Mammography in women undergoing hormone replacement therapy. Possible effects revealed at routine examination.

PURPOSE: A retrospective study of screen-film mammographs was performed in 960 postmenopausal women to evaluate the possible effects of hormonal replacement therapy on the breast parenchymal pattern. MATERIAL AND METHODS: Screen-film mammographs of 754 women (mean age 51.4 years) who had undergone hormonal replacement therapy (estrogen, gestagen; mean duration 2.4 years) were compared with findings in 206 women who had not received hormonal replacement therapy (mean age 52.3 years). Mastopathic changes were analyzed according to a 4-grade scale and the incidence of circumscribed lesions (such as fibroadenomas, cysts and malignancies) was further evaluated. RESULTS: In the treated women we found moderate mastopathic changes in 47.2%, intermediate changes in 2.4%, and extensive proliferations in 0.7%. For the untreated women the corresponding figures were 33.5%, 4.8%, and 1.4%. In the treated patients fibroadenomas were apparent in 3.9%, cystic lesions in 3.3%, and malignant lesions in 1.4%. In the untreated women fibroadenomas were evident in 11.6%, cystic lesions in 7.2%, and malignant lesions in 2.4%. CONCLUSION: Mastopathic changes might increase under hormonal replacement therapy. However, the higher incidence of circumscribed lesions in the untreated women might be due to the higher number of symptomatic women who sought examination. We also speculate as to whether the increased density of the breast parenchyma in the treated women might cause a higher number of mammographically undedectable lesions.

Hormonal, syndromal and EEG mapping studies in menopausal syndrome patients with and without depression as compared with controls.

UNLABELLED: The aim of the study was to investigate brain function in menopausal depression by EEG mapping, as compared with menopausal syndrome patients without depression and normal controls, and to correlate neurophysiological with clinical and hormonal findings in order to elucidate the pathogenesis of depression in the menopause. METHODS: One hundred and twenty-nine menopausal women, aged 45-60 years, with no previous hormonal replacement therapy were investigated in regard to hormones (estradiol [E2], follicle stimulating hormone [FSH]), clinical symptomatology (Kupperman Index [KI], Hamilton depression score [HAMD]) and brain function (EEG mapping). Based on KI and DSM-III-R research criteria for major depression, 3 groups were available for statistics (after removal of protocol violators): group A had a KI of <15 and no depression (n = 29); group B had a KI of > or = 15 and no depression (n = 29) and group C had a KI of > or = 15 and fulfilled the criteria for major depression (n = 60). RESULTS: EEG maps of depressed patients demonstrated less total power and absolute power in the delta, theta and beta band, more relative delta and less alpha power as well as a slower delta/theta and faster alpha and beta centroid than controls, suggesting a vigilance decrement. Group B did not differ from group A. Correlation maps showed significant relationships between estradiol levels and EEG measures (the lower the E2, the worse the vigilance) and between the EEG measures and the Hamilton depression (HAMD) score (the worse the vigilance, the higher the depression score). There were no correlations between the hormones E2 and FSH and the syndromes KI and HAMD. In the target variable, the asymmetry index, depressed patients showed less alpha power over the right than left frontal lobe, whereas normal controls exhibited the opposite. Group B did not differ from group A. The frontal asymmetry index was significantly correlated with the Hamilton depression score and suggests right frontal hyper- and left frontal hypoactivation in depression. CONCLUSIONS: Although hormonal findings are not directly linked to psychic changes, low estradiol levels do contribute to a decreased vigilance at the neurophysiological level , which is in turn correlated with higher depressive and menopausal symptomatology at the behavioural level. Depression is further correlated to a right frontal hyper- and left frontal hypoactivation.

Double-blind, placebo-controlled, hormonal, syndromal and EEG mapping studies with transdermal oestradiol therapy in menopausal depression.

