is continuous, taking 64 days in all. Once past puberty, the male remains fertile into old age. In contrast, the human female is born with a complete set of oogonia - no more develop after birth. The initial stages of the first meiotic division take place early in fetal life but, after synapsis and recombination, each cell enters a period of arrest until after puberty. One egg then matures in each monthly cycle. Ovulation occurs when the oocyte is at metaphase II of meiosis and completion of the second division occurs after fertilization. Although there are several million oogonia at the outset, most are lost before birth and only a few hundred ever mature. Once the egg store is depleted, the menopause begins and the woman becomes infertile.

Potential Importance of Phytoestrogens to Human Health Molecular Mechanisms of Action

Increased resistance to LDL oxidation has also been reported in a 12-week single open-group dietary intervention with soy foods (60 mg total isofla-vones day) in normal postmenopausal women. A randomized crossover study in hyperlipidemic male and female subjects consuming soya-based breakfast cereals (168 mg total isoflavones day) and control breakfast cereals, each for 3 weeks, reported decreased oxidized LDL (total conjugated diene content) following consumption of the soy-based breakfast cereal compared to the control. Effects of soya isoflavones on arterial function, including flow-mediated endothelium-dependent vasodilation (reflecting endothelial function) and systemic arterial compliance (reflecting arterial elasticity), may contribute to vascular protection and these have been measured in a number of studies. A randomized double-blind study administering either soy protein isolate (118 mg total isoflavones day) or cesin placebo for 3 months to healthy male and postmenopausal...

Spinal cord compression

Primary neoplasms occur in the spine and are similar to those occurring in bones elsewhere in the body such as osteogenic sarcoma, osteoclastoma, chondroma and chron-drosarcoma. In children, Ewing's sarcoma may occur in the vertebrae and neuroblastoma within the extradural space. In patients with osteoporosis, particularly in post-menopausal women, collapse fractures can occur spontaneously or with minimal trauma (pathological fractures). Such fractures may be single or multiple. Osteomalacia can also lead to pathological fractures (see Chapter 20).

Endocrinology of ageing

In men, several hormonal systems show a gradual decline in activity during ageing, represented by a decrease in their bioactive hormone concentrations. The 'andropause' is characterized by a gradual decline in serum total and bioavailable testosterone, due to a decrease in testicular Leydig cell numbers and in their secretory capacity, as well as by an age-related decrease in episodic and stimulated gonadotropin secretion (Vermeulen 1991). Both cross-sectional (Vermeulen 1991) and longitudinal (Morley et al 1997) studies have shown that in healthy males mean serum total testosterone (T) levels decrease by about 30 between age 25 and 75, whereas mean serum free T levels decrease by as much as 50 over the same period. The steeper decline of free T levels is explained by an age-associated increase in sexhormone binding globulin (SHBG) binding capacity (Vermeulen & Verdonck 1972). Conflicting results have been reported concerning the question of whether luteinizing hormone (LH)...

Other Health Outcomes Bone Status Cancer and Diabetes

Although a number of the original weight cycling studies also tested associations between weight cycling and cancer, cancer end points have typically not followed the same patterns as cardiovascular disease. It has also been observed that temporary weight cycling (weight loss followed by weight gain) is not associated with increased risk of post-menopausal breast cancer.

Candida vulvovaginitis

Candida vulvovaginitis accounts for one-third of vaginitis. Up to 75 of women report having had at least one episode of candidiasis. The condition is rare before menarche. It is less common in postmenopausal women, unless they are taking estrogen replacement therapy.

Transport of Endogenous Lipids

Several LDL subclasses have been identified using gradient gel electrophoresis. Large, less dense LDL particles are commonly found in premenopausal women and men at low risk for CHD, whereas the small, more dense particles have been associated with a significant increased risk for myocardial infarction. The distribution of these particles appears to have a significant genetic component modulated by age and environmental factors.

