Exercise in the menopausal woman.

An exercise program for menopausal women that includes both aerobic and resistance training may prevent or relieve problems such as cardiovascular disease, obesity, muscle weakness, osteoporosis, and depression. The risk of cardiovascular disease increases in women after menopause; in both men and women, regular aerobic exercise may improve cardiorespiratory endurance and reduce the risk of cardiovascular disease. Aerobic exercise also prevents some age-related increases in body fat and it elevates resting metabolic rate, which correlates directly with lean body mass. Inactivity, not hormonal change, is the most common cause of obesity. Resistance training can improve muscle strength and bone density. Increases in bone mineral content have been found at lumbar vertebral and distal radial sites in women who participate in exercise programs. Weight-bearing exercise in conjunction with estrogen replacement therapy and calcium supplementation helps to prevent osteoporosis. Many women experience mood changes at menopause. Some of these symptoms are caused by chronic sleep deprivation due to night flushes and respond best to estrogen; others are related to levels of brain chemicals and respond favorably to exercise.

Plasma oxytocin concentrations in a pregnant woman with total vasopressin deficiency.

Plasma concentrations of oxytocin and vasopressin were determined by radioimmunoassay in a woman with clinical diabetes insipidus. Plasma oxytocin levels were normal and ranged from less than 0.25 microU/ml to 76 microU/ml during the last month of pregnancy and during spontaneous labor. Vasopressin requirements did not change during pregnancy. Unexplained vasopressin resistance and massive diuresis occurred early in the postpartum period. Plasma vasopressin concentrations were undetectable in the nonpregnant state. The documentation of normal oxytocin production and total vasopressin deficiency suggests that an anatomic defect is unlikely to cause this disorder unless it is limited to axons and cell bodies containing vasopressin and not oxytocin.

Pharmacokinetics of norelgestromin and ethinyl estradiol delivered by a contraceptive patch (Ortho Evra/Evra) under conditions of heat, humidity, and exercise.

The objectives of this randomized, open-label, three-period, incomplete block design study were to evaluate the pharmacokinetics of norelgestromin (NGMN) and ethinyl estradiol (EE) delivered by the contraceptive patch, Ortho Evra/Evra, and to evaluate patch adhesion under conditions of heat, humidity, and exercise. During each treatment period, 30 healthy women wore Ortho Evra on the abdomen for 7 days under one of six conditions (normal activity, sauna, whirlpool, treadmill, cool water immersion, or a combination of activities). Blood samples were collected before and several times to 240 hours after patch application. Mean serum concentrations of NGMN and EE generally remained within the reference ranges, 0.6 to 1.2 ng/ml and 25 to 75 pg/ml, respectively, during the 7-day wearperiodfor all activities. Only 1 (1.1%) of 87 patches completely detached spontaneously. Peel force measurements were comparable for all activities. Ortho Evra was well tolerated. In conclusion, Ortho Evra delivers efficacious concentrations of NGMN and EE and maintains adhesive reliability through 7 days of wear even under conditions of heat, humidity, and exercise.

Both midluteal serum progesterone levels and late luteal endometrial histology should be assessed in all infertile women.

Criteria for diagnosis of luteal phase deficiency vary among specialists. Adequacy of corpus luteum function usually is based on a midluteal serum progesterone (P) concentration or a late luteal biopsy. To compare these two methods of determining luteal phase adequacy, 42 midluteal P levels were compared with late luteal endometrial biopsies from the same cycles in 34 women undergoing evaluation for infertility. Eleven cycles contained both hormonal and histologic evidence of luteal phase inadequacy; 12 contained only hormonal evidence of inadequacy; 9 contained only histologic evidence of inadequacy; and 10 contained both hormonal and histologic evidence of adequate luteal function. These data suggest that both midluteal phase P levels and late luteal endometrial biopsies should be assessed in infertile women, because neither can be used to predict the other.

The relationship between long-distance running, plasma progesterone, and luteal phase length.

The chronic effects of long-distance running upon the menstrual cycle were studied in a healthy, ovulatory 30-year-old woman. Luteal phase plasma concentrations of follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, and progesterone were compared during a control and a training cycle. The luteal phase was shorter in cycles of greater mileage. Mid-luteal phase plasma progesterone concentrations were significantly lower during training.

Plasma prostaglandin F 2-alpha levels in dysmenorrehic women.

