Includes bibliographical references (leaves 254-288). Examines language used by general practitioners and in mass media to ask 'what are the implications of constructions of menopause for health care practice and public health for women at menopause?'. Presents the findings of qualitative analysis of semi-structured interviews with nine general practitioners working in rural South Australia and qualitative and quantitative analyses of 345 south Australian newspaper articles from 1986 to 1998.

Includes bibliographical references (leaves 254-288). / x, 288 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines language used by general practitioners and in mass media to ask 'what are the implications of constructions of menopause for health care practice and public health for women at menopause?'. Presents the findings of qualitative analysis of semi-structured interviews with nine general practitioners working in rural South Australia and qualitative and quantitative analyses of 345 south Australian newspaper articles from 1986 to 1998. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2001?

Estrogens greatly affect the activity and connectivity of serotonergic neural cell populations, which extend from clusters of nuclei in the brainstem, termed the raphe nuclei, where estrogen receptor β is the most abundantly expressed estrogen receptor subtype. Estrogenic effects on the raphe nuclei are primarily important for influencing various neuropsychological behaviors, including depression, mood swings and anxiety behaviors. Because of this connection, phases of intense hormone fluctuations for instance during menopause are often associated with several mood disturbances that often reduce the quality of life of menopausal women. Accordingly, long-term use of hormone replacement therapy appeared to be the method of choice for many menopausal women to help alleviate vasomotor symptoms, which may include neuropsychological changes such as depression. However, given the limitations and number of serious health risks attributed to hormone replacement therapy, natural compounds such as phytoestrogens are receiving widespread awareness due to their occurrence in medicinal plant extracts and a wide variety of food items including dietary supplements with respective health claims. Flavonoids, particularly the isoflavones and the naringenin-type flavanones, belong to a group of polyphenolic plant-derived secondary metabolites known to possess estrogen-like bioactivities. Nevertheless, little is known about their transactivational activity and their potential to regulate endogenous gene expression of estrogen responsive genes in the raphe nuclei due to the lack of suitable cellular models expressing sufficient amounts of functional estrogen receptor β. Hence, a raphe nuclei-derived cell line that expresses a functional estrogen receptor β was sought as a model to investigate effects of flavonoids in vitro. In this regard, RN46A-B14 cells derived from embryonic day 13 rat medullary raphe nuclei were primarily used in this study as the main cellular model. Nonetheless, expression of endogenous estrogen receptor β in these cells was not sufficient to pursue downstream investigations of estrogen-dependent activities. To overcome this deficit, a rat raphe nuclei-derived in vitro model that overexpresses a functional estrogen receptor β was initially established (herein termed RNDA cells) by stably transducing its parent cell line, RN46A-B14 cells, with a suitable lentiviral expression vector encoding a human estrogen receptor β gene. The stable expression and the functional characterization of the transgenic receptor was confirmed by Western blot analysis and luciferase reporter gene assays, respectively. The same reporter gene assay was used to scrutinize the transactivational activity of the flavonoids in RNDA cells. Key results revealed that Genistein, Daidzein, Equol, Naringenin and 8-Prenylnaringenin demonstrated high transactivational activity in a concentration-dependent manner by stimulating luciferase expression from an estrogen responsive element-regulated reporter gene construct transiently transfected in RNDA cells. Low transactivational activity was observed in RNDA cells in response to increasing concentrations of 7-(O-prenyl)naringenin-4'-acetate. However, no transactivational activity was noticed in response to 6-(1,1-Dimethylallyl)naringenin in the studied cell model. All effects elicited by the flavonoids were antagonized by the pure estrogen receptor antagonist, Fulvestrant, indicating that all substances act by binding to and activating the transgenic ERβ. Additional effects were observed in RNDA cells in response to a co-treatment of 1 µM of either Genistein or Daidzein, but not Equol, with 10 nM 17β-Estradiol. Slight antagonistic effects were observed in the same studied cell line when either 8-Prenylnaringenin or 7-(O-prenyl)naringenin-4'-acetate, but not Naringenin or 6-(1,1-Dimethylallyl)naringenin, were co-added with 17β-Estradiol. Results from the reporter gene assays were validated on the basis of regulation of mRNA expression of estrogen responsive genes following the global assessment of 17β-Estradiol-induced gene expression in this cell line using a DNA microarray technique. Out of 212 estrogen-regulated genes with at least two-fold change of expression, six were selected according to specific features of estrogenic regulation of expression. The expression of the six selected 17β-Estradiol-regulated genes was validated using quantitative real-time PCR analysis. The regulation of mRNA expression of the selected genes in response to the tested flavonoids was then investigated in RNDA cells. Additionally, because RNDA cells encode a temperature-sensitive mutant of the Simian Virus 40 large T-antigen, their neuronal differentiation is constitutive upon shifting them from conditions promoting proliferation (permissive temperature) to differentiation (non permissive temperature). Hence, the regulation of mRNA expression of the selected genes in response to the tested flavonoids was additionally investigated as RNDA cells differentiate. In RNDA cells grown under proliferative conditions, 17β-Estradiol up-regulated mRNA expression of camello-like 5, sex determining region Y-box 18 and keratin type I cytoskeletal 19. Similar effects were observed in response to 8-Prenylnaringenin, Genistein, Daidzein and Equol. In addition, 17β-Estradiol down-regulated mRNA expression of neurofilament medium polypeptide and zinc finger DHHC-type containing 2. Similar effects were observed in response to 8-Prenylnaringenin, Naringenin, Genistein, Daidzein and Equol. Yet, no effect was observed on the regulation of mRNA expression of solute carrier family 6 member 4 in response to 17β-Estradiol or the flavonoids in RNDA cells grown under proliferative conditions. When RNDA cells were shifted to conditions promoting differentiation, changes in cell morphology, in mRNA expression levels and in responsiveness towards 17β-Estradiol or the flavonoids were observed. These expression studies additionally highlighted some of the genes as indicator genes for RNDA cellular differentiation. The newly established RNDA cell line should prove useful to elucidate basic physiological properties of estrogen receptor β in the raphe nuclei. The present study should serve as the basis to help shed light on molecular and cellular mechanisms following the action of phytoestrogens, endocrine disruptors or other exogenous estrogen receptor ligands in neural cell populations, particularly the raphe nuclei, for further applications within the brain.