In a double-blind, placebo-controlled study, the antidepressant and vigilance-promoting properties of transdermal oestrogen in post-menopausal depression were investigated utilizing hormonal, syndromal and EEG mapping evaluations. Sixty-nine menopausal women, aged 45-60 years without previous hormonal replacement therapy, diagnosed as major depression without psychotic or suicidal symptoms (DSM-III-R criteria), were randomly assigned to a 3-month treatment with transdermal oestradiol [Estraderm TTS (ETTS) 50 micrograms, applied twice weekly] or placebo. No other psychoactive medication was allowed. After removal of protocol violators, 32 patients were evaluable in each group, which did not differ in age, height or weight. As five patients discontinued prematurely in both groups and in one placebo patient a post-drug EEG could not be obtained, 27 patients remained in the ETTS and 26 in the placebo group for efficacy analysis. While in the placebo group, oestradiol (E2) and follicle stimulating hormone (FSH) remained unchanged, E2 increased and FSH decreased significantly in the ETTS group. Syndromal evaluation showed a significant improvement in the Kupperman Index (KI) as well as Hamilton Depression Rating Scale (HAMD) in both groups, with no inter-group difference. However, EEG mapping demonstrated significant inter-drug differences in brain function, mostly over the left temporal region. While ETTS patients showed an increase of alpha and alpha-adjacent theta activity and a decrease of beta activity, as well as an acceleration of the delta/theta centroid and a slowing of the alpha, beta and total power centroid, no changes occurred in the placebo-treated patients. These neurophysiological findings suggest improvement of vigilance by oestrogen, previously referred to as "mental tonic" effect. There were no changes, however, in the frontal alpha asymmetry index, reflecting left frontal hypo- and right frontal hyperactivation. Thus, this neurophysiological variable represents a state-independent marker for depression. The tolerability of ETTS was very good.

The role of prolactin in the menopause.

Within a study on menopausal discomforts, 2322 women were seen for the first time at the Outpatients Department for Climacteric Disturbances and Prophylaxis of Osteoporosis at our clinic. Amongst routine hormonal examination we measured prolactin levels. We found hyperprolactinemia in 23 women. Furthermore, in 224 women who initially had normal hPRL values, an estrogen-gestagen replacement therapy was administered and within this we found a significant increase of the prolactin levels (P < 0.005). The role of prolactin in the climacteric period as well as the mechanism of the estrogen effect upon prolactin secretion are subjects of discussion.

Hormone replacement therapy: lipid responses to continuous combined oestrogen and progestogen versus oestrogen monotherapy.

Fifty-five postmenopausal women with climacteric complaints were randomly assigned to treatment with either 2 mg oestradiol valerate (E2V) (cyclic regimen: 21 days of treatment followed by a 7-day treatment-free interval), or 2 mg E2V combined with 1 mg cyproterone acetate (E2V+CPA) daily, over a 6-month period. Treatment was by the oral route in both cases. The aim was to compare the influence of these two hormone replacement therapy regimens on lipid metabolism. Blood samples were obtained before and after 1 and 6 months of treatment. Serum was analyzed for total cholesterol (TC), high-density lipoproteins (HDL), apolipoproteins A1 and B and triglycerides. The low-density lipoprotein (LDL) concentrations were derived by calculation. All parameters were evaluated in terms of mean +/- S.D. There was no significant difference in the response of the blood lipids to the two treatments, as assessed by analysis of variance (P greater than 0.05). Serum levels of TC were found to have fallen after month 1 and 6 by 5.3 and 5.6%, respectively, during E2V treatment and by 2.4 and 0.2% during E2V+CPA treatment. Serum HDL levels had increased after months 1 and 6 by 9.7 and 5.2%, respectively, in the E2V group and by 6.9 and 2% in the E2V+CPA group, which was also confirmed by the increase in apolipoprotein A1 levels. There was, however, a borderline increase in LDL and apolipoprotein B in the E2V+CPA group. Serum triglycerides were reduced and serum levels of SHBG increased during treatment in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bone density before and after the hormonal therapy of young women with hypergonadotropic hypogonadal amenorrhea]. / Knochendichte vor und nach Hormontherapie bei jungen Frauen mit hypergonadotroper hypogonader Amenorrhoe.

Dual energy X-ray absorptiometry of bone density in the lumbar vertebral column was performed in 32 young women (mean age 24.6 [19-34] years) with hypergonadotropic hypogonadal amenorrhoea. There was a significantly lower bone density (0.74 +/- 0.27 g/cm2) than in a control group of 27 women of similar age (1.17 +/- 0.081 g/cm2; P less than 0.001). Subsequently 21 of the 32 women received cyclical hormone substitution therapy for 24 months (day 1-30: 0.625 mg conjugated oestrogens; additionally, on days 20-30: 5 mg medrogestone; followed by a seven-day pause). After 6 months bone density, compared with that of the 11 untreated women, had increased significantly (P less than 0.001). It is therefore recommended that young hypoestrogenemic women should receive early and continuous hormone substitution treatment.

