Objectives To describe the effects of low-dose hormonal replacement therapy (HRT) on quality of life, metabolic parameters and blood pressure in postmenopausal women.
Methods Postmenopausal women ...untreated with HRT or sex steroids in the previous 12 months were randomized to treatment with 17β-estradiol (1 mg/day) plus drospirenone (2 mg/day) (E2++DRSP) or to calcium (controls). Quality of life was evaluated by the Women's Health Questionnaire (WHQ) at baseline and after 6 and 12 weeks of treatment. Anthropometric, metabolic and blood pressure measurements were performed before and after 3 months of treatment.
Results WHQ domain scores for vasomotor and somatic symptoms, anxiety/fears, depressed mood, sexual behavior and sleep problems decreased significantly in the E2++DRSP group relative to both baseline and control values (p < 0.05). Body mass index was unchanged, while waist circumference decreased significantly (p < 0.001) after E2++DRSP treatment. Significant decreases were also observed after E2++DRSP treatment for blood insulin values, insulin resistance (estimated by homeostasis model assessment) and systolic blood pressure (p < 0.001, all). In subjects with systolic blood pressure < 130 mmHg at baseline, no changes in systolic values were registered, while women with baseline high-normal systolic blood pressure (130-139 mmHg) showed significant decreases (p < 0.0069). E2++DRSP did not modify diastolic blood pressure values. In the calcium-treatment group, there were no significant changes in WHQ scores or in anthropometric, metabolic or blood pressure measurements.
Conclusion In postmenopausal women, E2++DRSP administration improves vasomotor symptoms and general aspects of quality of life and may positively influence cardiovascular risk factors.
Menopause and aging, quality of life and sexuality Genazzani, A. R.; Gambacciani, M.; Simoncini, T.
Climacteric : the journal of the International Menopause Society,
04/2007, Letnik:
10, Številka:
2
Journal Article, Conference Proceeding
Body weight was measured, and body fat distribution was determined by
dual energy x-ray in early postmenopausal women given either oral
calcium (500 mg/day; control group; n = 12) or hormonal
...replacement therapy (HRT), a combination of estradiol valerate (2
mg/day for 21 days) with cyproterone acetate (1 mg/day in the last 10
days of the treatment cycle; n = 15). There were no differences in
basal body weight or body fat distribution in the two groups before the
study. In the control group, a significant (P <
0.05) increase in body weight (from 61.8 ± 2.1 to 63.3 ±
1.9 kg after 12 months) paralleled a slight, but significant
(P < 0.05), increase in total body fat mass (from
23.8 ± 2.2 to 24.7 ± 2.2 kg), with an increase in fat in
the trunk (from 10.2 ± 0.4 to 11.3 ± 0.4 kg;
P < 0.01) and arms (from 2.4 ± 0.5 to
2.7 ± 0.2 kg; P < 0.05). These findings
demonstrate a shift to a prevalent central android fat distribution
after 12 months of observation in untreated postmenopausal women.
Conversely, in the HRT group, total body bone mineral showed a
significant (from 1089 ± 28 to 1106 ± 29
mg/cm2; P < 0.05) increase after 12
months, with no significant increase in body weight (from 62.2 ±
1.6 to 62.7 ± 1.6 kg), and no modifications in trunk (from
10.0 ± 0.2 to 9.8 ± 0.3 kg) and arm (from 2.43 ± 0.2
to 2.5 ± 0.1 kg) fat, but a significant increase in leg fat (from
7.1 ± 0.3 to 8.3 ± 0.4 kg; P < 0.05).
The present results suggest that HRT can counteract at least in part
the postmenopausal increase in body weight and body fat and prevent
central body fat distribution after menopause.
Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, ...symptoms, diagnosis, progression, prognosis and management of cardiovascular risk. Key risk factors that need to be controlled in the perimenopausal woman are hypertension, dyslipidemia, obesity and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older postmenopausal women can be applied to younger perimenopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older postmenopausal women no longer displaying menopausal symptoms. Both gynecologists and cardiovascular physicians have an important role to play in identifying perimenopausal women at risk of cardiovascular morbidity and mortality, and should work as a team to identify and manage risk factors, such as hypertension.
