ORCID Profile
0000-0002-2955-0415
Current Organisations
Royal Australasian College of Physicians
,
Monash University
,
Cabrini Hospital
,
Alfred Health
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Publisher: No publisher found
Date: 2007
Publisher: Oxford University Press (OUP)
Date: 05-01-2007
Abstract: DHEA is increasingly available commercially as a supplement aimed at improving libido and wellbeing in postmenopausal women. However there is scant evidence to support the use of DHEA for this purpose, and safety data for DHEA therapy are lacking. Dehydroepiandrosterone (DHEA) and its sulphate DHEAS are the most abundant circulating sex steroid hormones in women, providing a large precursor reservoir for the intracellular production of androgens and oestrogens in non-reproductive tissues. Levels of DHEA and DHEAS decline with age. It has been proposed that restoring the circulating levels of these steroids to those found in young people may have anti-ageing effects and improve wellbeing and sexual function. However this is not supported by the published literature. We have reviewed the physiology of DHEA and DHEAS in women and the published literature pertaining to the use of DHEA therapy for libido and wellbeing in postmenopausal women. The literature was searched using Medline (Ovid) and Pub-Med for original studies. Overall, the interpretation of data from randomised controlled trials conducted in well women is limited by inadequate s le size and short treatment durations with inconsistent results for the outcomes of libido and wellbeing. Studies of DHEA in women with adrenal insufficiency, although indicating potential improvements in mood and libido, are also limited by their short treatment phase durations. In addition safety data for DHEA therapy are lacking. The potential value of DHEA therapy for women still requires exploration in adequately powered well-designed randomised placebo-controlled trials. The studies of DHEA therapy in women with adrenal insufficiency suggest that this group is the most likely to derive health benefits from DHEA supplementation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Publisher: The Endocrine Society
Date: 02-09-2019
Abstract: This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynecologists.*
Publisher: Elsevier BV
Date: 07-1000
DOI: 10.1016/S1043-2760(00)00254-X
Abstract: Natural (human) and experimental (mouse) models of estrogen insufficiency have revealed hitherto unexpected roles for estrogens in both males and females. In postmenopausal women, and in men, estrogen no longer has a major role as a circulating hormone, but rather it functions locally as a paracrine or even 'intracrine' factor in tissue sites where it is formed. As a consequence, the tissue-specific nature of aromatase production assumes physiological and pathophysiological significance. The availability of circulating precursors is also important in sites where there is no local supply of C19 precursors, particularly in elderly women. The potential clinical significance of these findings in terms of the development of new therapeutic modalities is discussed.
Publisher: Cambridge University Press
Date: 20-08-2015
Publisher: Wiley
Date: 2007
DOI: 10.1002/ART.22535
Abstract: To evaluate the effects of age, physical activity, and body mass index (BMI) on patella cartilage volume and defects and bone volume in middle-aged women without knee pain. Magnetic resonance imaging was performed in 176 healthy women, ages 40-67 years, without knee pain to measure patella cartilage and bone volume and patella cartilage defects. The effects of age, physical activity, BMI, smoking, and alcohol were analyzed to determine whether associations existed between these variables and patella cartilage and bone volume and cartilage defects. Patella cartilage volume decreased with age (P = 0.01) and BMI (P = 0.05) after adjusting for age and patella bone volume. Patella bone volume was positively associated with body height in both the univariate and multivariate models. Cartilage defects in the patellofemoral compartment were present in 36.4% of the study population. Age, weight, and BMI were positively associated with the presence of cartilage defects in the multivariate analysis. This study demonstrated that although age is positively associated with both patella bone volume and cartilage defects, it is inversely associated with patella cartilage volume in healthy in iduals. Moreover, BMI is inversely associated with both patella cartilage volume and patella bone volume in middle-aged women without knee osteoarthritis. Longitudinal studies will be required to determine whether avoiding a high BMI will reduce the risk of developing patellofemoral osteoarthritis.
Publisher: BMJ
Date: 14-07-2009
Abstract: Bone marrow lesions (BML) are important in established knee osteoarthritis, predicting pain and progression of disease. Whether BML are also associated with longitudinal changes in knee structure in an asymptomatic population is unknown. 148 healthy pain-free women in middle age with no history of knee injury or clinical knee osteoarthritis who had a magnetic resonance imaging (MRI) scan performed on their dominant knee at baseline, had another MRI 2 years later to assess whether having a BML present at baseline affected change in tibiofemoral cartilage defects and tibial cartilage volume. BML were present in 14.9% of women at baseline. The risk of progression of total tibiofemoral cartilage defects was significantly higher when a very large BML was present (odds ratio 5.55, 95% CI 1.04 to 29.6) compared with when no BML was present, after adjusting for potential confounders. In the lateral compartment, the rate of cartilage volume loss was significantly greater when a BML was present after adjusting for confounders (regression coefficient 39.2 mm(3), 95% CI 11.1 to 67.2, p = 0.007). In healthy women without pain at baseline, large BML were associated with both progression of cartilage defects in the whole tibiofemoral joint and more rapid lateral tibial cartilage loss. These data suggest that the relationship between BML and knee cartilage in healthy women is similar to that described in established osteoarthritis. It is possible that BML may predict an increased risk of knee osteoarthritis and facilitate the identification of novel interventions to prevent disease.
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.MATURITAS.2008.12.017
Abstract: The aim of this study was to document the age-specific prevalence of different types of urinary incontinence (UI) in women and to identify the risk factors associated with each type of UI. A detailed self-administered questionnaire was mailed to 542 community-dwelling women, aged 24-80 years. The questionnaire included a validated instrument, the Questionnaire for Urinary Incontinence Diagnosis (QUID), for the assessment of stress, urge and mixed UI. Five hundred and six of the 542 women provided data (93.4%). The overall prevalence of any UI was 41.7% [95% confidence interval (CI): 37.2-45.8%]. Of the 210 women reporting UI, 16% [95% CI: 12.9-19.3%] reported stress only 7.5% [95% CI: 5.2-9.8%] reported urge only and 18% [95% CI: 14.7-21.5%] reported a mixed pattern. Stress incontinence was most common amongst middle-aged women (25.3% of women aged 35-44 years), while urge incontinence was most common in women over the age of 75 years (24.2%). In logistic regression analyses, obesity (p<0.001) and being parous (p=0.019) were found to be significantly associated with stress incontinence, increasing age (p=0.002) with urge incontinence, and being overweight (p=0.035) or obese (p<0.001) and having had a hysterectomy (p=0.021) with mixed incontinence. UI is a highly prevalent condition in women living in the community. Stress, urge and mixed incontinence have different age distributions and risk factors. These data are important in understanding the etiology, management and possible prevention of these conditions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: Informa UK Limited
Date: 02-02-2023
Publisher: Informa UK Limited
Date: 27-06-2014
DOI: 10.3109/13697137.2014.933411
Abstract: Women may expect to spend more than a third of their lives after menopause. Beginning in the sixth decade, many chronic diseases will begin to emerge, which will affect both the quality and quantity of a woman's life. Thus, the onset of menopause heralds an opportunity for prevention strategies to improve the quality of life and enhance longevity. Obesity, metabolic syndrome and diabetes, cardiovascular disease, osteoporosis and osteoarthritis, cognitive decline, dementia and depression, and cancer are the major diseases of concern. Prevention strategies at menopause have to begin with screening and careful assessment for risk factors, which should also include molecular and genetic diagnostics, as these become available. Identification of certain risks will then allow directed therapy. Evidence-based prevention for the diseases noted above include lifestyle management, cessation of smoking, curtailing excessive alcohol consumption, a healthy diet and moderate exercise, as well as mentally stimulating activities. Although the most recent publications from the follow-up studies of the Women's Health Initiative do not recommend menopause hormonal therapy as a prevention strategy, these conclusions may not be fully valid for midlife women, on the basis of the existing data. For healthy women aged 50-59 years, estrogen therapy decreases coronary heart disease and all-cause mortality this interpretation is entirely consistent with results from other randomized, controlled trials and observational studies. Thus. as part of a comprehensive strategy to prevent chronic disease after menopause, menopausal hormone therapy, particularly estrogen therapy may be considered as part of the armamentarium.
Publisher: Oxford University Press (OUP)
Date: 06-2010
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.SEMARTHRIT.2008.05.003
Abstract: Bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, yet their exact role, etiology, and natural history remain unclear. The aim of this study was to examine the natural history of BML in a healthy population and identify risk factors associated with their persistence and incidence. One hundred forty-eight healthy middle-aged women had magnetic resonance imaging performed on their dominant knee at baseline and 2 years later to assess the presence, natural history, and risk factors for persistence and incidence of BML. Approximately 46% of BML present at baseline completely resolved over 2 years. "Large" BML had the potential to improve, while the majority of "very large" remained stable. In those women with no BML at baseline, approximately 9% developed a BML over 2 years, the majority in the medial compartment. There was a trend toward weight being a risk factor for the development of "very large" BML (P = 0.08). The natural history of BML may be different in healthy persons compared with diseased states. The trend for weight as a risk factor for development of a "very-large" BML suggests there is potential to identify modifiable risk factors for BML in asymptomatic people and warrants further investigation.
Publisher: Informa UK Limited
Date: 30-01-2023
Publisher: Springer Science and Business Media LLC
Date: 2009
DOI: 10.1186/AR2873
Publisher: BMJ
Date: 04-2004
Abstract: To determine whether the amount of joint cartilage in healthy postmenopausal women is stable or changes over time, and whether oestrogen replacement therapy (ERT) influences this. A cohort study in healthy postmenopausal women without knee pain, initially selected on the basis of having either used ERT long term (more than five years) or never having used ERT. 81 women (42 taking ERT and 39 non-users) had baseline knee radiographs and magnetic resonance imaging (MRI) on the dominant knee 57 of these (70%) were followed with repeat MRI approximately 2.5 years later. Knee cartilage volume was measured at baseline and at follow up. Risk factors assessed at baseline, including ERT use, were tested for their association with change in knee cartilage volume over time. 29 subjects who were initially taking ERT and 28 non-users at baseline completed the study. Total tibial articular cartilage decreased, on average, by (mean (SD)) 2.4 (3.2)% per year (95% confidence interval for mean, 1.5% to 3.2%). Average annual reduction in medial and lateral tibial cartilage was 2.4 (3.6)% (1.4% to 3.3%) and 2.3 (4.2)% (1.2% to 3.4%), respectively. No association between ERT and the rate of reduction in cartilage volume was shown. Mean tibial cartilage volume loss in healthy postmenopausal women is between 1.5% and 3.2% a year. Whether this rate of change is similar throughout adult life or in men will require further investigation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2011
Publisher: Informa UK Limited
Date: 1988
DOI: 10.3109/09513599809029347
Abstract: We have investigated the effect of hypophysectomy on adult rat ovarian inhibin alpha- and beta A-subunit mRNA, serum inhibin, and circulating gonadotrophin levels. Immediate declines in ovarian inhibin gene expression and serum inhibin were observed following hypophysectomy, with a nadir on day 4. However, inhibin synthesis determined by these parameters was still apparent at 16 days post-hypophysectomy. Gonadotropin levels were suppressed following hypophysectomy and the fall in inhibin production was highly correlated with disappearance of FSH from the circulation. This study demonstrates that removal of pituitary gonadotropin stimulation results in diminished ovarian inhibin synthesis and provides further evidence indicating that FSH stimulates granulosa cell inhibin synthesis by enhancing inhibin gene transcription.
Publisher: Oxford University Press (OUP)
Date: 02-2016
DOI: 10.1016/J.JSXM.2015.12.033
Abstract: Androgens have been implicated as important for female sexual function and dysfunction. To review the role of androgens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of androgen therapy for female sexual dysfunction (FSD). We searched the literature using online databases for studies pertaining to androgens and female sexual function. Major reviews were included and their findings were summarized to avoid replicating their content. Quality of data published in the literature and recommendations were based on the GRADES system. The literature supports an important role for androgens in female sexual function. There is no blood androgen level below which women can be classified as having androgen deficiency. Clinical trials have consistently demonstrated that transdermal testosterone (T) therapy improves sexual function and sexual satisfaction in women who have been assessed as having hypoactive sexual desire disorder. The use of T therapy is limited by the lack of approved formulations for women and long-term safety data. Most studies do not support the use of systemic dehydroepiandrosterone therapy for the treatment of FSD in women with normally functioning adrenals or adrenal insufficiency. Studies evaluating the efficacy and safety of vaginal testosterone and dehydroepiandrosterone for the treatment of vulvovaginal atrophy are ongoing. Available data support an important role of androgens in female sexual function and dysfunction and efficacy of transdermal T therapy for the treatment of some women with FSD. Approved T formulations for women are generally unavailable. In consequence, the prescribing of T mostly involves off-label use of T products formulated for men and in idually compounded T formulations. Long-term studies to determine the safety of T therapy for women and possible benefits beyond that of sexual function are greatly needed.
Publisher: The Endocrine Society
Date: 06-2004
DOI: 10.1210/ER.2003-0016
Publisher: The Endocrine Society
Date: 13-08-2019
Abstract: There is a lack of understanding of what is normal in terms of sex steroid levels in older women. To determine whether sex steroid levels vary with age in and establish reference ranges for women years of age. Cross-sectional, community-based study. Included 6392 women ≥70 years of age. Sex steroids measured by liquid chromatography–tandem mass spectrometry. A reference group, to establish sex steroid age-specific reference ranges, excluded women using systemic or topical sex steroid, antiandrogen or glucocorticoid therapy, or an antiglycemic agent. The reference group of 5326 women had a mean age of 75.1 (±4.2) years, range of 70 to 94.7 years. Median values (range) were 181.2 pmol/L (3.7 to 5768.9) for estrone (E1), 0.38 nmol/L (0.035 to 8.56) for testosterone (T), 2.60 nmol/L (0.07 to 46.85) for dehydroepiandrosterone (DHEA), and 41.6 nmol/L (2.4 to 176.6) for SHBG. Estradiol and DHT were below method sensitivity in 66.1% and 72.7% of the s les, respectively. Compared with women aged 70 to 74 years, women aged ≥85 years had higher median levels of E1 (11.7%, P = 0.01), T (11.3%, P = 0.02), and SHBG (22.7%, P 0.001) and lower DHEA (30% less, P 0.001). Women with overweight and obesity had higher E1 (P 0.001) and T (P 0.03) and lower SHBG (P 0.001) than did women with normal body mass index. Smokers had 17.2% higher median T levels (P = 0.005). From the age of 70 years, T and E1 increase with age, despite a steady decline in DHEA. Whether E1 and T are biomarkers for longevity or contribute to healthy aging merits investigation.
Publisher: Wiley
Date: 02-2005
Abstract: This was a preliminary feasibility study to assess the pharmacokinetics and acute safety of a single dose of orally inhaled testosterone via the AERx system, a novel handheld aerosol delivery system in postmenopausal women. Twelve postmenopausal women stabilized on oral estrogen therapy were treated with a single dose of testosterone (0.1, 0.2, or 0.3 mg) by inhalation. Plasma concentrations of sex steroids were measured between 1 and 360 minutes. Pulmonary and cardiovascular adverse events were monitored. Inhaled testosterone produced a dose-dependent increase in plasma total and free testosterone. At the highest dose (0.3 mg), total and free testosterone increased from baseline (mean +/- SD, 0.6 +/- 0.3 nmol/L, 2.5 +/- 1.0 pmol/L) to maximum levels of 62.6 +/- 20.4 nmol/L (total) and 168.2 +/- 50.2 pmol/L(free), occurring 1 to 2 minutes after dosing. A 2-compartment model best described the free and total testosterone pharmacokinetic profile. Dihydrotestosterone levels were higher than baseline at 60 minutes (P < .0002). Estradiol did not vary, but sex hormone binding globulin and albumin fell. There were no adverse events related to the treatment. Administration of inhaled testosterone is safe and achieves a supraphysiologic "pulse" kinetic profile of total and free testosterone with a rapid return to pretreatment levels.
Publisher: Oxford University Press (OUP)
Date: 06-11-2021
Abstract: Can serum anti-Müllerian hormone (AMH) replace polycystic ovary morphology (PCOM) determined by ultrasound as a diagnostic component of polycystic ovary syndrome (PCOS)? Despite good correlations between serum AMH and PCOM, the use of a high serum AMH as a proxy for PCOM resulted in the reclassification of PCOS in 5% of study participants, with the main effect being more women identified, although some women previously classified as having PCOS were no longer classified as such. AMH has been proposed as an alternative to PCOM as a diagnostic component of PCOS. Previous studies are limited by poorly defining PCOS, use of infertile women as comparators, measurement of hormones by immunoassay that lack precision in the female range, low-resolution ovarian ultrasound and inconsistent handling and storage of serum s les. This is an Australian cross-sectional study of 163 non-healthcare-seeking women. Serum AMH was measured by both the Ansh picoAMH assay and the Beckman Coulter Access 2 (BA2) assay, in parallel with androgens measured by liquid chromatography–tandem mass spectrometry, in blood s les of women, not pregnant, breast feeding or using systemic steroids, who also underwent high-resolution ovarian ultrasound. PCOS was determined by the Rotterdam criteria with PCOM defined by the Androgen Excess-PCOS Taskforce recommendation of ≥25 follicles in at least one ovary. Cut-off serum concentrations that best identified women as having PCOM were identified by receiver operator characteristic (ROC) curves. A total of 163 women, mean (SD) age 32.5 (5.5) years, who provided a blood s le and had both ovaries visualized on ultrasound were included in the analysis. Women with isolated PCOM had higher median (range) Ansh AMH and BA2 AMH concentrations than those with no PCOS characteristics [56.9 pmol/l (34.6, 104.2) versus 18.7 (3.2, 50.9), P = 0.002 and 38.5 pmol/l (22.2, 100.2) versus 16.7 (3.5, 38.9), P = 0.002, respectively]. An AMH ≥ 44.0 pmol/l, suggested by the ROC curve, identified 80.6% of women with PCOM, falsely identified 15.2% of women without PCOM as having PCOS and had a positive predictive value of 55.6%. The negative predictive value was 94.9%. An AMH BA2 assay cut-off of ≥33.2 pmol/l provided a sensitivity of 80.6%, a specificity of 79.5% and a positive predictive value for PCOM of 48.1%. The negative predictive value was 94.6% for PCOM. When serum AMH was used in the place of PCOM as a diagnostic criterion for PCOS, the Ansh assay resulted in an additional seven women classified as having PCOS and no longer classified one woman as having PCOS. For the BA2 assay, eight additional and two fewer women were classified as having PCOS. Overall, both assays resulted in six more women being classified as having PCOS. Women with functional hypogonadotrophic hypogonadism were not excluded and may have been misclassified as having an oligo-amenorrhoea-PCOM phenotype. As study participants were predominantly Caucasian/White, our findings cannot be generalized to women of other ethnicities. Although serum AMH reflects the number of developing ovarian follicles, the absolute values vary between assays and specific reference ranges for in idual assays are required. Irrespective of the assay used, replacing PCOM with serum AMH to diagnose PCOS in a community-based s le altered the number of women classified as having or not having PCOS. Consequently, although overall the risk of women being identified as having PCOS would be increased, some women would no longer be classified as having this condition. The study was supported by the Norman Beischer Research Foundation and the Grollo-Ruzzene Foundation. S.R.D. is an NHMRC Senior Principal Research Fellow (Grant No. 1135843). S.R.D. reports unrelated support that includes grants from the NHMRC Australia, personal fees for educational activities from Besins Healthcare, Abbott Chile, BioFemme and Pfizer Australia, personal Advisory Board/consultancy fees from Theramex, Abbott Laboratories, Astellas, Mayne Pharmaceuticals, Roche Diagnostics, Lawley Pharmaceuticals and Que Oncology and has received institutional grant funding from Que Oncology and Ovoca research. The other authors declare no conflicts of interest. N/A.
Publisher: The Endocrine Society
Date: 02-1997
DOI: 10.1210/JC.82.2.702
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/13697130600641282
Abstract: Factors that contribute to cognitive decline in women from midlife remain poorly understood. There are circumstantial data indicating a positive association between homocysteine and cognitive decline and that endogenous and exogenous estrogen may influence homocysteine levels. The aim of this review was to establish what is known of the relationships between cognitive change and homocysteine levels, and the impact of the menopause transition and exogenous estrogen on homocysteine levels. We reviewed the recent published literature from 1993 to 2005 pertaining to the current understanding of the relationship(s) between plasma homocysteine levels and cognitive functioning and endogenous hormone levels and exogenous estrogen use in women. Hyperhomocysteinemia is consistently associated with cognitive decline. Dietary supplementation with vitamins may assist in normalizing homocysteine levels however, there is no evidence that this results in favorable effects on cognition. Changes in endogenous estrogen levels are inversely associated with changes in serum homocysteine. Consistent with this, estrogen therapy is associated with reductions in plasma homocysteine, with the greatest effects reported in women with higher levels of homocysteine at baseline. Limited data indicate that tibolone is associated with little change in homocysteine. The use of raloxifene, the most studied selective estrogen receptor modulator, is associated with a modest reduction in homocysteine. There are data to suggest an underlying link between homocysteine levels and cognitive decline. There is also evidence for a link between both the menopause transition and use of exogenous estrogen therapy and homocysteine levels. Clinical data do not support a role for exogenous estrogen in the prevention of dementia in older women however, the 'window of opportunity' theory suggests that there is a need for randomized controlled trials to evaluate the role of estrogen in the early postmenopausal years to protect against cognitive decline in later life.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.MATURITAS.2016.09.008
Abstract: We audited the files of 114 postmenopausal women who had been treated with subcutaneous Estrapel (50mg oestradiol implants). Of the 92 women who received more than one implant, the median number of days between implants was 223.5 (range 49-875), with an estimated median time to return to baseline of 311days (range 108-1228). Although oestradiol implants can provide an excellent non-oral treatment option, their prolonged action makes patient selection important, as the implants cannot easily be removed. In women with an intact uterus, the continuation of progestin therapy after cessation of implant therapy is imperative.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2015
Publisher: Springer Science and Business Media LLC
Date: 07-02-2008
DOI: 10.1007/S00198-007-0545-3
Abstract: A randomized trial was conducted in osteopenic postmenopausal women to compare the efficacy of tibolone versus raloxifene on BMD of the lumbar spine and hip. Tibolone increased lumbar spine and total hip BMD to a statistically significantly greater extent than raloxifene after two years of treatment. Both tibolone, a selective tissue estrogenic activity regulator (STEAR), and raloxifene, a selective estrogen receptor modulator (SERM), are known to prevent postmenopausal bone loss. However, no head-to-head studies to compare the efficacy on bone have been performed. A double-blind, randomized trial was conducted in osteopenic postmenopausal women aged 60-79 years to compare the effects of tibolone 1.25 mg/day to raloxifene 60 mg/day on bone mineral density (BMD). Serum osteocalcin and serum type I collagen C-telopeptides were measured as biochemical markers of bone metabolism. Three hundred and eight subjects were allocated to treatment. Both treatments significantly increased lumbar spine BMD, however the increase was significantly larger after tibolone treatment than after raloxifene treatment (at year 1: 2.2% versus 1.2%, p<0.01 and at year 2: 3.8% versus 2.1%, p<0.001). After 2 years of treatment, the increase in total hip BMD in the tibolone group was significantly larger than in the raloxifene group (p<0.05). Both treatments significantly reduced type I collagen C-telopeptides and osteocalcin levels when compared to baseline. Tibolone 1.25 mg/day for 2 years prevents postmenopausal bone loss in older women and results in a larger increase of BMD both at the lumbar spine and hip than raloxifene.
Publisher: Wiley
Date: 21-03-2021
DOI: 10.1111/CEN.14458
Abstract: To compare the performance of two anti‐Mullerian (AMH) assays over a range of concentrations, in s les collected from young women. A cross‐sectional method‐comparison study of 168 non‐healthcare‐seeking women. Included women were aged 18–39 years, not recently pregnant, breast feeding or using systemic hormones. Serum AMH levels were analysed with the Beckman Coulter Access 2 assay from fresh s les and the Ansh picoAMH assay using s les stored at −80°C, in a parallel setting. Comparisons between the two assays were examined using Bland‐Altman plots. Participants had a mean ± SD age of 32.6 ± 5.4 years and body mass index of 28.1 ± 7.9 kg/m 2 , and 60.1% were parous. Although the assay results were highly correlated (Spearman correlation .982, P .001), the relationship between the assays was nonlinear. Serum AMH values below 4 pmol/L were lower with the picoAMH assay compared with the Access AMH assay (mean difference in this range was −0.49 pmol/L), but for s les with a mean value above 10 pmol/L, the picoAMH assay consistently measured higher than the Access AMH assay (mean difference in this range was +8.2 pmol/L). As AMH concentrations increased the absolute discrepancy between the assays also increased. This study demonstrates that despite the high correlation between two commercially available AMH assays, the assays performed in a discordant manner at high and low concentrations. Hence, the results of these assays are not interchangeable, highlighting the need to establish specific reference limits for in idual assays to guide clinical decision‐making and the challenge of establishing future universal cut‐offs for the application of AMH levels in clinical practice.
Publisher: Proceedings of the National Academy of Sciences
Date: 12-12-2000
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
DOI: 10.1097/GME.0000000000000767
Abstract: To determine the prevalence of hypoactive sexual desire dysfunction (HSDD) and its associated factors in women aged 65 to 79 years. A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on electoral rolls. Sexual function and sexual distress were assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, respectively. HSDD was defined as the presence of both low sexual desire and sexually related personal distress. The mean ± SD age of the 1,548 women was 71 ± 3.4 years and 52.6% were partnered. Among the participants, 88.0% (95% confidence interval [CI], 86.3%-89.6%) had low sexual desire, 15.5% (95% CI, 13.8%-17.4%) had sexually related personal distress, and 13.6% (95% CI, 11.9%-15.4%) had HSDD. The HSDD was more common among partnered than among unpartnered women (23.7% vs 5.9% P 0.001). Being partnered (adjusted odds ratio [AOR] = 4.21 95% CI, 2.50-7.07), having vaginal dryness during intercourse (AOR = 2.37 95% CI, 1.58-3.55), having symptomatic pelvic floor dysfunction (AOR = 1.92 95% CI, 1.29-2.92), and having moderate-to-severe depressive symptoms (AOR = 4.15 95% CI, 2.16-7.96) were independently associated with having HSDD. In a subanalysis, HSDD was more common among sexually active than sexually inactive women (31.5% vs 17.3% P 0.001). Furthermore, 32% (95% CI, 27.7%-38.3%) of partnered sexually active women had HSDD, as did 22% (95% CI, 11.5%-37.8%) of unpartnered sexually active women. HSDD is common and associated with potentially modifiable risk factors in older women. It should not be assumed that unpartnered older women are sexually inactive or are not distressed by low sexual desire.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
DOI: 10.1097/GME.0B013E3181CA0ADB
Abstract: The aim of this study was to translate the standard Greene Climacteric Scale (GCS) and a urogenital symptom scale into colloquial Chinese (Hong Kong) and test their validity and reliability in Hong Kong Chinese women. The scales were translated with standard techniques, and cross-cultural construct validity, internal consistency, test-retest reliability, and responsiveness were tested on s les of women aged 40 to 60 years recruited from the community. A total of 611 women, with mean (SD) age of 48.9 (5.3) years, provided completed scales for the study. Confirmatory factor analysis demonstrated construct validity of the translated standard GCS. The items were found to have good homogeneity in measuring the scale concepts (Cronbach alpha > 0.7). But the three-item urogenital scale had poor internal consistency (Cronbach alpha = 0.43), and a combination of this scale with the standard GCS resulted in a reduced model fit to the data. Test-retest reliability for the GCS was good on women recruited for a retest (n = 52). The translated GCS was found to be responsive to change over time (effect size, 0.59 n = 19). The Chinese (Hong Kong) version of the standard GCS is a valid and cultural-equivalent instrument. Our data do not support inclusion of the urogenital scale to the standard GCS. Measurement of urogenital symptoms is subject to further study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
Publisher: Massachusetts Medical Society
Date: 1998
DOI: 10.1056/NEJM199801013380113
Abstract: In routine, Ayurveda practitioners prefer classical pharmaceutical form of herbal medicines in compare to modern extracts. To explore the difference of efficiency between whole drug powder of Phyllanthus niruri plus root decoction of Sida cordifolia and modern extracts of the same in compared to placebo in patients of diabetic poly-neuropathy. A randomized, partly-double-blinded, placebo-controlled trial evaluated the efficacy of two different pharmaceutical forms of herbal medicines over placebo in 90 patients (30 in each group) of diabetic sensory polyneuropathy for first three weeks period. After three weeks, active herbal medication groups were continued with their assigned medicaments for next 5 weeks period and all placebo-patients were randomized again into 2 groups of active medication and treated for next 8 weeks. Patients were assessed with Neuropathy Total Symptom Score 6 and sensation thresholds. Significant effect of both form of herbal medicines over placebo was found in aching pain [F (2, 49) = 6.79, p = 0.002], allodynia [F (2, 59) = 6.74, p = 0.002], burning pain [F (2, 82) = 14.66, p < 0.0001], numbness [F (2, 77) = 16.37, p < 0.0001] and pricking pain [F (2, 50) = 14.23, p < 0.0001]. After the 8 weeks period, no significant difference was identified between the effect of both the herbal treatment on aching pain (U = 220, p = 0.03), allodynia (U = 421.5, p = 0.29), burning pain (U = 881.5, p = 0.846), numbness (U = 778, p = 0.92) and pricking pain (U = 260, p = 0.15). Both herbal groups have significant effect to reduce NTSS-6 score in compare to placebo. No significant difference found between the effect of two different pharmaceutical forms of Phyllanthus niruri and S. cordifolia.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.MATURITAS.2015.11.002
Abstract: To investigate the awareness of breast cancer (BCa) and BCa screening amongst women at midlife in Bangladesh. A nationally representative cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 isions in Bangladesh, using a multistage cluster s ling technique. The factors associated with the awareness of BCa and breast assessment of asymptomatic women were investigated separately, using multivariable logistic regression. Of the 1590 participants, mean age 42.3 (±8.0) years, 81.9% had ever heard of BCa and 64.2% of any methods of BCa screening, respectively. Awareness of BCa was associated with being aged 40-49 years (adjusted OR 2.04, 95% CI 1.46-2.84), aged 49-59 years (1.96, 1.32-2.91), being overweight (1.46, 1.07-2.01) and obesity (1.62, 1.01-2.62), while inversely associated with rural dwelling (0.37, 0.22-0.61), primary education (0.44, 0.27-0.70), having no education (0.23, 0.14-0.36) and parity (0.62, 0.44-0.87). Of the 750 women who were aware of clinical breast examination (CBE) or mammography, reasons provided for not undergoing screening included that they had no symptoms (92%) and that they did not know screening was needed (40%). 8% of women reported CBE. Women with no education were less likely to have undergone CBE (0.38, 0.141.04 p=0.059). Lack of understanding of the assessment of asymptomatic women is the key obstacle to BCa screening uptake in Bangladesh. Health education programs, especially BCa awareness programs, have the potential to increase BCa awareness and down-staging of the disease.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
Publisher: Oxford University Press (OUP)
Date: 12-2013
DOI: 10.1111/JSM.12310
Publisher: The Endocrine Society
Date: 09-2005
DOI: 10.1210/JC.2004-1747
Abstract: Context: Hypoactive sexual desire disorder (HSDD) is one of the most common sexual problems reported by women, but few studies have been conducted to evaluate treatments for this condition. Objective: The objective of this study was to evaluate the efficacy and safety of a testosterone patch in surgically menopausal women with HSDD. Design: The design was a randomized, double-blind, parallel-group, placebo-controlled, 24-wk study (the Intimate SM 1 study). Setting: The study was performed at private or institutional practices. Patients: The subjects studied were women, aged 26–70 yr, with HSDD after bilateral salpingo-oophorectomy who were receiving concomitant estrogen therapy. Placebo (n = 279) or testosterone 300 μg/d (n = 283) was administered. There were 19 patients who withdrew due to adverse events in the placebo group and 24 in the 300 μg/d testosterone group. Intervention: Testosterone (300 μg/d) or placebo patches were applied twice weekly. Main Outcome Measure(s): The primary end point was the change in the frequency of total satisfying sexual activity at 24 wk. Secondary end points included other sexual functioning end points and safety assessments. Results: At 24 wk, there was an increase from baseline in the frequency of total satisfying sexual activity of 2.10 episodes/4 wk in the testosterone group, which was significantly greater than the change of 0.98 episodes/4 wk in the placebo group (P = 0.0003). The testosterone group also experienced statistically significant improvements in sexual desire and a decrease in distress. The overall safety profile was similar in both treatment groups. Conclusion: In the Intimate SM 1 study, the testosterone patch improved sexual function and decreased distress in surgically menopausal women with HSDD and was well tolerated in this trial.
Publisher: Springer Science and Business Media LLC
Date: 2003
DOI: 10.2165/00024677-200302020-00001
Abstract: To date, no formal definition of female androgen insufficiency (FAI) based on strong epidemiological data exists. However the proposed key symptoms of FAI, being reduced libido, diminished well-being, and lowered mood, have been reported to respond well to testosterone replacement, generally without significant adverse effects. Androgens are quantitatively the predominant sex steroid in women, circulating in the micro- and nanomolar concentration range, compared with picomolar levels of estrogens. Androgens have important physiological roles in women, acting both as precursors for estrogen biosynthesis and directly via the androgen receptor. The most significant biologically active androgen is testosterone, which circulates bound tightly to sex hormone binding globulin and loosely to albumin. Circulating androgen levels decline in the years preceding menopause. This may be attributed to the gradual reduction in adrenal androgen production with age and to the loss of cyclical ovarian androgen production in the late reproductive years. Those who experience surgical menopause, have adrenal insufficiency or pituitary insufficiency, or those who experience premature ovarian failure, also have reduced androgen production. Androgen replacement therapy in the form of either dehydroepiandrosterone or testosterone is becoming increasingly widespread for the treatment of FAI. Evidence exists for the benefits of such therapy in relieving both the physical and psychological symptoms thought to be due to FAI in clinically affected women. However, clear guidelines regarding the diagnosis of androgen insufficiency, optimal therapeutic doses, and long-term safety remain lacking.
