Habitual physical activity is a meaningful predictor of well-being in mid-life women: a longitudinal analysis.

OBJECTIVES: To examine whether physical-activity patterns over a period of 4 years are associated with well-being. DESIGN: A sample of 399 women aged 50-60 years participated in the study. Measures included rate of physical activity and other life style behaviors, well-being, health status, and interpersonal stress. Sufficient and insufficient exercisers were identified, and the association of this dichotomy with well-being, along with the contribution of the other variables, was examined. RESULTS: The distribution of physical-activity patterns remained stable over the 4 years of the study, with 40% of the women exercising leisurely and 15-20% exercising vigorously four to seven times a week. Approximately 50% of the women were considered sufficiently active in terms of public recommendations. Random effects regression analysis revealed that sufficient exercise along with a low frequency of daily hassles, relatively few menopausal symptoms, and a low level of interpersonal stress significantly contributed to the variability of well-being. CONCLUSIONS: These data evoke the need for a better understanding of exercise behavior and its promising potential contribution to the well-being of middle-aged women.

Adherence to the Mediterranean Diet Is not Related to Beta-Amyloid Deposition: Data from the Women's Healthy Ageing Project.

BACKGROUND: Research has indicated the neuroprotective potential of the Mediterranean diet. Adherence to the Mediterranean diet has shown preventative potential for Alzheimer's disease incidence and prevalence, yet few studies have investigated the impact of Mediterranean diet adherence on the hallmark protein; beta-amyloid. OBJECTIVES: To investigate the association between Mediterranean diet adherence and beta-amyloid deposition in a cohort of healthy older Australian women. DESIGN: This study was a cross-sectional investigation of participants from the longitudinal, epidemiologically sourced Women's Healthy Ageing Project which is a follow-up of the Melbourne Women's Midlife Health Project. SETTING: Assessments were conducted at the Centre for Medical Research, Royal Melbourne Hospital in Melbourne, Australia. F-18 Florbetaben positron emission tomography scanning was conducted at the Austin Centre for PET in Victoria, Australia. PARTICIPANTS: One hundred and eleven Women's Healthy Ageing Project participants were included in the study. MEASUREMENTS: Mediterranean diet adherence scores for all participants were calculated from the administration of a validated food frequency questionnaire constructed by the Cancer Council of Victoria. Beta-amyloid deposition was measured using positron emission tomography standardised uptake value ratios. RESULTS: Gamma regression analysis displayed no association between Mediterranean diet adherence and beta-amyloid deposition. This result was consistent across APOE-ε4 +/- cohorts and with the inclusion of covariates such as age, education, body mass index and cognition. CONCLUSIONS: This study found no association between adherence to the Mediterranean diet and beta-amyloid deposition in a cohort of healthy Australian women.

A comparison of Geriatric Depression Scale scores in older Australian and Japanese women.

AIMS: The aim of this study was to compare the prevalence of depressive symptoms in Australian and Japanese populations of community-dwelling older women using the Geriatric Depression Scale (GDS-15). In addition, the relationship between lifestyle and health factors and higher ratings of depressive symptoms was also examined to determine if there were culturally consistent risk factors associated with higher depressive symptom scores. METHODS: A total of 444 community based women aged between 65 and 77 years completed a depressive symptom measure (GDS-15) and provided information on common lifestyle factors. The Australian sample (n = 222) were drawn from the Women's Healthy Ageing Project and the age-matched, Japanese sample from the Kumamoto Ageing Study of Mental Health (n = 222). The GDS was chosen to; (1) reduce the impact of physical symptoms associated with old age and, (2) reduce the inflation in scores that may result from the Japanese tendency to endorse somatic items more often than Western adults. RESULTS: Mean GDS total scores were significantly higher for the Japanese population 3.97 ± 3.69 compared with 1.73 ± 2.7 for Australian women. The percentages of women scoring in the normal; mild and moderate ranges for depression were 91, 7 and 2% for Australia and 67, 24 and 9% for Japan. Scores remained significantly higher for the Japanese cohort when controlling for lifestyle and health factors associated with depression. The analysis of lifestyle and health characteristics showed that the greatest difference between cohorts was in the area of living status, with more Australian women living with their partner and more than three times as many Japanese women living with their children. When the data for the countries was considered independently employment status affected the likelihood of higher depression scores in the Australian sample while heart disease and poor sleep impacted the risk for the Japanese population. CONCLUSIONS: Significantly more Japanese women scored within the mild and moderate ranges on the GDS compared with their Australian peers, even when controlling for possible confounding factors. Of the lifestyle and health factors assessed in this analysis no single variable was a common risk factor for higher depressive scores for both countries. The presence of cultural influences that may impact the risk of experiencing depressive symptoms, and culture specific patterns of item endorsement on depressive symptom measures, needs to be explored in more detail.

Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women's Midlife Health Project.

The prevalence of osteoarthritis (OA) is greater in women then men. Weight, a factor strongly associated with osteoarthritis, is significantly increased over the menopausal transition. Despite the high prevalence of osteoarthritis, a disabling disease with limited treatment options, there is a paucity of studies in women. The longitudinal phase of the Melbourne Women's Midlife Health Project, is a population-based prospective study of 438 Australian born women who have been followed annually over 11 years. 257 (59%) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and hands. In this study, X-rays were scored for evidence of osteoarthritis using a validated scale, by two investigators who were blinded to questionnaire results. Information on hormone therapy use, physical activity, smoking, BMI and age were obtained by both self-administered and face-to-face questionnaires. Results showed that one hundred and twenty-eight women (56%) had evidence of radiological OA. Forty-nine (21.6%) had evidence of radiological knee OA. One hundred and one (44.5%) had evidence of radiological hand OA. Compared to baseline, at 11th year of follow-up participants had put on weight (4 kg range -14 to 25 kg) and a larger proportion (25% vs. 40%) reported exercising frequently (P = 0.005). Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up. Smoking was associated with a lower prevalence of radiological knee OA. The prevalence was 61% among never smokers compared to only 39% among those who smoked (P < 0.05). Total OA was associated with never having used hormone therapy (odds ratio 2.7; CI 1.1-6.9). There was a trend for increasing level of physical activity at ages 20-29 to be associated with an increased risk of knee OA (P value 0.03 for trend). In conclusion increasing age, BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA. In contrast, smoking appeared to be associated with less knee OA. Never having used hormone therapy was a risk factor for radiological hand and knee OA. Further work will be needed to determine whether modification of these factors can prevent the development of OA.

Comparative study of attitudes to eating between male and female students in the People's Republic of China.

OBJECTIVE: This study was conducted to compare eating attitudes and lifestyles of male and female college students in China (Beijing). SUBJECTS AND METHODS: The subjects of this study consisted of 217 male and 177 female college students. They were asked to fill out the Eating Attitudes Test-26 (EAT-26) and a lifestyle questionnaire. RESULTS: The percentages of those above the cutoff point on the EAT-26 for abnormal eating attitudes were 4.7% of male and 6.2% of female students. Body perception of being fat (distorted body image) was the factor most associated with abnormal eating attitudes. DISCUSSION: Weight related concern was prevalent amongst the Chinese students. This suggests that the culture of the beauty of thinness is common among young students in Beijing, particularly female students.

A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition.

