Prolactinomas: evolution after menopause

ABSTRACT Objetive The aim was to assess the evolution of tumor size and prolactin (PRL) levels in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists during fertile age, and the effects of suspension of drugs after menopause. Retrospective study, 29 patients with prolactinomas, 22 microadenomas and 7 macroadenomas, diagnosed during their fertile age were studied in their menopause; treatment was stopped in this period. Age at menopause was 49 ± 3.6 years. The average time of treatment was 135 ± 79 months. The time of follow-up after treatment suspension was 4 to 192 months. Results Pre-treatment PRL levels in micro and macroadenomas were 119 ± 57 ng/mL and 258 ± 225 ng/mL, respectively. During menopause after treatment suspension, and at the latest follow-up: in microadenomas PRL levels were 23 ± 13 ng/mL and 16 ± 5.7 ng/mL, respectively; in macroadenomas, PRL levels were 20 ± 6.6 ng/mL 5t5and 25 ± 18 ng/mL, respectively. In menopause after treatment suspension, the microadenomas had disappeared in 9/22 and had decreased in 13/22. In the group of patients whose tumor had decreased, in the latest follow-up, tumors disappeared in 7/13 and remained unchanged in 6/13. In macroadenomas, after treatment suspension 3/7 had disappeared, 3/7 decreased and 1/7 remained unchanged. In the latest control in the 3 patients whose tumor decreased, disappeared in 1/3, decreased in 1/3 and there was no change in the remaining. Conclusions Normal PRL levels and sustained reduction or disappearance of adenomas were achieved in most of patients, probably due to the decrease of estrogen levels. Dopamine agonists might be stopped after menopause in patients with prolactinomas.

Poor sleep in middle-aged women is not associated with menopause per se

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.

Plasma sodium and potassium levels in Sudanese menopausal women in Khartoum and Gezira State, Central Sudan

The objectives of this work is to assess the impact of estrogen and progesterone on menopausal women, using sodium and potassium level as the index of the menopause. This is prospective, descriptive cross sectional and case-control study was done in hundred and fifty menopausal women, the age range [45-85 years], duration of menstrual cycle [28-38 years] and duration of menopause [1-28 years], this study carry out in Khartoum and Gezira State, Central Sudan during May 2009 to July 2010. Fifty subjects volunteer as control group, the age range from 45 -55 years with match age, socioeconomic status were included. Plasma sodium and potassium were measured by flame photometer and t-test and correlation were used in statistical analysis for the comparison between test and control group. The result showed a significant difference between the mean of plasma sodium of the control group compared with that of the case group [mean +/- SD]: [140.67 +/- 4.9, 3. versus 128.00 +/- 4.3 mmol/L respectively, [P<0.05]. Poatassium is slightly increased in the test group when compared with the control group [mean 1SD]: [3.8 +/- 0.16 versus 4.60 +/- 0.72mmol/L respectively, p > 0.05]. Also, there was a strong positive correlation between plasma sodium level and the duration of the menopause in the test group [p< 0.05]. This study revealed increases of the plasma sodium and slightly plasma potassium level in menopausal women, and the elevation of plasma sodium is positively correlated with duration of the menopause

Déficit de Vitamina D en mujeres adultas de la Ciudad de Buenos Aires / Vitamin D deficit in adult women living in Buenos Aires City

El déficit de vitamina D se asocia con importante morbilidad. El objetivo de este estudio fue investigar la frecuencia de este déficit en una población de mujeres adultas y su asociación con distintas variables. Se evaluaron 224 mujeres mayores de 30 años atendidas en tres consultorios de clínica médica de la Ciudad de Buenos Aires entre octubre de 2006 y marzo de 2008. El nivel de 25 OH vitamina D, por radioinmunoanálisis, se clasificó como suficiente (> 30 ng/ml), déficit leve (entre 20 y 30 ng/ml) y déficit grave (< 20 ng/ml). La edad media fue de 58.3 ± 12.9 años; 77% eran posmenopáusicas. Presentaron déficit leve de vitamina D el 29.9% y déficit grave el 26.8%. El déficit grave se asoció con mayor edad promedio (62 años vs. 56 años, p = 0.003), con falta de exposición al sol (25.8 ng/ml vs. 31.7 ng/ml, p < 0.005), con mayor peso promedio (70 kg vs. 61 kg, p < 0.05), con inactividad física (27.8 ng/ml vs. 31.04 ng/ml, p = 0.0007) y con menor calcemia (9.26 mg/dl vs. 9.51 mg/dl, p < 0.01). No se asoció con tabaquismo ni con los valores de fósforo, creatinina ni TSH plasmáticas. El déficit de vitamina D es frecuente, en especial en mujeres añosas, sedentarias, poco expuestas al sol, obesas y con bajos niveles de calcio.