PMS and Dietary Factors

The abnormally high prolactin secretion of PMS via the ability of certain of its phytochemicals to mimic the action of dopamine by binding to dopamine receptors in the pituitary. Other herbs traditionally used in phytotherapy for PMS contain phyto-oestrogens. These molecules may have oestrogen-like action, either due to the steroidal nature of their active constituents (false unicorn root, Chamaelirium luteum A. Gray) or to the spatial similarity of active groups in their constituents, which allow them to bind to oestrogen receptors. Among the latter group are isoflavonoids and lignans, which appear to have 'adaptogenic' properties They are weakly oestrogenic at low circulating oestrogen concentrations and antioestrogenic at high oestrogen concentrations. Isoflavonoids are present in soya bean and its products and in medicinal herbs such as black cohosh (Cimicifuga racemosa Nutt.) these show a beneficial effect in reducing symptoms of PMS and the menopause. Lignans are present in high...

Venous thromboembolism

Early observational studies did not suggest an increased risk for venous thromboembolism (deep vein thrombosis or pulmonary embolism) in postmenopausal hormone users however, as reviewed elsewhere, several more recent studies have found a two- to fourfold increased risk in hormone users.61 The studies are consistent in showing an increased relative risk for current but not past use of hormones. Recent onset of current use conferred higher risk than long duration of use, consistent with an immediate effect on coagulation factors. Some but not all studies reported a dose-response relationship. Estrogen alone, as well as estrogen with progestin, appeared to be associated with higher risk. Though transdermal estra-diol causes less perturbation of coagulation proteins than oral estrogen, one study suggested that the risk for venous throm-boembolism was present for this formulation also. persisted over the duration of the study. These findings on an adverse event from a clinical trial are...

Treatment recommendations

Based on current evidence, postmenopausal hormone therapy is not recommended for prevention or treatment of CHD or stroke.64 For primary prevention, the American Heart Association (AHA) states that firm recommendations should await the results of ongoing randomized clinical trials, and that there are currently insufficient data to suggest that hormone therapy should be initiated for the sole purpose of primary prevention of cardiovascular disease.64 The AHA makes a stronger statement that hormone therapy should not be initiated for the secondary prevention of cardiovascular disease however women on hormone therapy for several years do not necessarily have to stop since they have presumably passed through the period of initial increased risk. Women with a prior history of venous throm-boembolism should be counseled against using hormone therapy.62 Because the trials have failed to show benefit for secondary prevention, and there are no published trial data for primary prevention, in...

The Paradox of Rapid Population Growth in Undernourished Populations

British data from the mid-nineteenth century on growth rates, food intake, age-specific fertility, sterility, and ages of menarche and menopause show that females who grew relatively slowly to maturity, completing height growth at ages 20 or 21 years (instead of 16-18 years, as in well-nourished contemporary populations), also differed from well-nourished females in each event of the reproductive span Menarche was later, for example, 15.0-16.0 years compared with 12.8 years adolescent sterility was longer, and the age of peak nubility was later the levels of specific fertility were lower pregnancy wastage was higher the duration of lactational ame-norrhea was longer the birth interval was longer and the age of menopause was earlier, preceded by a more rapid period of perimenopausal decline (Figure 6). Thus, the slower, submaximal growth of women to maturity is subsequently associated with a shortened and less efficient reproductive span. The differences in the rate of physical growth...

The Ambivalent Commitment of Medicine to the Gold Standard

Ambivalence among many oncologists must be counted among the difficulties of organizing randomized trials. Belief in the value of trials may conflict with belief in the value of a treatment outside a trial. In 1991, Belanger et al. reported on a survey of 230 oncologists about the impact of clinical trials on their preferred methods of treating breast cancer. They found that preferred treatments for primary breast cancer and inflammatory breast cancer were supported by clinical trials that adjuvant chemotherapy for node-negative breast cancer was not based on consistent improvement in survival and that adjuvant chemotherapy for postmenopausal women with node-positive breast cancer was contrary to results from large randomized clinical trials. They suggested that even large randomized clinical trials may have a minimal impact on practice if their results run counter to belief in the value of the treatment (p. 7).

Gender and cardiovascular disease

The sex differential in the age of onset of CHD is also one of the reasons why estrogen is of interest as a potential preventive treatment for CHD. Lipid levels in children of both sexes are similar until puberty, when high density lipopro-tein (HDL) cholesterol levels fall by about 10mg dl in boys only, while low density lipoprotein (LDL) cholesterol levels decrease by about 5mg dl in girls.2 These changes may be attributable to rising androgen and estrogen levels in boys and girls respectively. The sex differential for HDL cholesterol persists through adult life, but is less marked in older persons. LDL cholesterol levels rise during adulthood, and in older women LDL cholesterol levels eventually catch up with those in men. Estrogen levels in women gradually decline, starting some years before the menopause, during which time LDL cholesterol levels rise and HDL cholesterol levels decrease.3 These lipid changes may underlie the lower CHD risk in premenopausal women, and the gradual...