The aims of this study were to describe, in relation to date of final menses, the average androgen levels of women in the years before and after this date, and to determine the extent to which these average levels were dependent on age and body mass index (BMI) and the degree of tracking in residual androgen levels, or the extent to which individuals above (below) the mean for their age or time relative to final menstrual period (FMP) and BMI remain above (below) the mean as time progresses. Serial levels of serum sex hormone-binding globulin (SHBG), testosterone (T), and dehydroepiandrosterone sulfate (DHEAS) were measured annually in 172 women from the Melbourne Women's Midlife Health Project who experienced a natural menopause during 7 yr of follow-up. Fasting blood samples were drawn between days 4-8 if women were still menstruating or after 3 months of amenorrhea. The free androgen index (FAI) was calculated as the ratio ofT to SHBG x 100. Means of the log-transformed androgen levels were analyzed as a double logistic function of time relative to FMP as well as age and BMI, and correlations between repeated androgen levels were measured. Mean SHBG levels decreased by 43% from 4 yr before to 2 yr after the FMP. The time of most change was 2 yr before FMP [95% confidence interval (CI), 0.8-3.2]. SHBG levels were, on the average, 5% lower for each halving of estradiol (E2) levels and 4% lower for each kilogram per m2 of BMI (P < 0.0001). About one third of the decline in SHBG was explained by E2 and BMI. After adjusting for all variables, SHBG showed strong tracking. Mean T levels did not vary with time relative to FMP and were independent of age and BMI. Residual values of T showed weak tracking. The FAI increased by 80% from 4 yr before FMP to 2 yr after FMP, and changed maximally 2.2 yr before FMP (95% CI, 1.2-3.2). The FAI was not related to age or E2, but was, on the average, 4% higher for each kilogram per m2 of BMI (P < 0.0001). Residual values of FAI showed moderate tracking. Mean DHEAS levels were not related to the FMP, but were 1.5% lower for each year of age (P < 0.01) and 3.8% lower for each kilogram per m2 of BMI (P < 0.0001). Residual values of DHEAS showed strong tracking. It is concluded that SHBG and FAI levels change at the time of the menopause, at least partially due to the decline in E2. DHEAS decreases as a function of age, not time relative to FMP, and T remains unchanged during the menopausal years. SHBG and DHEAS show a high degree of stability within an individual over time.

Bone turnover markers and bone density across the menopausal transition.

We measured lunbar spine and femoral neck bone mineral density (BMD); urine markers of bone resorption; serum markers of bone formation; and serum gonadotrophin, estradiol and inhibin concentrations in a population-based cohort of 281 women aged 45-57 yr. Women were classified into pre-, peri-, and postmenopausal groups, depending on menstrual bleeding patterns. Compared with premenopausal women, BMD was lower only in postmenopausal women but not in women currently using hormone replacement therapy (HRT). BMD decreased with age in the perimenopausal group. Compared with premenopausal women, perimenopausal women had 20% greater urine N-telopeptide excretion (P < 0.05) and a doubling of gonadotrophin levels (P < 0.01), whereas serum estradiol and bone formation marker concentrations were no different. Postmenopausal Women had greater levels of bone turnover markers (P < 0.0001), except free deoxypyridinoline and type I procollagen propeptide. Among postmenopausal women, bone resorption markers were lower in those using HRT. Levels of nearly all bone turnover markers were positively related to serum FSH concentrations (P < 0.0001). Overall, the major independent predictors of BMD were age, urine N-telopeptide, serum bone alkaline phosphatase, and serum, FSH, whereas urine free deoxypyridinoline was positively related to BMD in pre- and perimenopausal women. In conclusion, the perimenopause is associated with elevated bone resorption rates and declining BMD, and factors in addition to estrogen deficiency may also contribute to the pathogenesis of postmenopausal osteoporosis.

The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample.

In a study of the endocrinology of the perimenopausal years, levels of serum FSH, estradiol (E2), immunoreactive inhibin (INH), testosterone, and sex hormone-binding globulin were measured in a population-based sample of 380 women (mean age, 49.4 yr; range, 45.6-56.9 yr). Subjects were divided into women who reported continuing regular menstrual cycles (27%; group I), a change in menstrual flow without a change in frequency (23%; group II), a change in frequency but no change in flow (9%; group III), changes in both frequency and flow (28%; group IV), and at least 3 months since their last menstrual period (13%; group V). After adjusting for age and body mass index, the geometric mean FSH increased across menstrual groups and, compared with group I, was 53% higher in group IV (P < 0.0005) and 253% higher in group V (P < 0.0001). Age- and body mass index-adjusted geometric means for E2 and INH in group V were 54% and 53% of those in group 1, respectively (P < 0.005, P < 0.0001). Women in group V who did not have a menstrual period in the next year had higher FSH and lower E2 and INH levels than those who subsequently went on to have at least one more menstrual period (P < 0.05). FSH was negatively correlated with E2 (r = -0.30) and INH (r = -0.39), whereas INH was positively correlated with E2 (r = 0.45). We conclude that an increase in serum FSH and decreases in E2 and INH are the major endocrine changes associated cross-sectionally with the menopausal transition.

