Role of antimüllerian hormone as a biomarker of the menopausal transition.

OBJECTIVE: The objectives of this study were to clarify changes in antimüllerian hormone (AMH) concentrations during the menopausal transition and to determine whether AMH may serve as a marker to predict the onset of menopause. METHODS: Blood samples were collected annually for 6 years from 595 women living in Iwaki, Japan. We selected 44 women according to strict criteria: those older than 40 years at first participation; those who had their regular menstruation; those whose menstrual cycle had changed from regular to irregular or those who met the final menstrual period; and those who did not take medication that may affect the menstrual cycle. Serum AMH concentrations were determined by the newly developed AMH Gen II assay kit. Stage of the menopausal transition was defined according to the Stages of Reproductive Aging Workshop. RESULTS: Among the 44 women who participated in the study, 29 experienced menopause during the study (group A), whereas the remainder developed irregular menstrual cycles (group B). AMH was consistently found to be undetectable for 3 years before menopause, suggesting that AMH is a sensitive marker for predicting the onset of menopause. In addition, serum AMH was detectable at low levels in women from group B until menstrual cycles became irregular, suggesting that AMH serves as a marker for diagnosing the menopausal transition. CONCLUSIONS: When AMH levels fall below detectable levels, women at the menopausal transition will progress to menopause within 3 years.

Effect of the umbilical cord blood acid-base status and gas values on the yield of mononuclear cells and CD34⁺ cells.

AIM: To investigate the influence of umbilical cord blood (CB) acid-base status and gas values on the yield of mononuclear cells and CD34⁺ cells, pH, pCO2, pO2, HCO3⁻ and base excess were measured in arterial CB samples obtained from normal full-term deliveries. The relationship of these values with the yield of mononuclear cells and CD34⁺ cells detected in venous CB was analyzed. MATERIAL AND METHODS: A total of 145 CB units were collected from full-term vaginal deliveries at a single hospital. Immediately after delivery, a segment of the umbilical cord was double clamped, and arterial CB was analyzed to determine the acid-base status and gases. Venous CB was collected in a sterile collection bag and processed for cell separation within 24 h of collection. The relationship between umbilical arterial acid-base status, each gas value, and the yield of mononuclear cells and CD34⁺ cells was analyzed. RESULTS: Statistically significant correlations were observed between the net weight of CB and the total mononuclear and CD34⁺ cell counts. In addition, there was a negative correlation between the mononuclear cell counts and pH, but a positive correlation between the mononuclear cell counts and pCO2. However, no significant differences were observed between the primipara and multipara groups in terms of the net weight of CB, total mononuclear cell counts and total CD34⁺ cell counts. CONCLUSION: The findings of the present study show that the mononuclear cell counts are correlated with arterial CB pH and pCO2, suggesting the involvement of fetal hypoxia on the yield of mononuclear cells.

[Estrogens for treatment of osteoporoses].

It has been noted that estrogens have strong effects for suppression of bone absorption and prevention of fracture. Although WHI reports emphasized on adverse events of hormone replacement therapy (HRT) too much to avoid this therapy for osteoporosis, recently there are several statements for HRT with positive assessment. Those mentioned that considering risk factor of HRT and age factor, it is possible to use estrogens safely. There is the evidence that estrogens prevent bone fractures in not only osteoporotic women but also healthy women. It is a unique effect that only estrogen has among antiosteoporotic drugs. Taking these characters into consideration, it seems that estrogen therapy is useful for prevention of fractures in perimenopausal women irrespective of bone condition.

[Evidence of hormone replacement therapy for osteoporosis].

Postmenopausal bone estrogen deficiency causes rapid bone loss. Therefore hormone replacement therapy (HRT) has been considered as a rational therapy for postmenopausal not only for osteopenia but also osteoporosis. The results of Women's Health Initiative (WHI) hormone trial had given the strong restriction on HRT. However recent closer analyses have shown that HRT initiated for early menopausal women brings many benefits without elevation of the risks, and that the appropriate selection of dose level or a way to apply can also reduce the risks of HRT. HRT has many physiological effects that were not seen in other drugs and so HRT can be considered as one of the most effective treatment for postmenopausal osteoporosis.