Thesis (Ph. D.)--Deakin University, 2003. / Title from PDF title page (viewed on Dec. 15, 2005). Includes bibliographical references (leaves 202-225).

Made available in DSpace on 2014-12-17T14:13:49Z (GMT). No. of bitstreams: 1 MariaTABCM_DISSERT.pdf: 247939 bytes, checksum: cb096019e991f8f3059823ed5c01ce36 (MD5) Previous issue date: 2010-10-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Stress urinary incontinence (SUI) is defined as "involuntary loss of urine" due to several processes that alter the ability of the bladder to hold urine properly, regarded as a social and hygienic problem that adversely affects quality of life. In postmenopausal women, IU is associated with atrophy and weakness of the pelvic floor muscles. The objective this study was investigate, using the onehour pad test, stress urinary leakage (SUI), evaluate and compare their results in postmenopausal and premenopausal women. The survey was characterized as a cross-sectional study. The study consisted of 60 postmenopausal women were divided into GIU - consisting of 34 volunteers complaining of involuntary loss of urine during stress - and GSIU - consisting of 26 volunteers without complaints of loss of urine during stress, and 15 women, during the premenopausal (GPM), and ovulatory with normal menstrual cycle. All volunteers were evaluated clinically, subjected to one-hour pad test, after the biochemical evaluation of blood and sex hormones. Statistical analysis was performed by descriptive analysis, ANOVA, Turkey?s post-test and Pearson correlation. The results showed that 100% of postmenopausal patients had involuntary loss of urine during one hour pad test (GIU: 4.0 g; GSIU: 4.5 g). GPM remained continent after an hour pad test (GPM: 0.4 g). In addition, Pearson showed a strong correlation between urine loss with time since menopause (r = 0.8, p <0.01) and body mass index - BMI (r = 0.7; p = 0.01). These data suggest that the one-hour pad test is a useful test to assess and quantify urinary leakage, including those volunteers who had no previous complaint of SUI / A incontin?ncia urin?ria (IU) ? definida como perda involunt?ria de urina decorrente de diversos processos que alteram a capacidade da bexiga de reter a urina adequadamente. A IU surge com o avan?ar da idade e m mulheres na p?s-menopausa, seu aparecimento associa-se a atrofia e a fraqueza da musculatura do assoalho p?lvico. O objetivo deste estudo foi investigar, com o uso do pad test de uma hora, as perdas urin?rias aos esfor?os (IUE), avaliar e comparar seus resultados em mulheres na p?s-menopausa e na pr?menopausa. A pesquisa foi caracterizada como um estudo transversal. O estudo foi composto por 60 mulheres na p?s-menopausa, divididas em GIU constitu?do por 34 volunt?rias com queixa de perda involunt?ria de urina aos esfor?os e GSIU constitu?do por 26 volunt?rias sem queixa de perda de urina aos esfor?os, e 15 mulheres, no per?odo da pr?-menopausa (GPM), ovulat?rias e com ciclo menstrual normal. Todas as volunt?rias foram avaliadas clinicamente, submetidas ao pad test de uma hora, ap?s avalia??o bioqu?mica do sangue e dos horm?nios sexuais. A estat?stica foi feita atrav?s da an?lise descritiva, o teste param?trico ANOVA, o p?s-teste de Turkey e a correla??o de Pearson. Os resultados mostraram que 100% das pacientes na p?smenopausa apresentaram perda involunt?ria de urina durante o pad test de uma hora (GIU:4,0g; GSIU:4,5g). O GPM manteve-se continente ap?s o pad test de uma hora (GPM:0,4g). Al?m disso, a correla??o de Pearson mostrou um forte rela??o entre as perdas de urina com o tempo de menopausa (r=0,8;p<0,01) e com o ?ndice de massa corporal IMC (r=0,7;p=0,01). Os dados obtidos sugerem que o pad test de uma hora ? um exame ?til para avaliar e quantificar as perdas urin?rias, inclusive daquelas volunt?rias que n?o apresentavam queixa pr?via de IUE