Prospectively measured levels of serum follicle-stimulating hormone, estradiol, and the dimeric inhibins during the menopausal transition in a population-based cohort of women.

The aims of this study were: 1) to describe, in relation to the date of final menses, the average hormone levels of women in the years before and after this date and to determine the extent to which these average levels were dependent on age and body mass index (BMI); and 2) to determine the degree of tracking in residual hormone levels [i.e., the extent to which individuals above (below) the mean for their age or time relative to final menstrual period (FMP) and BMI remain above (below) the mean as time progresses]. Serial levels of serum FSH, circulating estradiol (E2), and the dimeric inhibins (INH) A and B were measured annually in 150 women who experienced a natural menopause during 6 years of follow-up. Means of the log-transformed hormonal levels were analyzed as a double-logistic function of time relative to FMP, as well as age and BMI and correlations between repeated hormonal levels, were measured. Mean FSH levels started to increase from about 2 years before the FMP, increased most rapidly about 10 months before the FMP, and had virtually plateaued by 2 years after the FMP. FSH levels were, on average, 3% greater for each year of age and 2% lower for each kg/m2 of BMI. After adjusting for time relative to the FMP, logFSH showed modest tracking. Age-adjusted values of logFSH were moderately correlated across time, and much of this tracking was explained by the actual timing of a woman's FMP. Mean E2 levels started to decrease about 2 years before the FMP, decreased most rapidly around the time of the FMP, and had virtually plateaued by 2 years after the FMP. E2 levels were lower, on average, by about 9% per year of age, and residual values showed weak tracking. Levels of both INHA and INHB decreased, on average, in the years before the FMP and were undetectable (INHA, < 10 pg/mL; INHB, < 25 pg/mL) in the majority of women by the time of the FMP and in almost all women by 4 years post-FMP. Significant negative correlations between log serum FSH and log E2 (r = -0.73) and log INHA (r = -0.41) and log INHB (r = -0.36) were observed. It is concluded that substantial changes in reproductive hormone levels occur within 1-2 yr on each side of the FMP, that falling concentrations of E2 and the INH contribute to the rising concentrations of FSH, and that there is no single reliable hormonal marker of menopausal status for an individual woman.

Menstrually Related Disorders: points of consensus, debate, and disagreement.

It seems that during the past decade we have been witnessing an evolution of a consensus on the phenomenology and time course of various types of MRDs. We are in a stage in which definitions and diagnostic criteria can be developed, but their broad acceptance is still not assured. The etiology and pathophysiology are still fiercely debated, but reasonable and feasible methods for scientific elucidation of the various hypotheses are in place and are followed by solid groups. Despite the uncertainty concerning the etiology of MRDs, reasonably efficient treatment modalities do exist, and most sufferers of MRDs should expect an eventual alleviation of their symptoms if they are treated in a specialized, established, and up-to-date program.

Relationship of endogenous sex hormones to lipids and blood pressure in mid-aged women.

PURPOSE: The relationship between endogenous sex hormones and blood lipids was examined in a representative sample of 438 Australian-born women 45 to 56 years of age taking part in a longitudinal study of the menopausal transition. Data from 363 women who were taking neither exogenous hormones nor lipid-altering medications, were not diabetic, and who had provided blood samples were available for analysis. METHODS: Multiple linear regression was used to examine the relationship between sex hormones and high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides, and diastolic blood pressure (DBP), taking account of the effects of age, body mass index (BMI), smoking, alcohol intake, and exercise. RESULTS: There was no significant relationship between estradiol and HDL, LDL, triglyceride, or DBP levels. Free androgen index was positively associated with LDL. However, BMI was an important predictor of all three lipid measures and DBP. HDL was positively associated with age and was highest among women with lowest BMI, high alcohol intake, and in nonsmokers. LDL increased with BMI, free androgen index, and age, but was lower amongst women who exercised more than two or three times per week. Triglyceride also increased with BMI, and was higher among smokers. DBP increased with BMI only. CONCLUSIONS: The results do not support the view that endogenous sex hormones are strongly associated with cardiovascular risk factors around the time of menopause.