Publisher: BMJ
Date: 07-2005
Publisher: Oxford University Press (OUP)
Date: 03-2016
DOI: 10.1016/J.JSXM.2015.11.015
Abstract: Sex steroids are important in female sexual function and dysfunction. To review the role of estrogens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of estrogen therapy for female sexual dysfunction to update the previously published International Society of Sexual Medicine Consensus on this topic. Panel members reviewed the published literature using online databases for studies pertaining to estrogen in female sexual function and dysfunction. Attention was specifically given to clinical trials that had reported on sexual function outcomes in women treated with estrogen. Quality of data published in the literature and recommendations were based on the GRADES system. Observational studies that have considered relationship factors and physical or mental health have reported that these factors contribute more to sexual functioning than menopausal status or estrogen levels. Few clinical trials have investigated estrogen therapy with sexual function as a primary outcome. The available data do not support systemic estrogen therapy for the treatment of female sexual dysfunction. Topical vaginal estrogen therapy improves sexual function in postmenopausal women with vulvovaginal atrophy (VVA) and is considered first-line treatment of VVA. Oral ospemifene, a selective estrogen receptor modulator, is effective for the treatment of VVA and might have independent systemic effects on female sexual function. For sexual problems, the treatment of VVA remains the most pertinent indication for estrogen therapy. When systemic symptoms are absent, estrogen therapy ideally can be administered by a vaginal preparation alone. Systemic estrogen therapy with combined estrogen and progestin in non-hysterectomized women is indicated for women who require treatment for vasomotor and/or other systemic estrogen deficiency symptoms. The improvement in well-being achieved by relief of vasomotor and other symptoms might improve libido in some women and abrogate further intervention.
Publisher: Wiley
Date: 07-03-2011
DOI: 10.1002/PON.1949
Abstract: To explore the beliefs held by breast cancer (BC) survivors about the factors that contribute to the development of their BC. The BUPA Health Foundation Health and Well-being after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive BC. Participants completed an enrollment questionnaire (EQ), first follow-up questionnaire (FQ1) and a second follow-up questionnaire (FQ2), 12 months and 24 months post-EQ, respectively. In the FQ2, women were asked whether they believed anything contributed to the development of their BC and whether they had made lifestyle changes since the FQ1. Well-being was assessed at the FQ2 using the psychological general well-being index (PGWB). In total, 1496/1684 women completed the FQ2 and 43.5% reported belief in a factor that may have contributed to their developing BC. These women were more likely to be younger (p<0.0001) and educated beyond high school (p<0.0001). Stress (58.1%) was the most common reason given, followed by previous use of hormone therapy (17.0%) and a family history of any cancer (9.8%). Women who believed stress contributed to their BC had lower PGWB scores than other study participants (70.9 ± 16.1, n = 361 versus 77.3 ± 14.9, n = 1071, mean difference = 6.4, 95% CI: 4.6-8.2 p<0.0001) and were more likely to have made lifestyle changes since their BC diagnosis. Many women with BC believe that stress has contributed to their condition. Women who held this belief were more likely to adopt strategies to reduce stress than those who did not.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.MATURITAS.2012.06.011
Abstract: In recent years the perimenopause has become recognised as a 'window of vulnerability' for women's mood. The risk of depression during perimenopause is high and treatment failure is common. Perimenopausal depression encompasses both new onset (first episode) depression occurring during perimenopause as well as a relapse during perimenopause in women with a history of depression. Perimenopausal depression is increasingly recognised as a new subtype of depression with specific clinical characteristics. Current treatments for perimenopausal depression have high failure rates, multiple adverse effects and potentially damaging long term consequences. This review examines both new onset and relapsed depression during perimenopause, biological mechanisms of perimenopausal depression, and the role of hormonal therapies.
Publisher: Oxford University Press (OUP)
Date: 09-2009
DOI: 10.1111/J.1743-6109.2009.01381.X
Abstract: Dehydroepiandrosterone (DHEA) and its sulfate DHEAS, which are the most abundant steroids in women, decline with age. We have shown association between low sexual function and low circulating DHEAS levels in women. The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young in iduals improves sexual function. Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week randomized, double-blind, placebo controlled trial and received either DHEA 50 mg or placebo (PL) daily. Efficacy was assessed through 26 weeks. The main outcome measures were the change in total satisfying sexual events (SSE) and the change in the Sabbatsberg Sexual Self-Rating Scale (SSS) total score. Secondary measures were the Psychological General Well-Being Questionnaire (PGWB), and the Menopause-Specific Quality of Life Questionnaire (MENQOL). Hormonal levels, adverse events (AEs), serious adverse events (SAEs) and clinical labs were evaluated over 52 weeks. Eighty-five participants (91%) were included in the 26-week efficacy analysis. There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS, PGWB, and MENQOL change scores. Overall AE reports and number of withdrawals as a result of AEs were similar in both groups however more women in the DHEA group experienced androgenic effects of acne and increased hair growth. In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA resulted in no significant improvements in sexual function over PL therapy over 26 weeks.
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/AJO.12829
Publisher: Springer Science and Business Media LLC
Date: 26-08-2009
DOI: 10.1007/S00520-009-0726-Z
Abstract: The aim of this study was to document the psychological well-being of a group of women with invasive breast cancer (BC) on an average of nearly 2 years after their diagnosis. Participants were women in the Medical Benefits Fund Australia Limited Foundation Health and Wellbeing after Breast Cancer Study, a cohort study of 1,684 women recruited within 12 months of their diagnosis with invasive BC, who completed their first annual follow-up questionnaire. Psychological well-being was measured using the Psychological General Well Being Index questionnaire (PGWB) in women with BC. The PGWB questionnaire was completed by 1,589 women on an average of 92 weeks after their BC diagnosis, of whom 46 had evidence of active disease. PGWB total scores for all age groups of the BC cohort were lower than community-based norms (p or =70, 60-<70, 50-60 p = 0.002 for age group 40-<50 and p = 0.05 for age group <40). PGWB total scores for the BC cohort were positively associated with age (p < 0.001) and living with others (p < 0.01) and inversely associated with active disease (p < 0.001) and education beyond secondary school (p = 0.03). For the domain of anxiety, there was no statistically significant association with living with others but an inverse association with education beyond school. A higher level of education may be associated with increased anxiety and lower well-being. Social support is particularly important for women with BC who are known to live alone.
Publisher: Wiley
Date: 03-2004
Publisher: BMJ
Date: 04-2001
DOI: 10.1136/ARD.60.4.332
Abstract: Osteoarthritis (OA) is increasingly prevalent in the years after menopause. Epidemiological data suggest that the use of oestrogen replacement therapy (ERT) may protect against knee OA. To test the hypothesis that long term ERT (longer than five years) is associated with increased knee cartilage in postmenopausal women. The study involved 81 women (42 current users (> or = five years) of ERT and 39 who had never used it). Articular cartilage volumes were determined by processing images acquired in the sagittal plane using a T1 weighted fat suppressed magnetic resonance sequence on an independent work station. After bone size had been accounted for, ERT users had higher tibial cartilage volume than non-users. Total tibial cartilage volume was 7.7% (0.23 ml) greater in the group of ERT users (2.98 (0.47) ml mean (SD)) than in the untreated group (2.75 (0.50) ml). The difference, after adjustment for the significant explanatory factors (years since menopause, body mass index, age at menopause, and smoking), between the ERT users and non-users increased from 0.23 ml to 0.30 ml (95% confidence interval 0.08 to 0.52, p=0.008). These differences persisted after exclusion of women with OA. After adjustment for multiple confounders, women using long term ERT have more knee cartilage than controls. This may indicate that ERT prevents loss of knee articular cartilage.
Publisher: American Medical Association (AMA)
Date: 11-12-2002
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.JOCA.2007.10.018
Abstract: Meniscal tears detected using magnetic resonance imaging (MRI) have been identified as a risk factor for the development and progression of Osteoarthritis, however the prevalence and significance of meniscal tears in healthy, asymptomatic adults remains to be studied. We investigated the prevalence of meniscal tears in a healthy pain free population of post-menopausal women and whether meniscal tears in this population are associated with changes in cartilage volume and defects and tibial plateau bone area over 2 years. Fifty-seven post-menopausal women underwent MRI of their dominant knee at baseline line and approximately 2 years later to assess meniscal tears, cartilage volume, cartilage defects and tibial plateau bone area. Forty-six percent of women had a meniscal tear in either the medial and/or lateral compartment. Women who had a tear were older (P=0.01) and had more lateral cartilage defects (P=0.02). Medial meniscal tear was associated with 103 mm(2) greater tibial plateau bone area within the medial [95% confidence of interval (CI) 6.2, 200.3 P=0.04] and a lateral meniscal tear with a 120 mm(2) greater area within the lateral compartment (95% CI 45.5, 195.2 P=0.002). This study demonstrates that meniscal tears are common in asymptomatic post-menopausal women and that they become more common with age. Meniscal tears were also associated with greater tibial plateau bone area but not cartilage volume, providing support to the hypothesis that tibial plateau bone changes occur before significant pathological changes in cartilage. Whether increased tibial plateau bone area predisposes to an increased risk of degenerative meniscal tears or whether it is a consequence of altered biomechanical forces in relation to meniscal tear will need to be determined.
Publisher: Cambridge University Press
Date: 26-07-2012
Publisher: Oxford University Press (OUP)
Date: 11-2012
Publisher: Mary Ann Liebert Inc
Date: 07-2017
Abstract: The association between menopausal vasomotor symptoms (VMS) and depressive symptoms remains controversial. We aimed to examine the associations between moderate-severe VMS and moderate-severe depressive symptoms. Nationally representative cross-sectional survey of 2,020 noninstitutionalized Australian women aged 40-65 randomly recruited between October 2013 and March 2014. Symptoms were assessed by the Menopause-Specific Quality of Life Questionnaire, the Beck Depression Inventory-II, with score ≥20 defined as moderate-severe depressive symptoms. Cigarette, alcohol, and psychotropic medication use was also assessed. Binge drinking was defined as four standard drinks on one occasion. VMS were classified as moderate-severe for 267 of the 2,020 women (13.3%). After adjusting for multiple factors, including age, partnership status, paid employment, housing insecurity, and body mass index, when compared to women with no or mild VMS, women with moderate-severe VMS were more likely to have moderate-severe depressive symptoms (odds ratio [OR] 2.80, confidence interval [95% CI], 2.01-3.88, p < 0.001). Having moderate-severe depressive symptoms was associated with a greater likelihood of use of psychotropic medications (48.9%, 95% CI, 43.1-54.8 vs. 20.1%, 95% CI, 18.2-22.1, p < 0.001), smoking (25.9%, 95% CI, 20.8-30.9 vs. 12.2%, 95% CI, 10.6-13.7, p < 0.001), and binge drinking at least weekly (15.1%, 95% CI, 11.0-19.2 vs. 10.3% 95% CI, 8.8-11.7, p = 0.015). Moderate-severe VMS are independently and significantly associated with moderate-severe depressive symptoms.
Publisher: The Endocrine Society
Date: 23-01-2021
Publisher: Oxford University Press (OUP)
Date: 02-2010
Publisher: Elsevier BV
Date: 05-1997
Publisher: Informa UK Limited
Date: 12-07-2014
DOI: 10.3109/13697137.2014.926322
Abstract: There is a paucity of information regarding women's expectations of medical treatment for female sexual dysfunction (FSD) and their self-appraisal of treatment outcomes. The aims of this study were to explore women's perception and expectations of treatment and their experiences of treatment for FSD using a qualitative approach. First-time attendees to an endocrinologist with the complaint of sexual difficulties were identified and were invited to take part in an in-depth interview on the same day as, but prior to, their medical consultation. Follow-up phone interview took place 3-4 months later. Seventeen women, aged 26-70 years, participated in the face-to-face interview. Ten of these participated in the follow-up interview. Four major themes emerged from the women's narrative stories: (1) personal psychological distress associated with FSD, (2) concern about the adverse effect of FSD on the relationship with their sexual partner, (3) a belief in a relationship between FSD and 'hormone deficiency', and (4) an expectation of treatment, which included positive physical and sexual changes. Health professionals should be aware of the high degree of psychological distress that can result from FSD and consider available treatment options, which may include hormone therapy.
Publisher: Wiley
Date: 04-2014
DOI: 10.1111/IMJ.12205
Abstract: Although there is evidence that minimal surveillance is compatible with an optimal outcome in women after early stage breast cancer, little is known of the surveillance that these women receive. To describe the intended clinical follow up and patterns of use of imaging modalities in low-risk breast cancer survivors who are at least 5 years from diagnosis. Participants in the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study with stage 1 invasive breast cancer at diagnosis, who had survived free of recurrence or new primary breast cancer for at least 5 years, provided information for this analysis. The most common choice of physician follow up was with one doctor only (54%). Within this group, the most frequent choice was a general practitioner (GP) (63%) followed by medical oncologist (23%). Thirty-five per cent of women said that they intended to consult two doctors and within this group, the most common combination was a GP and a medical oncologist (45%). This was despite two out of three women reporting being advised that there was no need to consult a medical oncologist. Over 90% of women reported having a mammogram with, or without, breast ultrasound in the previous 12 months. There was a low rate of use of other imaging tests in the absence of clear indications. Minimising unnecessary medical consultations by women with breast cancer at low risk of recurrence 5 years from diagnosis will require education about the benefits of a minimal surveillance strategy.
Publisher: The Endocrine Society
Date: 07-2005
DOI: 10.1210/JC.2005-0212
Abstract: Context: Changes in androgen levels across the adult female life span and the effects of natural menopause and oophorectomy have not been clearly established. Objective: The objective of this study was to document the effects of age on androgen levels in healthy women and to explore the effects of natural and surgical menopause. Design, Setting, and Participants: A cross-sectional study was conducted of 1423 non-healthcare-seeking women, aged 18–75 yr, randomly recruited from the community over 15 months. Main Outcome Measures: Serum levels by age of total testosterone (T), calculated free T, dehydroepiandrosterone sulfate, and androstenedione in a reference group of women free of confounding factors. Women in the reference group had no usage of exogenous steroid therapy no history of tubal ligation, hysterectomy, or bilateral oophorectomy and no hyperprolactinemia or polycystic ovarian syndrome. The effects of natural and surgical menopause on sex steroid levels were also examined. Results: In the reference population (n = 595), total T, calculated free T, dehydroepiandrosterone sulfate, and androstenedione declined steeply with age (P & 0.001), with the decline of each being greater in the earlier than the later decades. Examination of serum androgen levels by year in women aged 45–54 yr showed no independent effect of menopausal status on androgen levels. In women aged 55 yr or older, those who reported bilateral oophorectomy and were not on exogenous steroids had significantly lower total T and free T levels than women 55 yr or older in the reference group. Conclusions: We report that serum androgen levels decline steeply in the early reproductive years and do not vary because a consequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production. These significant variations in androgens with age must be taken into account when normal ranges are reported and in studies of the role of androgens in women.
Publisher: Informa UK Limited
Date: 13-02-2023
Publisher: Informa UK Limited
Date: 04-07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2004
DOI: 10.1097/01.GME.0000087981.28957.CF
Abstract: To compare the effects of transferring from low-dose, transdermal estrogen to raloxifene with a phase of alternate-day raloxifene therapy with or without low-dose transdermal estrogen on patient satisfaction, endometrial changes, and overall safety in healthy, postmenopausal women previously administered hormone therapy. Healthy postmenopausal women were randomized to one of two treatment groups: raloxifene + low-dose, transdermal estrogen (RLX+E) and raloxifene + placebo (RLX+P). The study consisted of four equal phases of 8 weeks each: Phase I (low-dose, transdermal estrogen, 25 microg/day), phase II (double-blind, alternate-day raloxifene 60 mg + low-dose, transdermal estrogen or placebo patch), phase III (alternate-day RLX 60 mg + placebo patch), and phase IV (raloxifene 60 mg/day + placebo patch). Primary endpoints included patient satisfaction, endometrial changes, overall safety, and quality of life. Sixty women were randomized in this study. Baseline characteristics were similar between the two treatment groups. For the primary analysis (phase II to phase IV, inclusive), there were no significant differences between the therapy sequences for patient satisfaction, endometrial thickness, or quality of life. In the therapy comparison phase (phase II), mean change in patient satisfaction score was 3.2 mm (SD = 16.2) for RLX+E and -17.1 mm (SD = 38.7) for RLX+P (P = 0.003), whereas mean change in endometrial thickness was 0.8 mm (SD = 2.7) for RLX+E and -0.9 mm (SD = 1.5) for RLX+P (P = 0.021). The RLX+P group showed a significantly greater increase in vasomotor events, with a mean score change of 1.7 (SD = 1.9) compared with a mean score change of 0.2 (SD = 1.8) in the RLX+E group (P = 0.005). There were no statistically significant differences between the two therapy groups in the reporting of treatment-emergent adverse events. Gradual conversion to raloxifene from low-dose estrogen, with a progression from 60 mg every alternate day to 60 mg/day, is a viable option in potentially symptomatic, postmenopausal women.
Publisher: Oxford University Press (OUP)
Date: 03-2014
DOI: 10.1111/JSM.12426
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2006
DOI: 10.1097/01.GME.0000179049.08371.C7
Abstract: Evaluation of the use of testosterone therapy for hypoactive sexual desire disorder (HSDD) after oophorectomy has mostly involved women treated with oral estrogen preparations. We investigated the efficacy and safety of a testosterone patch in surgically menopausal women receiving concurrent transdermal estrogen. Women with HSDD after oophorectomy, for whom this was a concern, who were using transdermal estrogen, were recruited to a 24-week, randomized, double-blind, placebo-controlled trial in Europe and Australia. Patients were randomly allocated to placebo (n = 40) or testosterone 300 microg/day (n = 37) treatment. Primary endpoints were changes in sexual desire measured by the sexual desire domain of the Profile of Female Sexual Function and the frequency of satisfying sexual activity at 24 weeks. Sixty-one women (79%) completed the trial. All subjects who received at least one application of study medication were included in analysis. The testosterone-treated group experienced a significantly greater change from baseline in the domain sexual desire score compared with placebo (change from baseline, 16.43 versus 5.98 P = 0.02). The domain scores for arousal, orgasm, decreased sexual concerns, responsiveness, and self-image as well as decreased distress were also significantly greater with testosterone therapy than placebo. The frequency of satisfactory sexual events increased but was not statistically different between treatment groups (P = 0.06) Adverse events occurred with similar frequency in both groups, and no serious risks of therapy were observed In this study, transdermal testosterone therapy via a skin patch improved sexual desire and other sexual function domains. It was well tolerated in these oophorectomized women with HSDD receiving concomitant transdermal estrogen.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2013
DOI: 10.1007/S00520-013-1763-1
Abstract: The aim of this work was to study the incidence and prevalence of self-reported lymphedema in breast cancer survivors between 2 and 4 years following diagnosis, the factors associated with the development of lymphedema and the impact of lymphedema on psychological well-being. We assessed self-reported lymphedema in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study, a questionnaire-based study of 1,683 women newly diagnosed with their first episode of invasive breast cancer in Victoria, Australia. Psychological well-being was assessed using the Psychological General Well-being Index. Two years after diagnosis, nearly 20 % of women reported lymphedema and this proportion remained above 18 % 2 years later. However, self-reported lymphedema was a dynamic phenomenon, with the condition resolving in some women and others reporting onset for the first time up to 4 years from diagnosis. Lymphedema 2 years from diagnosis was positively associated with the number of nodes removed at initial surgery, although this variable only explained a small proportion of the likelihood of reporting lymphedema. The presence of lymphedema was associated with lower psychological general well-being. Lymphedema after breast cancer treatment frequently has a dynamic pattern and may emerge as an issue for women several years after their initial treatment. It is associated with a lower level of general well-being.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/AR2428
Publisher: Springer Science and Business Media LLC
Date: 17-02-2009
DOI: 10.1007/S10689-009-9236-X
Abstract: To document the prevalence of family history of breast cancer (BC) amongst women newly-diagnosed with invasive BC and to explore the relationship between family history and cancer size and stage. A cross-sectional analysis was conducted on baseline questionnaire data from a cohort study of 1,684 women diagnosed with invasive BC within the previous 12 months and recruited between 2004 and 2006 in Victoria, Australia. Women with affected first degree relative(s) were more likely to have a smaller BC (odds ratio for <or=10 mm 1.74, 95% CI: 1.32-2.29) and stage I BC (odds ratio 1.31, 95% CI: 1.01-1.70) at diagnosis than women with no affected relatives. There was no significant difference in BC size and stage between women with only affected second degree relatives and women with no affected relatives. Women with a first degree relative with BC had smaller, earlier stage cancers at diagnosis, possibly reflecting more diligent use of breast screening amongst women who considered themselves at increased risk of developing the disease.
Publisher: Oxford University Press (OUP)
Date: 20-11-2015
DOI: 10.1634/THEONCOLOGIST.2015-0235
Abstract: Cervical cancer (CCa) is the second most common cancer among women in Bangladesh. The uptake of CCa screening was less than 10% in areas where screening has been offered, so we investigated the awareness of CCa and CCa screening, and factors associated with women's preparedness to be screened. A nationally representative, cross-sectional survey of women aged 30–59 years was conducted in 7 districts of the 7 isions in Bangladesh, using a multistage cluster s ling technique. Factors associated with the awareness of CCa and screening uptake were investigated separately, using multivariable logistic regression. On systematic questioning, 81.3% and 48.6% of the 1,590 participants, whose mean age was 42.3 (±8.0) years, had ever heard of CCa and CCa screening, respectively. Having heard of CCa was associated with living in a rural area (adjusted odds ratio [OR]: 0.42 95% confidence interval [CI]: 0.26–0.67), being 40–49 years old (OR: 1.59 95% CI: 1.15–2.0), having no education (OR: 0.25 95% CI: 0.16–0.38), and being obese (OR: 2.04 95% CI: 1.23–3.36). Of the 773 women who had ever heard of CCa screening, 86% reported that they had not been screened because they had no symptoms and 37% did not know screening was needed. Only 8.3% had ever been screened. Having been screened was associated with being 40–49 years old (OR: 2.17 95% CI: 1.19–3.94) and employed outside the home (OR: 3.83 95% CI: 1.65–8.9), and inversely associated with rural dwelling (OR: 0.54 95% CI: 0.30–0.98) and having no education (OR: 0.29 95% CI: 0.10–0.85). Lack of awareness of CCa and of understanding of the concept of screening are the key barriers to screening uptake in women at midlife in Bangladesh. Targeted educational health programs are needed to increase screening in Bangladesh with the view to reducing mortality.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.JOCA.2006.04.014
Abstract: Although knee alignment is associated with the progression of knee osteoarthritis (OA), it is unclear which features that characterize radiographic OA are related to alignment. The aim of this study was to examine the relationship between static knee joint alignment (measured as a continuous variable) and the radiographic features of knee OA (joint space narrowing and osteophytes). One hundred and twenty one adults with symptomatic knee OA were recruited using a combined strategy including referral from specialist centres, arthritis support groups and media advertising. X-rays were performed to classify the severity of disease and to determine static knee alignment. Increasing varus knee alignment was associated with increasing risk of medial compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.005). Increasing valgus knee alignment was associated with an increased risk for lateral compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.002). This study has demonstrated that the static knee angle, measured as a continuous variable, is an important determinant of the compartment-specific features of radiographic knee OA. Further work is required to determine whether interventions aimed at correcting these relatively minor levels of varus and valgus angulation will have an effect on the risk of tibiofemoral OA.
Publisher: Informa UK Limited
Date: 27-10-2015
DOI: 10.3109/13697137.2014.937689
Abstract: To systematically review published articles for the prevalence of menopausal symptoms in Asian women. A comprehensive and systematic literature search was performed using MEDLINE, EMBASE, PsycINFO, CINAHL, SCOPUS and Google scholar in June 2013 to retrieve all English-language studies that included information on the prevalence of menopausal symptoms in women living in Asian countries. Risk of bias of included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. Twenty-three independent studies met our inclusion criteria. Physical symptoms were the most prevalent symptoms compared to psychological, vasomotor and sexual symptoms. There was a wide variation in the prevalence of all symptoms across the menopausal stages due to the differences in modes of recruitment, study design, s ling procedures, the time frame over which symptoms were assessed and use of different diagnostic or screening tools. A high level of bias was observed for both external and internal validity for most studies. Although there is a wide variation in the reported prevalence of menopausal symptoms, physical symptoms predominate, followed by psychological symptoms, vasomotor symptoms and sexual symptoms. Further studies of representative s les are necessary to understand whether the variations in prevalence reporting are a function of methodological issues or due to ethnic, cultural or other socioeconomic differences.
Publisher: Wiley
Date: 15-09-2021
DOI: 10.1111/CEN.14592
Abstract: To document associations between anti‐Müllerian hormone (AMH) and circulating androgens in nonhealthcare‐seeking premenopausal women. Community‐based, cross‐sectional study. Eastern states of Australia. Women aged 18–39 years not using systemic hormones, not pregnant or breastfeeding within 3 months, and not postmenopausal. AMH, measured by the Beckman Access 2, 2 site immunometric assay from fresh s les, and testosterone, androstenedione, dehydroepiandrosterone (DHEA) and 11‐oxygenated C19 steroids, measured by liquid chromatography–tandem mass spectrometry. Data were available for 794 women, median age of 33 years (range: 18–39). 76.1% were of European ancestry and 48.2% were parous. Serum AMH was positively associated with testosterone ( rho = .29, p .001) androstenedione ( rho = .39, p .001) and DHEA ( rho = .10, p = .005) but not 11‐ketoandrostenedione or 11‐ketotestosterone. When adjusted for age, body mass index and smoking, using quantile regression, independent positive associations remained between AMH and testosterone ( β coefficient: 20.90, 95% confidence interval [CI]: 13.79–28.03 p .001) and androstenedione ( β coefficient: 5.90, 95% CI: 3.76–8.03 p .001). The serum concentration of testosterone was greater at the top AMH quintile than other quintiles (0.56 nmol/L [range: 0.21–1.90] vs. 0.36 nmol/L [range: 0.13–0.87] p = .001) in women with self‐reported polycystic ovary syndrome. The positive associations between serum testosterone and androstenedione and AMH in premenopausal women is consistent with androgens directly or indirectly influencing AMH production during follicular development. As the highest AMH concentrations are most likely to be seen in women with multifollicular ovaries, it would be expected that women with multifollicular ovaries would have higher serum testosterone. Therefore, whether hyperandrogenemia and multifollicular ovaries should be considered independent characteristics of polycystic ovary syndrome warrants review.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
DOI: 10.1097/GME.0B013E31817E5CE0
Abstract: Although low back pain is characterized by both pain and disability, there is a paucity of studies that have concurrently examined risk factors for these features in community-dwelling women. We aimed to investigate the prevalence and identify factors associated with both back pain and disability. A questionnaire was mailed to 542 women from a community-based research database. Detailed demographic data were collected, including participants' menopause, relationship, and employment status. Point and period prevalence estimates for back pain were derived. Participants were classified based on pain intensity and disability scores calculated from the Chronic Pain Grade Questionnaire, and factors associated with high levels of pain and disability were examined. A total of 506 (93.4%) women completed the questionnaire. More than 90% of participants had experienced low back pain, with 75.1% and 22.5% reporting pain in the past 12 months and currently, respectively. Seven percent of women reported a high level of disability and 16% reported high-intensity pain. Women with higher levels of disability were more likely to have a higher body mass index and to have pain currently, whereas those with greater pain intensity were more likely to be younger, have a higher body mass index, not be employed outside the home, drink alcohol, and have current pain. Low back pain is a common problem for community-based women. A high body mass index and current pain were factors independently associated with both high pain intensity and disability. Longitudinal investigation is required to determine the predictive nature of these factors and their potential role in preventing pain and disability.
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1445-5994.2003.00346.X
Abstract: Background : The parenteral administration of oestradiol acutely protects against exercise‐induced myocardial ischaemia in women, but whether this effect is sex specific is not known. Aims : The effects of acutely administered conjugated equine oestrogen on exercise‐induced myocardial ischaemia in men with established coronary heart disease were investigated in a randomized, placebo‐controlled, double‐blind cross‐over trial. Methods : Twenty men, aged 62 ± 11.6 years, with reproducible exercise‐induced myocardial ischaemia were treated with either intravenous conjugated equine oestrogen (25 mg) or saline prior to undergoing an exercise stress test. Primary end‐points were total exercise time and time to 1 mm ST‐segment depression. Results : All participants completed the protocol. Total exercise time exceeded the baseline value in 17 of the 20 men following saline, and in 17 of the 20 men following oestrogen pretreatment. Time to 1 mm ST‐segment depression exceeded the baseline value in 14 of the 19 men following saline, and following oestrogen administration, exceeded baseline in 13 of the 19 men. There was no significant difference between the two treatments in either time to 1 mm ST‐segment depression or total exercise time. A period effect was apparent for total exercise time ( P = 0.05) but not for time to ST‐segment depression. Conclusion : Acute parenteral oestrogen therapy did not increase total exercise time or time to the onset of electrocardiographic changes of ischaemia in men with chronic stable coronary artery disease. These findings contrast the favourable effects of oestrogen in women in comparable studies and indicate a sex specificity for the acute cardiovascular effects of oestrogen. (Intern Med J 2003 33: 221−224)
Publisher: Elsevier BV
Date: 02-1996
DOI: 10.1016/0378-5122(95)00966-3
Abstract: Premature ovarian failure (POF) is common, affecting approximately 1% of women. It is defined as gonadal failure before the age of 40 and patients may clinically present with either primary or secondary amenorrhoea. This review concentrates on the clinical aspects of POF, with sequential discussion on the aetiology and epidemiology, clinical manifestations and relevant investigations, concluding with an overview of management. In addition, the scientific basis for our current understanding of POF is summarized to provide a comprehensive overview of the erse pathophysiological mechanisms that may underlie this disorder. Despite the heterogeneity of causes of POF, the fundamental treatment principles are the same. In this review the initiation of hormone replacement therapy in the younger woman and the importance of long term follow-up and treatment are emphasized.
Publisher: Elsevier BV
Date: 12-2015
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.SEMARTHRIT.2006.12.008
Abstract: To evaluate the relationship between serum testosterone (T), preandrogens and sex hormone binding globulin (SHBG), and the knee structure in middle-aged women without knee pain. One hundred and thirty-nine healthy women without knee pain, aged 40 to 67 years, underwent magnetic resonance imaging of their dominant knee to measure tibial and patella cartilage volumes and defects, respective bone area and volume, and bone marrow lesions. The serum level of T, preandrogens, and SHBG were analyzed using linear regression to determine whether associations existed between these hormones and knee structure. Free T and total T showed no association with cartilage volume or bone structures in the knee. SHBG showed a statistically positive association with patella bone volume after adjusting for confounders (P = 0.02). Our study suggests there are no associations between serum levels of T or the preandrogens and knee structure in women. The observed positive association between SHBG and patella bone volume may reflect a favorable effect of estrogen exposure on patella bone volume.
Publisher: Informa UK Limited
Date: 24-07-2021
Publisher: The Endocrine Society
Date: 31-05-2020
Publisher: Springer Science and Business Media LLC
Date: 04-2006
DOI: 10.1038/NCPURO0439
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.JGO.2013.12.003
Abstract: Management of older women with breast cancer (BC) is challenging, as age-related comorbidities may limit treatment. We present 5-year follow-up data from women aged 70 years or older (70+), at the time of diagnosis of their BC, compared with younger women (<70 years). Data is from an Australian cohort study of women with their first episode of invasive BC (Bupa study). Participants completed an enrollment questionnaire (EQ) within 12 months of diagnosis and annual follow-up questionnaires (FQ) for 5 years (FQ1-5). Data collected included details of the BC and its treatment. Psychological wellbeing was measured by the Psychological General Wellbeing Index (PGWB). At diagnosis, 274 (16%) women were aged 70+ and of them, 90% were aged 70-79 years. Compared with women aged <70 years, the women aged 70+ were less likely to have positive nodes, they were less likely to receive radiotherapy and chemotherapy and were more likely to have pre-existing cardiovascular morbidities. By FQ5 women aged 70+ were less likely to be taking oral adjuvant endocrine therapy (OAET) and were more likely to have died from causes other than BC. At FQ5, women 70+ reported less anxiety and better self-control. Women aged 70+, compared to <70 years, had less advanced disease, received radiation and chemotherapy less often, were more likely to have cardiovascular disease at the time of diagnosis, were less likely to be taking OAET at the 5-year assessment, and were more likely to die of causes other than breast cancer.
Publisher: Oxford University Press (OUP)
Date: 02-02-2022
Publisher: Oxford University Press (OUP)
Date: 2010
DOI: 10.1111/J.1743-6109.2009.01629.X
Abstract: Endocrine changes during aging as well as endocrine disorders may either directly or indirectly modulate female sexual function by altering sex hormones, or by impacting on vascular, neurogenic, or psychologic factors. To review information on the impact of the hormonal changes associated with aging or those caused by endocrine disorders on female sexual function and current information on the risks and benefits of hormonal treatments. Committee members outlined topics and reviewed the published literature on endocrine aspects of female sexual function over a 2-year period. Presentation of the recommendations were presented at the International Consultation on Sexual Medicine Paris, France 2009 and revised accordingly. Quality of data published in the literature and recommendations were based on the GRADES system. Recommendations and guidelines concerning the role of sex hormones and endocrine disorders in female sexual function were derived. Hormones are only one component of the many factors that contribute to normal sexual function in women. Further research is needed as to the impact of hormones and endocrine disorders on female sexual dysfunction and the benefits and risks of hormonal therapies.
