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94214447 Ovarian function, therapy- oriented definition of menopause and climacteric
Abstract
section
/ Maturitas
women who take tibolone (Livial-Organon). Design: A two year comparative nonrandomised prospective study of women taking tibolone (2.5 mg) and control subjects not on medication. Setting: Teaching hospital menopause and well women clinic. Subjects: One hundred women who were recently menopausal (between 6 and 36 months since last menstrual period). Fifty were commenced on tibolone and 50 received no medication. Main outcome measures: Episodes of bleeding throughout the two year study period were recorded. Oestradiol levels were measured at baseline and at six, 12 and 24 months. The age of menopause and time since last menstrual period (LMP) were noted. Results: Twenty percent (12f59) (95% CI 11.0% to 32.8%) of women in the tibolone group had breakthrough bleeding compared with 9.4% (5/23) (95% CI 3.1% to 20.7%) in the control group. Of the women who bled in the tibolone group, 50% had LMP between six and I2 months prior to entering the study, and 83% were younger than the average age of menopause. Sixty-seven percent had detectable oestradiol levels on at least one occasion over the two years (live women had detectable oestradiol levels and did not bleed). None had evidence of endometrial stimulation at dilatation and curettage. Eighty percent of women who bled in the control group were between six and 12 months since LMP on entry into the study, and 80% had detectable oestradiol levels during the study. At dilatation and curettage there was no evidence of endometrial stimulation. Conclusions: A minority of women will bleed on tibolone therapy. Women who are likely to bleed are younger, are recently menopausal, and may have remaining endogenous oestrogen production. 94214447 Ovarian tindon, climacteric Utian W.H.
therapy- oriented definition of meoopause and
Departmeni of Reproductive Univ. Med. Sch., University Cleveland, OH 44106
Biology, Hospitals,
Case Western Reserve 2074 Abington Road,
EXP. GERONTOL. 1994 2913-4 (245-251) The lack of uniformity in descriptive terminology applied to the cessation of human female menstruation and events related thereto has retarded scientific progress and resulted in confusion and, perhaps, therapeutic mismanagement. Inevitably, many published clinical studies do not clearly define the population being tested, and conclusions drawn are misleading or invalid. Although menopause refers to the final menstrual period (often defined retrospectively by 6-12 months amenorrhea) and climacteric to the transition from reproductive to nonreproductive stage of life, the event is not necessarily associated with any obvious symptom except amenorrhea. When symptoms do occur, collectively referred to as the climacteric syndrome, they are generated by an interaction between endocrine, so&cultural, and psychological factors, and perhaps concurrent aging phenomena as well. Based on the premise that some women with intact ovaries demonstrate endocrine compensatory mechanisms after menopause (i.e., that there are two types of postmenopausal ovary-one active and one essentially inert) and that women whose menses cease because of surgery (ovariectomy) or chemotherapy, they should not be included
22 (199s)
65
63-66
with those undergoing a natural menopause (i.e., represent an atypical group), an ovarian function, therapy- oriented delinition for climacteric is proposed.
94214449 Menopause: An evolutionary perspective Austad S.N. Department of Biological Moscow, ID 83843
Sciences,
University
of
Idaho,
EXP. GERONTOL. 1994 29/3-4 (255-263) Evolutionary biologists classify theories of menopause as either: (*I) adaptive, suggesting that female reproductive cessation results from its selective advantage, in that the increased risk of personal reproduction late in life makes it biologically more advantageous to rechannel reproductive energy into helping existing descendents, or (*2) nonadaptive, indicating menopause is an artifact of the relatively recent dramatic increase in human longevity. With the possible exception of pilot whales, no mammals studied to date are known to commonly exhibit reproductive cessation in nature. To demonstrate adaptive menopause, one would need to establish both that the longevity of preagricultural humans commonly allowed them to exhibit menopause, and that postreproductive females could assist their descendents sufficiently to compensate for the loss of personal reproduction. The data on longevity of preagricultural humans with respect to the adaptive menopause hypothesis are mixed. Evolutionary models evaluated with data from modem hunting-gathering or agricultural humans fail to find that humans can assist their descendents sufficiently to offset the evolutionary cost of ceasing reproduction. However, assuming the human body has been physiologically adapted to the conditions extant during the vast majority of human history, it may be well worth pursuing how the signs and symptoms of menopause are affected by dietary, exercise, and reproductive hormone regimes mimicking those of the late Paleolithic era.
94214453 The evolution of ovarian oocyte decline with aging and possible relationships to Dowa syndrome and Akheher dii Finch C.E. Department University
of Biological Sciences, Andrus Gerontology Center, of Southern California, Los Angeles, CA 90089-0191
EXP. GERONTOL. 1994 2913-4 (299-304) Evolutionary aspects of menopause are considered from several perspectives. First, the programmed exhaustion of ovarian oocytes appears to be a general trait of mammals that is not as widely found in other vertebrates. Second, studies on mice suggest that the maternal age effect that accelerates the incidence of Down syndrome is due not to age per sebut to dwindling ovarian oocyte pools. Because Down syndrome inevitably leads to Alzheimer-type neuropathology, there is reason to consider hormonal intervention strategies to reduce the risk of Down syndrome. Third, estrogens may be a protective factor in Alzheimer disease, which is another link to menopause and another rationale for special hormonal interventions.