Complications Related To Major Abdominal Surgery

Hysterectomy remains one of the most common major surgical procedures in the United States. It also carries a significant morbidity, with postoperative infection rates reported between 3.9 and 50 percent for abdominal hysterectomies and 1.7 to 64 percent for laparoscopic vaginal hysterectomies. There are numerous risk factors for postoperative infections. Lower socioeconomic status is a risk factor for infection in gynecologic surgery, which may be related to inadequate nutrition or poor hygiene. Obesity also carries an increased risk of infection, possibly due to poor hygiene, altered nutrition, or increased operative time. Additional risk factors include altered immunocompetence, diabetes, lack of prophylactic antibiotics when indicated, premenopausal stage, or excessive amount of operative blood loss.

Specific Nutrients Calcium

Decade, there is a steady decline in bone calcium. This is especially marked after menopause in women, when estrogen declines, and often leads to bone loss (osteopenia) to below a threshold that predisposes women in particular to fractures (osteoporosis). Osteoporosis is not just a disease of the elderly, and may occur in much younger patients, especially athletic young women, those with anorexia nervosa, those on steroids and other medications, and in anyone on prolonged bed rest, including astronauts experiencing long periods of weightlessness.

Bone turnover and agerelated bone loss

Age-related bone loss therefore occurs more rapidly in trabecular bone (which turns over more rapidly) and is increased by factors that promote bone turnover (transient calcium deficiency). Risk factors or disease states associated with either low peak bone mass or increased rates of loss include small body size, nulli-parity, inactivity, early natural menopause, anorexia, thyrotoxicosis, and Cushing's syndrome.

Recommended Dietary Intakes

The US and Canadian recommended iron intakes are intended to meet the requirements of 97.5 of the healthy population, replacing excreted iron and maintaining essential iron functions with a minimal supply of body iron stores. They also assume a relatively high bioavailability of the dietary iron. The recommended 8mg daily for adult men and postmenopausal women can easily be met with varied Western-style diets. More careful food choices are needed to obtain the 18 mg recommended to meet requirements for 97.5 of adult menstruating women. This higher recommendation reflects the high menstrual iron losses of some women the median iron requirement is 8.1 mg for menstruating women.

Stamp I Stamp Ii Stamp Iii Stamp Iv Stamp V

Disease, suggesting that the dose-response curve would be steeper in the adjuvant (or early-stage) setting than in the metastatic setting. This appeared to be true for the CMF regimen in breast cancer treatment, but results differed for pre- and postmenopausal women (Hortobagyi 2000, p. 588).

Physical Sex Differences Gross Physical Differences

Women's and men's waist-hip ratios differ strikingly (about 0.7 vs. 0.85). Women's waist-hip ratio changes, thickening with both pregnancy and menopause thus a ratio of 0.7 in a woman sends the message I am young, and not pregnant. Across a variety of cultures, men find women's typical waist-hip ratio of 0.7 most attractive (Singh, 1993 Singh & Luis, 1995), and women do not find wide hips in men attractive. Related physical sexual differences may be exaggerated in specific environments for example, in some populations in harsh environments, women store fat on the buttocks, giving an exaggerated shape that reflects ability to thrive in harsh conditions (Low, 2000).

Management of Hypercalcemia Based on Severity

Other options available for managing mild hypercalcemia in patients with asymptomatic primary hyperparathyroidism include estrogen therapy in postmenopausal women, oral phosphate therapy and the use of bisphosphonates. Other causes of mild hypercalcemia, besides primary hyperparathyroidism, are approached best by dealing directly with the underlying etiology. For example, the hypercalcemia of hyperthyroidism is best handled by treating the hyperthyroidism. The hypercalcemia of granulomatous diseases such as sarcoid and tuberculosis is best handled by treating the disorder itself.