Publisher: Elsevier BV
Date: 12-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.NEUROPSYCHOLOGIA.2009.10.013
Abstract: Mental rotation is a task known to activate the parietal cortical regions. The present study aimed to investigate whether there is differential activation of regions within the parietal lobe and to reveal functional subspecialisation of this region by examining the effects of increasing angle of rotation. Functional magnetic resonance imaging was performed in nine healthy female subjects whilst undertaking a parametric mental rotation task. The task comprised 6 alphanumeric characters presented in their normal or mirror-reversed orientation. Behaviourally, subjects showed increased reaction times with increased angle of rotation, with differential effects between the alphanumeric characters numbers having greater reaction times than letters. BOLD signal increase was observed bilaterally in the middle occipital gyrus and medial frontal gyrus, in the right superior and inferior parietal lobules and in the left superior temporal gyrus. Parametric increases in activation with increasing angle of rotation were observed bilaterally in the superior and inferior parietal lobules and in the right medial frontal gyrus, with greater parametric effects in the superior parietal lobules compared to the inferior parietal lobules. Our findings suggest subspecialisation of the posterior parietal lobules during mental rotation, with differential responses in the superior and inferior regions.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 06-2003
DOI: 10.1016/S0960-0760(03)00204-8
Abstract: The role of androgen treatment in women remains controversial. The proposed "Female Androgen Insufficiency Syndrome" (Fertility and Sterility, April 2002) describes a number of non-specific symptoms including unexplained fatigue, decreased well being/dysphoric mood and/or blunted motivation and diminished sexual function. An estimated 40% of women experience sexual dysfunction, highlighting the need for ongoing research into this field in order to fully define the possible contribution of androgen insufficiency. The increasing availability of products, such as dehydroepiandrosterone (DHEA) supplements also points to the need for controlled studies to assess the safety of these and other preparations. Measurement of androgens in women requires sensitive assays with the ability to detect low levels and a narrow range with precision. Normal ranges of androgens for women of reproductive and post-reproductive age remain poorly defined. Debate exists as per importance of measurement of free versus total testosterone, with the "free androgen index" offering an alternative method of assessment of testosterone availability. Testosterone treatment is being developed for women in the form of transdermal patches, gels or cream, with percutaneous implants in common usage in some countries. Recent research has highlighted alternative means of administration, such as oral inhalation or buccal lozenge. DHEA is widely available in some countries. Research to date has demonstrated improvements in libido and sexual function, mood and well being. Evidence points to other potential benefits of androgen treatment, including preservation of bone mass, a possible protective role in breast cancer and beneficial effects on cognition. Adverse effects of androgen treatment in women are dose-dependent and include virilisation, mood disturbance and acne. These are uncommon if appropriate doses are administered and highlight the need for treatment to be closely monitored clinically and biochemically. Beneficial effects of testosterone treatment in post-menopausal women with lowered androgen levels have been well documented, and preliminary evidence suggests a role for treatment in pre-menopausal women with symptoms and lowered testosterone levels.
Publisher: Elsevier BV
Date: 08-1986
DOI: 10.1016/S0006-291X(86)80408-9
Abstract: We have used a bovine cDNA probe for the A-subunit of inhibin to demonstrate the presence of inhibin in the ovaries of immature female rats: the levels of mRNA were increased following treatment of the rats with pregnant mare serum gonadotrophin (PMSG), suggesting modulation by PMSG of ovarian inhibin synthesis at least at the level of transcription. Furthermore, we report the unexpected finding of significant levels of inhibin mRNA in the corpora lutea of mature female rats. No inhibin mRNA was demonstrable in the uterus or placenta.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Oxford University Press (OUP)
Date: 11-2007
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.CLINTHERA.2014.06.037
Abstract: This study compared the pharmacokinetics of a single dose of 1% testosterone solution after application to the inner arm or the axilla as application sites for transdermal testosterone therapy. Healthy, not pregnant, premenopausal women, 18 to 45 years of age with a body mass index of 20 to 28 kg/m(2) were enrolled into a single-center, open-label, randomized, 2-way crossover study. Serum total testosterone (TT), free testosterone (fT), and sex hormone binding globulin concentrations were measured. Pharmacokinetic parameters determined from serum TT and fT included area under the serum concentration versus time curve from time zero (pre-dose) until 72 hours post-dose (AUC0-72), Cmax, and Tmax. Descriptive statistics were performed on serum concentrations of TT and fT for each site. ANOVA was performed on AUC0-72 and Cmax. A single-dose application of 1% testosterone solution to the inner arm and the axilla produced clear increases in TT and fT. Slower and lower increases in TT and fT were observed after treatment to the inner arm. Based on baseline-corrected AUC versus time curves, the bioavailability of 1% testosterone solution was increased 2-fold for the axilla compared with the inner arm. The absorption of a 1% testosterone solution was significantly greater after application to the axilla than to the inner arm. Study number DDS16 Australian Therapeutic Goods Administration, CTN 2005/158.
Publisher: Elsevier BV
Date: 04-1995
DOI: 10.1016/0378-5122(94)00898-H
Abstract: To investigate the role of androgens in increasing bone density and improving low libido in postmenopausal women, we have studied the long-term effects of estradiol and testosterone implants on bone mineral density and sexuality in a prospective, 2 year, single-blind randomised trial. Thirty-four postmenopausal volunteers were randomised to treatment with either estradiol implants 50 mg alone (E) or estradiol 50 mg plus testosterone 50 mg (E&T), administered 3-monthly for 2 years. Cyclical oral progestins were taken by those women with an intact uterus. Thirty-two women completed the study. BMD (DEXA) of total body, lumbar vertebrae (L1-L4) and hip area increased significantly in both treatment groups. BMD increased more rapidly in the testosterone treated group at all sites. A substantially greater increase in BMD occurred in the E&T group for total body (P < 0.008), vertebral L1-L4 (P < 0.001) and trochanteric (P < 0.005) measurements. All sexual parameters (Sabbatsberg sexual self-rating scale) improved significantly in both groups. Addition of testosterone resulted in a significantly greater improvement compared to E for sexual activity (P < 0.03), satisfaction (P < 0.03), pleasure (P < 0.01), orgasm (P < 0.035) and relevancy (P < 0.05). Total cholesterol and LDL-cholesterol fell in both groups as did total body fat. Total body fat-free mass (DEXA, anthropometry, impedance) increased in the E&T group only. We concluded that in postmenopausal women, treatment with combined estradiol and testosterone implants was more effective in increasing bone mineral density in the hip and lumbar spine than estradiol implants alone. Significantly greater improvement in sexuality was observed with combined therapy, verifying the therapeutic value of testosterone implants for diminished libido in postmenopausal women. The favourable estrogenic effects on lipids were preserved in women treated with T, in association with beneficial changes in body composition.
Publisher: Oxford University Press (OUP)
Date: 2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
DOI: 10.1097/GME.0B013E3182610CAB
Abstract: The aim of this study was to investigate the extent of discontinuation of oral adjuvant endocrine therapy (OAET) in women nearly 4 years from the diagnosis of their first episode of invasive breast cancer and the reasons for such discontinuation. We used a large, prospective cohort study of women who had been diagnosed with their first episode of invasive breast cancer between 2004 and 2006, recruited through a state-based cancer registry. All participants completed an enrollment questionnaire (EQ) within 12 months of diagnosis and annual follow-up questionnaires (FQs) thereafter. The data in this report were obtained from the EQ and the first three FQs. A total of 1,370 women with hormone receptor-positive disease completed the EQ. At the completion of the third FQ nearly 4 years from diagnosis, 1,193 women remained in the study. Use of OAET peaked by 2 years postdiagnosis. At nearly 4 years from diagnosis, 18% of the 1,193 women remaining in the study were not taking OAET. Of these women, just more than half had ceased therapy mainly owing to a range of adverse effects, predominantly estrogen deficiency symptoms, but the remainder (8% of women remaining in the study) had never used OAET. Our study confirms that early discontinuation of OAET due to estrogen deficiency symptoms remains an important issue despite calls for strategies to address this problem. The number of women potentially suitable for OAET but not receiving it was almost as great as the number of those who have discontinued therapy.
Publisher: The Endocrine Society
Date: 07-08-2019
Abstract: Whether serum androgen levels can identify women with “androgen insufficiency” or “androgen excess” is unresolved thus, what constitutes “normal” remains uncertain. We sought to determine whether androgens, including 11-oxygenated C19 steroids, vary with age, menstrual cycle, or body mass index (BMI), during the reproductive years. Cross-sectional study recruited from eastern Australian states. A total of 588 women, aged 18 to 39 years, who were not pregnant, lactating, or using systemic hormone therapy, with regular menstrual cycles and no previous diagnosis of polycystic ovarian syndrome. Sex steroids measured using liquid chromatography-tandem mass spectrometry. Testosterone and androstenedione concentrations were significantly higher during the menstrual cycle mid- and luteal phases than in the early follicular phase, with median values across the cycle of 0.34 nmol/L (range, 0.04 to 1.01) and 1.97 nmol/L (range, 0.53 to 7.89), respectively. No cyclical variations were found in dehydroepiandrosterone (DHEA 4.91 nmol/L range, 0.08 to 23.51), 11-ketoandrostenedione (11KA 7.99 nmol/L range, 0.07 to 31.67), or 11-ketotestosterone (11KT 1.27 nmol/L range, 0.03 to 7.61). Overweight women had lower median testosterone (P 0.05), DHEA (P 0.05), and 11KA (P 0.01) levels than normal-weight women. All C19 steroids were significantly lower (P 0.01) in those aged 35 to 39 years than in those aged 18 to 25 years. The median 11KA/androstenedione (4.3:1) and 11KT/testosterone (3.9:1) ratios did not change with age, after adjustment for BMI and cycle stage. We have demonstrated that 11KA and 11KT are stable across the menstrual cycle and make major quantitative contributions to the circulating androgen pool. All C19 androgens declined with age before menopause hence, age-specific reference ranges are required for the interpretation of androgen levels in premenopausal women.
Publisher: The Endocrine Society
Date: 03-2008
DOI: 10.1210/JC.2007-2128
Abstract: It has been proposed that dehydroepiandrosterone and dehydroepiandrosterone sulfate (DHEAS) exert neuroprotective effects in the brain, yet evidence of associations between the endogenous levels of these steroids and measures of cognitive function is lacking. The objective of the study was to investigate whether circulating levels of DHEAS independently contribute to aspects of cognitive function in women in the community. This was a community-based, cross-sectional study. Two hundred ninety-five women, aged 21-77 yr, were recruited from a community-based data set and participated between September 2003 and December 2004. Women were excluded if they reported any health condition that might potentially adversely affect cognitive function. The in idual scores of a comprehensive battery of tests of cognitive function and the serum level of DHEAS (square root transformed) were measured. In the multiple linear regression analysis, the DHEAS term made a significant independent positive contribution to the Controlled Oral Word Association Test score, a measure of executive function. In addition, women with a DHEAS level in the highest tertile who also had more than 12 yr of education performed better on both Digit Span Forward and Digit Span Backward tests, which are tests of simple concentration and working memory, respectively. Higher endogenous DHEAS levels are independently and favorably associated with executive function, concentration, and working memory.
Publisher: Informa UK Limited
Date: 22-05-2012
DOI: 10.3109/13697137.2012.657589
Abstract: The loss of estrogen at menopause and the gradual decline in testosterone with age are associated with urogenital atrophy and, as a result, urogenital tract symptoms, including lower urinary tract symptoms and dyspareunia. These symptoms will persist unless treated. To review the prevalence of urogenital tract symptoms and sexual health problems associated with menopause and the role in the use of hormone therapy for the treatment of symptomatic women, with a specific focus on what has been learned since the first publication of the Women's Health Initiative (WHI) estrogen and estrogen + progestin studies. Studies support the use of local estrogen therapy, but not systemic estrogen therapy, for the treatment of urge urinary incontinence, overactive bladder and to reduce the number of urinary tract infections. The current evidence does not favor a beneficial effect on stress urinary incontinence. Local estrogen therapy is effective for the treatment of dyspareunia caused by vulvovaginal atrophy. Preliminary studies suggest a potential role for both intravaginal dehydroepiandrosterone and testosterone in the treatment of dyspareunia secondary to vulvovaginal atrophy, however, confirmatory studies are required before either therapy can be recommended. Post WHI, there is a need for medical practitioners to proactively raise the topic of urogynecological and sexual health in order to discuss the most suitable treatment option.
Publisher: Wiley
Date: 26-04-2023
DOI: 10.1111/AJO.13683
Abstract: Whereas symptomatic endometriosis may affect work performance, the impact of endometriosis in the general community is not known. The associations between endometriosis and each of sick leave and work ability, were investigated in a large s le of non‐healthcare seeking women. This community‐based, cross‐sectional study recruited 6986 women, aged 18–39 years, from three eastern states of Australia between 11 November 2016 and 21 July 2017. Women were identified as having endometriosis if they had undergone a pelvic ultrasound and reported a diagnosis of endometriosis. Working women completed the Work Ability Index. Participants were predominantly of European ancestry (73.1%) and 46.8% were overweight or had obesity. The prevalence of endometriosis was 5.4% (95%CI 4.9–6.0%) with the highest prevalence of 7.7% (95%CI 6.5 to 9.1%) for women aged 35–39 years. Among the 4618 working women, those with endometriosis had significantly more sick days from work (33.6% reported ≥10 days vs 13.5%, overall χ 2 P 0.001). Endometriosis was associated with a greater likelihood of poor to moderate work ability, after adjusting for age, body mass index, ethnicity, relationship status, student status, insecure housing, being a carer for another person, parity, ever use of assisted reproductive technologies, and depressed mood (odds ratio 1.90, 95%CI 1.40–2.58, P 0.001). This study provides new evidence that the negative impact of endometriosis on work attendance and work ability is not limited to women with prevalent symptoms and severe disease, but appears to encompass women across a broader spectrum of this condition in the community.
Publisher: Bioscientifica
Date: 06-1999
Abstract: It is now apparent that in men and in postmenopausal women, estrogens have important physiological and pathophysiological roles. However, importantly, these actions are at a local level, namely paracrine, autocrine, and even 'intracrine' rather than endocrine in the classical sense. Thus for ex le local estrogen biosynthesis in the bones of men plays a hitherto unsuspected role in the maintenance of bone mineralization and in epiphyseal fusion and in the testes, estrogen is essential for male germ cell development. On the other hand, in postmenopausal women, the mesenchymal cells of the breast are the major source of estrogen responsible for breast cancer development. This realization points to the importance of circulating C19 precursors in the maintenance of adequate estrogen biosynthesis in extragonadal sites and suggests the possibility of new therapies to block estrogen synthesis in a tissue-specific fashion.
Publisher: Informa UK Limited
Date: 02-2021
DOI: 10.1080/13697137.2020.1866530
Abstract: Premature ovarian insufficiency (POI) results in both estrogen and testosterone insufficiency. Whether testosterone therapy may be of benefit for women with POI is uncertain. Presently, the only evidence-based indication for testosterone therapy for women is for the treatment of postmenopausal women with low sexual desire with associated personal distress. Consistent with this, available evidence does not support the prescription of testosterone to prevent cardiometabolic disease, bone loss, sarcopenia, or cognitive decline or to improve well-being and low mood in postmenopausal women. Data pertaining to the treatment of women with POI with testosterone are limited. This article reviews androgen physiology in premenopausal women and the impact of POI on circulating androgen concentrations, summarizes findings from observational studies and clinical trials of testosterone therapy in premenopausal women and women with POI, and concludes with recommendations regarding testosterone use in women with POI.
Publisher: Oxford University Press (OUP)
Date: 04-04-2008
DOI: 10.1093/RHEUMATOLOGY/KEN244
Abstract: Although cartilage loss occurs with advancing age and is a hallmark of OA, the factors that affect cartilage change are not well established. The aim of this study was to explore the determinants of change in patella cartilage volume over 2 yrs among healthy middle-aged women with no clinical knee OA. One hundred and forty-eight women with no clinical knee OA were recruited from a previous population-based cross-sectional study of healthy women aged 40-67 yrs. MRI was performed at baseline and at 2 yrs, to assess patella cartilage and bone volume. Self-reported exercise was assessed by questionnaire. Annual loss of patella cartilage volume was 1.6% (95% CI 1.2, 1.9). Age was positively associated with patella cartilage volume loss after adjustment for confounders (P = 0.05). For every 1 mm(3) increase in patella bone volume at baseline, annual cartilage loss was reduced by 8.05 mm(3) (95% CI 12.91, 3.19 P < 0.001). Fortnightly participation in exercise promoting an increased heart and respiratory rate for at least 20 min also tended to be associated with a reduced rate of patella cartilage volume loss (P = 0.09). Among middle-aged women with no clinical knee OA, advancing age expedites the rate of patella cartilage volume loss, while increased patella bone volume and exercise participation tends to be associated with a reduction in the rate of patella cartilage volume loss. Interventions targeting modifiable factors, such as physical activity, warrant further investigation as they may help to prevent patellofemoral OA.
Publisher: Wiley
Date: 17-10-2021
DOI: 10.1111/AJO.13445
Abstract: Workplace policies regarding women’s reproductive and menopausal health are garnering global attention. The peri‐ and post‐menopause stages may be turbulent times for many women, with some experiencing debilitating symptoms and some none at all. While the symptoms of menopause should be recognised by employers due to their various impacts, the implementation of policies that pertain to all women can alienate older female workers by creating prejudice surrounding work capability. This piece identifies other avenues for the inclusion of menopausal symptoms through pre‐existing policy and highlights the issues facing menopausal women in this current age.
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1016/J.FERTNSTERT.2005.05.058
Abstract: To evaluate the clinical usefulness for the measurement of testosterone (T) values in the "low" female range with a direct radioimmunoassay (RIA) for total T by comparing total T values measured by this assay with values determined by conventional RIA after organic solvent extraction/column chromatography. Cross-sectional study. Victoria, Australia. Two hundred fifty-nine healthy women, aged 18-75 years, recruited from the community. Fasting serum s les were obtained and stored at -80 degrees C. Total T measurement. Total T was measured by the direct RIA method using antibody-coated tubes and iodine-labeled T tracer. For comparison, total T levels were also measured using the conventional RIA method after organic solvent (ethyl acetate:hexane [3:2]) extraction and celite column partition chromatography before RIA. The mean T level by direct RIA was 0.76 nmol/L (median, 0.70 SD, 0.54 minimum, 0.10 maximum, 3.2). The mean difference between the two measurements (direct RIA - conventional RIA) was -0.28 (SD, 0.3). The direct RIA value was 63% (95% confidence interval, 26%-155%) of the conventional RIA estimate. For the classification of values at the lower end of the range, there was very good agreement beyond chance (kappa = 0.68-0.74) for values in approximately the lowest 10th-40th percentiles. The direct RIA is a clinically useful assay for the study of the issue of "low" T within the female population.
Publisher: American Association for Cancer Research (AACR)
Date: 2009
DOI: 10.1158/0008-5472.SABCS-1148
Abstract: Abstract #1148 Background: Women aged under 55 receiving breast cancer treatment frequently experience temporary or permanent menopause as a result. Although defining menopause status in these patients is problematic it fundamentally influences subsequent medical management. No definitive data or consensus exists to guide what surveillance is required in these women, particularly with respect to treatment with aromatase inhibitors (AIs) and/or ovarian suppression and for contraceptive advice.The ENHANCE Group, first convened in Australia in 2006, consists of 19 members, comprising Medical Oncologists, Breast Surgeons, Endocrinologists, Gynaecologists and a Consumer Representative. The aim of the Group is to develop practical advice on the management of QoL and adverse event issues associated with hormonal therapy of breast cancer in areas where high-level evidence is insufficient to inform practice. The Group produces recommendations for healthcare professionals and information leaflets for patients. All recommendations are supported with the maximum evidence available together with broad expert opinion.& #x2028 Methods:A review of the literature identified information regarding the definition of menopause, tests of menopause status and likelihood of menopause following different adjuvant chemotherapy regimens. Data on the likelihood of return of ovarian function was also identified. In addition, the use and benefit of ovarian function suppression and AIs for treatment of different subpopulations of breast cancer patients was reviewed. Using this review and expert opinion provided by members of the Group, an algorithm for determination of menopausal category was developed. Management recommendations, according to menopausal category were then determined.& #x2028 Results:Five distinct menopause categories were identified: Premenopausal, Postmenopausal, Very Low, Low, and Moderate potential for ovarian function recovery. Menopausal status prior to adjuvant chemotherapy, type of adjuvant treatment, age, duration of amenorrhoea, oestradiol and FSH levels and use of tamoxifen determined placement into the categories. The algorithm includes suggested monitoring practice, both clinical and biochemical, for each of the menopause categories and guidance for patients who have had a hysterectomy. The recommendations indicate: (i)contraceptive advice according to age and menopause category (ii)appropriate use of AIs with suggested monitoring practices (iii)monitoring suggestions for patients where ovarian function suppression may be appropriate (iv)advice to be provided to patients to assist in monitoring menopausal status. A separate information sheet was developed to inform patients about menopause monitoring.& #x2028 Conclusions:Ovarian function can return after a considerable period of amenorrhoea in patients undergoing systemic treatment for breast cancer. Return of ovarian function influences endocrine treatment of breast cancer, but it is often difficult to monitor accurately, and an appropriate schedule has not been investigated. Our work provides evidence-based recommendations (including expert opinion) for best practice in this area. Citation Information: Cancer Res 2009 (2 Suppl):Abstract nr 1148.
Publisher: Oxford University Press (OUP)
Date: 05-2008
DOI: 10.1111/J.1743-6109.2008.00780.X
Abstract: Satisfaction with sexual function in community-based women has not been well-described, and little is known of differences in sexual function between pre-(PreM) and postmenopausal (PM) women. The aim of this article was to describe sexual function in PreM and PM women who self-identify as being satisfied or dissatisfied with their sexual life. A cross-sectional questionnaire study was conducted among 349 sexually active community-based women, aged 20-65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Scores from a daily diary of sexual function for 4 weeks, examining the frequency of sexual thoughts, interest, and activity. One hundred and eighty-four women (53%) were PreM, and 165 (47%) were dissatisfied with their sexual life. The median number of days with sexual activity or events per month for all women was 8 (ranges 2-28 days 2-57 events). Ninety-two percent of reported events involved a partner, 86% involved intercourse, and in 40% the woman initiated the activity. Women satisfied with their sexual life had higher frequencies of sexual thoughts, interest, events, and initiation of activity than dissatisfied women (P < 0.0001). PreM satisfied women had higher frequencies of sexual thoughts, numbers of days with sexual activity, and events per month than PM satisfied women (P < 0.05). PreM oral contraceptive pill (OCP) users had significantly lower average frequencies of sexual thoughts, interest, and days of sexual activity per month (P < 0.05), whereas PM women hormone therapy (HT) users had higher frequencies of sexual thoughts and sexual interest (P = 0.04 and P = 0.05, respectively) compared to nonusers. There were no differences in sexual function between PreM and PM women who were sexually dissatisfied. Sexual activity mostly involved a partner, partner initiation, and intercourse. Sexually satisfied women reported more sexual thoughts, interest, events, and initiation of sexual activity than dissatisfied women. PreM sexually satisfied women reported more sexual thoughts, days with sexual activity, and sexual events per month compared to PM satisfied women. OCP and HT use appeared to have contrasting effects on sexual function.
Publisher: The Endocrine Society
Date: 10-2014
DOI: 10.1210/JC.2014-2260
Abstract: To update practice guidelines for the therapeutic use of androgens in women. A Task Force appointed by the Endocrine Society, American Congress of Obestricians and Gynecologists (ACOG), American Society for Reproductive Medicine (ASRM), European Society of Endocrinology (ESE), and International Menopause Society (IMS) consisting of six experts, a methodologist, and a medical writer. The Task Force commissioned two systematic reviews of published data and considered several other existing meta-analyses and trials. The GRADE methodology was used the strength of a recommendation is indicated by a number "1" (strong recommendation, we recommend) or "2" (weak recommendation, we suggest). Multiple e-mail communications and conference calls determined consensus. Committees of the Endocrine Society, ASRM, ACOG, ESE, and IMS reviewed and commented on the drafts of the guidelines. We continue to recommend against making a diagnosis of androgen deficiency syndrome in healthy women because there is a lack of a well-defined syndrome, and data correlating androgen levels with specific signs or symptoms are unavailable. We recommend against the general use of T for the following indications: infertility sexual dysfunction other than hypoactive sexual desire disorder cognitive, cardiovascular, metabolic, or bone health or general well-being. We recommend against the routine use of dehydroepiandrosterone due to limited data concerning its effectiveness and safety in normal women or those with adrenal insufficiency. We recommend against the routine prescription of T or dehydroepiandrosterone for the treatment of women with low androgen levels due to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration, or other conditions associated with low androgen levels because there are limited data supporting improvement in signs and symptoms with therapy and no long-term studies of risk. Evidence supports the short-term efficacy and safety of high physiological doses of T treatment of postmenopausal women with sexual dysfunction due to hypoactive sexual desire disorder. Importantly, endogenous T levels did not predict response to therapy. At present, physiological T preparations for use in women are not available in many countries including the United States, and long-term safety data are lacking. We recommend that any woman receiving T therapy be monitored for signs and symptoms of androgen excess. We outline areas for future research. Ongoing improvement in androgen assays will allow a redefinition of normal ranges across the lifespan this may help to clarify the impact of varying concentrations of plasma androgens on the biology, physiology, and psychology in women and lead to indications for therapeutic interventions.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.2165/00003495-200868150-00001
Abstract: Hypopituitarism is a rare disorder, but its prevalence has increased as a result of an increase in secondary causes of hypopituitarism such as traumatic brain injury and cranial irradiation. Estrogen with or without progestogen (progestin) treatment is conventional therapy in women with hypopituitarism. Recent data demonstrate that women with hypopituitarism may experience marked androgen deficiency as a consequence of secondary loss of function of the adrenal cortex and/or ovaries. This deficiency is not always considered and therefore androgen therapy is not routinely prescribed. Recent clinical trials indicate that testosterone supplementation in physiological doses for androgen-deficient women with hypopituitarism may improve psychological well-being and sexual function, and increase bone mineral density and lean body mass. Dehydroepiandrosterone (DHEA prasterone) supplementation may be an option for women with hypopituitarism who have secondary adrenal insufficiency and low levels of DHEA and DHEA sulfate. While short-term treatment with testosterone or DHEA appears to be safe, long-term safety data are lacking. Androgenic adverse effects limit the acceptability of treatment for some women. Further studies to establish the efficacy and safety of androgen treatment for long-term intervention in a larger group of hypopituitary androgen-deficient women are needed.
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.MATURITAS.2004.07.008
Abstract: To compare the efficacy and patient acceptability of intranasal and transdermal 17beta-oestradiol delivery systems for postmenopausal symptoms in Australasian women. Symptomatic postmenopausal women were randomly assigned to treatment with either intranasal 17beta-oestradiol, 300 microg daily (n = 66) or transdermal matrix patch 17beta-oestradiol, 50 microg/day (n = 66) for 12 weeks, followed by a 4-week period with the alternate treatment. Efficacy was compared between groups using the modified Greene climacteric scale, the menopause quality of life (MENQOL) questionnaire and vasomotor symptoms at week 12. Patient acceptability was compared by a satisfaction questionnaire at week 16 and patient preference at week 16. Intranasal and transdermal therapy produced significant reductions in both the Modified Greene and MENQOL scores, and in the occurrence of hot flushes and night sweats at week 12. The overall rate of reported vasomotor symptoms was lower on patients treated with the nasal spray. Both therapies were well tolerated with similar adverse event rates. Satisfaction and preference were similar for both modes of drug delivery. Intranasal oestradiol therapy route has comparable efficacy and safety to that of transdermal oestradiol matrix patch therapy with no difference in patient preference or satisfaction.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.MATURITAS.2011.06.005
Abstract: Vaginal atrophy is a common symptom of postmenopausal estrogen deficiency and can present as dryness, irritation, infection and dyspareunia and can affect sexual function and quality of life. Currently vaginal atrophy is treated with the intravaginal application of preparations containing estradiol or estriol, which are both effective and safe. It has been proposed that intravaginally administered dehydroepiandrosterone (DHEA) can be used to treat vaginal atrophy. DHEA and its sulphate DHEAS are the most abundant circulating sex steroid hormones in women, and provide a large precursor reservoir for the intracellular production of androgens and estrogens in non-reproductive tissues. Levels of DHEA and DHEAS decline with age. Although there is some evidence to support the use of intravaginal DHEA for postmenopausal women with symptoms of vaginal atrophy, independent studies are required to confirm this. In addition studies regarding the effects of vaginal DHEA on sexual function in women without vaginal atrophy are needed. Given that the efficacy and long term safety of low dose vaginal estradiol and estriol therapy is well established and that vaginal estrogen requires application of 2-3 times a week, rather than daily dosing the benefit of daily vaginal DHEA over estrogen also needs to be considered as women may find it unpalatable to adhere to daily dosing with a cream preparation.
Publisher: Elsevier BV
Date: 06-2002
Abstract: The concept of an androgen deficiency syndrome in women is a relatively old one, although it has gained substantially increased attention in recent years. Androgens are quantitatively the predominant sex steroid in women, circulating in the micro- and nanomolar concentration range, compared with picomolar levels of oestrogen. The most significant biologically active androgen is testosterone, which circulates bound tightly to sex hormone-binding globulin (SHBG) and loosely to albumin. It is generally held that the non-SHBG bound fraction is the bioavailable moiety. Hence interpretable testosterone measurements require data on total concentrations as well as the SHBG level. Testosterone deficiency occurs in a number of situations such as hypopituitarism, primary ovarian and adrenal failure, exogenous corticosteroid use and oral oestrogen therapy (due to the elevation of SHBG and suppression of gonadotrophins). Clinical symptoms of androgen deficiency include lethargy, tiredness and loss of sex drive and interest, and have responded well to androgen replacement, generally without significant side-effects.
Publisher: Oxford University Press (OUP)
Date: 27-09-2006
DOI: 10.1093/RHEUMATOLOGY/KEI108
Abstract: Cartilage defects are present in subjects with knee osteoarthritis (OA). Although they are often present in healthy subjects, there is little data on the natural history of cartilage defects. The aim of this study was to examine the change in cartilage defects over 2 yr and to identify factors associated with this change. One hundred and twenty-four healthy subjects underwent magnetic resonance imaging of their dominant knee at baseline and follow-up. Cartilage defects were scored (0-4) at five sites. Bone size was determined at medial and lateral tibial plateau and patella. Height, weight, body mass index and physical activity were measured by standard protocols. Eighty-six subjects completed the study. The mean cartilage defect score of each tibiofemoral compartment increased over time. However, medial and lateral tibiofemoral defect score decreased in 5% of the subjects. Cartilage defects were more likely to progress in males than females in each in idual compartment (P<0.001 for medial tibiofemoral, P=0.005 for lateral tibiofemoral and P=0.01 for patellar cartilage). Baseline cartilage defect score was negatively associated with the progression of cartilage defects in each compartment (all P<0.001). Although knee cartilage defects progressed over time in the majority of normal subjects, those of the highest severity tended to regress. Male gender and baseline cartilage defect score were the main factors associated with the progression of cartilage defects. Larger studies will be required to identify factors associated with the progression and regression of lesions.
Publisher: SAGE Publications
Date: 06-2004
DOI: 10.1258/136218004774202373
Abstract: There is now substantial evidence from randomised controlled trials that testosterone therapy will improve sexual satisfaction and mood in surgically menopausal women treated with concurrent oestrogen, with less data in naturally menopausal women and premenopausal women. However, long-term safety data for combined-oestrogen testosterone therapy are lacking, and the effects of testosterone-only therapy in postmenopausal women are unknown. Although there appears to be considerable potential for testosterone to improve the quality of life for selected women, inappropriate and/or excessive use of testosterone carries the risk of masculinisation and possibly more serious side effects. All women treated with testosterone need to be carefully monitored both biochemically and clinically and should have long term follow up for adverse sequelae.
Publisher: AMPCo
Date: 08-2015
DOI: 10.5694/MJA14.01723
Abstract: To document the prevalence of, and factors associated with, the use of complementary and alternative medicines (CAMs) for vasomotor symptoms (VMS) and other symptoms of menopause in Australian women aged 40-65 years. Cross-sectional questionnaire-based study of Australian women aged 40-65 years living independently in the community. Women able to complete a questionnaire in English were recruited by telephone between October 2013 and March 2014 from a large, representative, national, continually refreshed database derived from the electoral roll. Use of CAMs for VMS and other menopausal symptoms (eg, arthralgia, depression and sleep disturbance), assessed using the Menopause-Specific Quality of Life questionnaire. Of 5850 women contacted, 2911 agreed to participate, and 2020 eligible women returned completed questionnaires (response rate, 34.53%). Most of the women were postmenopausal (54.90%), resided in metropolitan areas (62.70%) and were born in Australia (80.43%). The prevalence of use of CAMs for VMS was 13.22%. Phytoestrogens were most commonly used for VMS (6.29%), followed by evening primrose oil (3.91%) and ginseng (1.73%). Compared with premenopausal women, perimenopausal women (odds ratio [OR], 2.09 95% CI, 1.42-3.06) and early postmenopausal women (OR, 1.83, 95% CI, 1.21-2.76) were more likely to use any CAM for VMS. The prevalence of use of CAMs for other symptoms was 32.23% being postmenopausal and older were the factors associated with this use. Australian women at midlife are using CAMs that are known to be ineffective for managing VMS. Health care providers need to be more involved in guiding women in the treatment of VMS and other menopausal symptoms. More judicious use of supplements such as fish oil and glucosamine, particularly by older women, is needed until their efficacy and safety profiles are better understood.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.MATURITAS.2013.11.007
Abstract: There is a high incidence of depression in women presenting to menopause clinics. The aim of this review was to determine if there is an association between depressive symptoms or major depressive disorder (MDD) and vasomotor symptoms (VMS). A systematic review of the literature was conducted according to PRISMA guidelines. 33 relevant publications were found, 12 from three large studies. Overall, we found that there is a bidirectional association between VMS and depressive symptoms. This has been established in well-conducted, large observational studies. There does not appear to be a relationship between VMS and MDD. However, studies examining VMS and MDD were prone to bias making it difficult to draw any conclusions.
