Climacteric symptoms are related to thyroid status in euthyroid menopausal women.

BACKGROUND: Climacteric symptoms are a variety of disturbing complaints occurring during menopausal transition, many of which may be influenced by hormonal abnormalities other than related to sex steroids. AIM OF THE STUDY: In this study, we investigated the association between the intensity of climacteric symptoms measured with the Kupperman index and a thyroid status. MATERIAL AND METHODS: We evaluated by measuring serum thyrotropin (TSH), and free thyroxine (fT4) 202 euthyroid women admitted to the Department of Gynecological Endocrinology, Poznan University of Medical Sciences because of climacteric symptoms. Patients were both in perimenopause (n = 74) and postmenopause (n = 128), with no history of thyroid disorders. RESULTS: Results presented as the mean value and standard deviation were as follows: age 54.2 ± 4.9 years, BMI 26.8 ± 4.6 kg/m2, Kupperman index 26 ± 13.1 points, TSH 2.4 ± 2.6 mU/l, fT4 1.2 ± 0.37 ng/dl. We observed a negative correlation between fT4 and the time since the last menses (R = - 0.38; p = 0.02) as well as between serum TSH concentration and sweating (R = - 0.18; p = 0.03), general weakness (R = - 0.17; p = 0.03), and palpitation (R = - 0.18; p = 0.02) and a positive correlation between fT4 and nervousness (R = 0.34; p = 0.007) and palpitations (R = 0.25; p = 0.04). In the perimenopausal subgroup, there was a positive correlation between fT4 and general weakness (R = 0.42; p = 0.03), palpitations (R = 0.50; p = 0.009), and paresthesia (R = 0.46; p = 0.01). In the postmenopausal subgroup, there was a negative correlation between TSH and sweating (R = - 0.21; p = 0.03). CONCLUSIONS: Menopausal symptoms are related to thyroid status in euthyroid menopausal women.

The improvement of hirsutism and the decrease of testosterone concentration in the peripheral blood serum after removing an endometrioid ovarian cyst.

The study describes the case of a patient, in which as a result of removing an endometrioid ovarian cyst, there was an improvement as regards hirsutism and the decrease of testosterone concentration in the serum of peripheral blood.

The genetic background of climacteric symptoms in women during menopause.

The subject of the study is the evaluation of the correlation between the polymorphism of candidate genes in the etiology of depression and the occurrence of the symptoms of the climacteric syndrome in women during menopause. The group subjected to the study comprised of 203 women aged between 42-65 years: 71 of them still menstruated (premenopausal group) and 132 at least one year after the last period (postmenopausal group), admitted to the Department of Gynecological Endocrinology at the University of Medical Sciences in Poznan with symptoms of the climacteric syndrome All the examined women were evaluated according to the degree of severity of the climacteric syndrome symptoms using the Kupperman index and the concentration of FSH, LH hormones, 17ß-estradiol, PRL, total testosterone, and DHEAS in peripheral blood serum. Among the candidate genes in the aetiology of depression the following were selected for the research: the serotonergic system receptor genes: 5HTR2A, 5HTR1B, 5HTR2C, TPH 1, TPH2, and MAO-A; the genes of noradrenergic and dopaminergic systems (COMT, NET), the genes of the GABAergic (GABRBl) system, a gene of the estrogen receptor (ESR1), and the genes of the enzymes crucial in the methyl cycle (MTHRF, MTR, and MTHFD1). With regards to the correlation between the examined polymorphisms and the occurrence of the symptoms of the climacteric syndrome, the associations analysis indicated a connection between GABRBl.TaqI polymorphism and the occurrence of vertigo in premenopausal women (0.0198; after correction: 0.0497 CC to CA). The correlation was also found regarding the examined polymorphisms and the concentration of the examined hormones in blood serum: TPH1.MaeI polymorphism and the LH concentration in the postmenopausal group (0.004; after correction: 0.014 CC to CA), NET.Eco1471 polymorphism, and the 17ß-estradiol concentration in the postmenopausal group (0.0208; after correction: 0.048 GG to GA) and HTR2AMspI polymorphism and PRL concentration in all examined women (0.03; after correction: 0.038 TT to CT).

Depressive symptoms' pattern in postmenopausal women.