The relationship between the menstrual cycle and female sexual interest in women with PMS complaints and volunteers.

This study assesses the influence of menstrual cycle phases and hormones on female sexual interest in both a nonclinical sample of volunteers (n = 18) and women who complained of premenstrual tension (n = 150). Women were assessed prospectively for two menstrual cycles with daily symptom charts. In addition mental status was assessed clinically and the Moos Menstrual Distress Questionnaire completed in the follicular and premenstrual phases. On the basis of these assessments women were assigned to subject groups. During the second cycle, daily 24-h urinary estrogens and urinary pregnanediol were determined. Sexual interest and feelings of well-being were recorded on a daily symptom rating chart. Sexual interest was found to be significantly higher in the follicular and ovulatory phases, than in the luteal, premenstrual, or menstrual phases. Sexual interest and feelings of well-being were correlated (R = 0.29). Sexual interest and feelings of well-being were not correlated with urinary estrogen or pregnanediol levels.

Sexual response following hysterectomy and oophorecomy.

This is a report of a retrospective study of 89 patients who had undergone hysterectomy and oophorectomy. The aims of this study were to identify factors associated with sexual deterioration attributed to the operation. In the sample interviewed, 33 patients (37%) complained of a deterioration of their sexual relationships, which they attributed to the operation. Preoperative expectations of sexual alteration were found to be significantly associated with subsequent sexual dysfunction, and specifically with loss of desire for sexual intercourse. Estrogen administration, while not affecting overall sexual behavior, was specifically associated with less dyspareunia. It was concluded that sexual dysfunction following hysterectomy and oophorectomy was mainly associated with psychologic factors.

Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women.

OBJECTIVE: To determine the frequency of hot flushes in a population sample of 453 pre-, peri-, and postmenopausal women (aged 48-59 years), and to investigate the relationship of hot-flush reporting with menstrual status, serum levels of estradiol (E2), inhibin, and FSH, history of premenstrual complaints, and physical and life-style factors. METHODS: We used a population-based sample. Interviews were conducted in the women's homes. RESULTS: Frequency of hot-flush reporting was associated with menstrual status (P < .001). Twenty-nine percent of women who had more than 3 and less than 12 months of amenorrhea, and 37% of postmenopausal women experienced hot flushes several times a day. In total, 13% of premenopausal women, 37% of perimenopausal women, 62% of postmenopausal women, and 15% of women on hormone therapy reported having had at least one hot flush in the previous 2 weeks. Follicle-stimulating hormone levels were higher in women who experienced hot flushes at least once a day or more (P < .001); E2 levels were higher in women experiencing one or no hot flushes per week (P < .001). The women in the perimenopausal group who experienced hot flushes had higher FSH levels (P = .008) and were more likely to have reported premenstrual complaints at the first interview 3 years earlier (P = .03). In the postmenopausal group, there was no significant difference with any of the variables studied between the women who were experiencing hot flushes and those who were not. CONCLUSION: Reporting of hot flushes is greatest 3 months or more after the final menstrual period. The frequency of hot flushes is associated with increasing FSH, decreasing E2, and a history of premenstrual complaints.

Hormones and sexuality: effect of estrogen and progestogen.

