Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study.

OBJECTIVE: To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause. SUBJECTS: Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. METHODS: Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year. RESULTS: Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73). CONCLUSIONS: This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Effects of long-term administration of an oral contraceptive containing ethinylestradiol and cyproterone acetate on lipid metabolism in women with polycystic ovary syndrome.

BACKGROUND: The effects of an oral contraceptive pill containing cyproterone acetate on lipid metabolism in women with polycystic ovary syndrome (PCOS) was studied. MATERIALS AND METHODS: Seventy-two women with PCOS were treated for 36 consecutive cycles with an oral contraceptive containing 0.035 mg of ethinylestradiol and 2 mg of cyproterone acetate. Hormonal, lipid and glucose profiles were studied before and after 12 and 36 cycles of treatment. Lipid, lipo-and apolipoprotein values were compared to a healthy control group. Statistical analysis was by one way analysis of variance and Bonferroni's t tests. RESULTS: The treatment suppressed gonadotropin and androgen values and increased the levels of sex hormone binding globulin. After 12 and 36 cycles a significant increase in triglycerides, high density lipoprotein (HDL) cholesterol system, and apoprotein B levels was seen. Low density lipoprotein (LDL) cholesterol and LDL cholesterol/HDL cholesterol ratio were reduced. Insulin and glucose plasma concentrations did not change. During treatment triglycerides, total cholesterol and apoprotein B values were higher than in the control group. There were no differences in plasma levels of LDL-C and HDL-C in PCOS and in the control group. CONCLUSION: Lipid and lipoprotein changes observed after treatment could be due to the estrogen dominance of the treatment. The plasma concentration of triglycerides and total cholesterol during treatment does not change appreciably and the LDL-C/HDL-C ratio improved.

PIP: In Italy, endocrinologists at the University of Brescia compared the hormonal, lipid, and glucose profiles of 72 women with polycystic ovary syndrome (PCOS) and acne using an oral contraceptive (OC) (0.035 mg ethinyl estradiol and 2 mg cyproterone acetate) with those of 39 women who did not have PCOS. They examined their profiles before and after 12 and 36 cycles of treatment. After cycle 12, the OC reduced luteinizing hormone (LH), follicle stimulating hormone (FSH), and all androgen levels (p 0.01), while it increased the levels of sex hormone binding globulin (SHBG) (p 0.01). After 12 cycles, the levels of triglycerides, high density lipoprotein (HDL) cholesterols, apoprotein A1, apoprotein A2, and apoprotein B increased significantly [respectively, 52%, 19% (HDL), 15% (HDL2), and 8% (HDL3), 34%, 35%, and 11%; p 0.05]. The lipid profile after cycle 36 was not much different than it was after cycle 12. At baseline, the PCOS women had lower levels of HDL cholesterol and apoproteins A1 and A2 than did the controls (p 0.05). After 36 cycles of OC treatment, PCOS women had higher levels of triglycerides, total cholesterol, and apoprotein B than controls (p 0.05). Between baseline and cycle 36 of OC treatment, the low density lipoprotein (LDL) cholesterol/HDL cholesterol ratio fell from 1.99 to 1.58. The final ratio equalled that of the controls. The higher estrogenic activity of the OC was probably responsible for the lipid and lipoprotein changes affected by treatment. These findings show that the OC produced an anti-atherogenic lipo-apolipoprotein pattern which corrected the metabolic effects of hyperandrogenism.

Gonadotropin-releasing hormone agonist (GnRH-A) in hirsutism.

Twenty-five women presenting moderate-severe PCOS-dependant hirsuitism were treated for 6 months with GnRH-A (Group A) or pill-combined and GnRH (Group B). Both therapeutic regimens significantly decreased androgen plasma levels. Hair diameter reduced in Group A by 22-34% and in Group B by 25-35%, while hirsuitism score respectively decreased by 22 and 24%. Clinical results, overlapping in the two groups, prove that GnRH-A are active in hirsuitism. Side effects, however, especially a decreased bone density (3.9%) in Group A make it necessary an association with oral contraceptive.

Treatment of moderate and severe hirsutism by gonadotropin-releasing hormone agonists in women with polycystic ovary syndrome and idiopathic hirsutism.

