Osteoporosis, the most common human bone disease, affects 8 million American women and has significant morbidity and mortality. Screening is important in older women and younger postmenopausal women with additional risk factors for osteoporosis/fracture. Preventive measures include avoiding smoking, excessive alcohol/caffeine intake, and falls in addition to maintaining adequate calcium/vitamin D intake and exercise. Estrogen/hormone therapy may be considered in some patients. Various medications have proven efficacy in treating postmenopausal osteoporosis; however, potential adverse effects such as hypocalcemia, worsening of renal impairment, and osteonecrosis of the jaw must be considered. The optimal duration of therapy requires further investigation.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20671号 / 医博第4281号 / 新制||医||1024(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 万代 昌紀, 教授 小川 修, 教授 溝脇 尚志 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

OBJECTIVE: Premature ovarian failure is a disease with many far reaching and serious consequences. Little is known about the complete etiology of the disease or what women may be at an increased risk for developing it. We sought to evaluate the prevalence of premature ovarian failure among women born in the United States and women not born in the United States who were patients of Boston Medical Center. We compared the prevalence of POF in these two groups to evaluate any relationships that may exist between birthplace and premature ovarian failure. METHODS: We collected data from the data warehouse of Boston Medical Center. We used data from women who had an FSH test done between the ages of 18 and 40 before June 30, 2013 as the control. We also compiled data of women who had an FSH level over 15mIU/ml as well as those who had diagnoses in SDK and Logician. Birthplaces data was also compiled for those women who had an FSH level>15mIU/ml. RESULTS: Women born outside of the U.S had a slightly higher prevalence of POF when compared to women born in the United States. Data analysis showed a significant difference among the two groups with p<0.0001 for each group. When birthplace data was compiled, Haiti had the highest number of women with FSH>15mIU/ml with Cape Verde and the Dominican Republic having the next highest amounts of women. CONCLUSION: Our study highlights the possible relationship that exists between premature ovarian failure and birthplace. This was a preliminary study to gather data that may be used in future, more specific studies to be done on the topic. These future studies should further investigate the reason this relationship exists, other causes that may be associated with premature ovarian failure, and further analysis of the prevalence of POF in various areas of the world.

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No description available.

Menopause, the cessation of reproductive capabilities before death, is a detrimental trait for female fitness, yet persists in all human populations. Numerous hypotheses have been published to describe how menopause has been maintained but failed to explain the origin and genetic basis of this trait. In 2013, Morton et al. proposed an influence of the mate choice behaviour, specifically a bias in mating ages that could allow for a trait, seemingly detrimental to fitness, to become neutrally fixed in a population. The goal of our research, presented herein, is to understand the role of the mating system, the sexual behaviour of a group, and especially mate choice, on the origin and evolution of menopause under a serial monogamy scenario. Analysis was conducted using an agent-based computational model that simulated populations. The populations were generated according to specified demographic parameters and reproduced according to a serial monogamy mating system. With the model, parameters were investigated including population lifespan, fecundity, pairing eligibility, age of loss of fecundity, and timing of decay in fecundity. Simulations revealed that, under certain restrictions, menopause can neutrally evolve. When mate choice was restricted to a particular age preference bias, menopause can appear with no diminishment of fitness. This novel mode for the origin of menopause is inferred to result from the accumulation of deleterious mutations in the female genome. By combining this ability of fertility-diminishing mutations to accumulate with research into the genetic basis of menopause, we provide a system for the evolution of menopause in a population of serial monogamy. / Thesis / Master of Science (MSc) / Despite decades of research into menopause, there remains no clear understanding of how this deleterious trait came to persist in the human population. It has been proposed that a bias in mate choice such that only younger females are chosen to mate can result in the accumulation of deleterious mutations, ultimately leading to menopause. We analyzed the evolution of menopause under a mating system of serial monogamy by a computational simulation. We came to three main conclusions. Firstly, under modern demographic parameters, menopause cannot evolve under serial monogamy. Secondly, in a population of shortened longevity, similar to chimpanzee, menopause neutrally appears at an age presently experienced by women. Finally, when mate choice is restricted such that only young females are eligible to mate within a system of serial monogamy, menopause can evolve. This means with the current mate choice shift towards older women, menopause can be postponed or even eliminated.