Introdução: O tratamento hormonal para amenizar sintomas do climatério é bem conhecido, mas nem sempre pode ser indicado para grande parte das mulheres. Por estes motivos, tem-se testado várias opções de tratamento não hormonal, cujos resultados nem sempre são satisfatórios e conclusivos. Objetivo: Avaliar a eficácia da cinarizina no tratamento dos sintomas climatéricos. Casuística e método: Foram estudadas prospectivamente 62 mulheres climatéricas sintomáticas com predomínio de ondas de calor que preencheram os critérios de inclusão e exclusão com idade variando de 45 a 60 anos, as quais foram avaliadas pelo Índice Menopausal de Kupperman (IMK), e atendidas no Setor de Ginecologia Endócrina e Climatério do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram divididas aleatoriamente em dois grupos: S com 27 pacientes (25 mg de Cinarizina a cada 12 hs, v.o., por 6 meses) e M com 35 pacientes (1 comprimido de placebo a cada 12hs, v.o., por 6 meses). Resultados: No grupo S a média etária foi 53,9 anos; 51,9% brancas e 48,1% negras; e no grupo M a média etária foi de 54,7 anos; 51,4% brancas e 48,6% negras. Os níveis pressóricos e o índice de massa corpórea foram semelhantes, entre os grupos. A análise do IMK e suas variantes comparativamente nos grupos S e M nos tempos 0 e 1 foi p=0,235 e p=0,406, respectivamente. Conclusões: A cinarizina foi semelhante ao placebo no alívio dos sintomas do climatério avaliados pelo IMK. Houve melhora significante do sintoma vertigem nas pacientes que receberam cinarizina. / Introduction: The hormonal treatment for relief of climateric symptoms is well-known but most women can not be treated with homones. For this reason several treatments without hormones has been evaluated with no conclusive results yet. Objective: Evaluate the efficacy of cinnarizine in the treatment of climacteric symptoms. Casuistry and Method: Were prospectively studied 62 symptomatic climacteric women with prevalence of hot flashes who met the inclusion and exclusion criteria aged from 45 to 60 years, evaluated by Kupperman\'s Menopause Index (KMI) attended at the Sector of Endocrinology Gynecology and Climacteric from the Medical School of the Hospital das Clinicas of the University of São Paulo. The subjects were divided alleatory in two: 27 patients Group S (Cinnarizine 25mg every 12h) and Group M with 35 (1 Placebo each 12h). Results: In group S the mean age was 53.9 years; 51.9% white and 48.1% black; and in group M the mean age was 54.7 years; 51.4% white and 48.6% black. Blood pressure levels and body mass index were similar in both groups. The analysis of the KMI and their variables comparision betwen groups (S and M) at time 0 and 1 was p=0.235 and p=0.406 respectively. Conclusions: Cinnarizine was similar to placebo for recipe of climacteric symptoms evaluated by KMI. There was significant improvement of symptom vertigo in patients treated with cinnarizine.