Publisher: American Medical Association (AMA)
Date: 02-11-2005
Publisher: Informa UK Limited
Date: 11-11-2023
DOI: 10.1080/13697137.2022.2139600
Abstract: This review was conducted to explore the association between endogenous testosterone blood concentrations and cognitive performance among community dwelling postmenopausal women. We searched Ovid MEDLINE, EMBASE, PsycINFO and Web of Science databases for observational studies with at least 100 postmenopausal participants. The results were categorized by study design, reporting of total or free testosterone and risk of bias assessments, narratively. Ten of the 26 articles retrieved for full-text review met the inclusion criteria, six provided cross-sectional data, seven provided longitudinal data and one provided case-control data. Cognitive performance tests differed between studies. Eight studies measured testosterone by immunoassay, one by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and one did not specify their methodology. Eleven different cognitive domains were tested by 37 different instruments. Irrespective of the study design, the findings were inconsistent and inconclusive. Both positive and inverse associations were reported for each of global cognition and immediate and delayed verbal recall. The majority of studies reported no association between total or free testosterone and cognitive performance. Although this review did not demonstrate an association between testosterone and cognitive performance in postmenopausal women, the findings should be considered inconclusive due to the imprecision of testosterone measurement and the methodological heterogeneity of the included studies.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
DOI: 10.1097/GME.0B013E318174F16E
Abstract: Oral estrogen therapy suppresses insulin like growth factor I (IGF-I) levels, whereas conventional dose transdermal estradiol (E2) does not. However, it has been proposed that if sufficiently high serum E2 levels are achieved, nonoral E2 will also suppress serum IGF-I. The aim of the study was to investigate the effects of intranasal E2 with norethisterone (E2/NET) versus oral E2/NET acetate on IGF-I, IGF binding protein 3, and insulin resistance in postmenopausal women. This was a randomized, multicenter, double-blind, double-dummy trial. Postmenopausal women were randomized to receive either daily intranasal E2/NET (175 microg/275 microg) as a spray and a placebo tablet (n = 41) or oral E2/NET acetate (1 mg/0.5 mg) plus placebo intranasal spray (n = 41) for 1 year. Fasting plasma concentrations of IGF-I, IGF binding protein 3, glucose and insulin, glucose and insulin at 120 minutes post-glucose challenge, and the homeostasis model assessment for insulin resistance were assessed at baseline and after 52 weeks of treatment. The two groups were well matched for all clinical and biochemical parameters at baseline. There were no significant between-group differences for fasting and 120-minute glucose, insulin, homeostasis model assessment for insulin resistance, and IGF binding protein 3. The mean IGF-I level at week 52 was significantly lower for women treated with oral versus intranasal therapy (116 +/- 21 [SD] versus 134 +/- 33 [SD], P = 0.005) and the mean difference in change over 52 weeks in IGF-I was significantly different between groups (-19, 95% CI:-37 to -1, P = 0.04). In healthy postmenopausal women, intranasal E2 at a dose that results in serum levels that exceed the proposed threshold for growth hormone and IGF-I effects, does not alter IGF-I levels. This suggests that the effect of exogenous estrogen on IGF-I is a function of the method of administration rather than being dose related.
Publisher: BMJ
Date: 08-02-2012
DOI: 10.1136/BMJ.D7664
Publisher: American College of Physicians
Date: 15-01-2013
Publisher: Oxford University Press (OUP)
Date: 08-04-2021
Abstract: Does the application of reference ranges for sex steroids and the modified Ferriman-Gallwey (mFG) scale established in the community from which the study s le was drawn, combined with the most conservative polycystic ovary morphology (PCOM) criteria to the recognised diagnostic criteria for polycystic ovary syndrome (PCOS) improve the certainty of diagnosis of PCOS in non-healthcare-seeking women? Despite application of the stringent definitions of the elements used to diagnose PCOS in a non-healthcare seeking community-based s le, the risk of diagnostic uncertainty remains. There is heterogeneity in prevalence estimates for PCOS due, in part, to lack of standardisation of the elements comprising the recognised National Institutes of Health (NIH), Rotterdam and Androgen Excess Society (AE-PCOS) diagnostic criteria. The AE-PCOS Society proposed refinements to the definitions of biochemical androgen excess and PCOM that can now be incorporated into these sets of diagnostic criteria to estimate PCOS prevalence. An Australian cross-sectional study of 168 non-healthcare-seeking women. The 168 included women were aged 18–39 years, euthyroid and normoprolactinemic, not recently pregnant, breast feeding or using systemic hormones. Each provided menstrual history and assessment of the mFG, had measurement of sex steroids by liquid chromatography, tandem mass spectrometry, and a pelvic ultrasound. The presence of PCOS was determined using modified (m) NIH, Rotterdam, and AE-PCOS criteria according to AE-PCOS Society recommendations. Overall, 10.1% of the included participants met the mNIH PCOS criteria, which requires the presence of menstrual dysfunction, while 18.5% met the mRotterdam and 17.5% the AE-PCOS criteria, with the latter requiring hyperandrogenism. Eight of the 27 participants with menstrual dysfunction, 10 of 31 women with PCOM, and 39 of 68 women with hyperandrogenism had no other feature of PCOS. Of the 19 participants with hyperandrogenaemia, 10 met the mNIH criteria (52.5%) and 14 met both the mRotterdam and AE-PCOS criteria (78.9%). Women who had the combination of hyperandrogenism and PCOM explained the greatest discrepancy between the mNIH and the other criteria. Clinical androgenisation relied on participant self-assessment, which has been shown to be valid when compared with clinician assessment. The s le size was a function of both the strict inclusion criteria and the requirements of non-healthcare-seeking women having a blood draw and pelvic ultrasound which may have introduced a selection bias. Despite applying stringent cut-offs for serum androgens, the mFG scale and the ovarian follicle count, these criteria remain arbitrary. Accordingly, healthy women may be captured by these criteria, and misidentified as having PCOS, while women with the condition may be missed. Consequently, PCOS remains a diagnosis to be made with care. The study was supported by the Grollo-Ruzzene Foundation. Dr S.R.D. is an NHMRC Senior Principal Research Fellow (Grant no. 1135843). S.R.D. has been paid for developing and delivering educational presentations for Besins Healthcare, BioFemme and Pfizer Australia, has been on Advisory Boards for Theramex, Abbott Laboratories, Mayne Pharmaceuticals and Roche and a consultant to Lawley Pharmaceuticals and Que Oncology and has received has received institutional grant funding for Que Oncology research there are no other relationships or activities that could appear to have influenced the submitted work. N/A
Publisher: Wiley
Date: 28-06-2005
DOI: 10.1002/ART.21148
Abstract: The significance of asymptomatic knee cartilage defects in healthy in iduals is not known. The aim of this study was to examine the association between cartilage defects in the knee and cartilage volume both cross-sectionally and longitudinally in healthy, middle-age adults. Eighty-six healthy men and women (mean +/- SD age 53.8 +/- 8.8 years) underwent T1-weighted fat-suppressed magnetic resonance imaging of their dominant knees at baseline and at the 2-year followup visit. Knee cartilage volume was measured. Cartilage defects were scored according to a grading system (0-4) and as present (a defect score of > or = 2) or absent in the medial and lateral tibiofemoral compartments. Cartilage defects in the medial and lateral tibiofemoral compartments were very common (in 61% and 43% of subjects, respectively). Those with cartilage defects had a 25% reduction in medial tibial cartilage volume, a 15% reduction in lateral tibial cartilage volume, and a 19% reduction in total femoral cartilage volume relative to those with no cartilage defects in cross-sectional analyses (all P < 0.05). In the medial tibiofemoral compartment, the annual loss of tibial cartilage in those with cartilage defects was 2.5% (95% confidence interval [95% CI] 2.2%, 3.1%) compared with an annual loss of tibial cartilage of 1.3% (95% CI 0.5%, 2.0%) in those with no defects (P = 0.028), independent of other known risk factors for osteoarthritis (OA). These data suggest that the presence of asymptomatic, non-full-thickness medial tibiofemoral cartilage defects identifies healthy in iduals most likely to lose knee cartilage in the absence of radiographic knee OA. Thus, interventions aimed at reducing or reversing cartilage defects may reduce the risk of subsequent knee OA.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Elsevier BV
Date: 07-2005
Publisher: Oxford University Press (OUP)
Date: 16-12-2013
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.BREAST.2013.05.013
Abstract: This study examined pregnancy-associated breast cancer (PABC) and pregnancy following treatment for breast cancer. We analysed data from a questionnaire-based, prospective study of women diagnosed with breast cancer. Timing of diagnosis in relation to pregnancy was self-reported in the enrolment questionnaire. Women reported subsequent pregnancies in annual follow-up questionnaires, up to at least 5 years from diagnosis. Women with PABC made up 3.3% of women <48 years at diagnosis and 14.3% of women aged <35 years at diagnosis. Nine of 46 (19.6%) women who were aged <40 years at diagnosis, and had either no children, or only one child, became pregnant subsequent to their diagnosis, and 8 experienced a live birth. As the number of women with PABC was small, conclusions from this study are limited. However, young women should be alert to PABC, especially in the post-partum period. Some women, with incomplete families at diagnosis, are choosing to have one or more pregnancies following treatment.
Publisher: Springer Science and Business Media LLC
Date: 09-04-2011
DOI: 10.1007/S00520-011-1150-8
Abstract: Smoking and alcohol consumption after breast cancer diagnosis have received little attention. The aim of this study was to describe the change in smoking and alcohol consumption of women in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study in the first 2 years after diagnosis. We documented cigarette and alcohol use at diagnosis in a prospective cohort study of 1,588 Australian women with invasive breast cancer in an enrolment questionnaire and again 2 years later (follow-up questionnaire, FQ1). Twelve percent of participants smoked at diagnosis. Nearly one third of these had quit by FQ1 and of those continuing, 1 in 4 were smoking fewer cigarettes per day. Smoking more at diagnosis was significantly associated with smoking at FQ1.Over 70% of women reported consuming alcohol in each questionnaire. The proportion of women consuming more than four alcoholic drinks per occasion at least weekly dropped between the time of diagnosis and FQ1, although by FQ1, 1 in 12 women still reported this drinking pattern. Smoking and alcohol consumption are important health issues for women with breast cancer. Health care providers should consider using evidence-based interventions to reduce smoking and drinking in this group.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
Publisher: Springer Science and Business Media LLC
Date: 23-08-2013
DOI: 10.1007/S11764-013-0306-6
Abstract: The aim of our study was to establish the prevalence of breast pain persisting 5 years after the initial treatment of breast cancer (BC) and the relationship between those persistent symptoms and general well-being. The study involved women from Victoria, Australia, who had survived at least 5 years from diagnosis, remained free from recurrence or new BC and completed the fifth annual follow-up questionnaire. Analysis involved both multivariable logistic and linear regression. Of 1,205 women, 45 % reported breast pain which persisted for at least 3 months following initial treatment, and of these, 80 % reported pain persisting for at least 5 years. The factor contributing most to the likelihood of persistent breast pain was current lymphedema however, a full multivariable model explained <10 % of the likelihood of breast pain persisting for 5 years. The presence of breast pain at 5 years was associated with only a modest reduction in general well-being. Breast pain persisting for at least 5 years after treatment for BC is common. As the pain is largely unexplained by factors associated with the characteristics of the cancer or its treatment, the contribution of patient expectations to persistent breast pain may be considerable. Where persistent pain occurs, referral for the management of pain and, where appropriate, lymphedema is warranted.
Publisher: American Medical Association (AMA)
Date: 06-07-2005
Abstract: It has been proposed that low sexual desire and sexual dysfunction are associated with low blood testosterone levels in women. However, evidence to support this is lacking. To determine whether women with low self-reported sexual desire and sexual satisfaction are more likely to have low serum androgen levels than women without self-reported low sexual desire and sexual satisfaction. A community-based, cross-sectional study of 1423 women aged 18 to 75 years, who were randomly recruited via the electoral roll in Victoria, Australia, from April 2002 to August 2003. Women were excluded from the analysis if they took psychiatric medication, had abnormal thyroid function, documented polycystic ovarian syndrome, or were younger than 45 years and using oral contraception. Domain scores of the Profile of Female Sexual Function (PFSF) and serum levels of total and free testosterone, androstenedione, and dehydroepiandrosterone sulfate. A total of 1021 in iduals were included in the final analysis. No clinically significant relationships between having a low score for any PFSF domain and having a low serum total or free testosterone or androstenedione level was demonstrated. A low domain score for sexual responsiveness for women aged 45 years or older was associated with higher odds of having a serum dehydroepiandrosterone sulfate level below the 10th percentile for this age group (odds ratio [OR], 3.90 95% confidence interval [CI], 1.54-9.81 P = .004). For women aged 18 to 44 years, having a low domain score for sexual desire (OR, 3.86 95% CI, 1.27-11.67 P = .02), sexual arousal (OR, 6.39 95% CI, 2.30-17.73 P<.001), and sexual responsiveness (OR, 6.59 95% CI, 2.37-18.34 P<.001) was associated with having a dehydroepiandrosterone sulfate level below the 10th percentile. No single androgen level is predictive of low female sexual function, and the majority of women with low dehydroepiandrosterone sulfate levels did not have low sexual function.
Publisher: Informa UK Limited
Date: 11-2007
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.MATURITAS.2018.04.007
Abstract: While low back pain significantly impacts on an in idual's well-being, our understanding of the role of well-being in the natural history of low back pain is limited. This cohort study aimed to investigate the association between psychological and general well-being and the development and progression of low back pain and disability in community-based women over a 2-year period. 506 women recruited from a research database were invited to participate. Overall psychological and general well-being and its subdomains were assessed at baseline using the Psychological General Well-Being Index (PGWB). The intensity of and degree of disability arising from low back pain were examined using the Chronic Pain Grade Questionnaire at baseline and at 2-year follow-up. Participants were categorized as having no, developing, resolving, or persistent high-intensity pain and disability. 444 participants (87.8%) completed the study. Women with persistent high-intensity pain had lower PGWB scores at baseline than those with no high-intensity pain at follow-up, after adjusting for confounders (M(SE) = 69.9(2.55) vs 80.1(2.63), p < 0.005). Furthermore, women with persistent high disability scores had lower well-being scores than those without persistent high disability scores (M(SE) = 69.1(3.49) vs. 81.2(0.802), p = 0.001). Moreover, lower scores in the well-being subdomains of general health and vitality were associated with persistent high pain intensity and disability (all p < 0.007). In summary, lower levels of general health and vitality were associated with persistent high-intensity low back pain and disability, suggesting that improving these aspects of well-being has the potential to reduce high levels of chronic low back pain and disability in community-based women.
Publisher: Oxford University Press (OUP)
Date: 03-2016
DOI: 10.1016/J.JSXM.2015.12.014
Abstract: In recent years, multiple hormones have been investigated in relation to female sexual function. Because consumers can easily purchase products claiming to contain these hormones, a clear statement regarding the current state of knowledge is required. To review the contribution of hormones, other than estrogens and androgens, to female sexual functioning and the evidence that specific endocrinopathies in women are associated with female sexual dysfunction (FSD) and to update the previously published International Society of Sexual Medicine Consensus on this topic. The literature was searched using several online databases with an emphasis on studies examining the physiologic role of oxytocin, prolactin, and progesterone in female sexual function and any potential therapeutic effect of these hormones. The association between common endocrine disorders, such as polycystic ovary syndrome, pituitary disorders, and obesity, and FSD also was examined. Quality of data published in the literature and recommendations were based on the Grading of Recommendations Assessment, Development and Education system. There is no evidence to support the use of oxytocin or progesterone for FSD. Treating hyperprolactinemia might lessen FSD. Polycystic ovary syndrome, obesity, and metabolic syndrome could be associated with FSD, but data are limited. There is a strong association between diabetes mellitus and FSD. Further research is required in particular, high-quality, large-scale studies of women with common endocrinopathies are needed to determine the impact of these prevalent disorders on female sexual function.
Publisher: Informa UK Limited
Date: 10-12-2012
DOI: 10.3109/13697137.2012.746656
Abstract: The profound estrogen depletion caused by aromatase inhibitors (AIs) is associated with musculoskeletal symptoms, but the underlying pathophysiology remains unclear. To assess the effects of AI therapy on structural changes in knee cartilage and subchondral bone over 2 years in postmenopausal women. Setting and participants Thirty women with breast cancer, mean age 58.5 (standard deviation ± 5.6) years and 62 healthy controls, mean age 56.5 (standard deviation ± 4.6) years. Annualized changes in tibial cartilage volume and subchondral bone area, and worsening of tibiofemoral cartilage defects from paired knee magnetic resonance imaging 2 years apart were compared between the two groups. The AI-treated women had significantly greater expansion of the tibial plateau than the control group. The mean annualized differences, after adjusting for age, body mass index and baseline bone area, were 22.1 mm(2) (95% confidence interval (CI) 7.6-36.6, p = 0.003) for the medial tibial plateau and 19.1 mm(2) (95% CI 9.6-28.5, p < 0.001) for the lateral tibial plateau. The annual change in tibial cartilage volume and the worsening of cartilage defects did not differ between women taking AI therapy and controls. AI therapy is associated with knee subchondral bone expansion knee with no effect on knee cartilage in postmenopausal women without pre-existing joint symptoms. This suggests the effect of severe estrogen depletion on knee is on bone, with the tibial bone expansion most likely a response to mechanical load in the setting of bone loss. Whether this then results in an increased risk of knee osteoarthritis will need to be determined.
Publisher: Springer Science and Business Media LLC
Date: 09-03-2010
DOI: 10.1007/S12672-010-0011-0
Abstract: Exposure to postmenopausal hormone therapy (HT) may affect the stage, histological type, and hormone receptor (HR) status of invasive breast cancer at the time of diagnosis. One thousand six hundred eighty-four women with newly diagnosed first invasive breast cancer were recruited to the "MBF Foundation Health and Wellbeing after Breast Cancer Study." Women using systemic HT estrogen (E) or E combined with progesterone (P) at the time of diagnosis of breast cancer were compared with those not using HT. Breast cancer tumor data were obtained from the Victorian Cancer Registry. Regression analysis was used to determine the associations between HT use or not at the time of diagnosis and tumor histology (ductal vs lobular), stage (I vs II, III, IV), HR status (ER+ or PR+ or both vs ER- or PR-). Of 1,377 women included in the analysis, 226 (16%) were using HT at the time of diagnosis. Of HT users, 20.4% had lobular breast cancer, 50% were stage I, and 85.8% had HR-positive tumors. Of non-users, 13.6% had lobular breast cancer, 48.2% were stage I, and 82.4% had HR-positive tumors. Use of systemic HT was associated with increased odds of having lobular compared with ductal breast cancer (OR = 1.75, 95% CI = 1.14-2.69, p = 0.01). There were no associations between HT use and either breast cancer stage or HR status. Women using systemic HT at the time of diagnosis were more likely to have lobular rather than ductal breast cancer compared with women not on HT.
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.JSAMS.2006.03.011
Abstract: Isolating the particular joints/limb segments associated with knee adductor moment variability may provide clinically important data that could help to identify strategies to reduce medial tibiofemoral joint load. The aim of this study was to examine whether or not foot and thigh rotation during human locomotion are significant determinants of knee adductor moment variability. Three-dimensional gait analyses were performed on 32 healthy adult women (mean age 54+/-12 years, mean BMI 25+/-4 kg m(-2)) with radiologically normal knees. The relationships between foot rotation, thigh rotation and the external knee adduction moment were examined during early and late-stance phases of the gait cycle. The degree of foot rotation correlated significantly with the magnitude of the peak knee adduction moment during late stance (r=0.40, p=0.024). No significant associations were apparent between thigh rotation and the peak knee adduction moment. The association between foot rotation and the knee adduction moment in this study suggests that women who walk with external rotation at the foot reduce their knee adduction moment during late stance. This result implies that changes in foot kinematics can modify the medial tibiofemoral load during gait, which may be important in the prevention and management of knee osteoarthritis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2006
DOI: 10.1097/01.GME.0000227400.60816.52
Abstract: Oral estrogen increases the levels of C-reactive protein (CRP), which is an independent risk factor for coronary heart disease in healthy in iduals. The aim of our study was to investigate the effects of intranasal 17beta-estradiol (E2) on serum CRP and its most potent stimulant, interleukin-6 in healthy postmenopausal women. Thirty-six healthy postmenopausal women (45-54 y) were enrolled. According to their in idual preferences, they were assigned to intranasal (n = 10), transdermal (n = 14), or oral (n = 12) continuous E2 treatment with a sequential progestin (10-14 d in a 28-d cycle). Blood s les were drawn at baseline and after 3, 6, and 12 months during the estrogen-only phase to adjust for the progestin effect. In women taking intranasal or transdermal E2, there were no significant changes in median serum CRP levels during the 12-month treatment period. In women taking oral E2 preparations, serum median CRP levels were significantly higher compared to baseline after 6 and 12 months of the therapy (P < 0.05). Conversely, serum median bioactive interleukin-6 levels were significantly lower after 6 and 12 months in women taking E2 intranasally or orally and after 12 months in women taking E2 transdermally (P < 0.05). The results of our study show that intranasal, similarly to transdermal, E2 administration does not increase serum CRP levels in postmenopausal women. They also support the hypothesis that CRP increase during oral estrogen treatment is not mediated by the enhancement of interleukin-6 production by the immune cells but is rather caused by the hepatic first-pass metabolism effect.
Publisher: Bioscientifica
Date: 05-2005
DOI: 10.1677/JOE.1.05847
Abstract: The climacteric is not a condition of the modern age, although with increased life expectancy over the centuries, more women will experience this physiological transition. As women are living longer there is a greater expectation that good health will be maintained through to the late decade. Thus the potential long-term adverse health consequences of using hormonal therapies (HTs) to alleviate menopausal symptoms are of considerable concern for women and medical practitioners. This concern is often the basis for a decision whether or not to use HT. We have reviewed the history of knowledge of the menopause and the development of HT for the treatment of climacteric complaints. We have also summarised the current evidence for specific benefits and risks of HT. Data indicate that postmenopausal HT is appropriate for the management of vasomotor symptoms, but that HT should not be prescribed for the prevention of cardiovascular disease or dementia. HT does prevent bone loss and osteoporotic fracture however, use for this purpose remains controversial. The risk of breast cancer with HT varies according to the preparation used, such that oestrogen without concurrent progestin appears to convey little, or possibly even no significant breast cancer risk. There is insufficient information regarding the long-term use of non-oral HT, low-dose HT or novel compounds such as tibolone or the selective oestrogen receptor modulators with respect to breast cancer and cardiovascular risk for specific recommendations to be made.
Publisher: The Endocrine Society
Date: 11-03-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2014
Publisher: Elsevier BV
Date: 07-2005
DOI: 10.1016/J.MATURITAS.2004.08.013
Abstract: Changes in the hormonal milieu at the menopause are associated with an increase in total adiposity and a more android pattern of fat distribution, with the latter associated with an increased risk of the metabolic syndrome. The aim of this study was to explore potential mechanisms that might contribute to the changes in body composition associated with the menopause transition. Using real-time PCR analysis, we have compared the expression of various factors involved in fat metabolism in subcutaneous abdominal and gluteal fat in premenopausal (Group 1 n=11), postmenopausal (Group 2 n=10) and postmenopausal women taking estrogen therapy (Group 3 n=10). All subjects were of normal body mass index, euglycemic and normolipemic. The postmenopausal women were older (Group 1, 43.1+5.0 versus Groups 2 and 3, 57.9+/-7.4 years, P<0.001 and 56.1+/-4.5 years, P<0.001, respectively). Expression analysis revealed that levels of transcripts encoding adiponectin, peroxisome proliferator-activated receptor gamma and fatty acid transporter, each associated with insulin sensitivity, were significantly greater in gluteal fat from estrogen deplete postmenopausal women than in fat from the other two groups (P<0.05). In contrast, levels of transcripts for acetyl CoA carboxylase alpha, long chain acyl CoA dehydrogenase and hormone sensitive lipase were significantly greater in abdominal fat from premenopausal women than either postmenopausal groups (P<0.05). These findings indicate both aging and the menopause transition are associated with changes in fat metabolism, which may contribute to the accumulation of body fat after menopause.
Publisher: Wiley
Date: 29-02-2016
DOI: 10.1111/AJO.12453
Abstract: A clinical practice audit was undertaken to share an Australian experience of the use of micronised progesterone (mP) 100 mg daily as part of menopausal hormone therapy (MHT). Ninety-nine women attending a single practitioner were offered the option of mP as a component of MHT, under the Australian Authorised Prescriber Scheme, over 2.5 years. Each of their files was independently audited. The mean age at commencement was 55.0 (SD 6.6) years. Of the 93 postmenopausal women, 7 were lost to follow-up, 18 discontinued and treatment was ongoing for 68. The mean duration of treatment for those ongoing was 1.7 (SD 0.5) years, and for those who discontinued, 0.6 (SD 0.6) years. The most common side effect was unscheduled bleeding, which was also the most common reason for discontinuation (5/18 women). None of the 15 women who had a transvaginal ultrasound examination had an endometrial thickness >5 mm. Of the 41 women who had at least one blood progesterone measurement performed, the median value was 11.3 (range 0.7-138) nmol/L. This audit indicates that mP is well tolerated when prescribed as MHT. Although there was no evidence of endometrial hyperplasia, further research is needed to establish the safety of mP for continuous combined MHT use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
DOI: 10.1097/GME.0000000000000903
Abstract: There is significant interest in the use of androgen therapy for postmenopausal women. This review provides background on endogenous androgens in women, describes factors that affect circulating androgen concentrations, and examines the relationship between low levels of androgens and sexual problems. Possible effects of androgens in postmenopausal women beyond sexual function also are discussed. Clinical trials of androgen therapy for the treatment of hypoactive sexual desire disorder are reviewed, with a discussion of potential risks. A practical approach to using androgens to treat low sexual desire with associated distress is presented, accompanied by an illustrative case.
Publisher: Mary Ann Liebert Inc
Date: 2017
Publisher: Wiley
Date: 2008
DOI: 10.1002/JOR.20465
Abstract: Although knee malalignment is a risk factor for the progression of unicompartmental knee osteoarthritis (OA), it is unclear how this relationship is mediated. Cartilage defects are known to predate cartilage loss and the onset of knee OA, and it may be that knee malalignment increases the risk of unicompartmental knee cartilage defects. Knee radiographs and MRI were performed on a total of 202 subjects, 36.6% of whom had radiographic knee OA, to determine the relationship between static knee alignment and knee cartilage defects. Analyses were performed for the entire cohort, as well as for healthy and OA subgroups. For every 1 degrees increase in a valgus direction, there was an associated reduced risk of the presence of cartilage defects in the medial compartment of subjects with knee OA (p = 0.02), healthy subjects (p = 0.002), and the combined (p < 0.001) group. Moreover, for every 1 degrees increase in a valgus direction, there was an associated increased risk of the presence of lateral cartilage defects in the OA group (p = 0.006), although the relationship between change toward genu valgum and lateral compartment cartilage defects did not persist for the healthy group (p = 0.16). This cross-sectional study has demonstrated that knee alignment is associated with the risk for compartment specific knee cartilage defects in both healthy and arthritic people. Given that the natural history of cartilage volume reduction appears to be predated by the presence of cartilage defects, whether knee alignment affects the longitudinal progression from cartilage defects to cartilage loss requires further examination.
Publisher: Informa UK Limited
Date: 04-12-2023
Publisher: Oxford University Press (OUP)
Date: 18-01-2023
Abstract: The early onset of menopause is associated with increased risks of cardiovascular disease and osteoporosis. As a woman’s circulating anti-Müllerian hormone (AMH) concentration reflects the number of follicles remaining in the ovary and declines towards the menopause, serum AMH may be of value in the early diagnosis and prediction of age at menopause. This systematic review was undertaken to determine whether there is evidence to support the use of AMH alone, or in conjunction with other markers, to diagnose menopause, to predict menopause, or to predict and/or diagnose premature ovarian insufficiency (POI). A systematic literature search for publications reporting on AMH in relation to menopause or POI was conducted in PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials up to 31 May 2022. Data were extracted and synthesized using the Synthesis Without Meta-analysis for diagnosis of menopause, prediction of menopause, prediction of menopause with a single/repeat measurement of AMH, validation of prediction models, short-term prediction in perimenopausal women, and diagnosis and prediction of POI. Risk-of-bias was evaluated using the Tool to Assess Risk of Bias in Cohort Studies protocol and studies at high risk of bias were excluded. A total of 3207 studies were identified, and 41, including 28 858 women, were deemed relevant and included. Of the three studies that assessed AMH for the diagnosis of menopause, one showed that undetectable AMH had equivalent diagnostic accuracy to elevated FSH (& .3 mIU/ml). No study assessed whether AMH could be used to shorten the 12 months of amenorrhoea required for a formal diagnosis of menopause. Studies assessing AMH with the onset of menopause (27 publications [n = 23 835 women]) generally indicated that lower age-specific AMH concentrations are associated with an earlier age at menopause. However, AMH alone could not be used to predict age at menopause with precision (with estimates and CIs ranging from 2 to 12 years for women aged & years). The predictive value of AMH increased with age, as the interval of prediction (time to menopause) shortened. There was evidence that undetectable, or extremely low AMH, may aid early diagnosis of POI in young women with a family history of POI, and women presenting with primary or secondary amenorrhoea (11 studies [n = 4537]). The findings of this systematic review support the use of serum AMH to study the age of menopause in population studies. The increased sensitivity of current AMH assays provides improved accuracy for the prediction of imminent menopause, but diagnostic use for in idual patients has not been rigorously examined. Prediction of age at menopause remains imprecise when it is not imminent, although the finding of very low AMH values in young women is both of clinical value in indicating an increased risk of developing POI and may facilitate timely diagnosis.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2015
DOI: 10.1007/S00198-015-3046-9
Abstract: This study establishes a profile for women at midlife, referred for a dual energy X-ray absorptiometry (DXA), most likely to have osteoporosis, and from this, a pre-DXA screening tool has been developed. These findings inform much needed evidence-based guidelines for targeted and effective screening for osteoporosis and osteoporotic fracture prevention in women at midlife. There is no consensus as to whether women at midlife should undergo screening dual energy X-ray absorptiometry (DXA) to identify osteoporosis (T-score < -2.5). We investigated the prevalence of osteoporosis in women, aged 40-65 years, referred to 42 community-based Australian radiology centres, and identified the characteristics that best predict osteoporosis in women having a screening DXA. One thousand four hundred and two women completed the study questionnaire and had DXA reports available. After excluding women with an established indication for a DXA (58 %), users of bone-specific medication (10.5 %) and cancer (7.6 %), 466 women were classified as having a screening DXA. Forty of these women had osteoporosis at the lumbar spine (n = 32, 6.9 %) or femoral neck (n = 17, 3.6 %). Three predictors of osteoporosis (postmenopausal, nonuse of hormonal therapy and body mass index) were identified and incorporated into the Monash Osteoporosis Risk Score for women at midlife (MORS). In the screened study population, the MORS had a sensitivity of 70 % and specificity of 66 %, with a positive predictive value of 16.2 % and negative predictive value of 95.9 % for osteoporosis. Very few women referred for a screening DXA scan will be found to have osteoporosis. The MORS, a simple decision tool, would have identified 70 % of the women in our screening DXA study population and would have eliminated over 60 % of the screening DXA studies. Hence, use of the MORS may reduce unnecessary DXA scans and facilitate identification of the majority of cases of osteoporosis in women aged 40 to 65 years.
Publisher: Informa UK Limited
Date: 24-07-2020
Publisher: American Medical Association (AMA)
Date: 09-2016
DOI: 10.1001/JAMAPSYCHIATRY.2016.1383
Abstract: A substantial proportion of women with schizophrenia experience debilitating treatment-refractory symptoms. The efficacy of estrogen in modulating brain function in schizophrenia has to be balanced against excess exposure of peripheral tissue. Raloxifene hydrochloride is a selective estrogen receptor modulator (mixed estrogen agonist/antagonist) with potential psychoprotective effects and fewer estrogenic adverse effects. To determine whether adjunctive raloxifene therapy reduces illness severity in women with refractory schizophrenia. This 12-week, double-blind, placebo-controlled, randomized clinical trial with fortnightly assessments was performed at an urban tertiary referral center and a regional center from January 1, 2006, to December 31, 2014. Participants included 56 women with schizophrenia or schizoaffective disorder and marked symptom severity despite substantial and stable antipsychotic doses. Data were analyzed using intention to treat as the basis. Adjunctive raloxifene hydrochloride, 120 mg/d, or placebo for 12 weeks. The primary outcome was the change in the Positive and Negative Syndrome Scale (PANSS) total score. Clinical response (defined as a ≥20% decrease in PANSS total score from baseline) and change in PANSS subscale scores, mood, cognition, reproductive hormone levels, and adverse events were also assessed. Of the 56 participants (mean [SD] age, 53 [7.7] years age range, 40-70 years mean [SD] duration of psychotic illness, 24 [11] years), 26 were randomized to raloxifene and 30 were randomized to placebo. Raloxifene produced a greater reduction in the PANSS total score relative to placebo (β = -6.37 95% CI, -11.64 to -1.10 P = .02) and resulted in an increased probability of a clinical response (hazard ratio, 5.79 95% CI, 1.46 to 22.97 P = .01). A significant reduction was found in the PANSS general symptom scores for the raloxifene compared with the placebo (β = -3.72 95% CI, -6.83 to -0.61 P = .02) groups. For patients who completed the full 12-week trial, there was not a statistically significant treatment effect on PANSS positive symptom scores (β for change in raloxifene vs placebo, -1.92 95% CI, -3.83 to 0.00 P = .05). Change in mood, cognition, and reproductive hormone levels and the rate of adverse events did not differ between groups. Raloxifene hydrochloride, 120 mg/d, reduces illness severity and increases the probability of a clinical response in women with refractory schizophrenia. This large trial of raloxifene in this patient population offers a promising, well-tolerated agent that has potential application in clinical practice. clinicaltrials.gov Identifier: NCT00361543.