Menopause, the complete cessation of menstrual cycles, apparently is a detrimental trait, yet all women experience it. Numerous theories have been proposed to explain the origin of menopause, but none has been satisfactory. In 2013, Morton et al. proposed a mate choice hypothesis to explain menopause and, using a computational model, showed how a bias in mating (i.e., older men preferring younger women) could have allowed such an otherwise detrimental trait to evolve neutrally through accumulation of female fertility-reducing mutations. To investigate whether biased mating could affect fecundity and fertility in a real system, two experimental populations were established using Drosophila melanogaster. Older males were mated with younger females and vice versa. Information was obtained, including data on fecundity, fertility, ovariole and matured egg chambers, and lifespan, for experimental, age-restricted-mating and control populations. A negative effect on the fecundity and fertility of the younger-mating sex was observed in restricted-mating compared to control populations. Age-restricted mating had no effect on longevity. Menopause could evolve according to the mate choice hypothesis. / Thesis / Master of Science (MSc) / All animals are expected to remain fertile until they die. Menopause is an enigma and an unsolved problem in evolutionary biology. Numerous theories have been proposed to explain menopause, but there is no clear understanding of how this fertility reducing trait evolved in the human population. It has been proposed that biased mate choice i.e., preference for younger females can lead to accumulation of fertility-reducing mutations and the evolution of menopause. In this study, mate choice theory was tested using altered (biased) mating schemes with Drosophila melanogaster and the results support the mate choice theory of menopause.

This qualitative study used a phenomenological approach to understand the experience of 10 later-life mothers who had a first child at age 35 or older and were in the process of raising a teenager. Data were collected with semi-structured interviews and analyzed using thematic coding. Initial findings suggest maternal age contributes to a positive parenting outcome due to life experience, emotional maturity and financial security. Drawbacks include fatigue and reduced fertility that limited family size, as well as competing life stages such as retirement and college. Older mothers felt in the mainstream. Clinical implications are discussed. / Master of Science

Background: Previous studies have addressed multiple sclerosis (MS) symptom management and improved health-related quality of life (HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment (MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. Methods: We identified 256 post-menopausal women with MS in the Women's Health Initiative Observational Study and examined changes from baseline to 3 years in activities of daily living, physical activity, SF-36 mental and physical component scales (MCS, PCS), and menopausal symptoms. In all adults, experimental studies published after 1965 were included if the sample was not restricted to participants with spasticity or trigeminal neuralgia and participant-reported pain was a primary or secondary outcome. Pain scores were reported as Cohen’s d. Results: Nine percent of post-menopausal women with MS were current smokers and 51% reported current MHT use. Smoking and MHT use had no effect on physical functioning, activities of daily living, or menopausal symptoms. Women with early age at smoking initiation experienced declines in MCS (adjusted β <20 vs. ≥ 25 years: -10.50, 95% Confidence Interval (CI) -2.1 to -18.1; adjusted β 20-24 vs. ≥ 25 years: -8.81, 95% CI: 0.6 to -17.4), but not in PCS. Relative to never MHT users, ever MHT users had higher MCS scores at year 3 compared to baseline (adjusted β: 3.0, 95% CI: 0.4 to 5.6), but no change in PCS. For all adults, transcutaneous electrical nerve stimulation (TENS; Cohen’s d: -3.34), nabixomols (Cohen’s d: -0.61), and dextromethorphan/quinidine (Cohen’s d: -0.22) were reported effective in reducing pain. Conclusions: Smoking prevention efforts should be increased for women with MS. Women with MS may also experience HrQOL gains with MHT, but contemporaneous data on MHT use is needed. TENS may be more effective than pharmacological methods in reducing MS pain.