Department of Advanced Nursing Science / DCur

Estrogens greatly affect the activity and connectivity of serotonergic neural cell populations, which extend from clusters of nuclei in the brainstem, termed the raphe nuclei, where estrogen receptor β is the most abundantly expressed estrogen receptor subtype. Estrogenic effects on the raphe nuclei are primarily important for influencing various neuropsychological behaviors, including depression, mood swings and anxiety behaviors. Because of this connection, phases of intense hormone fluctuations for instance during menopause are often associated with several mood disturbances that often reduce the quality of life of menopausal women. Accordingly, long-term use of hormone replacement therapy appeared to be the method of choice for many menopausal women to help alleviate vasomotor symptoms, which may include neuropsychological changes such as depression. However, given the limitations and number of serious health risks attributed to hormone replacement therapy, natural compounds such as phytoestrogens are receiving widespread awareness due to their occurrence in medicinal plant extracts and a wide variety of food items including dietary supplements with respective health claims. Flavonoids, particularly the isoflavones and the naringenin-type flavanones, belong to a group of polyphenolic plant-derived secondary metabolites known to possess estrogen-like bioactivities. Nevertheless, little is known about their transactivational activity and their potential to regulate endogenous gene expression of estrogen responsive genes in the raphe nuclei due to the lack of suitable cellular models expressing sufficient amounts of functional estrogen receptor β. Hence, a raphe nuclei-derived cell line that expresses a functional estrogen receptor β was sought as a model to investigate effects of flavonoids in vitro. In this regard, RN46A-B14 cells derived from embryonic day 13 rat medullary raphe nuclei were primarily used in this study as the main cellular model. Nonetheless, expression of endogenous estrogen receptor β in these cells was not sufficient to pursue downstream investigations of estrogen-dependent activities. To overcome this deficit, a rat raphe nuclei-derived in vitro model that overexpresses a functional estrogen receptor β was initially established (herein termed RNDA cells) by stably transducing its parent cell line, RN46A-B14 cells, with a suitable lentiviral expression vector encoding a human estrogen receptor β gene. The stable expression and the functional characterization of the transgenic receptor was confirmed by Western blot analysis and luciferase reporter gene assays, respectively. The same reporter gene assay was used to scrutinize the transactivational activity of the flavonoids in RNDA cells. Key results revealed that Genistein, Daidzein, Equol, Naringenin and 8-Prenylnaringenin demonstrated high transactivational activity in a concentration-dependent manner by stimulating luciferase expression from an estrogen responsive element-regulated reporter gene construct transiently transfected in RNDA cells. Low transactivational activity was observed in RNDA cells in response to increasing concentrations of 7-(O-prenyl)naringenin-4'-acetate. However, no transactivational activity was noticed in response to 6-(1,1-Dimethylallyl)naringenin in the studied cell model. All effects elicited by the flavonoids were antagonized by the pure estrogen receptor antagonist, Fulvestrant, indicating that all substances act by binding to and activating the transgenic ERβ. Additional effects were observed in RNDA cells in response to a co-treatment of 1 µM of either Genistein or Daidzein, but not Equol, with 10 nM 17β-Estradiol. Slight antagonistic effects were observed in the same studied cell line when either 8-Prenylnaringenin or 7-(O-prenyl)naringenin-4'-acetate, but not Naringenin or 6-(1,1-Dimethylallyl)naringenin, were co-added with 17β-Estradiol. Results from the reporter gene assays were validated on the basis of regulation of mRNA expression of