Hyperprolactinemia in the postmenopause: versions and contraversions

The prevalence of hyperprolactinemia in postmenopausal women is unknown and has been estimated as infrequent by many studies. Prolactinomas found after menopause are usually macroadenomas and remain unrecognized for a long time due to atypical clinical signs or their absence. The growth potential of prolactinomas persists after menopause, most of them are invasive and accompanied by high prolactin levels. Treatment with dopamine agonists is usually long-term, the goals of which are to reduce tumor size, normalize prolactin levels and the negative effects of hyperprolactinemia. Treatment with cabergoline makes it possible to achieve remission of the disease in the first years after discontinuation, however, the proportion of relapses in postmenopausal women increases 5 years after discontinuation of the drug. Remission of prolactinomas is not evident in postmenopausal women. The modern management of patients with prolactinoma and/or hyperprolactinemia does not have clear positions in the postmenopausal period. Controversial issues remain: an ambiguous relationship between prolactin levels and breast cancer, there are no convincing conclusions on the improvement of bone mineral density and/or a decrease in the risk of fractures with normalization of prolactin levels, there are no data on metabolic parameters after the end of treatment with dopamine agonists, conflicting information about the relationship of prolactin levels and the severity of the manifold manifestations of the climacteric syndrome. The use of estrogen-progestin drugs in women with hyperprolactinemia/prolactinomas is also not well understood. Thus, the problem of hyperprolactinemia in the perimenopausal and postmenopausal period is underestimated and requires additional research, as well as the development of diagnostic and therapeutic strategies for potential benefits in terms of weight loss, improving insulin sensitivity, reducing the risk of fractures, maintaining sexuality and psycho-emotional well-being.

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Hyperprolactinemia/Prolactinomas in the Postmenopausal Period: Challenges in Diagnosis and Management

Neuroendocrinology ◽

10.1159/000494725 ◽

2018 ◽

Vol 109 (1) ◽

pp. 28-33 ◽

Cited By ~ 4

Author(s):

Sandra Pekić ◽

Milica Medic Stojanoska ◽

Vera Popovic

Keyword(s):

Postmenopausal Women ◽

Dopamine Agonists ◽

Growth Potential ◽

Common Finding ◽

Mineral Density ◽

Cavernous Sinus Invasion ◽

The Metabolic Syndrome ◽

Postmenopausal Period ◽

Remission Maintenance

Hyperprolactinemia is not a common finding in postmenopausal women. Prolactinomas detected after menopause are usually macroadenomas. Due to atypical clinical features they may remain unrecognized for a long period of time. Interestingly the growth potential of prolactinomas remains after menopause. Most tumors are invasive and present with high prolactin levels. They respond to medical treatment with dopamine agonists in terms of prolactin normalization, tumor shrinkage, and improvement in pituitary function. Treatment with dopamine agonists is usually long term. Reducing doses of cabergoline to the lowest that keeps prolactin levels normal prior to withdrawal is proposed to patients with macroprolactinomas who normalize prolactin after > 5 years of treatment and who do not have cavernous sinus invasion. Cabergoline can achieve a high percentage of remission maintenance in the first years after withdrawal. However, the percentage of relapse-free patients 5 years after withdrawal is significantly lower. Besides recurrent hyperprolactinemia in a subgroup of macroprolactinomas after a long-interval tumor regrowth may be detected. Menopause cannot ensure remission of the tumor so long-term surveillance is suggested. In patients with microadenomas data on long-term remission rates (normalization of prolactin and disappearance of the tumor) after suspension of treatment with dopamine agonists are highly variable. The current strategy for microprolactinomas is not to treat hyperprolactinemia in menopause if it recurrs after discontinuation of dopamine agonists. This is based on: (1) reports that elevated prolactin levels may normalize in some women after menopause, (2) the fact that the association between prolactin levels and breast cancer is inconsistent in postmenopausal women, (3) the lack of clinical evidence that normalization of prolactin levels in postmenopausal women improves bone mineral density or reduces the risk of fracture, and (4) the fact that, concerning the metabolic syndrome, no data are available on metabolic parameters after suspension of treatment with dopamine agonists. For a change in strategy, i.e., for the potential benefits from treatment of hyperprolactinemia in the postmenopausal period with dopamine agonists concerning weight loss, improved insulin sensitivity, decreased fracture risk, and improved sexuality, more evidence is needed.

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Stress-Related Amygdala Metabolic Activity Is Associated With Low Bone Mineral Density in Postmenopausal Women: A Pilot 18F-FDG PET/CT Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.719265 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kisoo Pahk ◽

Hyun Woo Kwon ◽

Chanmin Joung ◽

Sungeun Kim

Keyword(s):