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/13697130802576666
Abstract: To compare the incidence of vaginal spotting/bleeding events and breast pain between therapy with tibolone 2.5 mg and continuous combined transdermal estradiol (E(2))/norethisterone acetate (NETA) 50 microg/140 microg after 24 weeks of treatment. A double-blind, double-dummy, randomized, controlled trial was performed and assessments were performed at baseline, week 12 and week 24. Bleeding/spotting events were recorded in a daily diary. Breast signs and symptoms were collected as adverse events. A total of 403 women (mean age 56 years) were randomized. Bleeding/spotting events during weeks 1-12 with tibolone and E(2)/NETA were experienced by 16% and 56% of women, respectively (p < 0.001). The corresponding percentages during weeks 13-24 were 12% and 51%, respectively (p < 0.001). E(2)/NETA was significantly more likely than tibolone to be associated with vaginal hemorrhage (11% vs. 0% p < 0.001) and breast signs and symptoms (11% vs. 4% p = 0.015). Early discontinuations resulting from adverse events were significantly more common in the E(2)/NETA group than in the tibolone group (20% vs. 12%), primarily related to withdrawal due to vaginal hemorrhage (8% vs. 0%). Tibolone has a significantly better tolerability profile than transdermal E(2)/NETA as measured by vaginal bleeding, breast pain and treatment continuation.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.MATURITAS.2009.03.020
Abstract: The aim of this study was to evaluate the safety of 52 weeks of DHEA 50mg daily oral dose given to postmenopausal women with low libido to improve sexual function. 93 postmenopausal women were enrolled in a 52-week randomised, double-blind, placebo-controlled trial and received either DHEA 50mg or placebo (PL) daily. The effects of DHEA versus placebo on lipid profile, insulin-glucose homeostasis and the endomentrium were assessed over 52 weeks. Oral DHEA, 50mg/day, was not associated with any effects on blood lipids or insulin resistance. The pattern of breakthrough bleeding did not substantially differ between the DHEA and PL groups and no significant adverse endometrial effects were apparent. The use of 50mg oral DHEA did not significantly alter lipid profile, insulin sensitivity or adversely affect the endometrium in postmenopausal women.
Publisher: Massachusetts Medical Society
Date: 06-11-2008
Publisher: Informa UK Limited
Date: 2004
Publisher: Informa UK Limited
Date: 19-02-2010
DOI: 10.3109/13697131003675922
Abstract: To evaluate the efficacy and safety of a transdermal testosterone patch (TTP, 300 microg/day) in naturally menopausal women with hypoactive sexual desire disorder (HSDD). A total of 272 naturally menopausal women, predominantly not using hormone therapy, were randomized in this 6-month, placebo-controlled, double-blind, multicenter study to receive twice weekly either TTP or an identical placebo. Efficacy endpoints measured were the 4-week frequency of satisfying sexual episodes (SSE) using the Sexual Activity Log, the sexual desire domain of the Profile of Female Sexual Function and distress by the Personal Distress Scale. Safety was assessed by adverse events, laboratory parameters and hormone levels. The TTP group demonstrated significant improvements in SSE (p = 0.0089) as well as in sexual desire (p = 0.0007) and reduced personal distress (p = 0.0024) versus placebo at 6 months (intent-to-treat analysis, n = 247). The results were significant for all three endpoints in the subgroup (n = 199) not using hormone therapy. Similar numbers of women treated with placebo and TTP discontinued (n = 39, 27.5% vs. n = 26, 20%), reported adverse events (including application site reactions) (n = 101, 71.1% vs. n = 81, 62.3%) and withdrew due to adverse events (n = 20, 14.1% vs. n = 9, 6.9%). No clinically relevant changes were noted in laboratory parameters. Serum free and total testosterone levels increased from baseline in the TTP group (geometric means 5.65 pg/ml and 67.8 ng/dl, respectively, at week 24) within the physiological range no changes were seen in estradiol and sex hormone binding globulin levels. TTP was effective in treating HSDD and improving sexual function in this study of naturally menopausal women with and without concurrent hormone therapy.
Publisher: Wiley
Date: 28-02-2003
DOI: 10.1046/J.1365-2265.2003.01774.X
Abstract: Postmenopausal hormonal therapy is used to manage the climacteric symptoms that impair the quality of life of a substantial number of women. The difficulty is achieving the desired effects with minimal side-effects and no adverse health risks. Fundamental to this is understanding the physiology of oestrogen in women and the metabolism of the therapeutic compounds. Although the effects of oral oestrogen therapy have been studied extensively, there is insufficient evidence to assess adequately the independent effects of progestin use, other oestrogen compounds, differing doses and duration of treatment. We have reviewed some basic concepts of oestrogen physiology and how these relate to exogenous oestrogen administration, the risks of greatest concern, and the role of androgens and newer treatment alternatives.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.MATURITAS.2014.07.004
Abstract: Whether moderate to severe obesity (body mass index (BMI)≥30 to <40kg/m(2)) contributes to breast cancer recurrence and mortality remains uncertain. 1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis. Of the 1155 included women, mean age, 58.4±11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR=1.71, 95%CI, 1.12-2.62, p=0.014), disease beyond Stage 1 (HR=2.87, 95% CI 1.73-4.75, p<0.001), OAET (HR=0.26, 95%CI 0.14-0.46, p<0.001), mastectomy (HR=3.28, 95%CI 1.98-5.44, p<0.001) and radiotherapy (HR=2.12, 95%CI 1.24-3.63, p=0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48-7.03, p=0.003) and OAET use (HR 0.41, 95%CI 0.17-0.98, p=0.046) were significantly associated with an event. Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis this is also true for women with Stage 1 disease, and is independent of age and treatment.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.MATURITAS.2009.12.017
Abstract: Dehydroepiandrosterone (DHEA) and its sulphate DHEAS are the most abundant sex steroids in women and provide a large reservoir of precursors for the intracellular production of androgens and estrogens in non-reproductive tissues. Levels of DHEA and DHEAS decline with age. It has been proposed that restoring the circulating levels of these steroids to those found in young women may have anti-aging effects and improve sexual function and wellbeing in postmenopausal women. To review the published literature for the efficacy of DHEA therapy data regarding safety. A systematic literature search of MEDLINE (Ovid) and Pub-Med (1966 to November 2009) for original studies that included any of the terms dehydroepiandrosterone, DHEA or DHEAS, sexual function, wellbeing, women and metabolic parameters of interest. Overall the interpretation of the data was limited by inadequate s le size and short treatment duration of available studies with inconsistent results. The more recent randomized controlled trials however do not support a benefit of oral DHEA therapy for women. A possible benefit that emerged is that vaginally administered DHEA may improve vaginal atrophy with concomitant improvements in sexual function in women who are estrogen deficient due to menopause. The potential value of oral DHEA therapy for postmenopausal women is called into question.
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.JOCA.2006.05.010
Abstract: There is evidence for tibial bone area to increase in response to risk factors for knee osteoarthritis (OA) in healthy subjects and to increase over time in subjects with knee OA. We performed a cohort study to examine whether tibial plateau bone area changes over time in healthy subjects and identify factors influencing the change. Eighty-one healthy women (age range 50-76 years) underwent magnetic resonance imaging (MRI) on their dominant knee at baseline and approximately 2.5 years later. Tibial plateau bone area was measured at baseline and follow-up. Risk factors assessed at baseline were tested for their association with change in tibial plateau bone area over time using multiple linear regression. The mean tibial plateau bone area increased from 1733+/-209 to 1782+/-203 mm(2) for the medial, and from 1090+/-152 to 1109+/-152 mm(2) for the lateral over the study period, representing an annual average increase rate of 1.2% (95% CI 0.03%, 1.6%) and 0.8% (95% CI 0.7%, 1.8%), respectively. Baseline tibial plateau bone area was inversely associated with the increase rate of tibial plateau bone area. There was a trend for static knee alignment to be related to the increase rate of tibial plateau bone area. In healthy women, tibial plateau bone area increases over time. Baseline tibial plateau bone area is the main factor affecting the rate of increase, with biomechanical factors, such as static anatomical alignment, likely to affect the expansion of tibial plateau. Further work will be needed to determine the effect of subchondral bone change in the pathogenesis of knee OA.
Publisher: The Endocrine Society
Date: 11-2015
DOI: 10.1210/JC.2015-2236
Abstract: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft. Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should in idualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures.
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1016/J.JOCA.2005.11.006
Abstract: The influence exerted on cartilage and bone volumes by locomotor patterns is poorly understood, particularly at the patellofemoral joint. The aim of this study was to investigate the relationship between sagittal plane movement at the tibiofemoral joint and patella cartilage and bone volumes during the locomotion of healthy adult females. Three-dimensional Vicon gait analyses and magnetic resonance imaging were performed on 20 healthy adult women. The relationships between the degree of tibiofemoral flexion and extension at varying stages of the gait cycle and the concomitant medial, lateral and total patella cartilage and total bone volumes were examined. For every degree the knee flexed during mid-stance, there was a 62.8 microL (95% confidence interval 3.7-122.0) increase in the medial patella facet cartilage volume after adjustment for age and the body mass index (BMI) (P = 0.04). A similar relationship that approached significance was observed for the lateral patella facet cartilage volume after adjustment for age and the BMI (P = 0.08). No association was observed between the sagittal plane tibiofemoral movements and the patella bone volume. The association between patella cartilage volume and tibiofemoral knee movement suggests that for every degree increase in knee flexion during mid-stance, there is an associated increase in patella cartilage volume. This may be the result of the geometry of the femoral condyle influencing patella tracking and or the retropatellar load exerted on the patella during walking. These results may have important implications for people who hyperextend their knee during gait and the pathogenesis of patellofemoral osteoarthritis.
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1016/S1521-690X(02)00078-7
Abstract: The concept of a female androgen insufficiency syndrome, although not new, remains somewhat controversial. Androgens are quantitatively the predominant sex steroid in women, circulating in the micromolar and nanomolar concentration range, compared with picomolar levels of oestrogens. The most significant biologically active androgen is testosterone (T), which circulates bound tightly to sex-hormone-binding globulin (SHBG) and loosely to albumin. It is generally held that the non-SHBG-bound fraction is the bioavailable moiety. Hence, clinically useful T measurements require data on total concentrations as well as SHBG level. Testosterone insufficiency occurs in a number of circumstances, including hypopituitarism, premature ovarian failure, adrenal failure, exogenous corticosteroid use and oral oestrogen therapy (causing elevation of SHBG and suppression of gonadotrophins). Clinical symptoms of androgen insufficiency include loss of libido, diminished well-being, fatigue and blunted motivation and have been reported to respond well to T replacement, generally without significant side-effects.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.MATURITAS.2004.06.020
Abstract: Testosterone therapy is being increasingly used in the management of postmenopausal women. However, as clinical trials have demonstrated a significantly increased risk of breast cancer with oral combined estrogen-progestin therapy, there is a need to ascertain the risk of including testosterone in such regimens. Evaluation of experimental and epidemiological studies pertaining to the role of testosterone in breast cancer. Literature review. The Jean Hailes Foundation, Research Unit. Mammary epithelial proliferation, apoptosis and breast cancer. In experimental studies, testosterone action is anti-proliferative and pro-apoptotic, and mediated via the AR, despite the potential for testosterone to be aromatized to estrogen. Animal studies suggest that testosterone may serve as a natural, endogenous protector of the breast and limit mitogenic and cancer promoting effects of estrogen on mammary epithelium. In premenopausal women, elevated testosterone is not associated with greater breast cancer risk. The risk of breast cancer is also not increased in women with polycystic ovary syndrome who have chronic estrogen exposure and androgen excess. However, in postmenopausal women, who are oestrogen deplete and have increased adipose aromatase activity, higher testosterone has been associated with greater breast cancer risk. Available data indicate the inclusion of testosterone in estrogen-progestin regimens has the potential to ameliorate the stimulating effects of hormones on the breast. However, testosterone therapy alone cannot be recommended for estrogen deplete women because of the potential risk of enhanced aromatisation to estrogen in this setting.
Publisher: The Endocrine Society
Date: 12-2009
DOI: 10.1210/JC.2009-1523
Abstract: Greater mammographic density is associated with increased breast cancer risk and reduced diagnostic mammographic sensitivity and may be seen with estrogen rogestin therapy (EPT). The effects of testosterone therapy on mammographic density in postmenopausal women not on EPT are not known. Our objective was to compare effects of two doses of the testosterone transdermal patch (TTP) with placebo in postmenopausal women without concomitant EPT on mammographic density over 52 wk. We conducted a randomized, double-blind, placebo-controlled, parallel-group, multinational trial. Patients included 279 postmenopausal women participating in a testosterone and sexual function study with paired mammograms for baseline and 52 wk/exit. Patients were randomized to placebo, TTP 150 microg/d, or TTP 300 microg/d, stratified by menopause type (natural or surgical). Change from baseline to wk 52 in the percentage of dense tissue (PD) on digital mammograms. A total of 250 women with paired mammograms for study baseline and wk 52 were included in the primary analysis. Mean age was 54.6 yr, baseline body mass index was 27.5 kg/m(2), and 78% were naturally menopausal. There were no baseline differences between groups. Mean changes from baseline (+/-SEM) in PD for placebo, TTP 150 microg/d and TTP 300 microg/d were small (0.05 +/- 0.16, 0.06 +/- 0.19, and 0.21 +/- 0.17%) and not significantly different. There were no statistically significant differences from placebo for total dense or nondense area and no significant relationships between hormone levels and PD after adjustment for body mass index. TTP therapy over 52 wk appears to have no significant effect on digitally quantified absolute or percent dense mammographic area in postmenopausal women not using EPT.
Publisher: Informa UK Limited
Date: 15-05-2013
Publisher: Wiley
Date: 25-07-2013
DOI: 10.1111/J.1741-6612.2011.00553.X
Abstract: To investigate vitamin D status among older women and to explore relationships between vitamin D and fracture risk and vertebral fractures. A total of 267 general practitioners recruited 2466 women aged >70 years with no known osteoporosis or fragility fracture. Serum 25-hydroxy vitamin D (25(OH)D), bone mineral density by dual-energy X-ray absorptiometry (DXA) and vertebral fracture on thoracolumbar X-ray were determined. A total of 2368 women, median age 76 years, provided data and of these 13% were on vitamin D supplements. 25(OH)D levels were available for 907 (44.1%) of those not taking vitamin D. 88.3% of these had a level below 75 nmol/L. Serum 25(OH)D was negatively associated with age (P = 0.003) and body mass index (P < 0.001), and positively associated with lower latitude, femoral neck DXA T-score (P = 0.044) and being Caucasian (P < 0.001). The vitamin D status of community-dwelling older Australian women is inadequate, yet the use of supplements is low.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.MATURITAS.2018.07.012
Abstract: To determine the prevalence of, and risk factors for, sub-types of urinary incontinence (UI) in a nationally representative s le of midlife Bangladeshi women. Bangladeshi women, aged 30-59, recruited by multi-stage cluster s ling, completed the Questionnaire for the Diagnosis of Urinary Incontinence. The prevalence and the factors associated with each form of UI were explored using multivariable weighted logistic regression. 59.3% of the women were premenopausal, 8.4% perimenopausal and 32.3% postmenopausal. 83.2% had a BMI < 28 kg/m The overall prevalence of UI amongst Bangladeshi midlife women is low, with urgency UI the most common form, in contrast to developed countries, where stress UI predominates. Being postmenopausal, having more than two children, being obese and working outside the home increase the likelihood of urgency UI, whereas higher socio-economic status and lower weight appear to be protective. Menopausal hormone therapy use was not reported by any study participants.
Publisher: Springer Science and Business Media LLC
Date: 07-2018
Abstract: Testosterone, an androgen that directly binds to the androgen receptor, has been shown in previous small randomized controlled trials to increase the reproductive outcomes of poor ovarian responders. In most of these studies, transdermal testosterone in relatively high doses was administered before ovarian stimulation with a duration varying from 5 to 21 days. Nevertheless, the key question to be asked is whether, based on ovarian physiology and testosterone pharmacokinetics, a short course of testosterone administration of more than 10 mg could be expected to have any beneficial effect on reproductive outcome. The rationale for asking this question lies in the existing scientific evidence derived from basic research and animal studies regarding the action of androgens during folliculogenesis, showing that their main effect in follicular development is defined during the earlier developmental stages. In addition, extreme testosterone excess is not only likely to induce adverse events but has also the potential to be ineffective and even detrimental. Thus, evidence from clinical studies is not enough to either "reopen" or "close" the "androgen chapter" in poor responders, mainly because the short administration and the high dose of testosterone is not in line with the ovarian actions of androgens and the presence of androgen receptors during follicular development.
Publisher: The Endocrine Society
Date: 14-09-2018
Abstract: Intravaginal testosterone (IVT) is a potential treatment of vulvovaginal atrophy (VVA) associated with aromatase inhibitor (AI) use. To investigate the effects of IVT on sexual satisfaction, vaginal symptoms, and urinary incontinence (UI) associated with AI use. Double-blind, randomized, placebo-controlled trial. Academic clinical research center. Postmenopausal women taking an AI with VVA symptoms. IVT cream (300 μg per dose) or identical placebo, self-administered daily for 2 weeks and then thrice weekly for 24 weeks. The primary outcome was the change in the sexual satisfaction score on the Female Sexual Function Index (FSFI). Secondary outcomes included vaginal symptoms and responses to the Profile of Female Sexual Function, the Female Sexual Distress Scale–Revised (FSDS-R), and the Questionnaire for UI Diagnosis. Serum sex steroids were measured. A total of 44 women were randomly assigned and 37 provided evaluable data, (mean age 56.4 years, SD 8.8 years). At 26 weeks, the mean between-group difference in the baseline-adjusted change in FSFI satisfaction scores was significantly greater for the IVT group than the placebo group (mean difference 0.73 units 95% CI, 0.02 to 1.43 P = 0.043). IVT cream resulted in significant improvements, compared with placebo, in FSDS-R scores (P = 0.02), sexual concerns (P & 0.001), sexual responsiveness (P & 0.001), vaginal dryness (P = 0.009), and dyspareunia (P = 0.014). Serum sex steroid levels did not change. Few women had UI symptoms, with no treatment effect. IVT significantly improved sexual satisfaction and reduced dyspareunia in postmenopausal women on AI therapy. The low reporting of UI among women on AI therapy merits further investigation.
Publisher: Wiley
Date: 17-09-2013
DOI: 10.1111/J.1445-2197.2012.06229.X
Abstract: There is no evidence of benefit in terms of survival or quality of life for intensive surveillance of women with early breast cancer (BC) and current guidelines reflect this. We have examined whether Victorian women, nearly 4 years from a diagnosis of localized BC, were being managed according to these guidelines. Participants are women in the BUPA Health Foundation Health and Wellbeing after Breast Cancer prospective cohort study. All participants completed an enrolment questionnaire within 12 months of diagnosis and then completed follow-up questionnaires every 12 months thereafter. In the third follow-up questionnaire, completed nearly 4 years from the time of diagnosis, women were asked about imaging tests they had in the previous 12 months. The analysis was completed on 673 women who were stage 1 at the time of diagnosis and had not reported evidence of recurrence or a new BC since diagnosis. Of the 673, 603 (89.5%) reported having had a mammogram in the previous 12 months and 319 (52.9% of those having a mammogram) reported a breast ultrasound. Seventy-one per cent of women reported no other imaging investigations in the previous 12 months. Our study shows that, nearly 4 years from diagnosis, Australian practitioners are generally adhering to guidelines about imaging surveillance of BC survivors. Practitioners could use the guidelines for the education of BC survivors about appropriate health surveillance.
Publisher: Mary Ann Liebert Inc
Date: 12-2008
Abstract: To report on the issues encountered in the recruitment of healthy naturally menopausal women in the community to a randomized placebo-controlled trial of dehydroepiandrosterone (DHEA) therapy for treatment of loss of sexual desire. Recruitment of women was achieved by advertising and media publicity. We have reported on the method by which women initially contacted us and the reasons for nonparticipation. Nine hundred and eighteen women contacted us about participating in the study 706 of these were telephoned screened, and 93 of these (10%) women were randomized to therapy. The main determinants for nonparticipation included ineligibility on phone screening (58%), withdrawal of interest either before or after screening (55%), and preexisting pathology after attending for screening (8%). Despite ongoing interest by women to participate in research for therapies to treat low libido, concerns about the use of any hormonal treatment and the time poverty experienced by many women at midlife present new barriers to recruitment and need to be considered in assessing the feasibility of studies in this field.
Publisher: Informa UK Limited
Date: 13-09-2011
Publisher: Oxford University Press (OUP)
Date: 21-10-2017
DOI: 10.1016/J.JSXM.2017.09.018
Abstract: Little is known of the impact of aromatase inhibitor (AI) therapy on sexual and pelvic floor function. To document the prevalence of, and factors associated with, low desire, sexually related personal distress, hypoactive sexual desire dysfunction (HSDD), and pelvic floor dysfunction in women 10 years after breast cancer diagnosis. This was a prospective, observational, community-based cohort study of Australian women with invasive breast cancer recruited within 12 months of diagnosis. 1,053 of the 1,305 who completed the initial 5 years of study follow-up agreed to be re-contacted, and 992 of these women alive 10 years after diagnosis were sent the study questionnaire. The main outcome measure was HSDD determined by a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI) plus a score of at least 11.0 on the Female Sexual Distress Scale–Revised (FSDS-R). Pelvic floor disorders, including urinary incontinence, fecal incontinence, and pelvic organ prolapse, were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with low desire, personal distress, and HSDD. 625 completed questionnaires were returned. The respondents’ median age was 65.1 years (range = 36.4–95.5). Current AI use was reported by 10% and tamoxifen use was reported by 3.4%. 521 of the 608 women (85.7% 95% CI = 82.9–88.5) who competed the FSFI desire domain had low sexual desire, and 246 of the 563 women (43.7% 95% CI = 39.6–47.8%) who completed the FSDS-R had sexually related personal distress. 221 of the 559 women (39.5% 95% CI = 35.5–43.6%) who completed the 2 questionnaires had HSDD. Current AI users were more likely to have HSDD than non-users (55.2% [95% CI = 42.2–68.1] vs 37.8% [95% CI = 33.5–42.0] P = .01). HSDD was more prevalent in sexually active, current AI users (66.7% 95% CI = 49.4–83.9) vs current non-users (43.6% 95% CI = 37.0–50.2 P = .02). In a logistic regression model, HSDD was significantly associated with current AI use and inversely associated with age. Fecal incontinence was more prevalent in AI users than in current non-users (29.8% [95% CI = 17.8–41.8] vs 16.4% [95% CI = 13.2–19.6], respectively P = .01). It is important to address women’s sexual health even many years after their breast cancer diagnosis. Strengths include a representative s le, use of validated questionnaires, and few missing data. Limitations include sexual activity being a 4-week recall. AI use is associated with HSDD and fecal incontinence in women who are 10 years after breast cancer diagnosis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2007
DOI: 10.1097/GME.0B013E31802F316B
Abstract: Exercise has been strongly promoted for the prevention of the major diseases of aging in women, such as cardiovascular disease and osteoporosis. However, conflicting data exist as to whether exercise benefits joint health and thus helps protect against degenerative processes such as knee osteoarthritis. The aim of this study was to examine the cross-sectional relationship between exercise and knee joint cartilage in women at midlife. A total of 176 women aged 40 to 67 years with no clinical knee osteoarthritis or history of significant knee injury were recruited from the community and had magnetic resonance imaging performed on their dominant knee to assess tibial cartilage volume and defects. The women completed a questionnaire to determine fortnightly exercise participation and frequency. Fortnightly participation in exercise at an intensity that caused tachypnea and an increased pulse rate for at least 20 minutes was positively associated with the volume of the medial tibial cartilage (P=0.02). There was a tendency for the frequency of exercise at this intensity to be positively associated with medial tibial cartilage volume (P=0.07). Exercise participation was not significantly associated with the presence of knee cartilage defects. Participation in exercise that causes tachypnea and an increased pulse rate for at least 20 minutes was associated with greater medial tibial cartilage volume, but not knee cartilage defects in non-healthcare-seeking women at midlife. More frequent exercise also tended to be associated with greater medial tibial cartilage volume. Although our findings need to be confirmed longitudinally, they provide further support for a beneficial effect of regular exercise on diseases related to aging.
Publisher: Oxford University Press (OUP)
Date: 07-2009
DOI: 10.1111/J.1743-6109.2009.01289.X
Abstract: Although the efficacy of testosterone for the treatment of hypoactive sexual desire disorder is well established, the effect of testosterone therapy on breast cancer risk remains uncertain. The incidence of invasive breast cancer among past and current testosterone users. Retrospective cohort study of 631 women ever treated with testosterone between January 1989 and December 2007 in a clinical endocrinology practice. The incidence of invasive breast cancer since first exposure, and the standardized incidence rate ratio (IRR) calculated using Australian age-specific incidence rates for 2005. The mean age of the women at first exposure to testosterone therapy was 49.1 +/- 8.2 years, median treatment duration, 1.3 years, and mean follow-up of 6.7 +/- 4.6 years, providing 4,015 woman-years of follow-up. Twelve cases of invasive breast cancer occurred among 599 women breast cancer-free before treatment, giving an age adjusted IRR of 1.35 (95% confidence interval 0.76-2.38). There was no evidence of an independent effect of duration of exposure on breast cancer risk. In this study, testosterone use was not associated with a significant increase in breast cancer risk.
Publisher: Informa UK Limited
Date: 21-10-2014
DOI: 10.3109/13697137.2014.954997
Abstract: This study was undertaken to determine whether metformin would ameliorate insulin resistance, reduce weight and waist circumference and improve lipids in obese, but not morbidly obese, euglycemic women. Obese women (body mass index (BMI) ≥ 30 and 88 cm), aged 35-65 were randomized (1:1) to metformin 850 mg or identical placebo, twice daily for 26 weeks. The primary outcome was the change in insulin resistance determined by the homeostasis model of assessment (HOMA-IR). Secondary outcomes included fasting insulin, glucose, weight, waist circumference and BMI. Of the 125 women screened, 117 enrolled and 100 women, mean age 53 years, were included in the primary intention-to-treat analysis. Metformin resulted in statistically significant between-group difference in the change in HOMA-IR (change in median - 0.04 vs. placebo + 0.1, p = 0.018) and BMI (mean change - 1.00 kg/m(2) 95% confidence interval (CI) 1.37 to - 0.62 vs. placebo mean change 0.00 95% CI - 0.29 to 0.28, p < 0.001). Statistically significant reductions in HbA1c (p = 0.008) and fasting insulin (p = 0.03) and a borderline decrease in high density lipoprotein cholesterol (p = 0.07) were also observed for metformin, compared with placebo. No effects were seen for waist circumference, fasting glucose or other lipids. Treatment of euglycemic, obese, middle-aged women with metformin 1700 mg per day reduced insulin resistance and weight compared with placebo. Further studies are needed to determine whether the use of metformin will prevent the progression of insulin resistance to type 2 diabetes mellitus in obese women.
Publisher: The Endocrine Society
Date: 04-2001
DOI: 10.1210/JC.86.4.1842
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.YHBEH.2010.12.013
Abstract: In women, sexual function, hormones and aging are inextricably related. Sexual activity in women involves interest and motivation, the ability to become aroused and achieve orgasm, the pleasure of the experience and subsequent personal satisfaction. Androgens, as endogenous hormones or given as a therapy, potentially influence female sexual function, with research into the effects of exogenous androgens in women mostly devoted to effects on sexual desire. Some studies have been conducted to delineate the effects of testosterone on arousal, however arousal determined by laboratory measures does not always correlate with subjective reporting of a sensation of arousal. Overall large randomised controlled trials of exogenous testosterone show benefits over placebo on sexual desire, arousal, orgasm, pleasure and satisfaction. The aspects of consideration of androgen therapy for women that continue to stimulate debate in this therapeutic area include whether female sexual dysfunction is a condition that merits pharmacotherapy, how effective is such treatment and whether testosterone therapy is safe.
Publisher: Informa UK Limited
Date: 24-01-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.JOCA.2014.06.008
Abstract: There is evidence for an association between levels of urinary C-telopeptide fragments of type II collagen (uCTX-II) and risk of knee osteoarthritis (OA). The aim of this cohort study was to examine the association between uCTX-II levels and knee cartilage and bone changes in middle-aged women without clinical knee disease. 140 women, aged 40-67 years, with no significant knee pain, knee injury or any forms of arthritis, underwent knee magnetic resonance imaging (MRI) at baseline and 2 years later. Cartilage volume, cartilage defects, tibial plateau bone area and bone marrow lesions (BMLs) were measured using validated methods. Baseline uCTX-II was measured using enzyme-linked immunosorbent assay (ELISA). For every one unit (natural logarithm transformed) increase in baseline uCTX-II level, there was an increase in the prevalence of medial tibiofemoral cartilage defects (Odds ratio (OR) 4.36, 95% confidence interval (CI) 1.58-12.04), medial (80.2 mm(2), 95% CI 9.3-151.1) and lateral (86.0 mm(2), 95% CI 33.3-138.7) tibial plateau bone area, and the prevalence of lateral tibiofemoral BMLs (OR 10.62, 95% CI 1.82-61.85). Baseline uCTX-II levels were not significantly associated with baseline tibial cartilage volume or changes in knee cartilage volume or defects or bone area over 2 years, although there was a trend for the deterioration of medial tibiofemoral BMLs (P = 0.06). In middle-aged women without clinical knee disease, higher uCTX-II levels were associated with early detrimental structural changes at the knee (cartilage defects, tibial bone expansion and BMLs) at baseline but not over 2 years. Further work will be needed to determine its sensitivity to change and whether it predicts disease progression over longer time periods.
Publisher: Elsevier BV
Date: 04-1999
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.APMR.2008.07.030
Abstract: There is growing interest in the role of the knee adduction moment in the pathogenesis of knee pain and osteoarthritis. It is unclear whether the knee adduction moment is similar between the dominant and nondominant legs during locomotion. This study examined whether asymmetry exists in the peak knee adductor moments during gait in healthy adults. Cross-sectional study. Musculoskeletal Research Centre, La Trobe University, Melbourne, Victoria, Australia. Three-dimensional Vicon gait analyses were performed for 17 healthy men and women. Not applicable. The external dominant and nondominant peak knee adduction moments during early and late stance were analyzed to determine whether any significant differences occurred between limbs. Peak knee adductor moments for dominant and nondominant limbs were significantly correlated during early (R=0.61, P=0.009) and late (R=0.72, P=0.001) stance. After adjustment for age and sex, there was an associated 0.58 (P=0.030) and 0.98 (P=0.009) unit increase in the peak knee adduction moment in the nondominant leg, for every 1 unit increase in the dominant leg during the early and late stance phases of gait, respectively. Further evidence for symmetry was provided by the symmetry index, which was 0.04% and 0.62% for early and late stance, respectively. In healthy subjects, the magnitude of the dominant limb peak external knee adduction moments during stance, and in particular late stance, appears representative of the magnitude of the moment in the nondominant limb. These findings imply symmetry between these moments and may have important implications when collecting data for limb analyses among healthy subjects. Whether gait symmetry protects against the onset of unilateral (or increases the risk for bilateral) pathological joint changes will need to be confirmed longitudinally.
Publisher: Oxford University Press (OUP)
Date: 07-2004
DOI: 10.1111/J.1743-6109.2004.10105.X
Abstract: Women's sexual dysfunctions include persistent or recurrent disorders of sexual interest/desire, disorders of subjective and genital arousal, orgasm disorder, pain and difficulty with attempted or completed intercourse. There are limited recommendation/guideline documents pertaining to the diagnosis and treatment of women's sexual dysfunctions. To provide recommendations/guidelines concerning state-of-the-art knowledge for the clinical management of women's sexual dysfunctions. An International Consultation in collaboration with the major sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Ten experts from four countries compiled the Recommendations on Sexual Dysfunctions in Women. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. Recommendations and guidelines concerning the various sexual dysfunctions were updated. A comprehensive assessment of medical, sexual and psychosocial history is recommended for diagnosis and management planning. Indications for general and focused pelvic genital examination and laboratory testing are included. Recently revised definitions for sexual desire/interest disorder, arousal disorders (genital, subjective, combined and persistent), orgasm disorder, dyspareunia and vaginismus are presented. An evidence-based approach to management is provided. There is a need for more research and scientific reporting, re-assessment, and management of women's sexual dysfunction including long-term outcome studies.
Publisher: The Endocrine Society
Date: 07-2010
DOI: 10.1210/JC.2009-2509
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: Elsevier BV
Date: 12-1998
Publisher: Informa UK Limited
Date: 03-12-2011
DOI: 10.3109/13697137.2011.614026
Abstract: Cosmetic breast surgery is amongst the top five most commonly performed cosmetic surgical procedures. With breast cancer being the most common non-skin malignancy in women, the likelihood that a woman undergoing cosmetic breast surgery may have an occult breast cancer needs to be considered. Most of the available data pertaining to breast cancer diagnosis in the setting of cosmetic surgery are from studies of cosmetic breast surgery populations. We report on the prevalence of breast cancer as an incidental finding during cosmetic breast surgery in the context of women subsequently diagnosed with invasive breast cancer. The Bupa Health Foundation Health and Wellbeing after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive breast cancer. Participants completed an enrolment questionnaire and annual follow-up questionnaires for 5 years. At the second follow-up, 1.5% of women reported having undergone cosmetic breast surgery prior to being diagnosed with breast cancer, 16 had undergone breast reduction and seven had augmentations. Invasive breast cancer was diagnosed at the time of a cosmetic breast procedure in two women, in both an augmentation and a reduction procedure, which is 8.7% (95% confidence interval 23.5% to +20.9%) of the women in our study reporting a cosmetic breast procedure prior to diagnosis. Although prior cosmetic breast surgery was reported by few women, breast cancer was diagnosed in two women during the procedure. Surgeons performing elective breast surgery need to understand and apply consistent, reliable breast cancer screening practices.
