Elsevier S & T

Menopause: Biology and Pathobiology

Lobo, Rogerio A.; Kelsey, Jennifer; Marcus, Robert

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Table of contents

Cover
Menopause: Biology and Pathobiologyiii
Copyright Pageiv
Contentsv
Contributorsxiii
Prefacexvii
Part I: Basic Biology1
Chapter 1. Molecular Pharmacology of Estrogen and Progesterone Receptors3
I. Introduction3
II. Estrogen and Progesterone Receptors3
III. Established Models of Estrogen and Progesterone Action4
IV. Estrogen and Progesterone Receptor Isoforms and Subtypes5
V. Regulation of Estrogen and Progesterone Receptor Function by Ligands6
VI. Estrogen and Progesterone Receptor Associated Proteins8
VII. An Updated Model of Estrogen and Progesterone Receptor Action9
References9
Chapter 2. Ovarian Anatomy and Physiology13
I. Introduction13
II. Statement of the Problem13
III. The Primordial Follicle14
IV. The Adult Ovary15
V. Ovary Reserve21
VI. Accelerated Loss in OR: Activin Hypothesis26
VII. New Data on the Effects of Activin28
VIII. Statement of Conclusion28
References28
Chapter 3. Regulation of the Hypothalamic–Pituitary–Gonadal Axis: Role of Gonadal Steroids and I33
I. Introduction33
II. Functional Organization of the Hypothalamic–Pituitary–Ovarian Axis34
III. Anatomical and Biochemical Correlates of Gonadal Steroid Hormone Action in the Central Nervous37
IV. Ovarian Steroid Action in the Central Nervous System„Control of Reproduction41
V. The Menopause: Consequences of Steroid Hormone Loss on the Central Nervous System46
References51
Chapter 4. Gonadotropins and Menopause: New Markers61
I. Introduction61
II. Gonadotropin Parameters of the Normal Menstrual Cycle62
III. Structures of Gonadotropins and Their Fragments63
IV. Assay of Gonadotropins65
V. Changes in Gonadotropin Patterns in Menopause68
VI. Gonadotropin Fragments as Urinary Analytes70
References73
Chapter 5. Genetic Programming in Ovarian Development and Oogenesis77
I. Ovarian Differentiation Requires Only One X (Constitutive)77
II. Polygenic and Stochastic Control over Oocyte Number78
III. Monosomy X78
IV. X Chromosomal Mosaicism: 45,X/46,XX and 45,X/47,XXX80
V. Pitfalls in Localizing Ovarian Maintenance Genes to Specific Regions of the X81
VI. Genes on the X Short Arm81
VII. Genes on the X Long Arm83
VIII. Nature of X Ovarian Maintenance Determinants84
IX. Autosomal Chromosomal Abnormalities85
X. Autosomal Genes (Mendelian)85
XI. To What Extent is Premature Ovarian Failure Genetic?91
References91
Chapter 6. Neuroendocrine Regulation of the Perimenopause Transition95
I. Definition of Perimenopause95
II. Ovarian Determinants of Reproductive Aging96
III. Dynamic Gonadotropin Secretion in Young Women98
IV. Gonadotropin Changes during Perimenopause100
V. The Neuroreproductive Axis in Postmenopause102
VI. Brain Aging and Reproductive Senescence106
VII. Future Studies106
References108
Chapter 7. Changes in Men as They Age: The Manopause111
I. Introduction111
II. Age-Related Changes in the Male Reproductive System112
III. Age-Related Changes in Other Hormonal Systems115
IV. Other Changes with Aging Related to Hormonal Factors118
V. Androgen Effects on Sexual and Reproductive Function119
VI. Nonerectile Sexual Dysfunctions119
VII. Erectile Dysfunction120
VIII. Manopause and Mental Health124
IX. Psychological State and Sexual Function127
X. Conclusions127
References128
Chapter 8. Premature Ovarian Failure135
I. Early Reports of Premature Ovarian Failure135
II. Clinical Features of Premature Ovarian Failure136
III. Prevalence of Premature Ovarian Failure137
IV. Etiology of Premature Ovarian Failure138
V. Evaluation of Patients with Hypergonadotropic Amenorrhea142
VI. Therapy142
References143
Chapter 9. Perimenopausal Changes in FSH, the Inhibins, and the Circulating Steroid Hormone Milieu147
I. Introduction and Definitions147
II. Current Concepts of Ovarian Physiology as a Function of Age148
III. Major Longitudinal Studies of Steroids in Relation to the Final Menstrual Period150
IV. Hormonal Studies during the Menopausal Transition150
V. Conclusions154
References154
Part II: Epidemiology157
Chapter 10. Epidemiology: Methodologic Challenges in the Study of Menopause159
I. Introduction159
II. Study Design159
III. Data Collection Methods163
IV. Measurement Issues164
V. Analytic Considerations167
VI. Conclusion171
References171
Chapter 11. SWAN: A Multicenter, Multiethnic, Community-Based Cohort Study of Women and the Menopaus175
I. Introduction175
II. Overview of the Study Design176
III. Data Collection177
IV. Sampling and Recruitment179
V. Strengths and Limitations of SWAN183
VI. Summary185
Appendix A. SWAN Investigators185
Appendix B. Specific Sampling and Recruiting Strategies by Sites with List-Based Primary Sampling Fr186
Appendix C. Specific Sampling and Recruiting Strategies by Sites with RDD-Based Primary Sampling Fra187
References188