The study was conducted to elucidate the problem of depressive symptoms' pattern in climacteric women. The study included 128 postmenopausal women aged 47-65 years admitted to the Department of Gynecological Endocrinology, Poznan University of Medical Science because of climacteric symptoms. The authors assessed the intensity of climacteric symptoms with the Kupperman index and the severit of depressive symptoms with the Hamilton depression scale. They measured BMI of all studied women. The average score of the Hami ton scale in the studied group was 11 points (SD ± 7 points). No depressive symptoms were found in 40 (31.2%) of the study participants. A slight increase in the severity of the depression symptoms was found in 64 (50%) and 23 (29.9%) displayed depressive symptoms at moderate severity, while one (1.3%) study participant was diagnosed with very severe depressive symptoms. Depressive symptoms observe most often were: somatic symptoms of anxiety and fear experienced in 90 (70.2%), light and interrupted sleep reported in 88 (68.6%), an general symptoms in 88 (68.6%) of the study participants.

Pregnancy after ovarian wedge resection in a polycystic ovarian patient after laparoscopic ovarian cauterization.

The authors present a case of a pregnancy after ovarian wedge resection by laparotomy after unsuccessful ovarian drilling. A 28-year- old patient was admitted to the present outpatient clinic because of infertility, secondary amenorrhea, and hirsutism. Three years prior she had undergone laparoscopic ovarian drilling with no effect on menstrual pattern and fertility. After clinical and ultrasonographic ex- aminations, polycystic ovarian syndrome (PCOS) was diagnosed and consequently laparotomy with ovarian wedge resection was de- cided upon. Six weeks later patient was diagnosed with an early pregnancy.

Depressive symptoms and hormonal profile in climacteric women.

OBJECTIVES: The aims of the study were: evaluation of depressive symptoms in climacteric women, comparison of depressive symptoms between peri- and post-menopausal women, and assessment of a possible relationship between the presence of depressive symptoms and the hormonal profile of the studied women. MATERIALS AND METHODS: The study included 45 peri-menopausal and 95 post-menopausal women admitted to the Department of Gynecological Endocrinology, Poznafi University of Medical Sciences, because of climacteric symptoms. The following parameters were evaluated in all studied women: intensity of climacteric symptoms (Kupperman Index), intensity of depressive symptoms (Hamilton depression scale), serum concentrations of hypothalamic-pituitary-gonadal axis hormones (FSH, LH, 17ß-estradiol), prolactin (PRL) and androgens [total testosterone, dehydroepiandrosterone sulfate (DHEAS)]. FSH, LH, 17ß-estradiol, PRL, and total testosterone were evaluated by the immunoenzymatic methods and DHEAS was measured by the radioimmunological method. RESULTS: Psychic and somatic manifestations of anxiety and fear, shallow sleep, and general somatic symptoms were the most frequent depressive symptoms in both studied groups. Both investigated groups differed in relation to the incidence and intensity of symptoms from the genital system (observed more often in post-menopausal women) and hypochondria (noted more frequently in peri-menopausal women). Numerous relationships between the incidence and intensity of certain symptoms and serum concentrations of the investigated hormones were found in both groups. The correlations were different in peri- and post-menopausal subjects.

Serum prolactin concentration and severity of depression symptoms in climacteric women.

OBJECTIVE: The study was conducted to elucidate the problem of prolactin (PRL) serum concentration in menopausal women and its possible relations with climacteric and depressive symptoms. MATERIALS AND METHODS: The study included 202 women aged 40-65 years admitted to the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, because of climacteric symptoms. The authors assessed the intensity of climacteric and depressive symptoms with the Kupperman index and the Hamilton depression scale, measured BMI index, serum PRL, FSH, LH, 17ß-estradiol, total testosterone, and dehydroepiandrosterone sulfate (DHEAS) levels in all studied women. RESULTS: They found a correlation between serum PRL concentration and result of M. Hamilton depression scale (R = 0.21; p = 0.005) and a between serum PRL concentration and serum 17ß-estradiol concentration (R = 0.21; p = 0.003). CONCLUSION: The authors concluded that serum PRL concentration is related to severity of depressive symptoms in menopausal women.

Pregnancy in a patient with premature ovarian failure.

BACKGROUND: Premature ovarian failure (POF) occurs in about one in 100 women under 40 years of age. The authors report a case of a POF patient who conceived during hormonal replacement therapy (HRT). CASE: A 24-year-old woman with confirmed POF conceived spontaneously during HRT. CONCLUSION: Pregnancy is possible in women with POF.

Premature ovarian failure: diagnosis and treatment.