Plasma prostaglandin F 2-alpha (PGF 2-alpha) concentrations were compared in nine ovulatory dysmenorrheic women, one dysmenorrheic oral contraceptive user, and two nondysmenorrheic control subjects, in an effort to demonstrate a relationship between plasma PGF 2-alpha levels and dysmenorrhea. In addition, the effects of aspirin, a known inhibitorof prostaglandins synthesis, on dysmenorrhea and on PGF 2-alpha levels were investigated. No statistical difference was demonstrated between the plasma PGF 2-alpha levels of dysmenorrheic and nondysmenorrheic subjects throughout the menstrual cycle. Attainment of an adequate salicylate level was accompanied by a significant decrease in PGF 2-alpha levels. All dysmenorrheic subjects reported improvement in symptoms while taking aspirin. The greatest subjective relief was reported by women who began taking aspirin (10 grains every 4 hours) 3 or more days prior to the onset of bleeding.

Cervical mucus and serum estradiol as predictors of response to progestin challenge.

The present study was undertaken to assess the correlation between and relative predictive value of each of the following variables and progestin-induced withdrawal bleeding: cervical mucus appearance, serum E2 level, patient age, duration of amenorrhea, smoking and exercise habits, and body composition. Of 120 oligomenorrheic and amenorrheic women evaluated, only cervical mucus appearance and serum E2 level were significantly associated with response to progestin challenge. A multivariate logistical regression analysis showed cervical mucus to be the most predictive variable followed by serum E2 level. No absolute E2 level was found to discriminate between those who did and those who did not have withdrawal bleeding after progestin challenge. These data suggest that office examination of cervical mucus may be a useful indicator and guideline in planning therapy.

Pregnancy following the "insensitive ovary syndrome".

A patient in whom the "insensitive ovary syndrome" was followed by a successful pregnancy is reported and discussed. Conception occurred while this patient was receiving estrogen therapy. The marked differences in her ovarian responsivity to endogenous and exogenous gonadotropin stimulation remain enigmatic.

Factors associated with withdrawal bleeding after administration of oral micronized progesterone in women with secondary amenorrhea.

OBJECTIVE: To compare two dosages of oral micronized progesterone (P) and placebo for withdrawal bleeding and side effects. DESIGN: Prospective, randomized, double-blind. SETTING: Academic institution. PARTICIPANTS: Out of 190 screened with oligomenorrhea/amenorrhea, 60 who qualified completed the study. INTERVENTIONS: A 10-day course of (1) oral micronized P 300 mg, (2) oral micronized P 200 mg, or (3) placebo. MAIN OUTCOME MEASURES: Withdrawal bleeding, side effects, and changes in lipids. Endogenous estradiol (E2) concentrations at baseline and P concentrations during treatment were correlated with bleeding response. RESULTS: Withdrawal bleeding occurred in 90% of women taking 300 mg, 58% of women taking 200 mg, and 29% of women taking placebo (P less than 0.0002 for 300 mg versus placebo). Side effects occurred similarly among the groups (P = not significant). Lipid concentrations were unchanged. Endogenous E2 and treatment P concentrations were of limited predictive value for withdrawal bleeding. CONCLUSIONS: Progesterone 300 mg induced significantly more withdrawal bleeding than placebo, with similar side effects. Bleeding response cannot be predicted reliably from E2 and P concentrations.

Causes, evaluation, and management of athletic oligo-/amenorrhea.

Oligomenorrhea and amenorrhea are more common among athletes than among the general population. Although these conditions in athletes are often related to exercise and thinness, they may be caused by serious pathology too. All athletes with menstrual dysfunction deserve thorough evaluation and most need treatment.

Fetal heart rate measurement during maternal exercise--avoidance of artifact.

