Neuroendocrine Changes during Menopausal Transition

Menopause is the permanent cessation of menstrual cycles following the loss of ovarian follicular activity. Quality of life of postmenopausal woman is the result of a series of psychobiological transformations, that see in the reduction of sex hormones and steroids the etiopathogenetic determinant moment. Symptoms of menopause range from somatic side such as metabolic changes, increased cardiovascular disease, irregular vaginal bleeding, urogenital symptoms, vaginal dryness, osteoporosis and risk of bones fractures to changes of central nervous system as vasomotor symptoms, sleep disruption, mood changes, migraine, sexual dysfunctions. It is fundamental to know the mechanisms underlying changes in the central nervous system during menopause, related to hypoestrogenism, to be able to create appropriate target therapy for patients, improving their quality of life. In fact, the central nervous system is now one of the major targets of sex steroids that cannot be achieved disregard when dealing with the problem of choice of a particular type of MHT.

Hormone replacement therapy: update and practical prescribing

Peri-menopause and menopause are a normal part of ageing. Nikki Noble gives an overview of hormone replacement therapy and practical prescribing tips Menopause is a physiological event of ovarian failure due to a loss of ovarian follicular activity. This leads to a lack of oestrogen, resulting in the cessation of menstruation and loss of reproductive function. This article discusses the symptoms of menopause and treatment with hormone replacement therapy. This includes practical prescribing, side effects and long-term benefits and risks. The current shortages of hormone replacement therapy are also addressed. The aim of this article is to enable health professionals to define menopause and gain an understanding of the symptoms associated with it. After reading this article you should be able to: describe when peri-menopause and menopause occur, describe the common symptoms that may be experienced during peri-menopause and menopause, understand of the hormones used in hormone replacement therapy, and understand the practical prescribing of hormone replacement therapy and the benefits, risks, contraindications and side-effects.

TREATMENT OF MENOPAUSAL SYMPTOMS : A COMPARATIVE STUDY

Menopause is permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Women suffer many troublesome problems after menopause resulting from estrogen deficiency. Aim of this study is to compare symptomatic response in Indian women using different medicine preparations for treatment of menopausal symptoms. It is an observational prospective study conducted in PMCH Gynae OPD from October 2017 to September 2019. Two hundred women were enrolled and assigned to different treatment groups. There was 90.32% decrease in hot flushes in E2V group while it was 87.09% in CEE group. Psychosomatic symptoms reduced by 75% and 70% in E2V and CEE group respectively. Sexual and urinary symptoms also got more improved when treated with estrogen preparations. Both estradiol valerate and conjugated estrogen were effective in reducing severity of hot flushes, psychosomatic symptoms, sexual and urinary symptoms as compared to isoflavones and placebo. Isoflavones had very little advantage over placebo

Hysteroscopic evaluation of postmenopausal bleeding patients and its correlation with histopathological examination

Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information.

Hormone replacement therapy: update and practical prescribing

Menopause is a physiological event of ovarian failure due to a loss of ovarian follicular activity. This leads to a lack of oestrogen, resulting in the cessation of menstruation and loss of reproductive function. This article discusses the symptoms of menopause and treatment with hormone replacement therapy. This includes practical prescribing, side effects and long term benefits and risks. The current shortages of hormone replacement therapy are also addressed. The aim of this article is to enable healthcare professionals to define menopause and gain an understanding of the symptoms associated with it. After reading this article you should be able to: describe when peri-menopause and menopause occur, describe the common symptoms that may be experienced during peri-menopause and menopause, understand of the hormones used in hormone replacement therapy, and understand the practical prescribing of hormone replacement therapy and the benefits, risks, contraindications and side-effects.