Vitamin D deficiency is a common cause of morbidity. We prospectively studied 224 consecutive female patients in order to evaluate the prevalence of vitamin D deficiency and to assess the utility of various clinical and biochemical markers in predicting the deficiency. All of them were outpatients, 30 years old or older, and were evaluated from October 2006 through March 2008. Levels of 25 OH vitamin D > 30 ng/ml were considered sufficient. Mild deficiency was considered between 20 and 30 ng/ml and severe deficiency < 20 ng/ml. The mean age was 58 ± 12.9 years; 77% were menopausal. Twenty nine percent of the patients had mild deficit and 26.8% had severe deficit of the vitamin. Severe deficit was associated with increasing age (62 vs. 56 years, p = 0.003), absence of sun exposure (25.82 ng/ml vs. 31.7 ng/ml, p < 0.005), obesity (70 vs. 61 kg, p < 0.05), absence of physical activity (27.8 ng/ml vs. 31.04 ng/ml, p = 0.0007) and slightly low levels of serum calcium (9.26 mg/dl vs. 9.51 mg/dl, p 0.01). We did not find any association between smokers and non-smokers patients, levels of serum phosphorus, creatinine and TSH. Vitamin D deficiency is a common disorder. It correlates with older age, absence of physical activity, sun exposure, obesity and slightly low levels of serum calcium. Improving diagnosis of this condition may enable us to improve the management of this disease.

Analysis of Serum Levels of Anti-Mullerian Hormone, Inhibin B, Insulin-Like Growth Factor-I, Insulin-Like Growth Factor Binding Protein-3, and Follicle-Stimulating Hormone with Respect to Age and Menopausal Status

This study was undertaken to investigate age-dependent and postmenopausal changes in the serum levels of anti-Mullerian hormone (AMH), inhibin B, insulin-like growth factor (IGF)-I, IGF-binding protein-3 (IGFBP-3), and follicle-stimulating hormone (FSH), and to determine which of these markers best reflects the aging process in women. A total of 144 women aged 20-59 yr were enrolled in this cross-sectional study. Blood samples were obtained on cycle day 3 of regularly menstruating women (n=111), or at random in postmenopausal women (n=33). Data were analyzed with respect to premenopausal women age groups and compared in pre- and postmenopausal women. Area under the receiver operating characteristic curve (ROCAUC) analyses were performed to assess the ability of each marker to discriminate between the pre- and postmenopausal status. Serum levels of AMH, IGF-I, and IGFBP-3 decreased and serum levels of FSH increased significantly with age in premenopausal women. Serum luteinizing hormone (LH) was higher and inhibin B was lower in women in their 20-30's than in 40's. Serum levels of AMH and IGF-I showed a consistent decrease with all age groups. ROCAUC analysis showed that the diagnostic accuracy of AMH for menopausal status was similar to those of FSH, LH, and inhibin B, and was better than that of IGF-I. In conclusion, the serum AMH level appears to be the best marker of the aging process in premenopausal women.

Genotypes of vitamin D and estrogen receptors in pre and perimenopausal women from Córdoba, Argentina