section
/ Maturitas
women who take tibolone (Livial-Organon). Design: A two year comparative nonrandomised prospective study of women taking tibolone (2.5 mg) and control subjects not on medication. Setting: Teaching hospital menopause and well women clinic. Subjects: One hundred women who were recently menopausal (between 6 and 36 months since last menstrual period). Fifty were commenced on tibolone and 50 received no medication. Main outcome measures: Episodes of bleeding throughout the two year study period were recorded. Oestradiol levels were measured at baseline and at six, 12 and 24 months. The age of menopause and time since last menstrual period (LMP) were noted. Results: Twenty percent (12f59) (95% CI 11.0% to 32.8%) of women in the tibolone group had breakthrough bleeding compared with 9.4% (5/23) (95% CI 3.1% to 20.7%) in the control group. Of the women who bled in the tibolone group, 50% had LMP between six and I2 months prior to entering the study, and 83% were younger than the average age of menopause. Sixty-seven percent had detectable oestradiol levels on at least one occasion over the two years (live women had detectable oestradiol levels and did not bleed). None had evidence of endometrial stimulation at dilatation and curettage. Eighty percent of women who bled in the control group were between six and 12 months since LMP on entry into the study, and 80% had detectable oestradiol levels during the study. At dilatation and curettage there was no evidence of endometrial stimulation. Conclusions: A minority of women will bleed on tibolone therapy. Women who are likely to bleed are younger, are recently menopausal, and may have remaining endogenous oestrogen production. 94214447 Ovarian tindon, climacteric Utian W.H.
therapy- oriented definition of meoopause and
Departmeni of Reproductive Univ. Med. Sch., University Cleveland, OH 44106
Biology, Hospitals,
Case Western Reserve 2074 Abington Road,
EXP. GERONTOL. 1994 2913-4 (245-251) The lack of uniformity in descriptive terminology applied to the cessation of human female menstruation and events related thereto has retarded scientific progress and resulted in confusion and, perhaps, therapeutic mismanagement. Inevitably, many published clinical studies do not clearly define the population being tested, and conclusions drawn are misleading or invalid. Although menopause refers to the final menstrual period (often defined retrospectively by 6-12 months amenorrhea) and climacteric to the transition from reproductive to nonreproductive stage of life, the event is not necessarily associated with any obvious symptom except amenorrhea. When symptoms do occur, collectively referred to as the climacteric syndrome, they are generated by an interaction between endocrine, so&cultural, and psychological factors, and perhaps concurrent aging phenomena as well. Based on the premise that some women with intact ovaries demonstrate endocrine compensatory mechanisms after menopause (i.e., that there are two types of postmenopausal ovary-one active and one essentially inert) and that women whose menses cease because of surgery (ovariectomy) or chemotherapy, they should not be included
22 (199s)
65
63-66
with those undergoing a natural menopause (i.e., represent an atypical group), an ovarian function, therapy- oriented delinition for climacteric is proposed.
94214449 Menopause: An evolutionary perspective Austad S.N. Department of Biological Moscow, ID 83843
Sciences,
University
of
Idaho,
EXP. GERONTOL. 1994 29/3-4 (255-263) Evolutionary biologists classify theories of menopause as either: (*I) adaptive, suggesting that female reproductive cessation results from its selective advantage, in that the increased risk of personal reproduction late in life makes it biologically more advantageous to rechannel reproductive energy into helping existing descendents, or (*2) nonadaptive, indicating menopause is an artifact of the relatively recent dramatic increase in human longevity. With the possible exception of pilot whales, no mammals studied to date are known to commonly exhibit reproductive cessation in nature. To demonstrate adaptive menopause, one would need to establish both that the longevity of preagricultural humans commonly allowed them to exhibit menopause, and that postreproductive females could assist their descendents sufficiently to compensate for the loss of personal reproduction. The data on longevity of preagricultural humans with respect to the adaptive menopause hypothesis are mixed. Evolutionary models evaluated with data from modem hunting-gathering or agricultural humans fail to find that humans can assist their descendents sufficiently to offset the evolutionary cost of ceasing reproduction. However, assuming the human body has been physiologically adapted to the conditions extant during the vast majority of human history, it may be well worth pursuing how the signs and symptoms of menopause are affected by dietary, exercise, and reproductive hormone regimes mimicking those of the late Paleolithic era.
94214453 The evolution of ovarian oocyte decline with aging and possible relationships to Dowa syndrome and Akheher dii Finch C.E. Department University
of Biological Sciences, Andrus Gerontology Center, of Southern California, Los Angeles, CA 90089-0191
EXP. GERONTOL. 1994 2913-4 (299-304) Evolutionary aspects of menopause are considered from several perspectives. First, the programmed exhaustion of ovarian oocytes appears to be a general trait of mammals that is not as widely found in other vertebrates. Second, studies on mice suggest that the maternal age effect that accelerates the incidence of Down syndrome is due not to age per sebut to dwindling ovarian oocyte pools. Because Down syndrome inevitably leads to Alzheimer-type neuropathology, there is reason to consider hormonal intervention strategies to reduce the risk of Down syndrome. Third, estrogens may be a protective factor in Alzheimer disease, which is another link to menopause and another rationale for special hormonal interventions.