Premature ovarian failure (POF), also known as primary ovarian insufficiency, is diagnosed in the event when primary or secondary amenorrhea and hypoestrogenism with high levels of gonadotropins occur in women before the age of 40. POF, caused by genetic, autoimmune and environmental factors, leads to a decrease in numbers of primordial follicles, accelerated atresia, and impaired follicular function. The diagnosis of POF is an indication for hormonal replacement therapy (HRT), which should be continued until the mean age of menopause in a given population. HRT reduces the intensity of vasomotor symptoms and has a beneficial effect on the central nervous, skeletal, cardiovascular, and urinary-reproductive systems.

The c.1460C>T polymorphism of MAO-A is associated with the risk of depression in postmenopausal women.

OBJECTIVE: The aim of the study was an evaluation of possible relationships between polymorphisms of serotoninergic system genes and the risk of depression in postmenopausal women. METHODS: We studied 332 women admitted to our department because of climacteric symptoms. The study group included 113 women with a diagnosis of depressive disorder according to the Hamilton rating scale for depression; the controls consisted of 219 women without depression. Serum 17ß-estradiol concentrations were evaluated using radioimmunoassay, while polymorphisms in serotoninergic system genes: serotonin receptors 2A (HTR2A), 1B (HTR1B), and 2C (HTR2C); tryptophan hydroxylase 1 (TPH1) and 2 (TPH2), and monoamine oxidase A (MAO-A) were evaluated using polymerase chain reaction-restriction. RESULTS: We found that the 1460T allele of MAO-A c.1460C>T (SNP 1137070) appeared with a significantly higher frequency in depressed female patients than in the control group (P = 0.011) and the combined c.1460CT + TT genotypes were associated with a higher risk of depression (P = 0.0198). Patients with the 1460TT genotype had a significantly higher 17ß-estradiol concentration than patients with the 1460CT genotype (P = 0.0065) and 1460CC genotype (P = 0.0018). CONCLUSIONS: We concluded that depression in postmenopausal women is closely related to the genetic contribution of MAO-A.

Bilateral androblastoma (Sertoli-stromal cell tumor) of the ovary: a rare cause of virilization in a teenager.

A case of a 17-year-old patient diagnosed with bilateral androblastoma of the ovary is presented. The patient was admitted because of secondary amenorrhea, hirsutism and acne. After clinical, ultrasonographic and hormonal examinations an androgen-producing ovarian tumor was suspected and consequently laparotomy with right ovarian tumor excision and left ovary exploration was carried out. During surgery the right ovarian tumor was excised and exploration of the left ovary revealed an ovarian tumor with a diameter of 10 mm, which was then also excised. The pathologic diagnosis was a bilateral androblastoma of the ovary measuring 40 mm x 30 mm x 20 mm in the right ovary and 10 mm in diameter in the left ovary. We concluded that androblastomas, in spite of their low incidence, are a possibility that should always be considered in women of all ages presenting with signs of virilization.

Polymorphic variants of genes encoding MTHFR, MTR, and MTHFD1 and the risk of depression in postmenopausal women in Poland.

OBJECTIVE: Disturbances in the folate-dependent one-carbon metabolism have been reported in depression. Polymorphic variants of genes encoding key enzymes of folate and methionine metabolism may have an impact on catecholamine catabolism conducted by catechol-O-methyltransferase. METHODS: The distribution of polymorphisms of genes encoding methylenetetrahydrofolate reductase (MTHFR); methionine synthase (MTR); 5,10-methylenetetrahydrofolate dehydrogenase, 5,10-methenyltetrahydrofolate cyclohydrolase and 10-formyltetrahydrofolate synthetase (MTHFD1) was examined in postmenopausal women with (n=83) and without depression (n=89). RESULTS: We found a significant contribution of the MTHFR 677C>T polymorphic variants to depression in postmenopausal women. Odds ratio (OR) for women with depression and MTHFR TT genotype was 3.478 (95% CI=1.377-8.783), P=0.0096 and OR of the TT and CT genotypes was 2.345 (95% CI=1.258-4.373), P=0.0086. Moreover, after stratification based on depression severity in postmenopausal women, we found that the MTHFR TT genotype displayed a 4.831-fold increased risk of moderate and severe depression (95% CI=1.975-11.820, P=0.0008). We did not observe statistical differences in the distribution of MTR 2756A>G and MTHFD1 1958G>A polymorphic variants in groups of postmenopausal women with and without depression. However, the MTR GG genotype exhibited a 5.750-fold increased risk of moderate and severe depression in postmenopausal women (95% CI=1.547-21.379, P=0.013). CONCLUSIONS: Our findings indicate a significant role of folate and possible methionine metabolism involvement in the development of depression in postmenopausal women.

Comparison of fibrinolytic and metabolic system parameters in obese patients with polycystic ovary syndrome and women with simple obesity.