This study was planned to determine the effects of estrogen and progestogen on female sexual behavior. Forty-nine women who had undergone hysterectomy and bilateral salpingo-oophorectomy took part in a double-blind placebo-controlled cross-over study. Over a 12-month period each woman received 3 months each of ethinyl estradiol, 50 microgram per day; levonorgestrel, 250 microgram per day; combination of these 2 substances (Nordiol); and a placebo. Significant differences between medications were found in sexual desire, enjoyment, and orgasmic frequency. The most beneficial effects occurred during medication with ethinyl estradiol. There were no differences observed in the effect of homones or placebo on coital rate or on the analogue rating scales scored daily. The validity of this scale in the present study is questionable.

A prospective population-based study of menopausal symptoms.

OBJECTIVE: To identify symptoms that change in prevalence and severity during midlife and evaluate their relationships to menopausal status, hormonal levels, and other factors. METHODS: In a longitudinal, population-based study of 438 Australian-born women observed for 7 years with an 89% retention rate, 172 advanced from premenopause to perimenopause or postmenopause. Annual measures included a 33-item symptom check list; psychosocial, lifestyle, and health-related factors; menstrual status; hormone usage; and blood levels of follicle-stimulating hormone and estradiol (E2). RESULTS: Increasing from early to late perimenopause were the number of women who reported five or more symptoms (+14%), hot flushes (+27%), night sweats (+17%) and vaginal dryness (+17%) (all P <.05). Breast soreness-tenderness decreased with the menopausal transition (-21%). Trouble sleeping increased by +6%. The major change in prevalence was from early to late perimenopause, except for insomnia, which showed a gradual increase. Those variables most related to onset of hot flushes were number of symptoms at early perimenopause (P <.05), having an unskilled or no occupation (P <.05), more than 10 pack-years of smoking (P <.01), and decreased E2 (P <.01). The onset of night sweats increased with the change in E2 (P <.05). The onset of vaginal dryness decreased with more years of education (P <.05). Trouble sleeping was predicted by prior lower well-being (P <.01), belief at baseline that women with many interests hardly notice menopause (P <.01), and hot flushes (P <.01). CONCLUSION: Although middle-aged women are highly symptomatic, the symptoms that appear to be specifically related to hormonal changes of menopausal transition are vasomotor symptoms, vaginal dryness, and breast tenderness. Insomnia reflected bothersome hot flushes and psychosocial factors.

Is incontinence associated with menopause?

OBJECTIVES: To estimate (1) the prevalence of urinary incontinence in a population-based sample of Australian women aged 45-55 and to identify the factors associated with urinary incontinence; (2) the incidence of urinary incontinence over a 7-year follow-up period and to identify whether the transition from pre- to postmenopause is associated with the development of urinary incontinence. METHODS: This was a cross-sectional study of 1897 women and a 7-year longitudinal follow-up of 373 of these women who were premenopausal at baseline. Annual interviews and physical measurements were taken in their homes. RESULTS: Cross-sectional: the prevalence of urinary incontinence was 15%; multivariate analysis found that urinary incontinence patients were significantly more likely than those without incontinence to have higher body mass index (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.15, 1.95), have had gynecologic surgery (OR 2.17, 95% CI 1.42, 3.32), report urinary tract infections (OR 4.75, 95% CI 2.28, 9.90), diarrhea or constipation (OR 1.95, 95% CI 1.27, 3.00), and have had three or more children (OR 1.47, 95% CI 1.06, 2.05). Longitudinal: during the 7-year follow-up, the average prevalence of urinary incontinence was 18% and the overall incidence 35%. Women who experienced a hysterectomy during the follow-up period had a higher incidence. CONCLUSION: Urinary incontinence in middle-aged women is more closely associated with mechanical factors than with menopausal transition.

Mood and the menstrual cycle.

A majority of women are aware of menstrual cycle-related changes in mood and behaviour. Psychiatric disorders may also be influenced by the menstrual cycle. A premenstrual tension syndrome has been described. Research into the prevalence, aetiology and management of this condition has been hampered by additions and alterations to the original description and methodological difficulties involved in menstrual cycle research. Biological, psychological and sociological theories have been proposed to explain menstrual cycle-related mood changes. Our own studies have found evidence of ovarian steroid disturbances, and impaired psychological functioning in women with the premenstrual syndrome. Therapeutic approaches must consider both aspects. Medication often makes the patient more accessible and receptive to regimens aimed at increasing coping skills. More vigorous research into this disorder is needed.