Publisher: Informa UK Limited
Date: 06-07-2014
DOI: 10.3109/13697137.2014.929651
Abstract: A number of learned societies, including the International Menopause Society, have produced position statements pertaining to the use of postmenopausal hormone therapy. These documents are highly informative but are not designed for use by primary-care physicians and nurse practitioners during routine consultations. Our aim was to produce a toolkit for practitioners that could be used during office consultations to assist them in the assessment and management of the menopause. We used clinical experience in primary care, combined with published diagnostic algorithms, positions statements from learned medical societies and relevant peer-reviewed literature to develop assessment and management algorithms relevant to the primary care of women age 40 years and older. The resultant 'Practitioner's Toolkit for Managing the Menopause' comprises algorithms for the reasons why a woman might present, determination of menopausal status, key information that should be ascertained, issues that may influence treatment decision-making, hormonal and non-hormonal treatment options, symptom management and patient review, and a brief supporting document. We believe these algorithms and supporting document provide an accessible desktop tool for health-care practitioners caring for women at midlife. The toolkit has been endorsed by the International Menopause Society for global use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Oxford University Press (OUP)
Date: 09-2006
DOI: 10.1111/J.1743-6109.2006.00285.X
Abstract: A considerable number of double-blind randomized controlled studies investigating the effects of pharmaceutical intervention on female sexual functioning have been published in recent years. However, a comparison between outcomes of various studies is difficult as no generally accepted/correct approach to research has been established yet. To be able to translate trial results to daily clinical practice, current limitations and issues in drug intervention studies in female sexual dysfunction (FSD) need to be clarified. To evaluate the needs in research into intervention in FSD by reviewing published studies. A systematic review of double-blind randomized controlled intervention trials on FSD. Definitions of study populations, inclusion and exclusion criteria, use of power calculations, outcome measures and treatment duration. A total of 25 double-blind randomized controlled trials investigating the effects of pharmaceutical intervention on female sexual functioning have been published. Of these, 11 studies required the diagnosis of FSD as an inclusion criterion. A standard methodology for research in this field is lacking. Significant differences in population inclusion requirements and tools for the measurement of change in sexual functioning were identified as major limiting factors. The investigation of FSD is an evolving area in that new definitions and a new model for female sexual functioning have been recently proposed. There is a need for experts in the field and regulating authorities to reach a consensus regarding appropriate inclusion and exclusion criteria for FSD trials and main outcome measures appropriate for the evaluation of drug interventions. This consensus should also determine which treatment effect is considered to be clinically relevant. Treatment efficacy and clinical relevance should be related to outcomes which are meaningful for affected women.
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.MATURITAS.2007.07.005
Abstract: Study to compare the effects of tibolone and raloxifene on health-related quality of life, sexuality and vaginal atrophy. A double-blind, randomized study was conducted in 308 osteopenic, but otherwise healthy, postmenopausal women (mean age 66 years) who received tibolone 1.25mg/day or raloxifene 60 mg/day for 2 years. Health-related quality of life was assessed by the women's health questionnaire (WHQ), sexual function by the McCoy female sexuality questionnaire (MFSQ) and vaginal atrophy by assessing the karyopycnotic index (KI) and vaginal maturation (VM). At week 104, the tibolone group showed a trend towards an improved health-related quality of life (HRQoL) mean score in eight out of nine WHQ domains. HRQoL scores approximated values for premenopausal women, being pre-defined as "clinically relevant". The raloxifene group showed a trend to a diminished HRQoL mean score from baseline to week 104. No difference could be assessed between the tibolone and raloxifene group in mean total score and separate domains' scores of the MFSQ, except for the vaginal lubrication domain (p=0.037). The increase in KI and VM was statistically significantly greater with tibolone than with raloxifene (for both KI and VM p<0.0001). Tibolone and raloxifene were equally well tolerated. In older postmenopausal women, tibolone treatment showed a trend towards an improvement in quality of life and sexuality when compared to raloxifene.
Publisher: Massachusetts Medical Society
Date: 28-08-1997
Publisher: The Endocrine Society
Date: 04-02-2019
Abstract: 11β-Hydroxyandrostenedione (11OHA4), 11β-hydroxytestosterone (11OHT), and their respective peripheral derivatives, 11-ketoandrostenedione (11KA4) and 11-ketotesosterone (11KT), have been implicated in androgen-related physiopathology. Little is known of these steroids in postmenopausal women or whether exogenous testosterone therapy influences their levels. The impact of exogenous testosterone on serum levels of 11-oxygenated steroids was determined in healthy postmenopausal women. Levels of 19-carbon (C19) steroids were measured by liquid chromatography–tandem mass spectrometry in serum obtained at baseline and at 12 and 26 weeks from 73 healthy postmenopausal women, aged 55 to 65 years, who participated in a randomized, double-blind, placebo-controlled clinical trial assessing the effects of transdermal testosterone on cognitive performance. Of the 11-oxygenated androgens, 11OHA4 was the most abundant (median, 6.46 nmol/L range, 1.51 to 23.82 nmol/L), with concentrations several fold greater than its precursor androstenedione (median, 1.38 nmol/L range, 0.52 to 2.92 nmol/L). Baseline median (range) testosterone and 11KT levels were similar [0.56 (0.23 to 1.48) nmol/L 0.85 (0.25 to 2.86) nmol/L, respectively). 11OHT was closely correlated with 11KT (Spearman rank correlation coefficient, 0.79 P & 0.001) and 11OHA4 correlated with 11KA4 (Spearman rank correlation coefficient, 0.73 P & 0.001). Testosterone therapy resulted in an increase in serum testosterone level, whereas all 11-oxygenated androgens remained unchanged throughout the 26 weeks of treatment. After menopause, the adrenal production of 11-oxygenated derivatives of androstenedione and testosterone contributes importantly to the total circulating androgen pool. Exogenous testosterone does not influence the circulating levels 11-oxygenated C19 steroids.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/AR2371
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Elsevier
Date: 2007
Publisher: Oxford University Press (OUP)
Date: 23-03-2004
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.BREAST.2012.04.006
Abstract: This study explored factors associated with the likelihood of reconstruction after unilateral mastectomy and the wellbeing of women after reconstruction. Data were from a questionnaire completed on average 1.8 years after diagnosis by 1429 women in the BUPA Health and Wellbeing After Breast Cancer Study. Logistic regression was used to model factors associated with reconstruction. The Psychological General Wellbeing Questionnaire was used to assess wellbeing. A total of 25.4% of 366 women who had a unilateral mastectomy had undergone a reconstruction nearly two years after diagnosis. Being younger (p<0.001), educated beyond school (p<0.04), living in the metropolitan area (p<0.001), having private health insurance (p=0.003), not having dependent children (p=0.004) and not having radiotherapy (p<0.001) explained just over 40% of the variation in reconstruction status. There was a modest difference between women who did and did not have a reconstruction in terms of wellbeing. Demographic factors strongly influence the likelihood of reconstruction after mastectomy.
Publisher: Informa UK Limited
Date: 19-04-2012
DOI: 10.3109/13697137.2012.658461
Abstract: The prevalence of major depression disorder in women is double that seen in men, with the menopause transition being associated with increased vulnerability to depression. Selective serotonin reuptake inhibitors (SSRIs), which constitute 70-80% of antidepressant prescriptions, are associated with secondary sexual dysfunction in 35-70% of users. Different strategies for approaching sexual dysfunction secondary to SSRI medication have been investigated. Most interventions fail to show significant benefit on sexual function compared to placebo moreover, adjuvant therapies commonly result in side-effects and tolerability problems. While antidepressant-associated sexual dysfunction in women has been a concern for many years, there remains a need for more research into the optimal management of antidepressant-associated sexual dysfunction in women, including multidisciplinary approaches. Further randomized, controlled trials assessing multidisciplinary approaches are required before clinicians or patients can be confident of the benefits of any intervention. Despite the efficacy of testosterone in improving sexual function in non-depressed women, there is no information regarding the efficacy of testosterone in treating antidepressant-associated sexual dysfunction in women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: The Endocrine Society
Date: 07-2001
DOI: 10.1210/JC.86.7.3053
Publisher: Massachusetts Medical Society
Date: 03-01-2002
Publisher: The Endocrine Society
Date: 10-2006
DOI: 10.1210/JC.2006-1121
Abstract: The objective was to provide guidelines for the therapeutic use of androgens in women. The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. The Task Force used systematic reviews of available evidence to inform its key recommendations. The Task Force used consistent language and graphical descriptions of both the strength of recommendation and the quality of evidence, using the recommendations of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group. The strength of a recommendation is indicated by the number 1 (strong recommendation, associated with the phrase "we recommend") or 2 (weak recommendation, associated with the phrase "we suggest"). The quality of the evidence is indicated by cross-filled circles, such that [1 cross-filled circle, 3 empty circles] denotes very-low-quality evidence, [2 cross-filled circles, 2 empty circles] low quality, [3 cross-filled circles, 1 empty circle] moderate quality, and [4 cross-filled circles] high quality. Each recommendation is followed by a description of the evidence. Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and e-mail communications. The drafts prepared by the task force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Committee (CAC), and Executive Committee. The version approved by the CGS and CAC was placed on The Endocrine Society's web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes. We recommend against making a diagnosis of androgen deficiency in women at present because of the lack of a well-defined clinical syndrome and normative data on total or free testosterone levels across the lifespan that can be used to define the disorder. Although there is evidence for short-term efficacy of testosterone in selected populations, such as surgically menopausal women, we recommend against the generalized use of testosterone by women because the indications are inadequate and evidence of safety in long-term studies is lacking. A review of the data currently available is presented, and areas of future research are outlined. To formulate clinical guidelines for use of testosterone in women, additional information will be necessary. This includes defining conditions that, when not treated with androgens, have adverse health consequences to women defining clinical and laboratory parameters that distinguish those with these conditions and assessing the efficacy and long-term safety of androgen administration on outcomes that are important to women diagnosed with these conditions. This necessary clinical research cannot occur until the biological, physiological, and psychological underpinnings of the role of androgens in women and candidate disorders are further elucidated.
Publisher: Informa UK Limited
Date: 11-2020
Publisher: Wiley
Date: 09-2002
Publisher: Informa UK Limited
Date: 09-07-2021
DOI: 10.1080/13697137.2021.1936486
Abstract: This study aimed to explore Australian health-care providers' knowledge of menopause and its consequences, and their views about menopause-related health care. This was a cross-sectional qualitative study of Australian general practitioners (GPs), gynecologists (GYs) and pharmacists (PHs). Recruitment was ultimately achieved through professional networks and cold calling. There were equal numbers of GPs, GYs and PHs, and equal numbers of males and females in each group. All participants demonstrated sound understanding of menopause and its consequences. A strong theme was recognition of high usage of complementary and alternative medicines (CAMs) by women for menopausal symptoms. Most participants highlighted lack of efficacy evidence for most CAMs, but the majority of GPs and PHs considered CAMs to 'have a role'. Most supported menopausal hormone therapy (MHT) when symptoms impaired quality of life. Limitations to comprehensive care included knowledge gaps and lack of time. Australian health-care providers appeared knowledgeable about menopause, but uncertain about its management. MHT prescription appeared limited to women with severe symptoms despite lifestyle modification and a trial of CAMs. The upskilling of clinicians providing care for women at midlife, with respect to the indications for and prescribing of MHT, urgently needs to be addressed.
Publisher: Springer Science and Business Media LLC
Date: 02-05-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
DOI: 10.1097/GME.0000000000001237
Abstract: This study aims to determine the prevalence and severity of menopausal symptoms in older postmenopausal women and, hence, the need for treatment options for women of this age. This is a cross-sectional questionnaire-based study conducted between October 2013 and March 2014 among 2,020 women aged 40 to 65 years and living independently across Australia. The main outcome measures were the prevalence of moderate to severe vasomotor symptoms (VMS), as measured by the Menopause-Specific Quality of Life Questionnaire, and the current use of prescription therapy for menopausal symptoms. The prevalence of moderate to severe VMS was as follows: 2.8% in premenopausal women, 17.1% in perimenopausal women, 28.5% in postmenopausal women younger than 55 years, 15.1% in postmenopausal women aged 55 to 59 years, and 6.5% in postmenopausal women aged 60 to 65 years. Prescription therapy for menopausal symptoms was used by 135 women: 120 (5.9%) women using hormone therapy and 15 (0.7%) women using nonhormonal medication. The factors positively associated with moderate to severe VMS were smoking (odds ratio, 1.6 95% CI, 1.1-2.3 P 0.05) and a body mass index of 25 to 29.9 kg/m 2 (odds ratio, 1.7 95% CI, 1.1-2.5 P 0.05) education beyond high school was inversely associated (odds ratio, 0.7 95% CI, 0.5-0.9 P 0.05). In this large, representative, community-based s le of women, there is a high prevalence of untreated moderate to severe VMS even in women aged 60 to 65 years. The use of vaginal estrogen and nonhormonal prescription therapy with proven efficacy for treatment of menopausal symptoms is strikingly low, suggesting that menopause remains an undertreated condition.
Publisher: American College of Physicians
Date: 17-07-2012
DOI: 10.7326/0003-4819-157-2-201207170-00005
Abstract: Although pregnancy is a risk factor for urinary incontinence (UI), the extent of UI in nulligravid women has not been reported. To investigate the rate of UI in a s le of young nulligravid women and its potential risk factors and effect on quality of life. Cross-sectional, self-administered questionnaire-based study. University c uses and medical and allied health clinics. Nulligravid Australian women aged 16 to 30 years. The Questionnaire for Urinary Incontinence Diagnosis, the Psychological General Well-Being Index (PGWBI), the King's Health Questionnaire, and the International Physical Activity Questionnaire-Short Form. Demographic variables and potential risk factors were also documented. 1018 of 1620 questionnaires (63%) were returned, and 1002 provided analyzable data. The mean age of participants was 22.5 years (SD, 3.2). The rate of any UI was 12.6% (95% CI, 10.5% to 14.7%). Incontinence was slightly more common in students than in nonstudents (13.2% [CI, 11.0% to 15.8%] vs. 10.6% [CI, 6.7% to 14.6%]). Rates of UI varied according to sexual activity and use of combined oral contraceptives (COCs), with highest rates reported by students who were ever sexually active and not using COCs (21.5% [CI, 16.7% to 27.3%]). Women with UI reported significantly lower overall well-being than women without UI and had worse PGWBI scores related to anxiety, depression, positive well-being, and self-control. A convenience s le of healthy, well-educated women was recruited, and response rates and participant characteristics varied by setting. In a s le of young nulligravid women, UI was associated with ever being sexually active and no COC use, as well as lower psychological well-being. Further research is needed to assess the prevalence and risk factors for UI in nulligravid women. None.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/AR2380
Publisher: Wiley
Date: 11-09-2012
DOI: 10.1111/J.1365-2265.2011.04301.X
Abstract: Sex hormone-binding globulin (SHBG) is a robust predictor of insulin resistance. Whether this is independent of circulating sex steroid levels remains uncertain. The aim of this study was to investigate the determinants of SHBG in postmenopausal women and whether the relationship between SHBG and insulin resistance is independent of oestrogen and androgen levels. A cross-sectional study of naturally and surgically menopausal women. Seven hundred and sixty three postmenopausal women not using any systemic hormone therapy, mean age 54·4 ± 5·8 years, recruited in the US, Canada, Australia, UK and Sweden between July 2004 and February 2005. Relationships between log-transformed (ln) SHBG and ln homoeostasis model assessment for insulin resistance (HOMA-IR) were explored, taking into account age, body mass index (BMI), blood pressure (BP) and circulating oestradiol, oestrone, testosterone and dihydrotestosterone. Taking into account age, race, years since menopause, menopause type, BMI, BP, prior postmenopausal hormone use and the sex steroids measured, 34·4% of the variation in SHBG could be explained by the model that included negative contributions by HOMA-IR, BMI and diastolic BP, and a positive contribution by total testosterone (P < 0·001). None of the sex steroids made independent contributions to HOMA-IR, which was best explained by the model that included BMI, SHBG, systolic BP and surgical menopause, with each variable being positively related to HOMA-IR (r(2) = 0·3152, P = 0·03). The relationship between SHBG and HOMA-IR, as an estimate of insulin resistance, is not explained by endogenous oestrogen and androgen levels and is, at least in part, independent of BMI in postmenopausal women.
Publisher: Emerald
Date: 2006
DOI: 10.1108/13527600610643493
Abstract: This paper seeks to critically review developments in the literature spanning personnel management, HRM, learning organization and intellectual capital approaches to employee utilization and development. The purpose being to identify the benefits, limitations and lessons for the management of people in the co‐operative and mutual sectors. The problem of inadequate Personnel or HRM systems in the majority of co‐operatives has been established by the author over a period of seven years, field work with co‐operative organizations including the international co‐operative alliance (ICA), asian confederation of credit unions (ACCU), and the British society for co‐operative studies. Direct interviews and a s le of HRM and Membership Relations audit forms developed as part of the ongoing field research and special project work have been applied to various co‐operative contexts in all the regions of the ICA. The findings are that co‐operatives generally are lagging behind the private sector in their application of all four approaches. Mostly smaller co‐operatives lack effective basic personnel systems and few of the larger co‐operatives go beyond HRM. This failure to develop clear programs for the utilization and development of their people is a missed opportunity. The membership base and its roots in a community of shared interests means that, whilst co‐operatives have lessons to learn from all four approaches, they can and must go beyond them if they are to optimize their people‐centered business advantage in the marketplace. The paper suggests a new strategy for co‐operatives of Co‐operative Social Capital Management to help them compete, whilst retaining their co‐operative difference.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Publisher: Wiley
Date: 05-05-2014
DOI: 10.1111/CEN.12459
Abstract: The aim of this study was to examine the effects of testosterone on verbal learning and memory in postmenopausal women. Randomized, placebo-controlled trial in which participants were randomized (1:1) to transdermal testosterone gel 300 mcg/day, or identical placebo, for 26 weeks. Ninety-two postmenopausal women aged 55-65 years, on no systemic sex hormone therapy. The primary outcome was the score for the International Shopping List Task (ISLT) of CogState. Secondary outcomes included other CogState domains, the Psychological General Well-Being Index (PGWB) and safety variables. Eighty-nine women, median age 60 years, were included in the primary analysis. Testosterone treatment resulted in statistically significantly better performance for the ISLT (improved verbal learning and memory) compared with placebo, adjusted for age and baseline score (mean difference 1·57 95%CI 0·13, 3·01) P = 0·03). There were no significant differences for other CogState domains or the PGWB scores. At 26 weeks, the median total testosterone was 1·7 nm (interquartile range (IQR) 1·1, 2·4) in the testosterone group and 0·4 nm (IQR 0·3, 0·5) in the placebo group. The small but statistically significant effect of testosterone treatment on verbal learning and memory in postmenopausal women provides the basis for further clinical trials.
Publisher: Elsevier BV
Date: 04-1999
DOI: 10.1016/S0960-0760(99)00054-0
Abstract: Androgens have significant and varied actions in women and there is now acknowledgment that women may experience symptoms secondary to androgen deficiency. There is also substantial evidence that prudent androgen replacement can be effective in relieving both the physical and psychological symptoms of androgen insufficiency, and is indicated for clinically affected women. Testosterone replacement for women is now available in a variety of formulations. It appears to be safe, with the caveat that doses are restricted to the 'therapeutic' window for androgen replacement in women, such that the beneficial effects on wellbeing and quality of life are achieved without incurring undesirable virilizing side effects. The predominant symptom of women with androgen deficiency is loss of sexual desire. This is not limited to women experiencing a surgical menopause but may also be a feature of women who have either undergone premature or natural menopause. There is increasing interest in other uses of androgen replacement in women that include premenopausal iatrogenic androgen deficiency states, glucocorticosteroid-induced bone loss, management of wasting syndromes and possibly premenopausal bone loss, premenopausal loss of libido and the treatment of the premenstrual syndrome.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Publisher: Wiley
Date: 04-01-2023
DOI: 10.1111/CEN.14874
Abstract: To explore the associations between endogenous testosterone blood concentrations and muscle mass, strength and performance in community dwelling women. Online databases, including Ovid MEDLINE, EMBASE and Web of Science, were searched for observational studies, with at least 100 female participants, reporting associations between endogenous testosterone blood concentrations and muscle mass, strength and performance. The findings were synthesized in a narrative review. Heterogeneity in study design and analysis precluded a meta‐analysis. Of the 36 articles retrieved for full‐text review, 10 met the inclusion criteria. Eight studies were cross‐sectional, 1 longitudinal and 1 provided both cross‐sectional and longitudinal data. Testosterone was measured by liquid chromatography‐tandem mass spectrometry in two studies and by immunoassay in 8. An association between total testosterone and muscle mass, strength or performance in women was not found. The studies of calculated free or bioavailable testosterone and lean muscle mass reported a positive association, but no association was reported for muscle strength or performance. Each included study was limited by a high risk of bias in at least one assessed domain. This review does not support an association between testosterone and muscle mass, strength or performance in women. This, together with the reported associations between free or bioavailable testosterone and muscle mass should be interpreted cautiously due to the predominant use of immunoassay and the inaccuracy of calculated variables. Additionally, biological significance of nonprotein bound testosterone has not been established. Further studies examining the relationship between precisely measured testosterone and muscle mass and function in women are required.
Publisher: Wiley
Date: 19-01-2010
DOI: 10.1111/J.1365-2265.2009.03670.X
Abstract: The available clinical evidence supports efficacy of testosterone therapy for the treatment of postmenopausal women with hypoactive sexual desire disorder (HSDD) who have undergone a comprehensive clinical evaluation. Although few preparations designed to deliver an appropriate dose of testosterone for women are available, use of testosterone by women for the management of HSDD is widespread. Issues that continue to simulate debate in this therapeutic area include whether HSDD is a condition that merits pharmacotherapy, how effective is such treatment and whether testosterone therapy is safe. Hence the question, should women receive androgen replacement therapy, and if so, how?
Publisher: Informa UK Limited
Date: 03-2004
DOI: 10.1080/03009740310004612
Abstract: Knee cartilage volume measurement requires significant time and training. Simplifying the measurement may improve feasibility. We investigated whether the area of cartilage shown on the middle slice of the medial and lateral tibial cartilages on sagittal MRI correlates with radiological features of osteoarthritis (OA), cartilage volume, and longitudinal change in cartilage volume. One hundred and seventy-three subjects (normal and osteoarthritic), who had serial magnetic resonance imaging (cartilage volume measured) and baseline weight-bearing antero-posterior radiographs of the same knee were examined. In the lateral compartment, with increasing grade of OA there was a significant reduction in cartilage area. In the medial compartment, this was true for medial joint-space narrowing (after adjusting for gender). There was a moderate to strong association between cartilage area and volume, especially in those with early or no OA. However, when change over time was examined, the strength of these relationships was weak. Our data suggests that cartilage area may provide a simple surrogate measure of cartilage volume, in cross-sectional studies, after adjustment for gender: especially in subjects with early disease. However, before it can be widely used, further investigation will be required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
DOI: 10.1097/GME.0000000000000938
Abstract: To assess the prevalence of, and factors associated with, moderate-to-severe depressive symptoms in community-dwelling older Australian women. A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on the electoral roll. Depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) tool. Vasomotor symptoms (VMS), vulvovaginal atrophy (VVA), and pelvic floor symptoms were assessed using validated questionnaires. Women were provided a comprehensive list of psychotropic medications (antidepressants, benzodiazepines, antipsychotics, and mood stabilizers) to identify their use over the preceding month. In all, 1,534 women completed the BDI-II. Overall, 34.2% (95% confidence interval [CI] 31.8%-36.7%) of women had VMS, 6.3% (95% CI 5.2%-7.7%) had moderate-to-severe depressive symptoms (BDI-II score ≥20), 26.8% (95% CI 24.6%-29.1%) had used any psychotropic medication in the previous month, and 17.5% (95%CI: 15.6-19.5%) had taken an antidepressant. Moderate-to-severe depressive symptoms were more common among women using antidepressants compared with nonusers (16.6% vs 4.3% P 0.001). Obesity (adjusted odds ratio [AOR] 2.18, 95% CI 1.17-4.04), living in financially insecure housing (AOR 3.84, 95% CI 2.08-8.08), being a caregiver to another person (AOR 2.39, 95% CI 1.36-4.19), being a smoker (AOR 2.28, 95% CI 1.12-4.66), having VMS (AOR 1.67, 95% CI 1.03-2.62), having pelvic floor dysfunction (AOR 1.78, 95% CI 1.08-2.94), and having vaginal dryness during intercourse (AOR 1.84, 95% CI 1.06-3.22, P 0.05) were positively and independently associated with moderate-to-severe depressive symptoms. Being currently partnered (AOR 0.57, 95% CI 0.33-0.97) and employed (AOR 0.38, 95% CI 0.16-0.92) were associated with a lower likelihood of depressive symptoms. In older women, depressive symptoms are common and are associated with social and financial insecurity, and with VMS.
Publisher: The Endocrine Society
Date: 02-2015
DOI: 10.1210/JC.2014-4264
Publisher: Informa Healthcare
Date: 18-09-2012
DOI: 10.1517/14656566.2012.725046
Abstract: Female sexual dysfunction (FSD) is a global health issue, with as many as 12% of women over 18 years old reporting sexual difficulties associated with distress. It is a multifaceted problem with psychological and biological causes. Affected women tend to have an impaired quality of life, a decreased level of well-being and relationship issues. Hence there is a need for management options for affected women. This paper focuses on current pharmacological options for the treatment of FSD, particularly estrogens and androgens, which have been extensively studied. Some investigational drugs are also described, including the centrally acting agents such as flibanserin and bupropion, and intravaginal DHEA and testosterone, which may be useful as an alternative for women with specific conditions, such as breast cancer survivors. Although approval for the use of testosterone for treatment of FSD is limited to some European countries and restricted to surgically menopausal women, there is extensive off-label use for this purpose. No other product has yet achieved regulatory approval for treatment of FSD. Completion of studies of nonhormonal FSD therapies and safety studies of testosterone may result in regulatory approval of such products for the treatment of FSD in the near future.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/13697130802635645
Abstract: To examine the relationships between well-being and different levels of both low back pain intensity and disability in women living in the community. A detailed, self-administered questionnaire was mailed to 542 community-dwelling women, aged 24-80 years. Participants provided demographic data and completed the Chronic Pain Grade Questionnaire and Psychological General Well-being Index (PGWB). A total of 506 participants (93.4%) returned completed questionnaires. Multivariate analysis revealed associations between lower total PGWB scores and both low (odds ratio (OR) -5.53 95% confidence interval (CI) -9.01, -2.06) and high pain intensity (OR -8.36 95% CI -13.8, -2.92) compared with no pain intensity, after adjusting for confounders. Lower total scores on the PGWB were also associated with low (OR -4.72 95% CI -9.04, -0.41) and high disability (OR -9.26 95% CI -15.2, -3.30), compared with no disability. There were also statistically significant associations between lower scores on the PGWB subdomains and low and high pain intensities, and low and high disabilities. We found that it is not only women with high pain intensity and disability who experience reduced well-being, but also those with low levels of pain and disability. Longitudinal investigation is needed to investigate the predictive nature of both low and high levels of pain and disability in determining poor well-being in community-based women.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.SEMARTHRIT.2004.07.007
Abstract: There is some observational evidence to suggest an effect of hormones on osteoarthritis (OA), especially in perimenopausal women. To review the epidemiological evidence for an effect of estrogen replacement therapy (ERT) on the incidence and prevalence of OA, especially radiological OA, and the effect of ERT on articular cartilage in women. The literature relating to these questions was reviewed using OVID Medline (1966 to March 2003). Some studies which have suggested a protective effect of ERT on the incidence and prevalence of OA. However, many of the confidence intervals include unity. Although a protective effect also was seen on articular knee cartilage in long-term users of ERT compared with never users, no difference in change in cartilage was seen over 2 years. There is weak epidemiological evidence suggesting a role for estrogen therapy in joint health in postmenopausal women. The data are more suggestive of an effect on large joint OA than small joint OA.
Publisher: BMJ
Date: 07-2005
Publisher: Wiley
Date: 09-02-2007
DOI: 10.1111/J.1365-2265.2007.02771.X
Abstract: The aim of this study was to evaluate whether subclinical thyroid disease is associated with impaired health-related quality of life and a more adverse cardiovascular disease risk profile. A community-based cross-sectional study. A total of 1423 non-healthcare-seeking women, aged 18-75 years were randomly recruited from the community via the electoral roll from April 2002 to August 2003. These were the scores for the Short-Form 36 (SF-36), the Psychological General Well-being Index (PGWI), thyroid hormone levels, serum lipids and high sensitivity C-reactive protein (hsCRP). Subclinical hypothyroidism (SCH) and subclinical hyperthyroidism (SCHyper) were defined as serum TSH > 4.0 mIU/l and < 0.5 mIU/l, respectively, with a normal free thyroxine (free T4) level. Evaluable data were available for all participants. 10.7% of all women had an abnormal TSH value. The prevalence of a low TSH level by age group ranged from 1.2% to 6.4%, whereas the prevalence of an elevated TSH level ranged from 2.8% to 9.2% and increased with age (P = 0.002). There were no significant differences between women with SCH or SCHyper and age-matched controls for the total PGWI score or the Mental and Physical Component Scores of the SF-36. Women with SCH were no different from controls for serum lipids or hsCRP. Using linear regression, SCH vs. euthyroidism did not make an independent contribution to variation in either total cholesterol or triglycerides, with or without adjustment for age +/- age(2) +/- BMI. Our data indicate that subclinical thyroid disease in women in the community is not associated with lower well-being or impaired health-related quality of life and SCH is not associated with increased serum markers of CVD risk.
Publisher: Wiley
Date: 02-2005
DOI: 10.1002/ART.20791
Abstract: Although obesity is widely accepted as a risk factor for knee osteoarthritis, it is not clear whether in idual components of body composition, such as the mass and distribution of muscle and fat, are associated with development of the disease. This study examined the effect of measures of body composition on the longitudinal change in tibial cartilage volume. Body composition, assessed via dual x-ray absorptiometry, and tibial cartilage volume, assessed via magnetic resonance imaging, were measured in 86 healthy men and women who were mid-life in age. Change in tibial cartilage volume was assessed by imaging each knee 2 years after the baseline measurement and determining the difference from baseline in tibial cartilage volume. Correlations were determined between the muscle and fat mass of the arm, leg, and total body and the volume of the lateral- and medial-tibial cartilage, as well as the change in tibial cartilage volume over 2 years, after adjusting for confounders. There was a significant association between muscle mass and the medial-tibial cartilage volume, independent of age, sex, body mass index, tibial bone area, and level of physical activity. Although there was a positive association between muscle mass and the lateral-tibial cartilage volume, this did not persist after adjustment for confounders. Loss of muscle mass was associated with an increased loss of medial- and lateral-tibial cartilage over 2 years, after adjusting for confounders. No relationship was apparent between fat mass and either medial- or lateral-tibial cartilage volume, or between fat mass and change in either medial- or lateral-tibial cartilage volume over 2 years, after adjusting for confounders. Muscle mass is an independent predictor of medial-tibial cartilage volume in healthy people in mid-life and is associated with a reduction in the rate of loss of tibial cartilage. This suggests that increased muscle mass may be protective against the onset of osteoarthritis.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.MATURITAS.2011.08.006
Abstract: To explore the effects of testosterone on cognitive performance in healthy postmenopausal women. Open-label pilot study. Nine postmenopausal women on non-oral hormone replacement therapy, aged 47-60 years received transdermal testosterone spray for 26 weeks. A control group of 30 women provided normative data for comparison. Scores from a computerized cognitive test battery performed pre- and post treatment, at 0 and 26 weeks. There were no differences between treatment/normative groups in any parameter at baseline. At week 26 scores for the International Shopping list task including delayed recall (verbal learning and memory) and the continuous paired associate learning task (visual learning and memory) were significantly higher in the treatment group as compared to the normative group (p<0.05). Significant improvements from baseline were observed for the International Shopping list delayed recall (verbal learning and memory) and Groton Maze recall tasks (visual learning and memory) for the treatment group (both p<0.05), after 26 weeks. There were no significant differences between baseline and week 26 in the normative group. In the regression analysis which modeled the score at week 26, and which included a bootstrapping approach, the beta coefficient for the treatment group was statistically significant when age and baseline score were taken into account for the International Shopping list task including delayed recall (both p<0.02). Testosterone improved cognitive performance in the domain of verbal learning and memory in a pilot study of healthy postmenopausal women and is worthy of further exploration in a randomized placebo controlled study.
Publisher: Informa UK Limited
Date: 15-09-2012
DOI: 10.3109/13697137.2012.707385
Abstract: The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition. We conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2012) for English-language studies that included the following search terms: 'menopause', 'midlife', 'hormone therapy' or 'estrogen' combined with 'obesity', 'body weight' or 'body composition'. Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated by estrogen therapy. Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen-progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes. The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.