The present study aimed to assess the fibrinolytic and metabolic system parameters in obese patients with polycystic ovary syndrome (PCOS) and to compare them in obese PCOS patients and women with simple obesity. We studied 19 obese women with PCOS (age: 25.1 +/- 4.6 years, body mass index (BMI): 34.7 +/- 3.9 kg/m2; mean +/- standard deviation) and 20 age- and BMI-matched ovulatory controls. We measured blood levels of 17beta-estradiol, testosterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEAS), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucose and insulin. The following fibrinolytic tests were also performed: euglobulin clot lysis time, plasminogen level, alpha2-antiplasmin activity, plasminogen activator inhibitor-1 activity, fibrinogen concentration and estimated fibrinolytic activity. Testosterone and LH levels were significantly higher in obese women with PCOS (p < 0.01 and p < 0.001, respectively). The groups did not differ with regard to 17beta-estradiol, prolactin, FSH, DHEAS, TC, TG, HDL-C, LDL-C, glucose and insulin. All of the fibrinolysis parameters with the exception of plasminogen were comparable between the two groups. Serum plasminogen level was lower in obese PCOS patients than in women with simple obesity (p < 0.05). Euglobulin clot lysis time was positively correlated with insulin (r = 0.88, p < 0.05) in both groups. Our results show that fibrinolysis is not suppressed in women with PCOS and that there is no difference in fibrinolytic activity between obese patients with PCOS and women with simple obesity.

Gherlin expression in women with polycystic ovary syndrome--a preliminary study.

The etiology and pathogenesis of polycystic ovary syndrome (PCOS) is still unknown. Using real-time PCR, we detected that polycystic ovaries showed almost ten times lower expression of ghrelin mRNA than normal ovaries, whereas the mRNA levels in blood cells were similar in both study groups. This suggests that the presence of ghrelin in PCOS and normal ovaries may have an autocrine/paracrine modulatory effect on ovary functions and local significance in the etiology of PCOS.

Relationship between climacteric symptoms and serum galanin levels in post-menopausal women.

OBJECTIVES: The aim of the study was to evaluate the possible relationship between climacteric symptoms and serum galanin concentrations in post-menopausal women. MATERIALS AND METHODS: We studied 38 women who attended the Department of Gynecological Endocrinology in Poznan because of climacteric complaints. The control group comprised 16 women [mean age 22.2 yr (SD+/-0.9 yr), range 18-24 yr] who were menstruating regularly and had normal body mass index. We evaluated the severity of climacteric symptoms using the Kupperman scale and we measured 17beta-estradiol, FSH and galanin serum concentrations by radioimmunoassay. RESULTS: The mean serum galanin concentration was 18.7 pg/ml (SD+/-16.1 pg/ml) in the study group and 21.9 pg/ml (SD+/-9.4 pg/ml) in the control group. The difference was not statistically relevant. The mean serum galanin concentration was 15.9 pg/ml (SD+/-12.6 pg/ml) in the group of patients with mild and moderate climacteric symptoms and 29.5 pg/ml (SD+/-23.3 pg/ml) in the group of patients with severe climacteric symptoms. The difference between the two groups was statistically significant (Student t-test: p<0.05). Climacteric patients with nervousness had lower serum galanin concentration than patients without this symptom (Student t-test: p<0.05). CONCLUSIONS: a) Serum galanin concentration in post-menopausal women is related to severity of climacteric syndrome; b) the presence of nervousness in post-menopausal women is related to lower serum galanin level.

Relationship between climacteric symptoms and serum serotonin levels in postmenopausal women.

OBJECTIVE: The aim of the study was to evaluate the possible relationship between climacteric symptoms and serum serotonin concentrations in postmenopausal women. MATERIALS AND METHODS: We studied 39 women who attended the Department of Gynecological Endocrinology in Poznan because of climacteric complaints. We evaluated climacteric symptom severity with the use of the Kupperman scale and we measured 17beta-estradiol, follicle stimulating hormone (FSH) and serotonin serum concentrations by radioimmunoassay. RESULTS: The mean serum serotonin concentration in the studied women was 48.9 ng/ml (standard deviation, SD +/- 24.1 ng/ml). The mean serum serotonin concentration in the group of patients with mild climacteric symptoms was 97.7 ng/ml (SD +/- 16.6 ng/ml), and in the group of patients with moderate and severe climacteric symptoms was 36.2 ng/ml (SD +/- 24.1 ng/ml). The difference between the two groups was statistically significant (Mann-Whitney test, p < 0.05). There was no difference in serum serotonin concentrations between patients with or without specific symptoms (Mann-Whitney test, p > 0.05). CONCLUSIONS: Serum serotonin concentrations in postmenopausal women are related to the severity of climacteric symptoms.