Decision analysis in the evaluation of specific products

Hormone replacement therapy Zubialde et al22 used a decision analytic model to assess gains in life expectancy resulting from the use of estrogen replacement therapy for postmenopausal women. Efficacy data for this analysis were obtained from a review of the literature which suggested that risk reduction with estrogen therapy for coronary artery disease was between 40 and 50 . Grade B2 The model did not assume an increased incidence in breast cancer in the principal analysis, but it did include an increased incidence of endometrial cancer. Results of the analysis suggested that the benefit of estrogen and progesterone therapy in average-risk women aged 50 years at the time of therapy initiation was 0-86 years, with a range of 0-41-1-19 years, whereas therapy in average-risk women aged 65 years at the time of therapy initiation was 0-47 years, with a range of 0-21-0-66 years. The authors reported that the benefits of estrogen and progesterone therapy were similar to the gains from...

Age and Gender as Risk Factors

The more favourable social course of the disorder observed in pre-menopausal women has to do with their higher level of social development in our culture as a result of a later illness onset and socially more adaptive illness behaviour. It does not appear to be related to women having a milder form of the disorder.

Familial Lipoprotein a Excess

Lp(a) concentrations are highly variable among individuals however, they tend to remain constant during a person's lifetime. Between 80 and 90 of the variability appears to be of genetic origin, owing, for the most part, to variations at the structural apo(a) gene locus. Lp(a) concentrations are inversely associated with a size polymorphism of apo(a). This polymorphism is due to differences in the number of a multiple repeat of a protein domain highly homologous to the kringle 4 domain of plas-minogen. Diets and medications used to lower LDL cholesterol levels do not appear to have a significant effect on Lp(a) concentrations however, niacin has been reported to decrease Lp(a) levels. There have been reports suggesting that diets high in trans fatty acids have some raising effects on Lp(a) levels, whereas estrogen replacement lowers Lp(a) in post-menopausal women.

What Has Care Got to Do with It Its Prescriptive Normative Associations

We draw attention to the presumptions lodged within this statement about the value of children and families, and the government's role in encouraging the production of more of these. Along similar lines, a paper setting out the brief of the Law Reform Commission of Canada to the Royal Commission stated that the role of government is to nurture procreative and family health (Jones 1992 121). To its credit, the Royal Commission comes down in favor of lesbian and or single women's access to AI and IVF, but it stops short of endorsing access for postmenopausal women. In other words, the ethics of care is being used to bolster a particular normative societal vision.

Risk Factors for Breast Cancer

Seventy-five percent of women with newly diagnosed breast cancer demonstrate no specific, identifiable risk factor. Most premenopausal breast cancer cases are genetically determined. In contrast, many post-menopausal cases are environmentally related.

Consumption of soybean and reduced incidence of disease

6.2.2.1 Phytoestrogens and Postmenopausal Activity The structure of soybean isoflavonoids is uniquely similar to that of estrogen (17) and may account for their weak ability to act as agonists at estrogen receptors (38). Many have speculated that soybean isoflavonoids may be useful for the treatment of somatic, mood, and cognitive disturbances associated with the onset of menopause (39). Diet supplementation with soybean phytoestrogens has been reported to ameliorate hot flashes and other symptoms of menopause (40-43). Soybean isoflavonoids may also have potential in natural chemoprevention therapies against long term health problems associated with menopause, particularly for osteoporosis (44-47). After menopause, the ovaries stop producing estrogen. Because estrogen positively affects the metabolism of calcium, lack of sufficient estrogen can lead to bone loss and osteoporosis (48). Hormone replacement therapy (HRT) can reduce bone loss and the risk of osteoporosis in postmenopausal...

Carcinoma Of The Breast Introduction

Breast cancer accounts for approximately 24 of all malignancies occurring in the female population in industrialised western societies and 18 of deaths in women due to malignant disease. In the UK there are approximately 117 cases per 100 000 women (34 000 new cases per annum). Thus, 1 at least 12 women will develop breast cancer during their lifetime and the incidence is rising by approximately 2 per annum. Breast cancer rarely occurs in women under the age of 25 years. Thereafter, the incidence increases steadily until at the time of the menopause, where the incidence plateaus out. After the menopause there is again a steady increase in

Natural Cures For Menopause

Natural Cures For Menopause

Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?

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