A menopausa é conseqüência da falência ovariana, caracterizada pela queda na produção de estrógenos, podendo causar na mulher vários sintomas e condições patológicas como vaginite atrófica, osteoporose e doençsa cardiovasculares. A terapia estroprogestiva é largamente prescrita na pós-menopausa, no entanto existem freqüentes efeitos colaterais e contra-indicações, inclusive possibilidade de aumento do câncer de mama. Devido a toda esta polêmica as terapias alternativas para combaterem os sintomas da menopausa estão largamente sendo exploradas, neste contexto cita-se os fitohormônios. A isoflavona é um deles obtido de várias plantas e mais usualmente da soja, que possui na sua molécula uma estrutura fenólica que se liga aos receptores de estrogênio e exerce um efeito estrogênico. Neste estudo enfocando a isoflavona, extraída da soja Glycine max, para o tratamento dos sintomas da menopausa, avaliou-se o efeito desse composto sobre a maturação do epitélio cérvico-vaginal e microbiota vaginal. Para isto propô-se um estudo randomizado, duplo cego, placebo controlado do qual participaram 49 voluntárias. Um grupo de 23 mulheres recebeu 1 cápsula/dia de 40 mg de caseína de leite, constituindo o grupo placebo e o outro grupo de 26 mulheres tratadas com 1 cápsula/dia de 40 mg de isoflavona. Amostras de urina e secreção vaginal para colpocitograma, colpocitograma com coleta úmida, bacterioscopia foram colhidas antes do início e ao término do tratamento. Foram determinados índice de maturação (I.M.) e valor de maturação (V.M.) pela técnica da citologia hormonal. O estudo da microbiota foi avaliado por exame direto a fresco e bacterioscopia de Gram. As mulheres participantes do estudo forneceram dados através de entrevistas mensais, antes do início e após o término do estudo, respondendo a questionários sobre queixas, sintomas, história da vida sexual, percepção da menopausa, estado de saúde e questões sócio demográficas. A avaliação destes dados aparece no índice de Kuppermann, nas maiores queixas e melhoras mais evidentes das mulheres tratadas com isoflavona. A avaliação do I.M. resultou no grupo tratado com isoflavona em redução significativa das células parabasais (P=0,003) no colpocitograma tradicional, em aumento significativo das células superficiais cianofílicas (P=0,006) e tendência de aumento das células superficiais eosinofílicas (P=0,18). No colpocitograma obtido por coleta úmida houve diminuição significativa das células parabasais (P=0,004), aumento significativo na porcentagem de células superficiais cianofílicas (P=0,008) e tendência de aumento das células superficiais eosinofílicas (P=0,18). No urocitograma houve redução significativa de células parabasais (P=0,008), aumento significativo na porcentagem de células superficiais cianofílicas (P=0,013) e aumento das células superficiais eosinofílicas (P=0,002). No grupo placebo não se observou variação significativa nos índices acima mencionados. O V.M. no grupo tratado com isoflavona apresentou aumento significativo (P=0,007) no colpocitograma tradicional, colpocitograma, obtido por coleta úmida (P=0,004); e no urocitograma (P=0,0008). No grupo placebo houve diminuição significativa (P=0,02) para este índice. Após o tratamento pela isoflavona houve aumento significativo de bacilos de Döederlein (P=0,005), diminuição significativa de 19,3% nos casos de vaginose bacteriana (índice de Nugent) e diminuição de outros agentes microbiológicos patogênicos. Houve diminuição dos sintomas da menopausa após o tratamento com isoflavona, também se observou diminuição das queixas após o tratamento com placebo. / The lack of estrogens characterizes postmenopausal condition and is associated with pathological conditions and symptoms, including atrophic vaginites, osteoporosis and cardiovascular disease. Hormone replacement therapy is recommended for postmenopausal women but there are contraindications and side effects. There are many alternative therapy researches in order to alleviate these symptoms. Soy isoflavone has hormonal effects in postmenopausal women, by binding a common phenolic structure to estrogens receptors. The aim of this study focusing isoflavone, extracted from soy beans Glycine max, was to evaluate the effects of isofavone on vaginal cytology, vaginal maturation index (M.I.), maturation value (M.V.), vaginal microbiota and menopausal symptoms. This study involved 49 postmenopausal women, a randomized double blind placebo controlled. The first group of 23 women was treated with 40 mg/day capsule of placebo (caseyne) and the second group of 26 women was treated with 40 mg/day capsule of isoflavone. Urine and vaginal samples for 3 slides: colpocytogram, wet sample colpocytogram, Gram-stained smears was taken at baseline and after treatment in order to determine M.I., M.V., vaginal microbiological findings and colpocytologic findings. Study participants answered an in-person interview with questions in order to determine menopausal symptoms, complains, menopause perception, sexual life, general health to determine, for instance the Kuppermann menopausal index (KMI) at baseline, every month and after six-months of treatment. The M.I. from traditional colpocytogram reduced significantly the parabasal cells (P=0,003), increased significantly the percentage of Superficial Cianophilic cells (P=0,006), there was a tendence of increasing the Superficial Eosinofilic cells (P=0,18). From wet sample colpocytogram, similar results were obtained: reduced significantly the parabasal cells (P=0,004), increased significantly the percentage of Superficial Cianophilic cells (P=0,008) there was a tendence of increasing the Superficial Eosinofilic cells (P=0,18).. In urocytogram, the results obtained were: reduced significantly the parabasal cells (P=0,008), increased significantly the percentage of Superficial Cianophilic cells (P=0,013), increase of Superficial Eosinofilic cells (P=0,002). For placebo group there were no significative changes. The Maturation Value, M.V. increased significtively (P=0,007) in traditional colpocytogram; in wet sample colpocytogram (P=0,004) and in urocytogram (P=0,0008), comparing with placebo was observed significant decrease (P=0,02) for M.V. After treatment with isoflavone there was significative increase of Döederlein bacillus (P=0,005), decrease of 19,3% in cases of bacterial vaginosis (Nugent score) and decrease of others pathogenic microbial agents. The symptoms decreased significatively in woman treated with placebo and decreased significatively in women treated with isoflavone.