Chapter 12. Demographics, Environmental Influences, and Ethnic and International Differences in the189
I. Introduction189
II. Demographic Characteristics191
III. Ethnic and International Differences193
IV. Environmental Influences193
V. Conclusions196
References197
Chapter 13. Distinguishing the Effects of Age from Those of Menopause203
I. Introduction203
II. Statement of the Problem204
III. Manifestations of Aging versus Menopause204
IV. Conclusions208
References208
Part III: Menopausal Systems Pathophysiology213
Chapter 14. Menopausal Hot Flashes215
I. Epidemiology of Hot Flashes215
II. Descriptive Physiology215
III. Objective Measurement of Hot Flashes218
IV. Endocrinology219
V. Thermoregulation and Hot Flashes221
VI. Circadian Rhythms222
VII. Sleep222
VIII. Treatment of Hot Flashes223
IX. Summary and Conclusions224
References225
Chapter 15. Cardiovascular Pathophysiology229
I. Introduction229
II. Sex-Specific Trends in Cardiovascular Risk with Age230
III. Epidemiologic Studies of Menopause and Cardiovascular Outcomes230
IV. Studies of Menopause and Cardiovascular Risk Factors234
V. Conclusions239
References239
Chapter 16. Insulin Resistance, Body Weight, Obesity, Body Composition, and the Menopausal Transitio245
I. Introduction245
II. Mechanisms for Sex Hormones, Body Composition/ Topology, and Insulin Regulation246
III. Ovarian Hormone Status and Body Composition/ Body Topology248
IV. Carbohydrate Metabolism and Change in Ovarian Hormone Status251
V. Linking Body Composition and Carbohydrate Metabolism with Hormone Status253
VI. Summary253
Appendix254
References257
Chapter 17. Influence of Estrogen on Collagen261
I. Introduction261
II. Structure of Collagen261
III. Age-Related Changes in Collagen262
IV. Skin263
V. Carotid Arteries266
VI. Urinogenital System267
VII. Concluding Remarks268
References268
Chapter 18. The Growth Hormone IGF-I Axis and Menopause271
I. Introduction271
II. Physiology of the GH/IGFs271
III. Diseases in Postmenopausal Life and Their Relationship to the GH/IGF-I Axis277
IV. Summary282
References282
Chapter 19. Bone and Calcium287
I. Biology of Ovarian Hormone Effects on the Skeleton287
II. Review of Bone Structure and Function288
III. Integration of Bone Cell Activity289
IV. Estrogen Effects on Epithelial Calcium Transport294
V. Estrogen and the Physiology of Calcium Homeostasis297
References303
Chapter 20. Menopause and the Skin309
I. Introduction309
II. Dryness309
III. Sweating310
IV. Atrophy310
V. Slowed Wound Healing311
VI. Topical Hormone Replacement Therapy312
VII. Psychological Effects of Menopausal Changes Related to Skin Appearance„Self-Image313
VIII. Summary313
References313
Chapter 21. Estrogen Therapy and the Brain315
I. Chapter Overview315
II. Estrogen and the Brain315
III. Estrogen Therapy and Cognitive Skills316
IV. Estrogen Therapy, Affective Disorders, And Mood317
V. Estrogen Therapy and Alzheimer's Disease317
VI. Estrogen Therapy and Stroke320
VII. Estrogen Therapy and Parkinson's Disease321
VIII. Concluding Perspective on Estrogen and the Brain321
References322
Chapter 22. The Gynourinary System327
I. Introduction327
II. Anatomy and Physiology328
III. Innervation329
IV. Mechanisms of Continence330
V. Treatment Modalities for Female Urinary Incontinence331
References336
Chapter 23. Is There a Relationship between Menopause and Mood?339
I. Introduction339
II. Theories of Menopause and Mood340
III. Methodological Issues340
IV Empirical Research: Menopause Status and Mood342
V. Empirical Research: Hormones and Mood347
VI. Conclusions348
References349
Chapter 24. Immunologic Aspects of Menopause353
I. Effects of Steroid Hormones on the Immune System353
II. Somatic Aging of the Immune System355
III. Effects of the Immune System and Its Decline on Other Events Associated with Menopause355
IV. Hormone Replacement Therapy„Effects on Autoimmunity and Immune Function356
V. Conclusions356
References356
Chapter 25. Cancers of the Female Reproductive System359
I. Introduction359
II. Breast Cancer360
III. Endometrial Cancer365
IV. Cancer of the Cervix370
V. Ovarian Cancer372
VI. Summary and Conclusions376
References376
Chapter 26. Menopausal Sexuality383
I. Introduction383
II. Menopausal Sexuality383
III. Role of Estrogen385
IV. Androgens and Postmenopausal Sexual Function387
V. Other Factors387
VI. Partner, Relationship, and Menopausal Sexuality389
VII. Interventions for Sexual Dysfunction390
References392
Part IV Intervention395
Chapter 27. Historical Perspectives397
I. Introduction397
II. Biological Considerations398
III. Psychologic Aspects402
IV. Sociocultural Perspectives402
References403
Chapter 28. Prevention Trials in Perimenopausal and Postmenopausal Women405
I. Introduction405
II. Hormone Replacement Therapy: Background406
III. The Postmenopausal Estrogen/ Progestin Trial406
IV. The Women's Health Initiative408
V. Heart Estrogen /Progestin Replacement Study411
VI. The Women's Health Study412