El propósito del estudio fue determinar la frecuencia de los genotipos de los receptores de vitamina D y de estrógeno y su relación con la densidad mineral ósea en mujeres sanas pre y perimenopáusicas de la ciudad de Córdoba y alrededores. Los genotipos se determinaron con la técnica de reacción en cadena de la polimerasa y análisis de los polimorfismos de longitud de fragmentos de restricción. Se usaron como restrictasas Bsm I y Fok I para el gen del receptor de vitamina D y Pvu II y Xba I para el gen del receptor de estrógeno. Se reclutaron y agruparon por edad doscientos diez mujeres pre y peri-menopáusicas. Sus niveles séricos de Ca y de hormona paratiroidea fueron similares, pero los de fósforo y b-Cross Laps disminuyeron con la edad. La densidad mineral ósea de cuello femoral disminuyó después de los 30 años. Las frecuencias genotípicas de ambos receptores fueron similares a aquéllas de otras mujeres caucásicas. No hubo asociación entre los genotipos de los receptores y la densidad mineral ósea. Los análisis de interacción entre ambos genes no evidenciaron influencia sobre la densidad mineral ósea, utilizándose edad, talla e índice de masa corporal como covariables. Los estilos de vida y hábitos de fumar y beber alcohol tampoco afectaron la densidad mineral ósea. En conclusión, estos datos no sostienen la hipótesis de que los genotipos de los receptores de vitamina D y de estrógeno influencian la densidad mineral ósea de columna lumbar y cuello femoral en mujeres sanas pre y perimenopáusicas de esta región de Argentina.

The aim of this study was to determine the frequency of vitamin D receptor and estrogen receptor genotypes and their relationship with the lumbar spine or femoral neck bone mineral density in healthy pre and perimenopausal women from Córdoba (Argentina) and adjacent areas. Genotypes were assessed by restriction fragment length polymorphism-polymerase chain reaction technique. Bsm I and Fok I for vitamin D receptor gene and XbaI and PvuII for estrogen receptor gene were used as restrictases. Two hundred and ten healthy pre and perimenopausal women were recruited and analyzed by age. Calcemia and serum parathyroid hormone did not change, but serum P and b-CrossLaps decreased with age. Femoral neck bone mineral density decreased significantly after 30 years old. Vitamin D receptor and estrogen receptor genotype frequencies were similar to those from other Caucasian women. No association between vitamin D receptor and estrogen receptor genotypes with the lumbar spine or femoral neck bone mineral density has been detected. Analysis of interaction between vitamin D receptor and estrogen receptor genes using covariates such as age, height and body mass index did not show any influence of the combination of those genotypes on bone mineral density. Lifestyle, smoking and alcohol intake had no effect on lumbar spine and femoral neck bone mineral density. To conclude, these data do not support the hypothesis that vitamin D receptor and estrogen receptor genotypes influence on lumbar spine and femoral neck bone mineral density in healthy pre and perimenopausal women from this area of Argentina.

A common mutation in cholesteryl ester transfer protein gene and plasma HDL cholesterol level before and after hormone replacement therapy in Korean postmenopausal women

BACKGROUND: Plasma cholesteryl ester transfer protein (CETP) functions to transfer cholesteryl ester from HDL to triglyceride-rich lipoproteins and regulates plasma HDL cholesterol level. A common mutation, the exon 15 A to G substitution at codon 442 (D442G) results in reduced plasma CETP activity and increased plasma HDL cholesterol level. Meanwhile, hormone replacement therapy (HRT) in postmenopausal women increases plasma HDL cholesterol level. METHODS: We investigated the frequency of D442G mutation and its effect on plasma HDL cholesterol level in Korean women. We also examined if the mutation has any effect on an increase in plasma HDL cholesterol level during HRT. RESULTS: Two hundred and twenty eight women aged over 40 years were recruited in this study. Of 228 women, 22 (9.6%) were identified as having the D442G mutation; 21 heterozygotes and 1 homozygote. The subjects with the mutation had higher plasma HDL cholesterol levels than those without the mutation (61.6 +/- 17.3 vs. 55.1 +/- 14.0 mg/dL, p < 0.05). After 12 month HRT, HDL cholesterol increased by 6.4% (3.6 +/- 13.2 mg/dL, p < 0.05) and D442G mutation did not have any significant effect on the change of plasma HDL cholesterol level. CONCLUSION: D442G mutation is common in Korean postmenopausal women and it is associated with increased plasma HDL cholesterol level. HRT for postmenopausal women increased plasma HDL cholesterol level in similar amounts regardless of the presence or absence of D442G mutation.

Study of the level of biochemical bone markers: NMID osteocalcin and bone resorptive marker (beta CTx) in Thai women.