Identification of measures predictive of age of puberty onset in gilts

A potential indicator of female lifetime productivity in swine is age of puberty, when a gilt achieves her first behavioral estrus. Follicular activity, as determined by tertiary follicle development, in prepubertal gilts begins during postnatal day (PND) 75 to 115. The central hypothesis of this study is that gilts demonstrating tertiary follicle development earlier in life, assessed using vulva size as a proxy, achieve puberty earlier in life compared with counterparts of a similar age and weight that lack tertiary follicle development. The objectives of this project were to identify a developmental time point when variation in ovarian development exists and to determine whether a relationship between the age prepubertal ovarian development and the age at onset of puberty exists. To accomplish this, 155 gilts of similar age (± 2 d) were weighed and vulva size measured on PND 75, 85, 95, 105, and 115. Vulva measures, including vulva width (VW), vulva length (VL), and vulva area (VA), were utilized as developmental proxies for follicular activity. At each time point, gilts (n = 10) were sacrificed and ovarian follicular activity recorded. In a subset of gilts (n = 105), estrus detection was conducted daily on PND days 126 to 200. Mean VA on PND 75, 85, 95, 105, and 115 was 596 ± 206, 683 ± 190, 864 ± 212, 1014 ± 228, and 1265 ± 252 mm2, respectively. Of the gilts demonstrating behavioral estrus, 28 were within PND 140 to 160, 36 between PND 161 to 180, 15 between PND 181 to 200, and 26 did not demonstrate estrus behavior within 200 d of age. All gilts euthanized at PND 75 lacked follicular activity as defined by having a minimum of 2 antral follicles per ovary, whereas 60%, 80%, 90%, and 100% demonstrated follicular activity on PND 85, 95, 105, and 115, respectively. Body weight at PND 75 and VW at PND 115 were correlated to age at first estrus (P < 0.05). Of the gilts whose VA was less than 1 SD from the mean on PND 95 (i.e., <652 mm2), 31% and 50% demonstrated their first behavioral estrus by PND 180 and 200, respectively. However, of gilts whose VA was within or greater than 1 SD of the mean (i.e., ≥652 mm2), 66% and 79% exhibited estrus prior to PND 180 and 200, respectively. These data support utilization of VA changes between 95 and 115 d of age as a useful tool to identify replacement gilts prior to puberty for inclusion into the sow herd.

Effect of Ferula communis L. on reproductive parameters in Awassi ewes

Nutrient composition of the diet affects follicular activity, embryonic development and reproductive hormones in ruminants. The objective of the present study was to investigate the effects of Ferula communis L. on some reproductive parameters of Awassi sheep. The experiment was carried out on 29 (15-16 months old) Awassi ewes. All ewes were allocated to receive either a control (14% CP and 11.7 MJ ME/kg, n=9) or a diet supplemented with 5% (75g, n=10) or 10% (150g, n=10) powdered F. communis root, respectively for 21 days. Oestrus was synchronized using intravaginal sponges, while oestrus behaviour was observed 24, 36 and 48h after the sponge removal. Blood samples were collected for the assessment of oestradiol and LH. At the end of the 21-day period, animals were slaughtered and ovarian structures were recorded. Corpora lutea tissues were cultured in vitro, and progesterone production was measured. The results indicate that the treatment of animals with 5% of F. communis root increased the percentage of animals in heat (80%, 60% and 10% for 5C, 10C, and the control group, respectively). Furthermore, the number of small follicles (1-3 mm) in treated groups was significantly higher than those of the control group. Moreover, the number of large follicles (>4 mm) in the control group was higher than those of the treatment groups. Plasma concentration of oestrogen and LH peak were similar in the control and treatment groups. Progesterone production by luteal cells cultured in vitro was higher for both treatment groups compared to the control. Herewith, supplementation of the diet of Awassi Sheep with F. communis root during the breeding season may enhance ovulation rate and luteal activity.

Role of diagnostic hysteroscopy in evaluation of postmenopausal bleeding

Background: Postmenopausal bleeding is defined as permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Incidence of abnormal uterine bleeding is 10% to 15% in postmenopausal bleeding. For evaluation of postmenopausal bleeding earlier dilatation and curettage was considered as gold standard which is a blind procedure, transvaginal sonography has improved the accuracy of endometrial morphology. Now the focus has shifted to hysteroscopic guided biopsy which is gold standard for evaluating postmenopausal bleeding it also has benefit of see and treat modality. The objective of this study was to study the significance of hysteroscopy in diagnosis of etiopathological factors of postmenopausal bleeding. To correlate the diagnosis by TVS, hysteroscopy and histopathological diagnosis.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital from June 2016 to September 2018. A total of 30 cases were evaluated. The commencement of the study was followed by approval of the institutional ethical committee.Results: In our study, 83.34% of patients with postmenopausal bleeding where in age group menopause is >55 years. 66.67% are overweight with BMI of 25-29.9. We evaluated the ET <4 mm, 4-12 mm, >12 mm thickness, 53.33% were between 4-12 mm of ET. In our study endometrial hyperplasia shows 30% in hysteroscopy, on HPE shows 33.33%, in atrophic endometrium 20% on HPE is also 20%, polyp shows 6.67% in both hysteroscopy and HPE, sub mucous myoma on both hysteroscopy and HPE shows 3.33% and Ca endometrium shows 3.33% in both hysteroscopy and HPE.Conclusions: Study of total 30 cases were conducted, by using Bettochi Office hysteroscope (2.9 mm). Sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy was calculated in each group of patients.