[Bone density screening in females in climacteric]. / Knochendichtescreening bei Frauen im Klimakterium.

Bonestability is not only determined by the content but also by the construction of the mineral part and the biochemical structure. In addition the organic parts are important, too. Result of the measurements shows only the bone-quantity. The development of several measurement techniques (highquality quantitative computertomography [QCT]) allow us diagnoses concerning the bone quality. Single photon absorptionsdensitometry (SPA), DPA (dual photon absorptiometry), DEXA (dual energy X-ray absorptiometry) and QCT (quantitative computertomography, peripher and central) are todays measurement techniques. In the meantime SPA looses the importance, also DPA-method is displaced by DEXA.

[Menopausal bone density in healthy females of Voralberg. Lack of relation to anamnesis]. / Menopausale Knochendichte bei gesunden Voralbergerinnen. Fehlende Beziehung zur Anamnese.

Bone density was evaluated in 182 healthy climacteric women. Women were recruted from a general prevention program. The results show deviation from 58.2 to 218.6--mean value 128.28, SD 30.91 mg/ccm K2HPO4. 28% of bone density values are under the fracture risk level citated in literature. No statistical relationship was found between bone density and anamnestic data--only the age at hysterectomy shows statistical correlation. The follow up after one year shows no predictive value of anamnestic data to the lost of bone mineral density.

Hypergonadotropic hypogonadic amenorrhea (World Health Organization III) and osteoporosis.

OBJECTIVE: To assess the bone mineral density in World Health Organization (WHO) III women after hormone replacement therapy. DESIGN: We studied the bone mineral density of 41 women with premature ovarian failure (hypergonadotropic hypogonadic amenorrhea--WHO III) before and during hormone replacement therapy. SETTING: All WHO III women were recruited from the Outpatient Department of the First Department of Gynecology and Obstetrics, University of Vienna Medical School, Austria, a public University Hospital. PATIENTS, PARTICIPANTS: Forty-one patients, 30 healthy women. INTERVENTIONS: Twenty-eight of 41 WHO III women received cyclic hormone replacement therapy consisting of 0.625 mg conjugated estrogen (days 1 to 30) and 5 mg medrogeston (days 20 to 30) in addition, with a 7-day interval. MAIN OUTCOME MEASURE: The bone mineral density was evaluated by single photon absorptiometry and dual energy x ray absorptiometry every 6 months (single photon absorptiometry six times, dual energy x ray absorptiometry four times). RESULTS: The bone mineral density in young women with hypergonadotropic hypogonadic amenorrhea (WHO III) was lower than in age-matched controls. Hormone replacement therapy produced an increase in bone mineral density in 28 WHO III women, whereas bone mineral density remained quite constant in the women without therapy. CONCLUSION: Hormone replacement therapy increases the bone mineral density of women with hypergonadotropic hypogonadic amenorrhea. Hormones should be substituted early and consistently in affected patients.

[Hypergonadotropic amenorrhea (WHO III) as osteoporosis risk]. / Die hypergonadotrope Amenorrhö (WHO III) als Osteoporoserisiko.

In 21 patients, suffering from amenorrhoeic hypergonadotropic ovarian insufficiency (age 27 +/- 3 years [FSH: 43 +/- 10, LH: 40 +/- 8]), the bone density was measured by single-photon densitometry (SPA), before starting a hormonal replacement therapy with oestrogen/progesterone. Every 5 months, the trend in bone density change was measured in all cases. The bone density before hormonal treatment was lower in the WHO III-group (1.36 +/- 0.21 g/cm; 1.09 +/- 0.26 g/cm2) than in the age-matched group (1.57 +/- 0.21 g/cm; 1.28 +/- 0.31 g/cm2). Bone density increased after hormonal therapy (p less than 0.05). These results point to the necessity of hormonal replacement therapy in cases of WHO III.

[Ambroxol versus betamethasone for the promotion of antepartum lung maturity in pathological pregnancies]. / Ambroxol versus Betamethason zur Förderung der antepartalen Lungenreife bei pathologischen Schwangerschaften.