VII. The Breast Cancer Prevention Trial413
VIII. Recent Trials of Agents That Reduce Bone Loss and Fracture Incidence414
IX. Study of Tamoxifen and Raloxifene417
X. Conclusion417
References417
Chapter 29. Estrogens: Different Types and Properties421
I. Steroidal Estrogens421
II. Nonsteroidal Estrogens423
III. Potency of Estrogens427
References427
Chapter 30. Progestogens429
I. Introduction429
II. Rationale for Use of Progestogens429
III. Progestogen Biologic Aspects430
IV. Conclusions441
References441
Chapter 31. Androgens445
I. Introduction445
II. Androgen Physiology in the Reproductive Years446
III. Physiological and Nonphysiological Causes of Testosterone Deficiency in Women446
IV. Clinical Consequences of Androgen Insufficiency and Evidence for Benefits of Testosterone Replac447
V. Potential Risks of Testosterone Replacement in Women451
VI. Which Women Are Most Likely to Benefit from Testosterone Replacement?453
VII. How Should Testosterone Replacement Be Prescribed?454
VIII. Conclusions455
References456
Chapter 32. Alternative Therapies to Hormone Replacement Therapy459
I. Introduction459
II. Phytoestrogens460
III. Herbs469
IV. Selective Estrogen Receptor Modulator: Raloxifene474
V. Recommendations474
References476
Chapter 33. Calcium Nutriture: A Model System for Understanding Menopause–Nutrient Interactions481
I. Introduction481
II. Calcium482
III. Vitamin D491
References492
Chapter 34. Exercise495
I. Introduction495
II. Physical Activity and Age at Menopause495
III. Physical Activity and Vasomotor Symptoms496
IV. Physical Activity and Psychological and Somatic Symptoms497
V. Physical Activity and Change in Disease Risk Factor Status499
VI. Conclusions504
References504
Chapter 35. Estrogens and Osteoporosis509
I. Magnitude of the Disease509
II. Definition of Osteoporosis509
III. Bone Mineral Density510
IV. Bone Remodeling512
V. Treatment of Postmenopausal Osteoporosis514
References527
Chapter 36. Osteoarthritis and Menopause535
I. Introduction535
II. Pathogenesis: Potential Mechanisms for the Role of Estrogen and Osteoarthritis536
III. Observations Related to Clinical or Epidemiological Studies537
IV. Summary540
References540
Chapter 37. The Epidemiology of Cardiovascular Disease and Postmenopausal Hormone Therapy543
I. Introduction543
II. Primary Prevention of Cardiovascular Disease and Stroke544
III. Secondary Prevention of Cardiovascular Disease547
IV. Association of Hormones with Lower Risk of CHD: Cause and Effect or Selection?548
V. Summary550
References550
Chapter 38. Interventions for the Control of Symptoms553
I. Introduction553
II. Disturbances in Menstrual Patterns554
III. Symptoms Due to a Decrease in Estrogen555
IV. Symptoms Associated with Progestin Treatment559
V. Conclusion559
References560
Chapter 39. Effects of Steroids on Mood/Depression563
I. Introduction563
II. Mood Disorders across the Female Life Cycle565
III. Brain Neurotransmitters and Mood569
IV. Catecholestrogens: The Estrogen-Mediated System in the Brain571
V. The Hypothalamic–Pituitary Axes571
VI. Steroid Hormones: Mechanism and Modulation of Neuronal Effects572
VII. Conclusion579
References580
Chapter 40. Hormone Replacement Therapy and Breast Cancer583
I. Background583
II. Steroid Hormones and Breast Cancer583
III. Patterns of HRT Use584
IV. Epidemiological Studies of the HRT/Breast Cancer Association585
V. Discussion588
References589
Chapter 41. HRT and Risk of Endometrial Cancer591
I. Endometrial Cancer591
II. Estrogen and Progestin Therapy599
III. Endometrial Surveillance602
IV. Physiology of Endometrial Shedding603
V. Summary603
References604
Chapter 42. Risk of Pulmonary Embolism/Venous Thrombosis607
I. Clinical Entities607
II. Diagnosis and Treatment608
III. Pathophysiology608
IV Incidence and Prognosis609
V. Clinical Recommendations613
References614
Chapter 43. Combined Estrogen/ Androgen Replacement Therapy: Benefits and Risks617
I. Introduction617
II. Historical Background617
III. Benefits of E/A Replacement Therapy618
IV. Risks of E/A Replacement Therapy620
V. Future Directions622
References623
Chapter 44. DHEA: Biology and Use in Therapeutic Intervention625
I. Introduction625
II. Androgens: Origin and Control625
III. DHEA, DHEAS, and Androgen Metabolites: Increase during Childhood and Decline with Age630
IV. DHEA Replacement632
V. Conclusions636
References637
Chapter 45. Menopause Issues for Older Women639
I. Introduction639
II. Selected Syndromes and Late Menopausal Women640
III. Therapeutic Considerations in Late Menopausal Women643
IV Conclusions645
References646
Chapter 46. Decision Analysis Applied to Postmenopausal Hormone Replacement Therapy649
I. Introduction649
II. Decision Analysis649
III. Review of Studies650
IV. Treatment Regimens651
V. Treatment Risks and Benefits651
VI. Estimated Changes in Life Expectancy652
VII. Limitations653
VIII. Summary653
References654
Index657
Color Plate SectionPlate 1