Postmenopausal Women ◽

Postmenopausal Osteoporosis ◽

Psychological Stress ◽

Metabolic Activity ◽

Fdg Pet ◽

Short Form ◽

Well Being ◽

Mineral Density ◽

Pet Ct ◽

Fdg Pet Ct

BackgroundPsychological stress is associated with postmenopausal osteoporosis. However, the underlying mechanism of stress-related brain neural activity with osteoporosis is not fully elucidated. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is an established method to evaluate the metabolic activity of brain amygdala, a region involved in stress. We aimed to evaluate the relationship between metabolic activity of amygdala (AmygA) and osteoporosis in postmenopausal women.Materials and MethodsA total of 115 postmenopausal women who underwent 18F-FDG PET/CT and dual-energy X-ray absorptiometry for routine health screening were enrolled in this study. AmygA was defined as the maximum standardized uptake value (SUVmax) of amygdala divided by the mean SUV of temporal lobe. The levels of psychological stress were measured using the Psychosocial Well-being Index-Short Form (PWI-SF).ResultsThe participants with osteoporosis exhibited significantly higher AmygA than without osteoporosis (0.81 ± 0.16 vs. 0.61 ± 0.13, p < 0.001). The AmygA value of 0.69 was suggested as an optimal cut-off value to identify participant with osteoporosis (sensitivity; 79.1%, specificity; 83.3%, area under the curve; 0.841, p < 0.001). Furthermore, AmygA showed significant association with osteoporosis in postmenopausal woman by multivariate analysis. Psychological stress scale (PWI-SF) was well correlated with AmygA and AmygA was highest in high stress risk-, intermediate in moderate stress risk-, and lowest in healthy group.ConclusionsAmygA measured by 18F-FDG PET/CT is associated with osteoporosis in postmenopausal women. Our results provide the possibility that stress-related neurobiological activity involving amygdala is linked with postmenopausal osteoporosis.

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Oral health and emotional well-being in premenopausal and postmenopausal women: a cross-sectional cohort study

BMC Women s Health ◽

10.1186/s12905-021-01480-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nil Yakar ◽

Asena Türedi ◽

Gülnur Emingil ◽

Çağdaş Şahin ◽

Timur Köse ◽

...

Keyword(s):

Oral Health ◽

Postmenopausal Women ◽

Tooth Loss ◽

Premenopausal Women ◽

Well Being ◽

Depressive Mood ◽

Mineral Density ◽

Cross Sectional ◽

Significant Difference ◽

Early Tooth Loss

Abstract Background Menopause, the absence of ovarian sex steroids, is frequently accompanied by emotional and physiological changes in a woman´s body, as well as oral health changes. The present study aimed to evaluate the association between the periodontal health status and emotional and physical well-being among postmenopausal women (PMW) in comparison with regularly menstruating premenopausal women (RMPW). Methods A total of 115 women (PMW, n = 56, mean age ± SD: 54 ± 5; RMPW, n = 59, mean age ± SD: 41 ± 4) received a comprehensive medical assessment and a full-mouth oral examination. All completed the Women’s Health Questionnaire (WHQ) to measure emotional and physical well-being. The corresponding bone mineral density (BMD) scores were obtained from participants´ medical records. Results Tooth loss was significantly higher in PMW than RMPW after adjusting for age (3.88 ± 2.41 vs 2.14 ± 2.43, p < 0.05). No significant difference was found in the prevalence of periodontitis between the two groups (PMW: 39.2%, RMPW: 32.2%, p > 0.05). The prevalence of periodontitis was associated with fewer daily brushing sessions in PMW (p = 0.021). Based on the WHQ, both PMW and RMPW with periodontitis had higher ‘’depressed mood’’ scores compared to periodontally healthy women (p = 0.06 and p = 0.038, respectively). The women who reported fewer daily toothbrushing sessions found to have higher depressive mood scores (p = 0.043). Conclusions Presence of periodontitis is associated with the emotional and physical well-being of women and reinforcement of oral healtcare is recommended at different stages of a woman’s life including menopause to reduce the risk for early tooth loss in women.

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Abstract #796012: Phase 1B Evaluation of the Pharmacokinetics and Pharmacodynamics of Abaloparatide Solid Microstructured Transdermal System in Postmenopausal Women with Low Bone Mineral Density

Endocrine Practice ◽

10.1016/s1530-891x(20)39452-0 ◽

2020 ◽

Vol 26 ◽

pp. 44-45

Author(s):

Joanna Rega

Keyword(s):

Bone Mineral Density ◽

Postmenopausal Women ◽

Bone Mineral ◽

Pharmacokinetics And Pharmacodynamics ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Phase 1B

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Diet Quality, a Term Subject to Change over Time

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000104 ◽

2012 ◽

Vol 82 (3) ◽

pp. 144-147 ◽

Cited By ~ 5

Author(s):

Ibrahim Elmadfa ◽

Alexa L. Meyer

Keyword(s):

Diet Quality ◽

Functional Foods ◽

Disease Risk ◽

Well Being ◽

Industrialized Countries ◽

Quality Factors ◽

Long Time ◽

Quality Diet ◽

Important Quality ◽

Health And Well Being

A high-quality diet is one of the foundations of health and well-being. For a long time in human history, diet was chiefly a source of energy and macronutrients meant to still hunger and give the strength for work and activities that were in general much harder than nowadays. Only few persons could afford to emphasize enjoyment. In the assessment of quality, organoleptic properties were major criteria to detect spoilage and oxidative deterioration of food. Today, food hygiene is a quality aspect that is often taken for granted by consumers, despite its lack being at the origin of most food-borne diseases. The discovery of micronutrients entailed fundamental changes of the concept of diet quality. However, non-essential food components with additional health functions were still barely known or not considered important until recently. With the high burden of obesity and its associated diseases on the rise, affluent, industrialized countries have developed an increased interest in these substances, which has led to the development of functional foods to optimize special body functions, reduce disease risk, or even contribute to therapeutic approaches. Indeed, nowadays, high contents of energy, fat, and sugar are factors associated with a lower quality of food, and products with reduced amounts of these components are valued by many consumers. At the same time, enjoyment and convenience are important quality factors, presenting food manufacturers with the dilemma of reconciling low fat content and applicability with good taste and appealing appearance. Functional foods offer an approach to address this challenge. Deeper insights into nutrient-gene interactions may enable personalized nutrition adapted to the special needs of individuals. However, so far, a varied healthy diet remains the best basis for health and well-being.

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