Are changes in sexual functioning during midlife due to aging or menopause?

OBJECTIVE: To determine whether changes in women's sexual functioning during midlife are due to aging or menopause. DESIGN: Prospective, observational study. SETTING: Population-based sample assessed in own homes. PATIENT(S): Four hundred thirty-eight Australian-born women aged 45-55 years and still menstruating at baseline. One hundred ninety-seven were studied for effects of the natural menopausal transition. Control group A (n = 44) remained premenopausal or early perimenopausal for 7 years. Control group B (n = 42) remained postmenopausal over 5 years. INTERVENTION(S): Nil; questionnaires and blood sampling annually. MAIN OUTCOME MEASURE(S): Shortened version of the Personal Experiences Questionnaire. RESULT(S): By the late perimenopause, there was a significant decline in the factors we had derived of sexual responsivity and total score, and there was an increase in the partner's problems factor. By the postmenopausal phase, there was a further decline in the factors sexual responsivity, frequency of sexual activities, libido, and in the total score, and a significant increase in vaginal dyspareunia and partner's problems. Sexual responsivity significantly declined in both control groups. CONCLUSION(S): Sexual responsivity is adversely affected by both aging and the menopausal transition. Other domains of female sexual functioning were significantly adversely affected when the women became postmenopausal. The relationship with the partner and his ability to perform sexually is adversely affected by the menopausal transition.

Comparative bioavailability of orally and vaginally administered progesterone.

OBJECTIVE: To study the pharmacokinetics of progesterone (P) in healthy premenopausal female volunteers to compare the bioavailability of orally or vaginally administered hormone. DESIGN: Subjects were randomly allocated to receive either oral P or a vaginal pessary then crossed over to the alternate preparation 1 month later. SETTING: The study was conducted in outpatient setting. SUBJECTS: All subjects were healthy, normal female volunteers who underwent a physical and gynecological examination before the study. None were using oral contraceptives. Ten subjects (mean age 32.6 +/- 7.3 years) entered the study and all completed it. INTERVENTIONS: Progesterone was administered as 200 mg of micronized hormone or as a pessary containing 400 mg. MAIN OUTCOME MEASURE: Plasma levels of P were measured by radioimmunoassay to test the apriori hypothesis of similar bioavailability. RESULTS: Peak plasma P concentrations attained within 4 hours after oral administration ranged from 8.5 to 70.6 ng/mL, whereas after vaginal administration the peak levels were attained within 8 hours and ranged from 4.4 to 181.1 ng/mL. Considerable interindividual variation was noted. Area under the plasma concentration-time curve for the two formulations was not significantly different (F = 1.09; P greater than 0.1; ANOVA). CONCLUSIONS: The two formulations had similar bioavailability.

PIP: This study examined the pharmacokinetics of progesterone (P) in healthy, premenopausal female volunteers in order to compare the bioavailability of orally or vaginally administered hormone. Subjects were randomly allocated to receive either oral P or a vaginal pessary and were then crossed over to the alternate preparation 1 month later. All subjects were healthy, normal female volunteers who underwent a physical and gynecological examination prior to this outpatient study. None used oral contraceptives. There were 10 subjects (mean age 32.6 +or- 7.3 years) who entered the study and all completed it. P was administered as 200 mg of micronized hormone or as a pessary containing 400 mg. Plasma levels of P were measured by radioimmunoassay in order to test the apriori hypothesis of similar bioavailability. Peak plasma P concentrations attained within 4 hours after oral administration ranged from 8.5 to 70.6 ng/mL, whereas after vaginal administration, the peak levels were attained within 8 hours and ranged from 4.4-181.1 ng/mL. Considerable interindividual variation was evident. Area under the plasma concentration-time curve for the 2 formulations was not significantly different (f=1.09; p0.1; ANOVA). The conclusion is that the 2 formulations had similar bioavailability.