Book details

Vendor Elsevier S & T
SKU 9780124537903
ISBN-13 9780080536200
Author Lobo, Rogerio A.; Kelsey, Jennifer; Marcus, Robert
Category Medical
Subject Gynecology & Obstetrics

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Menopause: Biology and Pathobiology is a comprehensive volume covering all aspects of the biology, anatomy, physiology, pathobiology, and pharmacology of menopause, as well as its diagnosis and management.
The book is divided into four sections: Basic Biology, Epidemiology, Menopausal Systems Pathophysiology, and Intervention. Basic Biology covers such fundamentals as ovarian anatomy and physiology, mechanisms of steroid hormone action, chronobiological effects, and premature menopause. Epidemiology includes, among others, chapters on methodology challenges in the study of menopause, how to distinguish the effects of age from those of menopause, and a discussion of the key differences in demographics, environmental factors, and ethnicity in the menopause experience. The Pathophysiology section contains chapters on menopause and its various effects on the body, including sexuality, skin, brain, the cardiovascular system, cancers, and mood. The final section includes detailed chapters on intervention and management techniques, with topics including alternative therapies to hormone replacement, exercise, and estrogens and osteoporosis.

* Well-referenced to allow easy look up of anything related to menopause
* Presents the latest thinking on basic science and clinical topics
* Exposes what the current gaps in our knowledge are
* Presents current expert opinions

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