Study of the level of NMID osteocalcin and Beta CTx in 700 Thai women. The mean of NMID osteocalcin = 21.45 SD = 11.18 95% CI = 20.12 to 22.79 ng/ml and betacrosslap = 0.445 ng/ml SD = 0.25 with 95% CI = 0.414 to 0.478 ng/ml in women who menopaused less than 10 years ago (n=237), these values were higher than in young adult females (n=63) and menstruating women (n=123) which was statistically significant (p=0.0001). The value of both bone markers in elderly women who had menopaused more than 10 years ago and were aged more than 60 years (n=94) showed a marked increase of NMID osteocalcin, 25.63 ng/ml SD = 14.22 ng/ml but the value of betacrosslap was below the young-menopausal women, 0.394 ng/ml SD = 0.241 ng/ml 95% CI = 0.344 to 0.444 ng/ml. Menopausal women are at a high risk of osteoporosis due to high bone turnover. In our study, the NMID osteocalcin had a high correlation with betacrosslap (r=0.789 p=0.0001) while both bone markers had a weak correlation with bone mass density of radius, lumbar spine and hip by DXA. (r=0.29 p=0.0001).

Efficacy of calcitriol to bone resorption and PTH level: clinical study.

Study of the effect of calcitriol (Rocaltrol) to bone markers and PTH level in 146 menopausal women. The result showed a dose of calcitriol 0.75 microgram/day for one month significantly decreased the level of PTH, bone marker for resorption and NMID osteocalcin 61.55, 69.92, 60.02 per cent respectively (p=0.000). The other group which took calcitriol 0.5 microgram/day had little change to such markers. The active form of vitamin D benefits bone health by enhancing osteocalcin formation, in addition vitamin D has moderate antiresorption and suppression of PTH secretion.

The parathyroid hormone level in Thai women.

Study of the correlation of parathyroid hormone (PTH) with age, radial bone mass and Nitrogenous mid fragment osteocalcin (NMID osteocalcin) in 226 menopausal women and 123 menstrual women. In menopausal women, aged between 50 and 69, the level of PTH did not increase with age (r=0.001, p=NS). Elderly women (n=123, age>70) showed a slight increase of PTH, 7.8 per cent compared to menstruating women. In elderly women (n=100, age>60) there was no weak correlation (r=0.11, p=0.0001) with bone mass of the distal end of the radius measured by Dual X-ray Absorptiometry (DXA) (Panasonic BDM-3) and no correlation between PTH and the resorptive bone marker, (betacrosslap) (r=0.11, n=122).

A comparative of the effect of tamoxifen on serum lipid and lipoprotein profile in premenopausal & postmenopausal women with breast carcinoma & associated risk of vascular complication.

To examine the effect of tamoxifen on serum lipid and lipoprotein profile of premenopausal and postmenopausal patients of breast carcinoma (with and without vascular disease) we performed a short term evaluation of serum lipid and lipoprotein profile of 38 pre and 42 post menopausal subjects of breast carcinoma (with and without vascular disease) at baseline and during 3 and 6 months of tamoxifen therapy. The lipid & Lp profile of premenopausal patients of Breast carcinoma without vascular disease showed no significant variation after 3 and 6 months of tamoxifen treatment than the corresponding baseline values, but in premenopausal subjects of breast cancer with vascular disease and post menopausal subjects of breast carcinoma (both with and without vascular disease), Serum TC, Apo-B and Lp (a) were significantly decreased and serum HDL and Apo A-I were elevated significantly, However serum TG remain unaltered in premenopausal patients of breast carcinoma with vascular disease but found to be elevated significantly in postmenopausal subjects of breast cancer, both, with and without vascular disease, after 3 and 6 months of tamoxifen treatment, than the corresponding baseline values. Also, the comparison of the results of the present study for pre and postmenopausal patients of breast cancer revealed that the administration of tamoxifen, as adjuvant therapy for breast cancer, is beneficial for postmenopausal patients of breast carcinoma with vascular disease as the drug minimises the risk of vascular disease by bringing significant improvement in serum lipid and Lp profiles of the patients but does not have any significant beneficial effect on familial hyperlipidemic patients of breast cancer.