Phalangeal osteosonogrammetry was introduced as a method for bone tissue investigation in 1992. It is based on the measure of the velocity of ultrasound (amplitude‐dependent speed of sound AD‐SoS) ...and on the interpretation of the characteristics of the ultrasound signal. In this study we have collected a database of 10,115 subjects to evaluate the performance of AD‐SoS and to develop a parameter that is able to quantify the signal characteristics: ultrasound bone profile index (UBPI). The database only includes females of which 4.5% had documented vertebral osteoporotic fractures, 16% lumbar spine dual X‐ray absorptiometry (DXA), and 6% hip DXA. The analysis of the ultrasound signal has shown that with aging the UBPI, first wave amplitude (FWA), and signal dynamics (SDy) follow a trend that is different from the one observed for AD‐SoS; that is, there is no increase during childhood. In the whole population, the risk of fracture per SD decrease for AD‐SOS was odds ratio (OR) 1.71 (CI, 1.58‐1.84). The AD‐SoS in fractured subjects was significantly lower than in a group of age‐matched nonfractured subjects (p < 0.0001). In a small cohort of hip‐fractured patients UBPI proved to be lower than in a control age‐matched group (p < 0.0001). When the World Health Organization (WHO) working group criteria were applied to this population to identify the T score value for osteoporosis, for AD‐SoS we found a T score of −3.2 and for UBPI we found a T score of −3.14. Sixty‐six percent of vertebral fractures were below the AD‐SoS −3.2 T score and 62% were below UBPI −3.14. We observed the highest incidence of fractures (63.6%) among subjects with AD‐SoS who had both DXA T score values below the threshold. We conclude from this study that ultrasound investigation at the hand phalanges is a valid methodology for osteoporosis assessment. It has been possible to quantify signal changes by means of UBPI, a parameter that will improve the possibility of investigating bone structure.
Aims: In order to assess the effects of menopause and hormonal replacement therapy (HRT) on body weight and body fat distribution (determined by dual energy X-ray), early postmenopausal women were ...given either oral calcium (500 mg/day, control group,
n=13) or HRT, a combination of estradiol valerate (EV, 2 mg/day for 21 days) with cyproterone acetate (CPA, 1 mg/day in the last 10 days of the treatment cycle,
n=18; Climen®, Schering).
Results: There were no differences in basal body weight and body fat distribution in the two groups before the study. In control group, a significant (
P<0.05) increase in body weight (from 63.5±2.0 to 68.7±2.0 kg after 36 months) paralleled a shift to a prevalent central, android fat distribution with a slight but significant (
P<0.05) increase in total body fat mass (from 23.4±2.1 to 29.1±2.1 kg), an increase in trunk (from 10.1±0.4 to 12.7±0.4 kg,
P<0.05), arms (from 2.4±0.2 to 2.9±0.2 kg,
P<0.05) and legs (from 6.5±0.4 to 7.8±0.4 kg,
P<0.05) fat. In the HRT group total body bone mineral showed a significant increase (from 1086±21 to 1128±19 mg/cm
2,
P<0.05) increase after 36 months, with no significant increase in body weight (from 62.6±1.8 to 65.0±1.9 kg), and no modifications in trunk (from 10.0±0.2 to 10.1±0.2 kg) and arms (from 2.4±0.1 to 2.6±0.1 kg) fat, but a significant increase in legs fat (from 6.9±0.3 to 9.9±0.4 kg,
P<0.05).
Conclusion: Present results demonstrate that menopause is associated with an accelerated increase in body weight and body fat, with a prevalent central, android fat distribution, that can be counteracted at least in part by oral HRT.
Recent controversies with hormone replacement therapy (HRT) have caused much concern in women and their health-care providers. As a result, the number of HRT users in the USA has fallen dramatically. ...Consequently, the potential HRT-induced reduction in fracture risk is lost so that, in the next few years, we can expect an excess of 43 008 fractures per year in women aged 65 - 69 years. In addition, the recent evidence on the merits of early initiation of HRT on cardiovascular disease risk and neurocognitive function and the effect of type and combination of hormones on breast cancer risk now require an urgent review by the regulatory authorities of their recommendations about HRT.
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