Although glucocorticoids have been universally implemented to stimulate fetal lung maturity, their effectiveness and side effects are still widely contested. In search of alternative drugs a double-blind study was conducted between June 1981 and June 1984 comparing betamethasone, a conventional corticoid, and ambroxol, a bromhexine metabolite for efficacy and tolerance in prenatal prevention of the respiratory distress syndrome (RDS) in premature infants and full-term neonates. The therapeutic efficacies of betamethasone and ambroxol for this indication proved to be comparable. Since the possible risks of corticoid therapy in abnormal pregnancies are repeatedly discussed in the literature and in daily clinical practice. 137 patients with EPH gestosis, placental insufficiency, diabetes mellitus, and premature rupture of the membranes were selected from the original group of 308 patients. Only minor side effects (e.g. nausea) were present in a few of the 137 cases undergoing treatment with the 2 test substances. No side effects were observed in the neonates. The incidence of fetal RDS was comparable in both groups (2.9% with ambroxol, 2.2% with betamethasone). Transient and mild RDS cases were slightly more frequent in the ambroxol group than in the betamethasone group. To date, contraindications to ambroxol treatment in abnormal pregnancies are unknown and since generally the rate of potential side effects is considered to be lower in comparison with corticoid treatment, the use of ambroxol especially in abnormal pregnancies corresponding indication can be recommended.

[Dynamic measurement of surface tension versus gas chromatography dipalmitoylphosphatidylcholine analysis of amniotic fluid; a comparison of a bedside method with a highly specialized surfactant analysis]. / Dynamische Oberflächenspannungsmessung versus gaschromatographische DPPC-Analyse im Fruchtwasser; ein Vergleich einer "Bedside" Methode mit einer hochspezialisierten Surfactantanalyse.

The diagnosis of fetal lung maturity by analysis of the amniotic fluid still constitutes a present-day problem. In this study the results of measuring the dynamic surface tension by the Wilhelmy-balance were compared with the DPPC (Dipalmitoyl-Phosphatidyl-Choline) and lecithin species-analysis by the quantitative capillary gas chromatography. The first possibility is a "bed-side"-method, which evaluates the effect of the surfactant in the amniotic fluid in its entirety, whereas the second method represents a highly specialized laboratory procedure analysing the most important part of surfactant contact. The surface tension of amniotic fluid is expressed by its value at 20% of the extension of the surface (gamma-min) as well as the hysteresis area. We were able to show a better correlation between the hysteresis area and the DPPC (r = 0.422, p less than 0.012) than between the gamma min and the DPPC (r = 0.370, p less than 0.031). The correlation between the hysteresis area respectively between the gamma-min, and the second gas chromatographically detectable component of the surfactant, PC 30 was not so distinct (r = 0.068, p less than 0.744; R = -0.355, p less than 0.075). Obviously this component of the surfactant is not as active on the surface and therefore not as important. Further we could show, a negative correlation to the lecithin species PC 34; with increasing surface activity and increasing lung maturity this lecithin species quantitatively recedes into the background.

[Psychosomatic aspects of females in the climacteric. The climacteric--psychosomatics--personality structure]. / Untersuchungen zur Psychosomatik an Frauen im Klimakterium. Klimakterium--Psychosomatik--Persönlichkeitsstruktur.

In this experimental study, the feelings of climacterium in two groups of menopausal women were compared (a test group with climacteric complaints vs a control group without complaints). 70 patients were given a questionnaire: EWL by Janke and Debus, FPI and Giessen-test. The evaluation of the socio-economic data exhibited the fact, that patients in the group with complaints took more drugs than the other group and were more inclined to weight gain. Gynecological data showed significant differences in the beginning and the experience of menstruation. Psychological tests of the group with complaints showed a lack of self-assurance and increased anxiety. These women had also a tendency toward psychosomatic disorders and were less assertive in their social contacts. The discriminant analysis of menopausal and personality variables classified the women equally into the group with complaints compared to the control group.

[The effect of oral contraceptives on bone density in climacteric females]. / Der Einfluss oraler Kontrazeptiva auf die Knochendichte bei klimakterischen Frauen.

The aim of the study was to investigate the influence of long-term administration of oral contraceptives on bone density in climacteric women. Two hundred (n = 200) climacteric women were allocated to three study groups (I, II, III). The first (n = 30) one had been using oral contraceptives for more than 10 years, the second (n = 50) one for between 2 and 9 years, while the third (n = 120) one had never used oral contraceptives. Bone mineral content (BMC) of the left forearm was measured by single photon absorptiometry. The results demonstrate that osteoporosis occurs later and is less frequent during the peri-menopause (p less than 0.05) in women who have used oral contraceptives on a long-term basis (greater than 10 yr). Our findings confirm that there is an important correlation between longterm use of oral contraceptives and bone density.