Avaliaçäo hormonal, bioquímica e citológica em mulheres com idade entre 40 e 55 anos, sem reposiçäo hormonal, no interior de Pernambuco - Brasil / Hormonal, biochemical and cytological evaluation of women between 40 aand 55 years old, withouuut hormonal replacement therapy, in the rural area of the state of Pernambuco - Brazil

O climatério é marcado por mudanças somáticas e psíquicas. Costuma iniciar numa faixa etária que vai de 40 a 55 anos de idade. Este estudo analisou cinqüenta mulheres (n=50) que näo faziam uso de reposiçäo hormonal e medicaçäo para cardiopatias, residentes no interior de Pernambuco - Brasil. Foram realizadas dosagens bioquímicas no sangue com os seguintes resultados: glicose - 86,7 porcento das mulheres eram normoglicêmicas e 13,3 porcento hiperglicêmicas, com média de 102,43 mg/dl. Transaminase (TGP) com média de 16,38 unidade F.R./ml, 97,8 porcento com níveis normais. O colesterol total apresentou média igual a 222,3 mg/dl. 77,8 porcento das mulheres se apresentaram hipercolesterolêmicas. Na avaliaçäo hormonal a dosagem de estradiol e progesterona foi realizada dividindo a amostra estudada em três grupos: A, B e C. O grupo A, formado por mulheres com ciclos menstruais normais (n=31), utilizado como controle, apresentou 90,32 porcento com níveis normais de estradiol. O grupo B, composto por mulheres com ciclos irregulares (n=6) onde 100 porcento das pacientes estavam dentro da normalidade para esta fase. O grupo C, representado por mulheres menopausadas (n=13), acima de doze meses de amenorréia, 69,23 porcento apresentaram níveis dentro do esperado e 30,77 porcento acima. A média do nível de estradiol foi 58,12 pg/ml (p<0,00174). Na determinaçäo da progesterona, o grupo A obteve 100 porcento das pacientes apresentando níveis dentro da normalidade. O grupo B também 100 porcento dentro da normalidade. No grupo C, 84,62 porcento estavam dentro da normalidade para a faixa etária e 15,38 porcento com níveis acima do esperado. A média geral foi 4,11 ng/ml. Na citologia foram encontrado 68,9 porcento dos esfregaços normotróficos, 24,4 porcento hipotróficos e 6,7 porcento säo atróficos. As mulheres menopausadas apresentaram um grande percentual de normotrofismo apesar de mostrarem baixos os níveis de estradiol. Os níveis de progesterona sofreram um decréscimo significativo porém sem alterar o trofismo cérvico-vaginal, mostrando que näo existe uma correlaçäo direta. Os resultados sugerem que a reposiçäo hormonal deve ser bastante criteriosa e estudada caso a caso, levando em grande consideraçäo os níveis de estradiol e progesterona e o padräo de trofismo cérvico-vaginal

Correlación ultrasonográfica e histológica en el adenocarcinoma de endometrio / Correlation of the ultrasonography and histologic in the endometrium adenocarcinoma

1) La ecografía tiene valor limitado en el diagnóstico de adenocarcinoma de endometrio debido al número de errores diagnósticos, sin embargo, sigue siendo de ayuda aunado al diagnóstico histológico. 2) La ausencia de ocupación de la cavidad o de aumento del grosor endometrial por US no descarta un proceso maligno. 3) En mujeres o post-menopáusicas el US tiene mayor utilidad en el diagnóstico de sangrados post-menopáusicos y para descartar carcinoma endometrial, pues cuanto mayor sea el volumen de la cavidad, másprobable es que el proceso sea maligno. 4) El US constituye una prueba útil como ayuda diagnóstica en el sangrado post-menopáusico, pero su utilidad es limitada en el diagnóstico temprano de carcinoma endometrial 5) El grado de...