OBJECTIVE: To compare the therapeutic effects of a GnRH-agonist (GnRH-a), leuprolide acetate (LA) depot, versus LA plus and oral contraceptive (OC) containing cyproterone acetate in the treatment of hirsutism. DESIGN: Randomized study. SETTING: Women addressed to the Department of Gynecological Endocrinology, University of Brescia, Brescia, Italy. PATIENTS: Thirty-two patients suffering from moderate and severe hirsutism secondary to polycystic ovary syndrome (PCOS) or idiopathic causes were selected. INTERVENTION: Leuprolide acetate was injected IM every 28 days in all patients; 16 women, randomly allocated, received LA plus OC. At the beginning and at the end of treatment hirsutism score and hair diameters were evaluated. RESULTS: Both treatment arms resulted in a decrease of hirsutism score and hair diameter, both in idiopathic hirsutism (16% to 31% versus 24% to 32%) and in hirsutism secondary to PCOS (23% to 33% versus 24% to 36%). CONCLUSIONS: Gonadotropin-releasing hormone agonist can improve moderate and severe hirsutism effectively. It is necessary to add an OC.

Triphasic pills: variability of endocrine parameters and of sex steroid-binding globulins.

A hundred and twenty healthy women who did not desire pregnancy were selected to check the effects of triphasic oral contraceptives on endocrine parameters and on plasma levels of steroid-binding proteins. Three groups of 40 women each were treated with 3 different pills containing different doses of ethynilestradiol in combination with noretistherone or levonorgestrel or gestodene, for a 6-month period. Serum concentrations of pituitary, ovarian and adrenal hormones, sex-hormone binding globulin and corticosteroid binding globulin were measured, basally and after the 6th cycle. Triiodothyronine and thyroxine were also tested. After 6 cycles the three oral contraceptives determined the inhibition of gonadotropins, ovarian steroids and Dehydroepiandrosterone Sulphate as well as an increase in Cortisol, triiodothyronine, thyroxine, sex hormone binding globulin and corticosteroid binding globulin. Prolactin levels did not vary. In the groups that receive the pills containing noretistherone, levonorgestrel and gestodene, sex hormone binding globulin increased by 138-136 and 156 per cent respectively, while corticosteroid binding globulin increased by 89-75 and 82 per cent respectively. The higher increase in sex hormone binding globulin, caused by gestodene-containing pill, testifies to the selectivity of this progestogen towards a lower androgenicity than norethisterone and levonorgestrel.

Weight loss and menstrual cycle: clinical and endocrinological evaluation.

This study explores the clinical and endocrine implications of weight loss. The frequency of menstrual abnormalities was found to be greatly influenced by reduction in body weight. The occurrence of amenorrhea appeared to be proportional to the rate of weight loss, while regular cycles and luteal phase deficiency were inversely correlated to weight loss. Endocrine variations were noted. Significant decreases in luteinizing hormone and follicle stimulating hormone levels occurred only in amenorrheic patients with a weight loss higher than 20%. The estradiol level decreased in proportion to the reduction in body weight. Cortisolemia increased in all patients, with higher values apparent in amenorrheic women presenting with a weight loss higher than 20%. The prolactin values were normal except in amenorrheic patients who had lower levels. A reduction of insulin levels occurred in all groups, with a significant difference found only in amenorrheic women in Group C (weight loss higher than 20%). The data suggest that weight loss in young women causes alterations in the menstrual cycle mainly through two mechanisms involving both the hypothalamic-pituitary-adrenal axis and ovarian steroidogenesis together with estrogen catabolism.

[Effects of therapy and pregnancy on hyperprolactemia caused by a pituitary adenoma. A clinical case]. / Effetti della terapia e della gravidanza nella iperprolattinemia da adenoma ipofisario. Caso clinico.

A woman who presented with amenorrhea and galactorrhea with a large prolactinoma (8.5 mm) which regressed on bromocriptine therapy is described. When treatment with bromocriptine was instituted (10 mg/daily) mean serum prolactin concentration fell from 490 ng/ml to 108 ng/ml. Despite a progressive reduction in size up to disappearance of the adenoma after the first 5 years of therapy, prolactin levels remained high. Bromocriptine treatment was stopped after 6 years, when pregnancy was diagnosed. Pregnancy proceeded without complications and lactation was initiated and maintained. After 8 months of breast-feeding, menstrual function resumed spontaneously and bromocriptine therapy was no longer required. Bromocriptine can cause not only a decrease in serum prolactin levels but also a regression in the size of prolactinomas in hyperprolactinemic women. No problems associated with pregnancy and/or breast-feeding were noted in these patients.