estrogen responsive genes following the global assessment of 17β-Estradiol-induced gene expression in this cell line using a DNA microarray technique. Out of 212 estrogen-regulated genes with at least two-fold change of expression, six were selected according to specific features of estrogenic regulation of expression. The expression of the six selected 17β-Estradiol-regulated genes was validated using quantitative real-time PCR analysis. The regulation of mRNA expression of the selected genes in response to the tested flavonoids was then investigated in RNDA cells. Additionally, because RNDA cells encode a temperature-sensitive mutant of the Simian Virus 40 large T-antigen, their neuronal differentiation is constitutive upon shifting them from conditions promoting proliferation (permissive temperature) to differentiation (non permissive temperature). Hence, the regulation of mRNA expression of the selected genes in response to the tested flavonoids was additionally investigated as RNDA cells differentiate. In RNDA cells grown under proliferative conditions, 17β-Estradiol up-regulated mRNA expression of camello-like 5, sex determining region Y-box 18 and keratin type I cytoskeletal 19. Similar effects were observed in response to 8-Prenylnaringenin, Genistein, Daidzein and Equol. In addition, 17β-Estradiol down-regulated mRNA expression of neurofilament medium polypeptide and zinc finger DHHC-type containing 2. Similar effects were observed in response to 8-Prenylnaringenin, Naringenin, Genistein, Daidzein and Equol. Yet, no effect was observed on the regulation of mRNA expression of solute carrier family 6 member 4 in response to 17β-Estradiol or the flavonoids in RNDA cells grown under proliferative conditions. When RNDA cells were shifted to conditions promoting differentiation, changes in cell morphology, in mRNA expression levels and in responsiveness towards 17β-Estradiol or the flavonoids were observed. These expression studies additionally highlighted some of the genes as indicator genes for RNDA cellular differentiation. The newly established RNDA cell line should prove useful to elucidate basic physiological properties of estrogen receptor β in the raphe nuclei. The present study should serve as the basis to help shed light on molecular and cellular mechanisms following the action of phytoestrogens, endocrine disruptors or other exogenous estrogen receptor ligands in neural cell populations, particularly the raphe nuclei, for further applications within the brain.

The primary purpose of this research was to examine the effects of HRT in women with acute estrogen deficiency from surgically induced menopause. The secondary purpose was to evaluate how HRT improves symptoms of acute estrogen deficiency and quality of life (QOL) in women using hormone supplementation. Peer reviewed articles published from 2000 to 2017 that were written in the English language with a focus on the use of HRT in women with acute estrogen deficiency after surgical menopause were evaluated for relevance. Evidence suggests the primary reason for decreased use of HRT is the associated risks outweighing the benefits; however, this is not reflected in health care provider's (HCP's) clinical experience. HCP's were more likely to prescribe HRT for themselves or family members if they were experiencing the negative side effects of estrogen deficiency due to surgical menopause, but not to women in their care with similar clinical manifestations of menopause. Additionally, serious risks associated with HRT for acute estrogen deficiency remain incongruent with HRT for women experiencing natural menopause; although risk for breast cancer due to HRT was a universal concern. Risks of HRT related to thromboembolism, stroke and heart disease, were discussed with comparison to the undesirable clinical manifestations of menopause. Results indicate further education and research is needed that explores the risks and benefits for HRT in women with sudden onset of estrogen deficiency from surgical menopause.

No description available.