Transabdominal and transvaginal ultrsonographic evaluation of cases of perimenopausal bleeding

The present work tested the diagnostic accuracy of transabdominal ultrasound [TAS] and transvaginal ultrasound [TVS] in 100 cases with perimenopausal bleeding relative to the pathological diagnosis. 52 patients had proliferative endometrium, 34 had endometrial hyperplasia, 5 had secretory endometrium, 4 had endometrial carcinoma, 3 had retained products of conception, and 2 had atrophic endometria. TAS had 87.5%, while TVS had 90.8% overall diagnostic accuracy. When endometrial thickness was <10 mm [TAS] or <12 mm [TVS] endometrial carcinoma was not reported and hyperplasia was unlikely. When uterine length was <80 mm hyperplasia/carcinoma was rare and when the length was >120 mm the incidence was more than 35%. When myometrial invasion was not detected the possibility of malignancy was only 2%. Ultrasonography [USG] detected associated or causative lesions correctly in nearly 88% of such cases. It detected endometrial carcinoma missed by D and C biopsy in 2 occasions. USG seems to have an important complementary role in evaluating cases of perimenopausal bleeding. TVS had marginal advantage over TAS, though it is not free of limitations that may need further evaluation

The possible role of hormonal levels in fibromyalgia

Estudiamos los niveles hormonales en 18 enfermas con fibromialgia. Once de ellas en etapa premenopáusica y 7 en el periodo postmenopáusico. Medimos los niveles séricos de estradiol, progesterona, hormonas folículo estimulante y luteinizante. Todas las pacientes tuvieron niveles normales de hormona luteinizante, hormona folículo estimulante y progesterona. Interesantemente, tanto el grupo de pacientes pre como portmenopáusicas, mostraron niveles significativamente disminuidos de estradiol. Algunos pacientes en los que no se obtuvo respuesta a tratamiento con tricíclicos y benzodiacepinas mostraron una buena respuesta cuando se les trató con estrógenos. Sugerimos la posibilidad de que el hipoestrogenismo participe en la patogénesis de la fibromialgia

Plasma estradiol and lipid profile in perimenopausal women.

This study was conducted to examine the estradiol level and plasma lipid profile in perimenopausal women. The estradiol and HDL levels were higher and LDL levels lower in premenopausal women than in postmenopausal women of the same age group. Higher HDL and lower LDL levels in premenopausal women are likely to protect them against atherosclerosis, and the difference may be casually related to estradiol levels.

Sangrado uterino transvaginal en la perimenopausia; estudio histopatologico de 206 casos / Bleed uterus transvaginal in the perimenopause; histopatologycal study of 206 cases

Se estudiaron 206 casos de sangrados transvaginales tanto en mujeres pre-menopausicas (50.49 %) y post-menopausicas (49.51 %). Las lesiones del cuerpo uterino fueron mucho mas frecuentes (79.1 %) que las del cuello uterino (20.9 %). Las diversas causas del sangrado en ambos grupos, relacionados con transtornos hormonales, especialmente de hiperestrogenismo, constituyeron la mayoria. Las lesiones neoplasicas, tanto de cuerpo como de cuello uterino, fueron mas frecuentes en las mujeres post-menopausicas conforme se senala en la literatura medica. El sangrado uterino parece ser frecuente en mujeres que estan en el periodo de la vida, que transcurre entre la madurez sexual y la senectud, cuando disminuye progresivamente la funcion ovarica y se establece un equilibrio hormonal. Este periodo conocido como climaterio o perimenopausia, tiene una duracion de aproximadamente 10 anos. Asimismo, existen grandes variaciones en relacion a la menopausia que es la interrrupcion de la funcion mestrual con el cese definitivo de la menstruacion. Sin embargo, se considera que la menopausia se instala, como termino medio, entre los 49 y 50 anos, al parecer influida no solamente por factores endocrinos sino tambien por factores psiquicos y socio-economicos. Por otra parte, la menopausia puede instalarse en forma neta, en forma gradual, con oligomenorrea que progresivamente llega a la amenorrea o puede alternarse con metrorragias de intensidad y duracion variables (1,2). Se puede dividir este periodo perimenopausico en el pre-menopausico que se caracteriza por la aparicion de sintomas circulatorios, nerviosos, psiquicos y las variaciones en los periodos menstruales como se senala arriba, que parece abarcar desde los 45 anos hasta el cese definitivo de la funcion menstrual y el post-menopausico cuando a la amenorrea se agregan alteraciones somaticas y troficas dependientes de la insuficioencia progresiva del ovario hasta la instalacion de la senectud. (3). Con el objeto de conocer mejor en nuestro medio las caracteristicas y las causas de los sangrados uterinos transvaginales, en este periodo de la vida de la mujer, se revisaron todos los casos consecutivos que fueron objeto de estudios histopatologicos.