Publisher: Springer Science and Business Media LLC
Date: 23-04-2015
DOI: 10.1038/NRDP.2015.4
Abstract: Menopause is an inevitable component of ageing and encompasses the loss of ovarian reproductive function, either occurring spontaneously or secondary to other conditions. It is not yet possible to accurately predict the onset of menopause, especially early menopause, to give women improved control of their fertility. The decline in ovarian oestrogen production at menopause can cause physical symptoms that may be debilitating, including hot flushes and night sweats, urogenital atrophy, sexual dysfunction, mood changes, bone loss, and metabolic changes that predispose to cardiovascular disease and diabetes. The in idual experience of the menopause transition varies widely. Important influential factors include the age at which menopause occurs, personal health and wellbeing, and each woman's environment and culture. Management options range from lifestyle assessment and intervention through to hormonal and non-hormonal pharmacotherapy, each of which has specific benefits and risks. Decisions about therapy for perimenopausal and postmenopausal women depend on symptomatology, health status, immediate and long-term health risks, personal life expectations, and the availability and cost of therapies. More effective and safe therapies for the management of menopausal symptoms need to be developed, particularly for women who have absolute contraindications to hormone therapy. For an illustrated summary of this Primer, visit: go.nature.com/BjvJVX.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.PSYNEUEN.2010.01.014
Abstract: Estrogen treatment may enhance the recovery of schizophrenia in women. However, adverse effects on uterine and breast tissue and other physical side effects may limit the long-term therapeutic use of estrogen. Raloxifene hydrochloride is a selective estrogen receptor modulator that acts as an estrogen antagonist in breast tissue and may have agonistic actions in the brain, potentially offering mental health benefits with few estrogenic side effects. To provide an indication of the potential therapeutic dose for raloxifene hydrochloride in postmenopausal women with schizophrenia, this study pools data from an ongoing randomized controlled trial of adjunctive 120 mg/day oral raloxifene hydrochloride (n=13) versus oral placebo (n=13), with data from a previous pilot study administering 60 mg/day raloxifene hydrochloride (n=9). Analysis of variance found significant interaction effects for total (p=.01) and general (p=.02) Positive and Negative Syndrome Scale (PANSS) symptomatology. Participants randomized to receive 120 mg/day raloxifene hydrochloride experienced a significantly more rapid recovery of total and general psychotic symptoms compared to both 60 mg/day raloxifene hydrochloride and placebo. The demonstrated benefit of adjunctive treatment with 120 mg/day raloxifene hydrochloride offers support for the potential role of this selective estrogen receptor modulator in treating postmenopausal women with schizophrenia.
Publisher: Elsevier BV
Date: 04-2002
DOI: 10.1016/S0015-0282(02)02969-2
Abstract: To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding definition, diagnosis, and assessment of androgen deficiency states in women. Evaluation of peer-review literature and consensus conference of international experts. Multinational conference in the United States. Premenopausal and postmenopausal women with androgen deficiency. Evaluation of peer-review literature and development of consensus panel guidelines. The term "female androgen insufficiency" was defined as consisting of a pattern of clinical symptoms in the presence of decreased bioavailable T and normal estrogen status. Currently available assays were found to be lacking in sensitivity and reliability at the lower ranges, and the need for an equilibrium dialysis measure was strongly emphasized. Causes of androgen insufficiency in women were classified as ovarian, adrenal, hypothalamic-pituitary, drug-related, and idiopathic. A simplified management algorithm and clinical guidelines were proposed to assist clinicians in diagnosis and assessment. Androgen replacement is currently available in several forms, although none has been approved for treatment of sexual dysfunction or other common symptoms of female androgen insufficiency. Potential risks associated with treatment were identified, and the need for informed consent and careful monitoring was noted. Finally, the panel identified key goals and priorities for future research. A new definition of androgen insufficiency in women has been proposed along with consensus-based guidelines for clinical assessment and diagnosis. A simplified management algorithm for women with low androgen in the presence of clinical symptoms and normal estrogen status has also been proposed.
Publisher: The Endocrine Society
Date: 2004
Abstract: We present the fourth case of an adult man (29 yr old) affected by aromatase deficiency resulting from a novel homozygous inactivating mutation of the CYP19 (P450arom) gene. At first observation, continuing linear growth, eunuchoid body proportions, diffuse bone pain, and bilateral cryptorchidism were observed. The patient presented also a complex dysmetabolic syndrome characterized by insulin resistance, diabetes mellitus type 2, acanthosis nigricans, liver steatohepatitis, and signs of precocious atherogenesis. The analysis of the effects induced by the successive treatment with high doses of testosterone, alendronate, and estradiol allows further insight into the roles of androgens and estrogens on several metabolic functions. High doses of testosterone treatment resulted in a severe imbalance in the estradiol to testosterone ratio together with the occurrence of insulin resistance and diabetes mellitus type 2. Estrogen treatment resulted in an improvement of acanthosis nigricans, insulin resistance, and liver steatohepatitis, coupled with a better glycemic control and the disappearance of two carotid plaques. Furthermore, the study confirms previous data concerning the key role of estrogens on male bone maturation, at least in part, and regulation of gonadotropin secretion. The biopsy of the testis showed a pattern of total germ cell depletion that might be due to the concomitant presence of bilateral cryptorchidism. Thus, a possible role of estrogen in male reproductive function is suggested but without revealing a direct cause-effect relationship. Data from this case provide new insights into the role of estrogens in glucose, lipid, and liver metabolism in men. This new case of aromatase deficiency confirms previous data on bone maturation and mineralization, and it reveals a high risk for the precocious development of cardiovascular disease in young aromatase-deficient men.
Publisher: Informa UK Limited
Date: 04-12-2015
DOI: 10.3109/13697137.2014.978754
Abstract: Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years. A systematic literature search of English-language publications was performed using MEDLINE, EMBASE, CINAHL, and PsycINFO. Twenty-three studies that included information on the prevalence of vasomotor and/or urogenital atrophy symptoms among older women (65 + years) met our inclusion criteria. Risk of bias of the included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. The available data suggest that vasomotor symptoms are experienced by a considerable proportion of older women, that symptoms of urogenital atrophy including urinary incontinence are widespread, and that women remain sexually active well into later life. A high degree of variability was observed for the prevalence of estrogen deficiency symptoms for women age 65+ years. Discrepancies in modes of recruitment, s ling procedures, time frames over which symptoms were assessed and use of different and non-validated assessment tools contributed to the inconsistencies across the published studies. Larger and appropriately s led studies, employing validated questionnaires, are still needed to establish the prevalence of persistent estrogen depletion symptoms in women aged 65+ years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1097/00042192-200512020-00016
Abstract: Although natural menopause is associated with loss of ovarian estrogen production, this life phase is followed by a significant increase in estrogen-related cancers, namely breast and endometrial cancer. These tissues, as well as adipose, skeletal, and vascular tissues and the brain are important sites of postmenopausal estrogen production. Circulating C19 steroid precursors are essential substrates for extragonadal estrogen synthesis however, the levels of these androgenic precursors decline markedly with advancing age. This implies an increase in capacity for extragonadal tissues to produce estrogen with age. To explore this, and the effects of the menopause transition and postmenopausal estrogen therapy on extragonadal estrogen biosynthesis, we have compared the expression of the aromatase gene and estrogen (ER) and androgen receptors (AR) in subcutaneous abdominal and gluteal fat taken from premenopausal (group 1: n = 11), postmenopausal (group 2: n = 10), and postmenopausal women taking estrogen therapy (group 3: n = 10). All subjects were of normal body mass index, euglycemic, and normolipemic. The postmenopausal women were older (group 1, 43.1 +/- 5.0 vs groups 2 and 3, 57.9 +/- 7.4 years, P < 0.001 and 56.1 +/- 4.5 years, P < 0.001, respectively) and had lower serum estradiol levels (group 2, 22.2 +/- 3.2 vs group 1, 442.5 +/- 248.2 pmol/L, P < 0.05), which were restored to premenopausal levels with estrogen therapy. Expression analysis revealed that levels of transcripts encoding aromatase were greater in gluteal than abdominal depots in each group in postmenopausal versus premenopausal women (P < 0.05). Use of hormone therapy did not influence aromatase gene expression in either depot. No differences were detected in the expression of ER or AR between groups of between tissue depots. Thus, the capacity of adipose tissue to produce estrogen seems to increase significantly with age at the time of menopause and to be unaltered by exogenous estrogen therapy. This difference in extragonadal estrogen production with age may play a pivotal role in the increase in estrogen-dependent malignancies in the postmenopausal years.
Publisher: Wiley
Date: 02-01-2021
DOI: 10.1111/CEN.14401
Publisher: Springer Science and Business Media LLC
Date: 27-05-2022
DOI: 10.1038/S41574-022-00685-4
Abstract: Every woman who lives past midlife will experience menopause, which, by definition, is complete cessation of ovarian function. This process might occur spontaneously (natural menopause) or be iatrogenic (secondary menopause), and can be further classified as 'early' if it occurs before the age of 45 years and 'premature' if it occurs before the age of 40 years. Globally, the mean age of natural menopause is 48.8 years, with remarkably little geographic variation. A woman's age at menopause influences health outcomes in later life. Early menopause is associated with a reduced risk of breast cancer, but increased risks of premature osteoporosis, cardiovascular disease and premature death. The cardinal symptoms of menopause, and adverse health sequelae, are due to loss of ovarian oestrogen production. Consequently, menopausal hormone therapy (MHT) that includes oestrogen or an oestrogenic compound ameliorates menopausal symptoms, while preventing menopause-associated bone loss and cardiometabolic changes. Importantly, comprehensive care of postmenopausal women involves lifestyle optimization (attention to nutrition and physical activity, reducing alcohol consumption and not smoking) and treating other established chronic disease risk factors. This Review offers a commentary specifically on the contemporary use of MHT and novel pharmaceutical alternatives to manage menopausal symptoms.
Publisher: The Endocrine Society
Date: 08-2019
DOI: 10.1210/JC.81.8.2759
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
DOI: 10.1097/GME.0B013E3181E77468
Abstract: Although bone density by dual-energy x-ray absorptiometry (DXA) is the standard measure for the diagnosis of osteoporosis, as a screening tool, it has significant cost and availability of DXA is not universal. Prospective Screening for Osteoporosis Australian Primary Care Evaluation of Clinical Tests (PROSPECT) was a national study undertaken to establish an effective prescreening protocol to be used in primary care facilitating targeted radiological investigation for osteoporosis in older women. Two hundred sixty-seven primary care physicians recruited 2,466 women 70 years and older who had no previous diagnosis of osteoporosis in a community-based cross-sectional study. The main outcome measures used were lumbar spine and femoral neck T-scores on DXA and presence of a vertebral fracture on thoracolumbar x-ray. Participant characteristics, gap-on-wall occiput test, and rib-to-pelvis distance measurements were provided by each primary care physician. Of the study population, 21.8% (95% CI, 19.9%-23.8%) had osteoporosis of the femoral neck and/or lumbar spine based on DXA, and 24.7% (95% CI, 22.5%-26.9%) had at least one vertebral fracture. Only 7.3% (95% CI, 6.2%-8.3%) had both osteoporosis and radiological vertebral fracture. Univariate and multivariate regression modeling of the demographic and clinical data collected resulted in a three-factor predictive tool for the diagnosis of osteoporosis and/or vertebral fracture that included the following variables: rib-pelvis distance greater than 2 fingerbreadths (yes/no), ever use of estrogen for more than 6 months (yes/no), and body mass index ( 30 kg/m²). Only screening women classified as moderate to high risk by the tool DXA plus plain x-ray would then result in 14% of women 70 years or older who were not being screened, with 93% of cases being detected. The Prospective Screening for Osteoporosis Australian Primary Care Evaluation of Clinical Tests tool will contribute to the diagnosis and management of osteoporosis by facilitating targeted screening and hence reducing the need for unnecessary radiology tests at the primary care level.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2003
Publisher: Mary Ann Liebert Inc
Date: 04-2018
Abstract: Little is known of the prevalence and severity of menstrual dysfunction, climacteric symptoms, pelvic floor disorders, sexual problems, and psychological wellbeing after lung transplantation in women. Adult female lung transplant recipients, attending the Alfred Hospital Lung Transplant Service in Melbourne, Australia participated in a women's health, cross-sectional questionnaire-based study. The 123 of 149 potential participants were recruited between September 2014 and July 2015. Their median age was 53.5 years, and 44 were premenopausal, 3 perimenopausal, and 76 postmenopausal. Moderate-severe menstrual and premenstrual symptoms were common, and 43% of partnered premenopausal women were not using contraception. Vasomotor symptoms (VMS) were common in postmenopausal women <55 years (80.0%), and the use of menopausal hormone therapy was low (8.9%). The estimated prevalence of low sexual desire associated with distress was 24.4%. Low wellbeing was significantly and independently associated with being aged 50 ≤ 60 years, moderate-severe VMS, impaired forced expiratory volume in 1 second, and psychotropic medication use. Our findings demonstrate that premenopausal lung transplant recipients need to be asked about bothersome menstrual symptoms, and contraceptive compliance needs regular review. Transplant recipients at midlife have substantially lower wellbeing than women of other ages and this needs attention, including assessment and management of menopausal symptoms.
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.PSYNEUEN.2005.11.001
Abstract: We tested and compared the use of two adjunctive hormonal agents, tamoxifen and medroxyprogesterone acetate (MPA), for the treatment of acute mania or hypomania. A total of 13 women with acute Bipolar Affective Disorder in the manic or hypomanic phase were recruited from a clinical population to participate in this 28-day, three-arm, double blind, placebo-controlled study. The women who received tamoxifen exhibited significant improvement in symptoms of mania from baseline to final assessment compared with the placebo group. The MPA group improved more than the placebo group. Further exploration of tamoxifen as a useful adjunct in the treatment of acute manic symptoms in women with Bipolar Affective Disorder is warranted.
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.MATURITAS.2005.03.011
Abstract: Recent trials have suggested an adverse early effect on cardiovascular risk of hormone therapy (HT) in postmenopausal women, an effect which could be due to an increase in arterial thrombosis via platelet activation. We examined the effect of HT on platelet surface expression of P-selectin, a marker of platelet activation, and plasma levels of soluble P-selectin, also believed to be a marker of platelet activation, and compared these effects with pravastatin, a drug proven to reduce cardiovascular events and reported to decrease both platelet and soluble P-selectin. Surface expression of platelet P-selectin, soluble P-selectin and fasting lipids were measured at baseline and 6 months in a randomized, double-blind study of postmenopausal hypercholesterolemic women comparing low-dose combined HT (1mg estradiol + 0.5 mg norethisterone acetate n = 26) with pravastatin (n = 24). After adjusting for baseline levels, HT and pravastatin produced similar reductions in soluble P-selectin (p < 0.0001 for both). The percentage of platelets expressing P-selectin was also reduced by pravastatin (p = 0.025), but there was a trend to an increase in platelet P-selectin expression with HT (p = 0.13), and a significant difference between pravastatin and HT in the changes in platelet P-selectin (p < 0.002). No relationship was evident between changes in soluble or platelet P-selectin and changes in lipids with either treatment. In postmenopausal hypercholesterolemic women, both pravastatin and HT reduced soluble P-selectin levels, but only pravastatin reduced P-selectin expression on the surface of platelets. An implication of these findings is that the reduction in soluble P-selectin by HT may occur by a non-platelet related mechanism.
Publisher: Informa UK Limited
Date: 27-05-2019
DOI: 10.3109/13697137.2013.801736
Abstract: The aim of this review was to summarize the literature regarding the potential role of testosterone therapy for women. The author conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2013) for English-language studies that included the following search terms: 'testosterone' or 'androgen' combined with 'women', 'therapy' or 'treatment'. Randomized, placebo-controlled trials have consistently shown that transdermal testosterone therapy improves sexual desire, arousal, orgasm frequency and satisfaction in premenopausal and postmenopausal women presenting with sexual desire/arousal problems. No adverse metabolic effects have been observed in these studies. In postmenopausal women, testosterone therapy has also been associated with favorable effects on body composition, bone, cardiovascular function and cognitive performance. Although androgens have many varied roles, the focus of testosterone therapy for women has been on improving sexual desire. Not only do testosterone effects on sexuality extend beyond libido, but testosterone has other key physiological actions. Issues that urgently need to be addressed include approval of a testosterone formulation that delivers a female dose such that physicians refrain from prescribing compounded testosterone or modifying doses of testosterone formulated for men and regulation of prescription of compounded androgens for women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2006
DOI: 10.1097/01.GME.0000227333.50867.4E
Abstract: To explore whether inhibition of the conversion of testosterone to estradiol modifies the effects of testosterone on cognition in 61 healthy, estrogen-treated postmenopausal women. Seventy-six postmenopausal women using transdermal estrogen for at least 8 weeks, with a serum total testosterone less than 1.2 nmol/L participated in a single-center, double-blind, randomized, placebo-controlled study. All participants received transdermal testosterone, 400 muL of a 0.5% testosterone gel, daily and were randomized to receive either letrozole 2.5 mg/day or an identical placebo tablet. The main outcome measure was cognition, evaluated using a comprehensive battery of standardized neuropsychological tests, at baseline and week 16. Thirty women in each group completed the study. Free testosterone increased from baseline in both groups, with no difference between groups. Free testosterone levels achieved were below the 90th centile for young women in 80% of the participants at week 16. Serum estradiol and sex hormone-binding globulin levels did not differ from baseline or between groups during the study. No clinically significant effects of testosterone treatment were seen for attention and working memory, psychomotor speed, or executive function. Significant improvements were seen for immediate and delayed visual and verbal memory and for simple concentration with testosterone therapy, all of which were unaffected by the aromatase inhibitor. We did not observe any effects of aromatase inhibition on cognition in healthy, estrogen-treated postmenopausal women treated with testosterone. This may be due to insufficient study power or a true lack of effect. However, our findings highlight that the detection of subtle changes in cognition in well women require the development of sensitive instruments and large randomized, controlled trials.
Publisher: Informa UK Limited
Date: 04-07-2018
Publisher: Wiley
Date: 08-1998
Publisher: Mary Ann Liebert Inc
Date: 12-2009
Abstract: The aim of this study was to investigate the level of understanding in women with newly diagnosed invasive breast cancer of the key clinical features of their disease that are important determinants in treatment decision making. The 1684 women aged between 26 and 88 years at diagnosis enrolled in a 5-year cohort study were asked by questionnaire about their estrogen receptor (ER) and progesterone receptor (PR) status and about their past or current treatment with adjuvant endocrine therapy. Information was linked with their ER and PR status determined from the histopathology report. Logistic regression analysis was used to explore the relationship between age and education status and the likelihood of being able to correctly report hormone receptor status, as well as the relationship between the likelihood of receiving adjuvant endocrine therapy and knowledge of hormone receptor status in women who were ER or PR positive. Not being able to correctly report hormone receptor status was associated with being older and having a lower level of education. Of women who were ER positive or PR positive or both and were at least 40 weeks from diagnosis, having received some form of endocrine therapy was significantly associated with self-identification as being ER or PR positive (OR=1.82, 95% CI 1.24-2.68, p=0.002), even when age was taken into account. That self-knowledge of hormone receptor status was independently associated with likelihood of receiving endocrine therapy suggests that the methods of helping women understand the nature of their breast cancer are worthy of review.
Publisher: Elsevier BV
Date: 08-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-0003
Publisher: Elsevier BV
Date: 12-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2005
Publisher: Informa UK Limited
Date: 20-10-2016
DOI: 10.1080/13697137.2016.1240771
Abstract: To investigate the prevalence of, and risk factors for, pelvic floor disorders (PFDs) in women in Bangladesh. A nationally representative s le of 1590 Bangladeshi women, aged 30-59 years, was recruited using a multistage cluster s ling technique, between September 2013 and March 2014. Urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) were assessed using validated questionnaires. The weighted prevalence and the factors associated with each PFD were investigated using multivariable weighted logistic regression. The weighted prevalence of UI was 23.7% (95% confidence interval (CI) 21.3-26.0%), FI 5.3% (95% CI 4.0-6.6%), POP 16.2% (95% CI 14.2-18.2%), and having at least one PFD 35.3% (95% CI 32.6-37.9%). Women were more likely to have at least one PFD if aged 40-49 years (adjusted odds ratio (AOR) 1.46, 95% CI 1.02-2.08 p = 0.040) or 50-59 years (AOR 2.39, 95% CI 1.59-3.58 p < 0.0001), compared with women aged 30-39 years. Having at least one PFD was positively associated with having three or more versus fewer children (AOR 1.61, 95% CI 1.14-2.27 p = 0.007), being in the middle (AOR 3.05, 95% CI 1.72-5.41 p < 0.0001), second lowest (AOR 2.49, 95% CI 1.39-4.47 p = 0.002) or lowest (AOR 3.13, 95% CI 1.68-5.86 p < 0.0001) wealth quintile compared with the highest, and self-reporting diabetes (AOR 2.55, 95% CI 1.54-4.23 p < 0.0001). One-third of Bangladeshi women aged 30-59 years had at least one symptomatic PFD. Risk factors included greater age, higher parity, lower wealth status and self-reported diabetes. The diagnosis, treatment, and prevention of PFDs in Bangladesh need greater attention, as the prevalence of these disabling conditions is likely to increase with the aging of the population.
Publisher: Wiley
Date: 27-02-2023
DOI: 10.1111/CEN.14898
Abstract: The role of circulating sex hormones on structural brain ageing is yet to be established. This study explored whether concentrations of circulating sex hormones in older women are associated with the baseline and longitudinal changes in structural brain ageing, defined by the brain‐predicted age difference (brain‐PAD). Prospective cohort study using data from NEURO and Sex Hormones in Older Women substudies of the ASPirin in Reducing Events in the Elderly clinical trial. Community‐dwelling older women (aged 70+ years). Oestrone, testosterone, dehydroepiandrosterone (DHEA), and sex‐hormone binding globulin (SHBG) were quantified from plasma s les collected at baseline. T1‐weighted magnetic resonance imaging was performed at baseline, 1 and 3 years. Brain age was derived from whole brain volume using a validated algorithm. The s le comprised of 207 women not taking medications known to influence sex hormone concentrations. A statistically higher baseline brain‐PAD (older brain age relative to chronological age) was seen for women in the highest DHEA tertile compared with the lowest in the unadjusted analysis ( p = .04). This was not significant when adjusted for chronological age, and potential confounding health and behavioural factors. Oestrone, testosterone and SHBG were not associated with brain‐PAD cross‐sectionally, nor were any of the examined sex hormones or SHBG associated with brain‐PAD longitudinally. No strong evidence of an association between circulating sex hormones and brain‐PAD. Given there is prior evidence to suggests sex hormones may be important for brain ageing, further studies of circulating sex hormones and brain health in postmenopausal women are warranted.
Publisher: Informa UK Limited
Date: 08-01-2014
DOI: 10.3109/13697137.2013.865721
Abstract: To systematically review the published data for the prevalence and severity of menopausal symptoms in Australian women. A comprehensive and systematic literature search was done using six databases to extract all English-language, peer-reviewed studies that contained information on the prevalence of menopausal symptoms among women living in Australia. Risk of bias of included studies was assessed using a risk-of-bias tool specifically designed for the systematic review of prevalence studies. Eight independent studies met our inclusion criteria. There was no consistent pattern of vasomotor, psychological, physical or sexual symptom prevalence for the studies that reported symptoms across the menopausal stages. The ranges of the prevalences for the various outcomes were wide. A high level of bias was observed related to both external and internal validities for the included studies. The available data for the prevalence of menopausal symptoms in Australian women are not sufficient to allow conclusive findings. A large, appropriately s led study using a validated questionnaire is needed to establish the prevalence and severity of menopausal symptoms in Australian women.
Publisher: The Endocrine Society
Date: 06-2011
DOI: 10.1210/JC.2010-2888
Abstract: It has been proposed that because dehydroepiandrosterone (DHEA) and its sulfate, DHEAS, are important precursors for estrogen and androgen production, treatment with DHEA is a physiologically based strategy for the alleviation of hormone deficiency symptoms in postmenopausal women. We have summarized the physiology of DHEA in women and reviewed the findings from randomized controlled trials (RCT) of the effects of DHEA therapy in postmenopausal women with normal adrenal function. We reviewed the medical literature for key papers investigating DHEA physiology and RCT of the use of DHEA in postmenopausal women through November 2010. The focus was on sexual function, well-being, metabolic parameters, and cognition as study endpoints. Although cross-sectional studies have indicated a link between low DHEA levels and impaired sexual function, well-being, and cognitive performance in postmenopausal women, placebo-controlled RCT do not show benefits of oral DHEA for any of these outcomes or favorable effects on lipids and carbohydrate metabolism. Taken together, findings from this review of the published literature of studies do not support the use of DHEA in postmenopausal women at this time.
Publisher: The Endocrine Society
Date: 06-02-2020
Abstract: An important element of the diagnosis of polycystic ovary syndrome is hyperandrogenism. To determine the distribution of modified Ferriman-Gallwey (mF-G) scores, as a measure of facial and body hair growth, and associations between the mF-G scores and serum androgen concentrations, including 11-oxygenated androgens. Cross-sectional study of non-health-care-seeking women, aged 18 to 39 years, recruited from the eastern states of Australia from November 2016 to July 2017. Participants provided an mF-G self-assessment that corresponded to their appearance when not using treatment for excess hair. Androgens were measured in 710 women by liquid chromatography and tandem mass spectrometry. The distribution of the mF-G scores was right-skewed. The median (range) mF-G score of all participants (73.1% Caucasian) was 5 (0–36). The mF-G scores were negatively associated with age (rs = 0.124 P & 0.0001) and positively associated with body mass index (BMI) (rs = 0.073 P & 0.0001). Only androstenedione remained significantly associated with mF-G scores when controlling for age and BMI. Cluster analysis identified 2 groups with mF-G score of & 10 and ≥ 10. Repeating the cluster analysis using the combined vector of mF-G score and androstenedione returned a similar cluster structure, and again separated the 2 groups at a mF-G score & 10 versus ≥ 10. A self-assessed mF-G score ≥ 10 is indicative of excess body hair. Androstenedione, as well as testosterone, should be measured when hyperandrogenism is being evaluated. The lack of association between mF-G scores and the 11-oxygenated androgens highlights the need for a better understanding of these steroids.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.FERTNSTERT.2015.09.017
Abstract: To determine the prevalence and severity of vasomotor symptoms (VMS) and sexual symptoms in community-dwelling older women, and to explore factors associated with VMS. Population-based cross-sectional study. Not applicable. A total of 1,548 women aged 65-79 years. None. The presence and self-rated severity of VMS (hot flashes, night sweats, or sweating), and sexual symptoms (intimacy, desire, and vaginal dryness) were determined with the use of the Menopause Quality of Life (MenQOL) questionnaire. All items of the vasomotor and the sexual MenQOL domains were completed by 1,532 and 1,361 of the study participants, respectively. Menopausal hormone therapy (MHT) use was reported by 6.2% of the women, and 6.9% reported using vaginal estrogen. Among the 1,426 women not using MHT, at least 1 VMS was reported by 32.8%. The prevalence of VMS rated as moderately to severely bothersome was 3.4%. A total of 54.4% of currently partnered women had sexual symptoms, and 32.5% reported vaginal dryness during intercourse in the past month. In the multivariate analysis, factors significantly associated with VMS were age, obesity, being a caregiver for another person, and bilateral oophorectomy. VMS and vaginal atrophy symptoms are common in community-dwelling older women, but they are predominantly untreated. The degree of distress caused by sexual symptoms among older women needs further exploration.
Publisher: Oxford University Press (OUP)
Date: 10-2009
DOI: 10.1111/J.1743-6109.2009.01406.X
Abstract: The extent to which low sexual function or sexual dissatisfaction in women impacts on well-being remains uncertain, yet this is a critical issue in the controversy as to the benefits of pharmacotherapy for women seeking treatment for female sexual dysfunction. Aim. To explore the relationship between well-being and self-perceived satisfaction with sexual function in women and to determine if there is an independent effect of menopausal status or age. A community-based cross-sectional study. A total of 421 women, aged 18 to 65 years were recruited from the community. Women were required to self-identify at study outset as being either satisfied or dissatisfied with their sexual life and be premenopausal or postmenopausal. Scores from the Psychological General Well-Being Index (PGWB), the Beck Depression Index (BDI) and a daily diary of sexual function. A group of 349 women were included in the analysis. Total PGWB and domain scores of positive well-being and vitality were lower in dissatisfied women compared to satisfied women. PGWB total and domain scores of depressed mood, positive well-being and vitality were higher in older women. Menopause did not have an independent effect on well-being. Women who self-identify as having sexual dissatisfaction have lower psychological general well-being. These findings reinforce the importance of addressing sexual health and well-being in women as an essential component of their health care.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.MATURITAS.2015.06.004
Abstract: The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40-65 years, taking into account socio-demographic and lifestyle factors. This was a cross-sectional survey of 2020 Australian women, aged 40-65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient (β)=-8.17, 95% confidence interval (CI) -10.90 to -5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered (β=-2.80, 95% CI -4.74 to -0.86), obese (β=-5.46, 95% CI -7.24 to -3.68) and a smoker (β=-3.47, 95% CI -6.10 to -0.84). Older age (β=0.29, 95% CI 0.06-0.42) and participation in paid and/or volunteer work (β=2.72, 95% CI 0.61-4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2014
DOI: 10.1007/S00198-014-2945-5
Abstract: Minimal-trauma fracture is an important issue in breast cancer survivors, especially rib fracture. The likelihood of fracture is affected by menopausal status and a diagnosis of osteoporosis prior to breast cancer. Most women reported at least one assessment of bone mineral density. We have investigated the self-reported frequency and pattern of minimal-trauma fracture (MTF) in breast cancer (BC) survivors at least 5 years from diagnosis, along with the use of bone mineral density (BMD) assessment. This study was carried out within the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study which is a questionnaire-based prospective cohort study of 1683 women diagnosed with their first invasive breast cancer between 2004 and 2006 and followed for at least 5 years. One thousand two hundred and five women, who remained free of recurrence or new breast cancer, completed the fifth annual follow-up. One hundred sixty-four (13.6%) reported at least one MTF. Rib fracture was the most common (52 fractures in 46 women). Compared with women who remained pre- eri-menopausal, either being postmenopausal at diagnosis (OR 3.53, 95% Confidence Interval (CI) 1.09-11.44, p=0.036) or changing from pre- to postmenopausal during follow-up (OR 3.97, 95% CI 1.21-13.10, p=0.023) was associated with a higher likelihood of fracture, as was having a diagnosis of osteoporosis at the time of diagnosis (OR 1.74, 95% CI 1.00-2.99, p=0.047). Most women (64.9%) reported at least one BMD assessment. Overall MTF is a problem for breast cancer survivors, with rib fracture a particular issue for women in our study. Both pre-existing osteoporosis and being postmenopausal are risk factors for subsequent MTF in women treated for breast cancer. Clinicians need to be mindful of fracture prevention medication in these groups.
Publisher: Springer Science and Business Media LLC
Date: 04-11-2008
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.JOCA.2007.04.010
Abstract: Bone marrow lesions (BMLs) have been shown to be associated with pain and progression of knee osteoarthritis (OA) in those with disease. The natural history of BMLs in a healthy population and their role in the pathogenesis of OA are unknown. The aim of this study was to determine the risk factors for BMLs in healthy subjects and the association of BMLs with knee structure. One hundred and seventy-six healthy, adult women with no history of knee injury, or clinical knee OA had magnetic resonance imaging performed on their dominant knee to assess BMLs, tibiofemoral cartilage defects, tibial cartilage volume and bone area. Thirteen percent of subjects had knee BMLs. The prevalence was higher in the medial tibiofemoral compartment. There was a significant positive association between BMLs and cartilage defects after adjusting for the potential risk factors: age, height, weight and cartilage volume [odds ratio (OR) 1.78 (95% confidence interval [CI] 1.12, 2.82), P=0.01]. BML was positively associated with tibial plateau bone area in the lateral compartment [OR 1.67 (95% CI 1.02, 2.71), P=0.04]. There was no significant association between BMLs and cartilage volume. Independent risk factors for BMLs after adjustment were increasing height [OR 1.18 (95% CI 1.02, 1.36), P=0.02 for lateral compartment] and weight [OR 1.04 (95% CI 1.01, 1.08), P=0.005 for total knee]. These data support that BMLs are present in a similar distribution to tibiofemoral knee OA. Their presence is associated with risk factors (height and weight) for knee OA, and the early structural changes of knee OA in subjects without knee pain and thus no clinical disease. Longitudinal studies will clarify whether BMLs relate to the pathogenesis of clinical knee OA.
Publisher: Informa UK Limited
Date: 21-04-2010
DOI: 10.1517/14656561003742962
Abstract: Over the last decade, the management of the menopause has attracted extensive public and professional debate and has become one of the most controversial areas in clinical practice. This review provides an overview of the field, primarily from a clinical practice perspective. However, as we have incorporated in this 'big-picture' snapshot of the field both conventional and complementary approaches to managing the menopause, it is not an exhaustive review of the literature. By reviewing menopausal management from the perspective of practicing clinicians, we hope readers will gain insight into decision making processes appropriate for dealing with symptomatic women. Although most women do not require pharmacotherapy for menopausal symptoms, many are severely affected by estrogen deficiency at and beyond menopause and, for such women, hormone therapy is important if they are to retain an acceptable quality of life. This article considers the drug treatment of the symptomatic postmenopausal woman and the safety issues related to these medications.
Publisher: Oxford University Press (OUP)
Date: 03-2008
DOI: 10.1111/J.1743-6109.2007.00726.X
Abstract: There are some data to suggest that tibolone improves sexual function in postmenopausal women. However, evidence about the effects of tibolone on female sexual dysfunction is lacking. To compare the efficacy on sexual function of tibolone 2.5 mg to continuous combined transdermal estradiol (E2)/norethisterone acetate (NETA) (50 microg/140 microg) in naturally postmenopausal women with sexual dysfunction. Differences between treatment groups in the change from baseline for the composite subscore of the arousal, desire, and satisfaction domains of the self-reported Female Sexual Function Index (FSFI). A multicenter, double-blind, randomized, clinical trial was performed. Sexual function was assessed with the FSFI at baseline, week 12, and week 24. The outcomes of the Female Sexual Distress Scale (FSDS) and the frequency of satisfying sexual events (daily diaries) were secondary end points. Four hundred three women, mean age 56, were included. Both therapies improved sexual function assessed by the FSFI. In the per protocol analysis, but not in the intent-to-treat analysis, the increase in FSFI scores was significantly larger in the tibolone group when compared with the E2/NETA patch group at week 24 (P = 0.036 and P = 0.025 for the composite subscore and total FSFI score, respectively). The satisfying sexual event rate increased from three to four times per 28 days at week 24 (P < 0.001 from baseline for both groups), with no difference between groups. The FSDS showed a significant decrease from baseline (P < 0.001), which was comparable for both treatment groups. Both treatments resulted to improved overall sexual function, as determined by scores on the FSFI, an increase in the frequency of sexual events, and a reduction in sexuality-related personal distress. The statistically significant higher FSFI scores in the tibolone group, when compared to the E2/NETA group, may be because of tibolone's combined estrogenic and androgenic properties.