The purpose of this study was to investigate the possibility that motion artifact may override the recording of fetal heart rate (FHR) with Doppler ultrasound fetal monitors during maternal exercise on cycle ergometers and treadmills, and to test the efficacy of two-dimensional ultrasound directed M-mode echocardiographs for determining FHR during maternal treadmill exercise. Four pregnant women (26 to 30 yr, means = 28, gestational age = 28 to 34 wk) pedaled a cycle ergometer at 25 to 50 W, while a second group (N = 4) (24 to 36 yr, means = 29, gestational age = 30 to 37 wk) walked on a treadmill at either 1.5 or 2.0 mph. Fetal monitor recordings (Hewlett-Packard 8040A) were consistent with pedal rate in the range of 50 to 70 rpm and with stepping rate in the range of 70 to 76 steps per min at 1.5 mph and 100 to 106 steps per min at 2.0 mph on the treadmill. Actual mean FHRs (audible signal from fetal monitor) were in the normal range [150.5 +/- 10.25 bpm (cycle ergometer) and 148.8 +/- 2.3 bpm (treadmill)]. In a separate session, the cycle ergometer group walked on a treadmill at a maternal heart rate of 140 bpm while FHR was determined by two-dimensional ultrasound directed M-mode echocardiographs. Off-line analysis of fetal cardiac cycle time (clinical graphics analyzer) allowed accurate FHR measurements which were not confounded by motion artifact. Mean FHR during maternal treadmill exercise (158.0 +/- 12.0 bpm) was not different (P greater than 0.05) when compared to pre-exercise standing (140 +/- 3.6) and also during the post-exercise period (sitting) (151 +/- 6.5) compared to the sitting pre-exercise measurements (147 +/- 8.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Drug therapy for the premenstrual syndrome.

The premenstrual syndrome is diagnosed historically, with symptoms recorded meticulously on a menstrual calendar. No physical findings or laboratory tests are helpful. Although this entity remains poorly understood, drug therapy is often indicated and remains empiric at present.

Menstrual disturbances in the athlete.

Women should be encouraged to exercise. Those who develop menstrual problems should be thoroughly evaluated to detect any serious causes and should be treated to prevent any serious results. The importance of exercise in the lifestyle of female athletes should be respected.

An active menopause: using exercise to combat symptoms.

There's no better time than the years surrounding menopause for a woman to start or renew an exercise program. Exercise may reduce the immediate symptoms of menopause, and it decreases the long-term risk of cardiovascular disease, osteoporosis, and obesity. The exercise prescription includes aerobic exercise, resistance training, and stretching components, and should be individualized according to the woman's exercise history.

Sports and Menstrual Function.

Until the role of exercise in amenorrhea is more fully understood, physicians should treat athletes as carefully as nonathletes. Their problems are not necessarily due to sports activities.

How I Manage Exercise-Related Menstrual Disturbances.

In brief: All women who stop menstruating or menstruate irregularly should be examined. Amenorrhea and oligomenorrhea are often related to heavy exercise, but in athletes as well as nonathletes these conditions can signal a serious pathologic condition. Even athletes with regular periods can experience hormone alterations, short luteal phase, or anovulation. Anovulation and hypoestrogenism are the two major conditions experienced by women with oligomenorrhea and amenorrhea. Anovulation may lead to endometrial pathology and an increased risk of breast cancer, while hypoestrogenism increases the risk of developing osteoporosis. Tests to pinpoint the causes of menstrual dysfunctions and measure estrogen levels are listed, and treatments to establish a proper balance of estrogen and progesterone are described.

Beyond the exercise prescription: making exercise a way of life.

When we hand a patient a prescription for medication, we may assume that it will be filled and taken as we've instructed. We too often discover later that fears or unanswered questions kept the patient from ever filling the prescription or that side effects led him or her to discontinue its use. And we may never learn what the patient did if he or she wants our approval or fears our response to the truth.

Exercise and menopause: a time for positive changes.

Exercise may help control a number of physical and psychological problems and changes associated with menopause and midlife, including depression, weight gain, loss of muscle mass and bone density, the risk of coronary artery disease, and possibly vasomotor symptoms. The basic prescription of aerobic exercise (20 to 60 minutes 3 to 5 days per week) and strength training (2 to 3 days per week) should be adapted to the patient's medical condition, fitness level, motivation, experience, and preferences. Exercise effects can be supplemented by estrogen therapy, a low-fat diet, and adequate calcium and vitamin D intake.

Exercise for midlife women.

Exercise is good for everyone, but it's more important than ever when you reach midlife. While regular exercise may not eliminate symptoms like hot flushes, it can improve your general well-being and increase your strength and stamina in daily life. If you want to lose fat or maintain a healthy weight, exercise is far more effective than diet alone. A physically active lifestyle, along with good nutrition and estrogen therapy, will also help protect you against heart disease, overweight, and osteoporosis.