Estimation of hormone replacement therapy influence on serum galanin level in postmenopausal women.

OBJECTIVE: The aim of this study was to evaluate the influence of exogenous hormones (estradiol and progestogen) used in hormone replacement therapy (HRT) on the serum galanin level in postmenopausal women with normal body weight. METHODS: We studied 20 postmenopausal patients (mean age 52.3 +/- 5.2 years) before and after 1 year of HRT. The mean duration of amenorrhea in these patients was 5.3 +/- 4.1 years. In all cases, body mass index was in the normal range (between 20 and 25 kg/m2). Serum galanin and estradiol concentrations were measured by radioimmunoassay before and after 1 year of treatment. Results were statistically analyzed with the use of specialist computer software. RESULTS: There was no statistically significant difference in serum galanin concentration before (8.24 +/- 3.63 pg/ml) and after (5.63 +/- 2.75 pg/ml) 1 year of HRT. Following HRT the serum estradiol level (0.09 +/- 0.015 ng/ml) was significantly higher than before starting therapy (0.021 +/- 0.018 ng/ml) (p < 0.001). Also, after HRT the mean serum follicle stimulating hormone (FSH) level (32.9 +/- 28.0 IU/l) was significantly lower than before starting therapy (91.7 +/- 38.5 IU/l) (p < 0.01). CONCLUSIONS: The study results suggest that HRT in postmenopausal women does not restore galanin levels to values typical of those in women of reproductive age.

The concentration of galanin in postmenopausal women before and after application of hormone replacement therapy compared to women of reproductive age.

BACKGROUND: Hormone replacement therapy (HRT) during menopause exerts an essential impact on neuroendocrine regulation within the hypothalamic-pituitary system. The sex steroids, especially estrogens, are responsible for the synthesis and secretion of neuropeptides and neurotransmitters, such as galanin, neuropeptide Y, the opioid peptides, dopamine, serotonin, and others. The purpose of our research was to evaluate the concentration of galanin in postmenopausal women before and after the application of HRT, and to compare these values to the concentrations found in women of reproductive age. MATERIAL AND METHODS: The experimental group consisted of 20 women (average age 53 +/- 5.2). The average time elapsed since the last menstruation in these women was 5.3 year I 1.4. RESULTS: The differences in the concentrations of galanin before (8.24 +/- 3.62 pg/ml) and after (5.63 +/- 2.75) the application of HRT were not statistically significant. These values were significantly lower, however (p<0.05), than the galanin concentrations in women of reproductive age (22.03 +/- 12.02 pg/ml). The concentrations of estradiol prior to the administration of HRT (0.021 +/- 0.02 ng/ml) were significantly lower (p.<0.001) than after the application of hormone replacement therapy (0.09 +/- 0.156 ng/ml). The concentrations of estradiol in the control group averaged 0.070 +/- 0.04 ng/ml, significantly higher than in the group of post-menopausal women given HRT (p.<0.05). No statistically significant difference was found between the galanin concentration in women of reproductive age and in postmenopausal women using HRT. CONCLUSIONS: Our research results indicate that serum galanin in postmenopausal women is significantly lower than in women of reproductive age. The application of hormone replacement therapy does not restore galanin concentrations to levels typical for women of reproductive age.

[Ovarian gonadal tumors in materials of the clinic of gynecological endocrinology of the Medical Academy in Poznan (1970-1998)]. / Nowotwory gonadalne jajnika w materiale kliniki endokrynologii ginekologicznej AM w Poznaniu (1970-1998).

11 patients with ovarian gonadal tumors were treated at Clinic of Endocrinological-Gynecology of Academy of Medicine in Poznan. All presented symptoms of hormonal ovetproduction. In 9 cases we performed adnexectomy, only in 1 case (patient after menopause) hysterectomy with bilateral adnexectomy.

[Primary amenorrhea caused by impaired cervical development: report of 3 cases]. / Pierwotny brak miesiaczki uwarunkowany wada rozwojowa szyjki macicy--opis 3 przypadków klinicznych.

We report 3 cases of primary amenorrhea accompanied by cyclic abdominal pain. In presented cases primary amenorrhea was caused by the absence of normally developed cervix. We applied surgical treatment--hysterectomy. In 1 case before hysterectomy we tried to reconstruct cervical canal. This effort was unsuccessfull.