Publisher: Informa UK Limited
Date: 03-2001
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.MATURITAS.2016.02.003
Abstract: It has been hypothesised that vasomotor symptoms (VMS), the hallmark of menopause, may affect women's workplace performance. The aim of this study was to investigate the association between VMS and self-reported work ability, taking into account socio-demographic characteristics. Study design/Main Outcome measures: A national cross-sectional survey of women, aged 40-65 years, was conducted between October 2013 and March 2014. Participants provided socio-demographic and lifestyle factors and completed the Menopause Specific Quality of Life Questionnaire (MENQOL) and the Work Ability Index (WAI). Of 2020 women who comprised the study s le, 1274 were in paid employment and 1263 completed the WAI. The WAI score was good-excellent for 81.5% of women and poor-moderate for 18.5%. After adjustment for socio-demographic characteristics, having any VMS was associated with greater likelihood of poor-moderate work ability [odds ratio (OR)=2.45, 95% CI 1.69-3.54]. Poorer work ability was significantly and independently associated with being un-partnered, obese or overweight, smoking, being carer and having insecure housing finance, but not with age. Overall, most women functioned well at work. We observed an association suggesting a relationship not only between menopausal VMS and personal wellbeing, but also between VMS and self-assessed work ability. Although 4 in 5 women functioned well at work, recognition of the association with VMS may improve wellbeing and work performance of working women at midlife.
Publisher: Wiley
Date: 26-02-2008
DOI: 10.1111/J.1442-2042.2007.01976.X
Abstract: Urinary incontinence in women is common and has a significant impact on the physical, psychological and socio-economic aspects of life. The aims of this study were to review the published reports on the prevalence and incidence of urinary incontinence in Australian women and to examine the methodological issues associated with these studies. Electronic searches of Medline, EMBASE and the Current Index to Nursing and Allied Health Literature databases were undertaken using 'Medical Subject Heading' terms and 'free text' words. We retrieved papers that investigated the prevalence and/or incidence of urinary incontinence in Australian women and were published in English after 1980. Methodological data from each study were tabulated. Seven studies were identified which examined the prevalence of urinary incontinence and two studies that reported its incidence. The prevalence of urinary incontinence varied between 12.8% and 46.0%. Study heterogeneity was a consequence of response rates, the inclusion of women in institutional care, the method of data collection, the questions used to identify different types of urinary incontinence and the way these questions were reported, the period over which the urinary incontinence had occurred and the severity of the incontinence. Two studies which examined incidence provided evidence that urinary incontinence can be a transient phenomenon. Research into the incidence and prevalence of urinary incontinence in Australian women exhibits significant heterogeneity in the findings due to methodological limitations. There is a need for future studies to employ validated instruments and give careful attention to the selection of participants and the reporting of age-specific data.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
DOI: 10.1097/GME.0B013E3181D991DD
Abstract: Our aim was to document patterns of consultation with alternative practitioners, use of complementary and alternative medicine (CAM) commonly used to alleviate menopausal symptoms, and lifestyle changes made by women in the first 2 years after their diagnosis with invasive breast cancer. A total of 1,588 women in the MBF Foundation Health and Wellbeing After Breast Cancer Study completed both the enrollment questionnaire and the first follow-up questionnaire (FQ1), on average, 41 and 92 weeks after diagnosis, respectively. The Menopause Quality of Life Questionnaire and the Psychological General Wellbeing Index were included in the FQ1. Logistic regression analysis was used to examine characteristics associated with consulting a CAM practitioner or using CAMs. At the time of completion of the FQ1, 16.4% of women had consulted a CAM practitioner and 10.6% reported using at least one CAM commonly used to alleviate menopausal symptoms. Women who consulted a CAM practitioner and women who were using at least one CAM at the time of completion of the FQ1 were, on average, younger and more educated and had a higher Menopause Quality of Life Questionnaire score than did women who did not. Of the women, 33.6% reported having made a dietary change, and the most common lifestyle change was an increase in physical activity, which was reported by 29.0% of women. The frequency of use of CAMs in common usage for menopausal symptoms by women with breast cancer was lower than anticipated, increased with time from diagnosis, and is associated with more severe menopausal symptoms.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.MATURITAS.2014.10.005
Abstract: To understand the challenges and experiences encountered during data collection for Bangladesh Midlife Women's Health Study (BMWHS) that investigated the low uptake of cervical cancer (CCa) screening barriers, understanding of breast cancer (BCa) knowledge and practices, the prevalence of urinary and fecal incontinence and menopausal symptoms. A multistage cluster s ling technique was used to recruit women from the 32 districts of Bangladesh that had offered CCa screening. Female interviewers were trained to undertake structured face-to-face interviews that incorporated both non-validated and several validated questionnaires, such as Question for Urinary Incontinence Diagnosis, Pelvic Organ Prolapse Distress Inventory, Colorectal-Anal Distress Inventory and Menopause-Specific Quality of Life. We completed surveys of 1590 women, estimated age 30-59 years, between September 2013 and March 2014. We implemented several strategies to deal with low literacy and used the temporal relationship between marriage and childbirth, and the average age of onset of menarche, to estimate age. Cultural and religious sensitivities and personal security were managed by engaging community leaders, limiting activities to daylight hours, adopting local codes of dress, such as the wearing of head scarves. Our major challenges and experiences included difficulties in age determination, selection of and access to households, interview privacy, lack of basic and health literacy, transportation, political unrest and security of the interviewers. By anticipating challenges, we have been able to comprehensively survey a representative s le of Bangladeshi women. Disseminating information about the field challenges and experiences from the BMWHS should assist other researchers planning to conduct surveys about women's health issues in similar context.
Publisher: Springer Science and Business Media LLC
Date: 29-10-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
DOI: 10.1097/GME.0000000000000615
Abstract: The aim of the study was to document the prevalence of menopausal symptoms and the extent to which women are bothered by vasomotor symptoms (VMS) and joint pain in Bangladesh. A total of 1,590 women, aged 30 to 59 years, participated in a cross-sectional, questionnaire-based study between September 2013 and March 2014. The main outcome measures were moderate to severely bothersome VMS and joint pain, measured by the Menopause-Specific Quality of Life questionnaire. Of participants, 59.4% were premenopausal, 8.4% perimenopausal, and 32.3% postmenopausal. Approximately all women reached menopause by the age of 50 years. The prevalence of moderate to severely bothersome VMS was 4.1% in premenopausal, 33.3% in perimenopausal, and 28.2% in postmenopausal women. Factors associated with moderate to severely bothersome VMS were being perimenopausal (odds ratio [OR] 46.34, 95% CI 13.29-161.56 P 0.001) or postmenopausal (OR 19.15, 95% CI 5.63-65.11 P 0.001) and obesity (OR 2.20, 95% CI 1.03-4.71 P = 0.042). The prevalence of moderate to severely bothersome joint pain was 40.3% in postmenopausal, 36.2% in perimenopausal, and 15.3% in premenopausal women. Moderate to severely bothersome joint pain was more likely both in perimenopausal (OR 2.64, 95% CI 1.63-4.29 P 0.001) and postmenopausal women (OR 2.96, 95% CI 2.06-4.24 P 0.001). Moderate to severely bothersome joint pain was also more likely in women with no education compared with women having education beyond secondary school (OR 2.38, 95% CI 1.02-2.32 P 0.001). No women reported prescription therapy for menopausal symptoms. This study demonstrates that a high proportion of Bangladeshi women experience moderate to severely bothersome VMS and joint pain. Despite the considerable symptom prevalence, no women reported treatment, suggesting that menopause remains neglected in Bangladesh.
Publisher: Informa UK Limited
Date: 15-07-2011
Publisher: The Endocrine Society
Date: 13-02-2020
Abstract: The recent Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC) publication calculated the attributable risk of breast cancer from use of estrogen alone and estrogen plus a synthetic progestogen for less than 5 to 15 or more years of use. This CGHFB report calculated attributable risk based on their findings of relative risk from pooled data from 58 studies. Notably, neither the CGHFBC nor other previous studies have examined the effect of underlying risk of breast cancer on attributable risk. This omission prompted us to determine the magnitude of the effect of underlying risk on attributable risk in this perspective. Meaningful communication of the potential risk of menopausal hormonal therapy requires providing women with the estimated risk above their existing underlying risk (ie, attributable risk). Therefore, we have estimated attributable risks from the data published by the CGHFBC, taking into account varying degrees of underlying risk. Based on the Endocrine Society Guideline on Menopausal Hormone Therapy (MHT), we ided groups into 3 categories of risk: low (1.5%), intermediate (3.0%), and high (6.0%) underlying risk of breast cancer over 5 years. In women taking estrogen plus a synthetic progestogen for 5 to 9 years, the attributable risks of MHT increased from 12, to 42, to 85 additional women per 1000 in the low-, intermediate-, and high-risk groups, respectively. The attributable risks for estrogen alone were lower but also increased based on underlying risk. Notably, the attributable risks were lified with duration of MHT use, which increased both relative risk and breast cancer incidence.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.MATURITAS.2015.12.012
Abstract: To assess the prevalence, and factors associated with, pelvic floor disorders in a representative s le of community-dwelling older Australian women. 1548 women, aged 65-79 years, were recruited to this cross-sectional study between April and August 2014. Pelvic floor disorders, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP), were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with each, and having one or more pelvic floor disorders. Among 1517 women (mean age=71.5 ± 4.1 SD years), 47.2% (95% CI, 44.7-49.7%) of women had one or more pelvic floor disorders, with 36.2% (95% CI, 33.8-38.6%) having UI, 19.8% (95% CI, 17.8-21.9%) having FI, and 6.8% (95% CI, 5.6-8.2%) having POP. Of the women with POP, 53.4% had UI, 33% had FI and 26.2% had both. The proportion of women with one or more pelvic floor disorders increased with parity from 34.6% (95% CI, 7.8-11.7%) for nulliparous women, to 45.3% (95% CI, 40.3-59.1%) for 1-2 births, and 52.1% (95% CI, 48.3-55.8%) for ≥ 3 births. Obese women were more likely to have at least one pelvic floor disorder (OR=1.77 95% CI, 1.36-2.31, p<0.01). Pelvic floor disorders are common in older women. Physicians caring for older women should be mindful that older women presenting with symptoms of one pelvic floor disorder are likely to have another concurrent pelvic floor problem.
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.EXGER.2007.02.005
Abstract: To date there is no clinical indication for the use of testosterone in women and long-term safety data is lacking. This minireview examines androgen therapy in women. Issues relating to research into sexual function and androgens in women are discussed. Androgen physiology is described and studies examining endogenous androgens in women cited. A Cochrane review found that adding testosterone to a hormone therapy regimen has beneficial effects on sexual function in postmenopausal women and subsequent studies have supported the role of testosterone in sexual function and well-being. However studies on safety and efficacy of testosterone beyond 24 weeks are lacking.
Publisher: Wiley
Date: 2013
DOI: 10.1111/J.1445-5994.2012.02930.X
Abstract: Recently, the dual-energy X-ray absorptiometry (DXA) diagnostic cut-off (T-score) for Australian Pharmaceutical Benefits Scheme (PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from -3.0 to -2.5. To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost. One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score ≤-2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of ≥20% deformity. Seven hundred and forty-six women (37.6%) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7%) had a T-score ≤-2.5 on DXA compared with 10.6% (n = 210) with a T-score ≤-3.0. Four hundred and eighty-three (24.4%) had at least one vertebral fracture. Only 8.5% (n = 168) had both a T-score ≤-2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to $460 compared with $398 for screening by thoracolumbar X-ray. The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure.
Publisher: Elsevier BV
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 11-01-2019
Publisher: Oxford University Press (OUP)
Date: 07-2004
DOI: 10.1111/J.1743-6109.2004.10112.X
Abstract: Various endogenous hormones, including estrogen, testosterone, progesterone and prolactin, may influence female sexual function. To provide recommendations for the diagnosis and treatment of women with endocrinologic sexual difficulties. The Endocrine Aspects of Female Sexual Dysfunction Committee was part of a multidisciplinary International Consultation. It included four experts from two countries and several peer reviewers. Expert opinion was based on committee discussion, a comprehensive literature review and evidence-based grading of available publications. The impact of hormones on female sexual function and their etiological roles in dysfunction is complex. Research data are limited as studies have been h ered by lack of precise hormonal assays and validated measures of sexual function in women. Sex steroid insufficiency is associated with urogenital atrophy and may also adversely affect central sexual thought processes. Systemic estrogen/estrogen progestin therapy alleviates climacteric symptoms but there is no evidence that this therapy specifically improves hypoactive sexual desire disorder (HSDD) in premenopausal or postmenopausal women. Exogenous testosterone has been shown in small randomized controlled trials (RCT) to improve sexual desire, arousal and sexual satisfaction in both premenopausal and postmenopausal women. However, as there is no biochemical measure that clearly identifies who to treat, use of exogenous testosterone should be considered only after other causes of HSDD have been excluded, such as depression, relationship problems and ill health. The clinical assessment of HSDD should include detailed medical, gynecologic, sexual and psychosocial history and physical examination including the external/internal genitalia. Hormonal therapy should be in idualized and risks/benefits fully discussed, and all treated women should be carefully followed up and monitored for therapeutic side effects. There is a need for prospective, multi-institutional clinical trials to define safe and effective endocrine treatments for female sexual dysfunction.
Publisher: Oxford University Press (OUP)
Date: 05-2017
DOI: 10.1016/J.JSXM.2017.03.254
Abstract: Low desire is the most common sexual problem in women at midlife. Prevalence data are limited by lack of validated instruments or exclusion of un-partnered or sexually inactive women. To document the prevalence of and factors associated with low desire, sexually related personal distress, and hypoactive sexual desire dysfunction (HSDD) using validated instruments. Cross-sectional, nationally representative, community-based s le of 2,020 Australian women 40 to 65 years old. Low desire was defined as a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI) sexually related personal distress was defined as a score of at least 11.0 on the Female Sexual Distress Scale–Revised and HSDD was defined as a combination of these scores. The Menopause Specific Quality of Life Questionnaire was used to document menopausal vasomotor symptoms. The Beck Depression Inventory–II was used to identify moderate to severe depressive symptoms (score ≥ 20). The prevalence of low desire was 69.3% (95% CI = 67.3–71.3), that of sexually related personal distress was 40.5% (95% CI = 38.4–42.6), and that of HSDD was 32.2% (95% CI = 30.1–34.2). Of women who were not partnered or sexually active, 32.4% (95% CI = 24.4–40.2) reported sexually related personal distress. Factors associated with HSDD in an adjusted logistic regression model included being partnered (odds ratio [OR] = 3.30, 95% CI = 2.46–4.41), consuming alcohol (OR = 1.48, 95% CI = 1.16–1.89), vaginal dryness (OR = 2.08, 95% CI = 1.66–2.61), pain during or after intercourse (OR = 1.63, 95% CI = 1.27–2.09), moderate to severe depressive symptoms (OR = 2.69, 95% CI 1.99–3.64), and use of psychotropic medication (OR = 1.42, 95% CI = 1.10–1.83). Vasomotor symptoms were not associated with low desire, sexually related personal distress, or HSDD. Given the high prevalence, clinicians should screen midlife women for HSDD. Strengths include the large size and representative nature of the s le and the use of validated tools. Limitations include the requirement to complete a written questionnaire in English. Questions within the FSFI limit the applicability of FSFI total scores, but not desire domain scores, in recently sexually inactive women, women without a partner, and women who do not engage in penetrative intercourse. Low desire, sexually related personal distress, and HSDD are common in women at midlife, including women who are un-partnered or sexually inactive. Some factors associated with HSDD, such as psychotropic medication use and vaginal dryness, are modifiable or can be treated with safe and effective therapies.
Publisher: Oxford University Press (OUP)
Date: 09-2004
Publisher: Informa UK Limited
Date: 30-10-2023
Publisher: Wiley
Date: 28-07-2014
DOI: 10.1002/ART.38651
Abstract: The increased prevalence of osteoarthritis (OA) in postmenopausal women suggests that changes in either circulating sex steroid concentrations or the tissue response to sex steroids may have a role in the pathogenesis of OA. The aim of this study was to examine whether circulating sex steroid concentrations are associated with the incidence of total knee and total hip replacement for OA. Study subjects (n = 2,621 all women) were recruited in 1990-1994 from the Melbourne Collaborative Cohort Study (MCCS). Circulating sex steroid concentrations were measured in blood s les obtained from the women at the time of recruitment. The incidence of total knee and total hip replacement for OA during 2001-2011 was determined by linking the MCCS records to the Australian Orthopaedic Association National Joint Replacement Registry. During the followup period, 115 women had undergone total knee replacement and 99 had undergone total hip replacement for OA. Greater log-transformed concentrations of estradiol were associated with a lower incidence of knee replacement (hazard ratio [HR] 0.70, 95% confidence interval [95% CI] 0.50-0.96), and greater log-transformed concentrations of androstenedione were associated with a lower incidence of hip replacement (HR 0.70, 95% CI 0.52-0.93). In contrast, greater log-transformed concentrations of sex hormone binding globulin (SHBG) were associated with a higher incidence of hip replacement (HR 1.70, 95% CI 1.05-2.77). A lower estradiol concentration is a risk factor for knee OA, while a lower androstenedione concentration and higher SHBG concentration are risk factors for hip OA in women. These findings suggest that circulating sex steroids have a role in the pathogenesis of OA, and that modifying these steroid concentrations may provide a potential strategy for the prevention and treatment of knee and hip OA.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.PSYNEUEN.2014.02.004
Abstract: Emerging research has suggested that hormone treatments such as selective oestrogen receptor modulators (SERMs) or progestins may be useful in the treatment of mania. The current pilot study compared the use of the SERM tamoxifen and the progestin medroxyprogesterone acetate (MPA), as an adjunct to mood stabiliser medications, for the treatment of mania symptoms in 51 women in a 28-day double blind, placebo controlled study. The primary outcome was the change between baseline and day 28 mania scores as measured by the Clinician Administered Rating Scale for Mania (CARS-M). Adjunctive MPA treatment provided greater and more rapid improvement in mania symptoms compared with adjunctive placebo and tamoxifen treatment. Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2004
DOI: 10.1097/01.GME.0000109316.11228.77
Abstract: The purpose of this study was to develop a self-administered, patient-based questionnaire to assess loss of sexual desire and associated symptoms in postmenopausal women with hypoactive sexual desire disorder (HSDD) experiencing distress. Preliminary items and domains of sexual function were identified through in idual and focus group interviews with postmenopausal women in the United States and Europe. A subset of items was selected for translation and further analysis. Cognitive interviews were conducted with women with HSDD and non-HSDD women in eight countries to ensure items would have the same meaning in seven languages. The resulting instrument was tested in 325 oophorectomized women with HSDD and 255 age-matched nonoophorectomized control women in the United States, Canada, Europe, and Australia. Psychometric item reduction analyses resulted in 37 items organized into seven domains characterizing female sexual function in postmenopausal women with HSDD. Excellent reliability and validity of the domains of the Profile of Female Sexual Function (PFSF) were observed in all geographic areas tested. Statistically significant differences between oophorectomized women with low libido and control women were found for all domains and all geographic areas. The PFSF is a new instrument specifically designed for measurement of sexual desire in oophorectomized women with low libido. Robust psychometric properties have been established in a large number of geographic regions and languages, making it useful for assessing therapeutic change in multinational clinical trials.
Publisher: Oxford University Press (OUP)
Date: 11-2008
DOI: 10.1111/J.1743-6109.2008.00967.X
Abstract: A validated questionnaire to assess the nature and quality of the recent female sexual experience and that can be employed to evaluate acute therapeutic effects does not exist. To validate an instrument with which researchers can evaluate the nature and quality of the female sexual experience within 24 hours of a sexual event. A cross-sectional questionnaire study in 349 sexually active community-based women, aged 20-65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Scores from the Monash Women's Health Program Female Sexual Satisfaction Questionnaire (MFSSQ), completed within 24 hours of sexual activity, on two occasions. Participants were 349 women who were sexually active at least once per fortnight, but not necessarily partnered. Almost equal groups of self-identified satisfied, dissatisfied, premenopausal, and postmenopausal women participated. Three hundred forty-five women (99%) completed one MFSSQ, and 326 women (94%) completed two separate questionnaires, each within 24 hours of a sexual event. Missing responses were few, good inter-item correlation was seen, and excellent reliability was demonstrated for most items, based on test-retest data. The questionnaire was able to discriminate well between sexually satisfied and dissatisfied women. The MFSSQ is a 12-item questionnaire specifically designed to assess the quality and nature of a recent sexual experience. It is easy and quick to administer, is reliable and valid, and has the potential to be used to assess the efficacy of acute interventions in the area of female sexual dysfunction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
Publisher: Wiley
Date: 27-06-2019
DOI: 10.1111/AJO.13021
Abstract: In Australia many hormonal contraceptives are not Pharmaceutical Benefits Scheme ( PBS ) supported, hence the use of different formulations have not been quantified. To document the use of hormonal contraceptives and factors associated with their use. Cross‐sectional, online questionnaire‐based study of 6986 Australian women, aged 18–39 years, recruited by email invitation from two large, representative databases. Main outcome measures were the prevalence of use of hormonal contraceptives and associated socio‐demographic characteristics. Of the 6600 potential hormone contraceptive users, 43.2% were current users. Most (63.6%) reported using a combined oral contraceptive ( COC ) of which 30.9% were non‐ PBS ‐supported anti‐androgenic progestin‐containing COC s. Use of long‐acting reversible contraceptives ( LARC ) or an injectable contraceptive was reported by 26.8%. Education beyond secondary school, being Australian born, rural residency, normal body mass index, age years and nulliparity were significantly associated with hormonal contraceptive use. Women who reported polycystic ovary syndrome or acne were more likely to be taking a third or fourth generation COC ( P 0.0001) and endometriosis was significantly associated with intrauterine system ( IUS ) use. Third or fourth generation COC use was reported by 12.1% of obese, current smokers. An estimated one‐third of Australian women aged 18–39 are taking a non‐PBS‐supported anti‐androgenic progestin COC , highlighting inequity in access to COC options. That hormonal contraceptive use is higher in rural areas is a novel finding and the proportion of LARC or injectable use suggests that uptake in Australia is higher than previously reported.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.JOCA.2007.11.011
Abstract: Although vastus medialis and vastus lateralis are important muscular determinants of patellofemoral joint function, it is unclear how these muscles relate to the structure of the patellofemoral joint. The aim of this cross-sectional study was to determine the relationship between the vasti muscles and patella cartilage volume and defects and patella bone volume. One hundred and seventy-five women, aged 40-67 years, with no knee pain or clinical lower-limb disease had magnetic resonance imaging (MRI) of their dominant knee. The cross-sectional areas of the distal vastus medialis and lateralis were measured 37.5mm superior to the quadriceps tendon insertion at the proximal pole of the patella. Patella cartilage volume and defects and patella bone volume were measured from these images using validated methods. There was no significant association between the distal vastus medialis cross-sectional area and patella cartilage volume. For every 1mm(2) increase in the distal vastus medialis cross-sectional area, there was an associated increased risk of patella cartilage defects [odds ratio (OR): 1.2 95% confidence interval (CI) 1.004, 1.5 P=0.05], and an associated increase in patella bone volume (OR: 3.9 95% CI 2.0, 5.8 P<0.001) after adjustment for potential confounders. There was no significant relationship between vastus lateralis cross-sectional area and measures of patella cartilage or bone. An increased cross-sectional area of the distal portion of the vastus medialis muscle is associated with an increased risk of patella cartilage defects, and an increase in patella bone volume among healthy women. Although these results need to be confirmed in longitudinal studies, they suggest that an increase in the distal vastus medialis cross-sectional area is associated with structural change at the patellofemoral joint.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Oxford University Press (OUP)
Date: 27-07-2018
Abstract: Polycystic ovary syndrome (PCOS) prevalence estimates vary when different diagnostic criteria are applied. Lack of standardization of in idual elements within these criteria may contribute to prevalence differences. A systematic review of studies reporting prevalence of PCOS, using at least one of the National Institutes of Health (NIH), Rotterdam or Androgen Excess Society (AE-PCOS) criteria, was conducted. The aim was to investigate the impact on prevalence reporting of different definitions of the clinical elements for PCOS diagnosis. A systematic search of Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Emcare and BIOSIS was conducted. The search was limited to English language and studies published between January 1990 and January 2018. Included articles needed to define PCOS by at least one of the NIH, Rotterdam or AE-PCOS criteria, be of an unselected population and be published as a full text article. Risk-of-bias was assessed. A total of 21 studies met the inclusion criteria. The random-effects pooled prevalence of PCOS in studies that used the NIH criteria (7% [95% CI: 6-7%]), was significantly different from that identified in studies that used the Rotterdam criteria (12% [95% CI: 10-15%], P < 0.0001) but not studies that used the AE-PCOS criteria (10% [95% CI: 6-13%], P = 0.075). The pooled estimates for Rotterdam and AE-PCOS were not significantly different from each other (P = 0.201). Pooled prevalence estimates were compared between studies separated on the basis of: oligo-amenorrhoea vs oligo-amenorrhoea plus short cycles, clinical androgen excess requiring hirsutism vs any clinical androgen excess, use of different versions and cut-offs for the Ferriman-Gallwey (F-G) score, and inclusion vs non-inclusion of oral contraceptive users. There were no statistically significant differences for any of these comparisons. There was insufficient information to allow subgroup analyses of definitions of polycystic ovaries. Inclusion of ovarian morphology results in statistically significantly higher pooled prevalence estimates for PCOS. Heterogeneity in prevalence estimates for PCOS reflect the broad clinical spectrum of the condition, lack of standardization of the elements within each set of diagnostic criteria and the use of a range of diagnostic cut-offs, as well as potential differences between study populations. The use of different definitions for anovulation and clinical androgen excess did not appear to contribute to differences in the estimated prevalence of PCOS in this study. However, as the number of studies in most of the comparison groups was small, real differences may have been missed. Uncertainty surrounding the diagnosis of PCOS urgently needs to be addressed in order to provide clinicians and their patients with greater diagnostic certainty, and hence reduce inappropriate labelling and the potential psychological harm that may accompany misdiagnosis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
DOI: 10.1097/GME.0B013E3181FEE03B
Abstract: The aim of this study was to document the age-specific prevalence of fecal incontinence (FI), as well as its relationship to childbirth and urinary incontinence (UI), in a community-based s le of Australian women. A total of 444 women aged 26 to 82 years, originally recruited from a community-based research database, completed a self-administered study questionnaire. Prevalence of FI was assessed using the Pelvic Floor Distress Inventory, and UI and its subtypes were determined using the Questionnaire for Urinary Incontinence Diagnosis. Univariate (Pearson's χ tests) and multivariate logistic regression analyses were used to assess the relationship between FI type and UI adjusting for age and body mass index (BMI). Data were analyzed for 442 women. The overall prevalence of any FI was 20.7% (95% CI, 16.9%-24.5%). Loose FI was reported by 91 of 442 women, yielding a prevalence of 20.7% (95% CI, 16.9%-24.5%). Well-formed FI was reported by 20 of 442 women, yielding a prevalence of 4.5% (95% CI, 2.6%-6.4%). All the women with well-formed FI also reported problems of loose FI. The prevalence of FI increased with age up to 75 years for both types of FI. FI was not related to parity (P = 0.9). The highest proportion of any FI (24.4%) occurred in women with a parity of four or greater however, 20.3% of nulliparous women reported FI. Within parous women, there was no significant association found between FI and history of self-reported instrumental delivery (P = 0.4). About two thirds of the women with loose and well-formed FI also reported coexisting UI. Loose FI was significantly associated with any UI (odds ratio, 2.8 95% CI, 1.7-4.8) after adjusting for age and BMI (P < 0.001). Well-formed FI was not significantly associated with any UI after adjusting for age and BMI. FI is a common condition affecting one in five adult women in the community. In our study, women with loose FI, but not well-formed FI, were more likely to have UI independent of their age and BMI. Being parous was not associated with an increased risk of any FI.
Publisher: Informa UK Limited
Date: 04-09-2023
Publisher: Massachusetts Medical Society
Date: 12-02-2009
DOI: 10.1056/NEJMC082428
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
DOI: 10.1016/J.JURO.2010.11.080
Abstract: We determined the incidence and resolution rates of different types of urinary incontinence in Australian women and examined the course of urinary incontinence with or without treatment. A total of 506 women originally recruited from a community based research database completed a baseline questionnaire in 2006 and a followup questionnaire in 2008. Urinary incontinence incidence and resolution were assessed using the Questionnaire for Urinary Incontinence Diagnosis. The Bristol Female Lower Urinary Tract Symptoms questionnaire was used to assess the impact of urinary incontinence on quality of life. At baseline and followup 442 women provided data. Mean ± SD age was 59.28 ± 12.1 years at followup. The total incidence of any new urinary incontinence was 17% (95% CI 12.4-21.6) in unaffected women and the total resolution rate was 16.8% (95% CI 11.4-22.2) in women with urinary incontinence during 2 years regardless of receiving treatment for urinary incontinence. There was also movement of women among the diagnoses of stress only, urge only and mixed urinary incontinence during followup. A total of 34 women reported having received treatment for urinary incontinence and 5 experienced resolution of the condition. All types of urinary incontinence were associated with impaired quality of life (p <0.001) and adversely impacted daily activity. A negative impact on quality of life (p = 0.02) was also observed in incident cases at followup compared with baseline. Our study shows that urinary incontinence is a highly dynamic clinical condition with movement among diagnostic subtypes of stress only, urge only and mixed urinary incontinence, and periods of resolution. Any urinary incontinence is significantly associated with impaired quality of life.
Publisher: Elsevier BV
Date: 1989
DOI: 10.1016/0303-7207(89)90196-2
Abstract: We have investigated the effect of administration of human chorionic gonadotrophin (hCG) to immature female rats pretreated with pregnant mare serum gonadotrophin (PMSG) on ovarian inhibin alpha-subunit mRNA, serum inhibin and circulating gonadotrophin levels. PMSG stimulation alone caused a 5-fold increase in relative inhibin alpha-subunit mRNA levels and a 12-fold increase in serum inhibin by 48 h. However, injection of hCG at 40 h suppressed PMSG-stimulated ovarian inhibin alpha-subunit mRNA and serum inhibin to levels at 48 h not statistically significantly different from controls. Serum follicle-stimulating hormone (FSH) fell after PMSG treatment, but rose after combined PMSG-hCG treatment. Serum luteinizing hormone (LH) was unchanged after PMSG alone but also rose after combined PMSG and hCG therapy. In conclusion, hCG suppresses ovarian inhibin synthesis in PMSG-stimulated immature female rats with preservation of the reciprocal relationship between inhibin and FSH. This immature female rat model therefore provides further insight into the effects of LH or hCG on granulosa cell inhibin production just prior to ovulation.
Publisher: American College of Physicians
Date: 04-09-2018
DOI: 10.7326/M18-1768
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.JSBMB.2013.05.006
Abstract: Testosterone is physiologically important for women. Serum testosterone levels decline with age, with the most precipitous fall being prior to menopause. There is no level of testosterone which defines a woman as being testosterone deficient. However, there is substantial high quality evidence to support the use of testosterone for the treatment of hypoactive sexual desire disorder in postmenopausal women. Although preliminary data suggests testosterone has favorable effects on bone and muscle mass, cognitive function and the cardiovascular system, further research regarding its therapeutic effects in these domains is warranted. As no testosterone product has been approved for women there is extensive off-label prescribing of testosterone products for women as well as the prescription of compounded therapy. This raises serious safety concerns and together with the evidence for the negative impact of FSD on quality of life, highlights the need for an approved testosterone formulation for women. This article is part of a Special Issue entitled 'Menopause'.
Publisher: International Commission for Plant Pollinator Relations
Date: 27-07-2022
DOI: 10.26786/1920-7603(2022)695
Abstract: During the main COVID-19 global pandemic lockdown period of 2020 an impromptu set of pollination ecologists came together via social media and personal contacts to carry out standardised surveys of the flower visits and plants in gardens. The surveys involved 67 rural, suburban and urban gardens, of various sizes, ranging from 61.18° North in Norway to 37.96° South in Australia, resulting in a data set of 25,174 rows, with each row being a unique interaction record for that date/site lant species, and comprising almost 47,000 visits to flowers, as well as records of flowers that were not visited by pollinators, for over 1,000 species and varieties belonging to more than 460 genera and 96 plant families. The more than 650 species of flower visitors belong to 12 orders of invertebrates and four of vertebrates. In this first publication from the project, we present a brief description of the data and make it freely available for any researchers to use in the future, the only restriction being that they cite this paper in the first instance. The data generated from these global surveys will provide scientific evidence to help us understand the role that private gardens (in urban, rural and suburban areas) can play in conserving insect pollinators and identify management actions to enhance their potential.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.2165/00003495-200868030-00001
Abstract: The investigation of female sexual dysfunction (FSD) is an evolving area in which definitions and models for female sexual functioning are being continually reviewed and revised. The lack of consensus amongst experts in the field and regulating authorities regarding appropriate inclusion and exclusion criteria for FSD trials, and main outcome measures appropriate for the evaluation of drug interventions has somewhat h ered progression in this area. Nonetheless, there is evidence from randomized controlled trials that androgen therapy improves the quality of the sexual experience for postmenopausal women with low libido, and preliminary data that this may also apply to premenopausal women.
Publisher: Oxford University Press (OUP)
Date: 04-2012
Start Date: 2018
End Date: 2022
Funder: National Health and Medical Research Council
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Funder: National Health and Medical Research Council
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Funder: National Health and Medical Research Council
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Funder: National Health and Medical Research Council
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Funder: National Health and Medical Research Council
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Funder: Bupa Health Foundation
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Funder: National Health and Medical Research Council
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Funder: Norman Beischer Medical Research Foundation
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Funder: National Health and Medical Research Council
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End Date: 2012
Funder: National Health and Medical Research Council
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Funder: National Health and Medical Research Council
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End Date: 2017
Funder: National Breast Cancer Foundation
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