Advertisement

Menopause and Ageing

  • Marta Caretto
  • Andrea Giannini
  • Tommaso Simoncini
  • Andrea R. Genazzani
Chapter
Part of the Reproductive Medicine for Clinicians book series (REMECL, volume 1)

Abstract

The decline in the reproductive capacity of women in the late fourth to fifth decade of life is accompanied by diverse sequelae, including vasomotor symptoms, an increased risk of osteoporosis, psychogenic disturbance and cardiovascular and cerebrovascular disease. Attempts to ameliorate losses in oestrogen through hormone replacement therapy (HRT) have, however, courted significant controversy relating both to increased risks of malignancy and vascular events, thereby standing as an exemplar for the difficulty in managing hormone balance during ageing. Dehydroepiandrosterone (DHEA) represents the most abundant sex steroid in plasma in men and women, but its serum concentration goes down to 10–20% of its maximum level by around the age of 70 years. Evidence suggest that lower levels of are associated with cardiovascular, cognitive and sexual impairment in women. Further aspects need to be better investigated, before drawing definitive conclusions on DHEA replacement therapy.

References

  1. 1.
    Treloar AE. Menstrual cyclicity and the pre-menopause. Maturitas. 1981;3(3–4):249–64.CrossRefGoogle Scholar
  2. 2.
    World Health Organization. Research on the menopause in the 1990s. In: Report of a WHO Scientific Group, World Health Organization Technical Report Series; 1996.Google Scholar
  3. 3.
    El-Sakka AI, Hassoba HM. Age related testosterone depletion in patients with erectile dysfunction. J Urol. 2006;176:2589–93.CrossRefGoogle Scholar
  4. 4.
    Janicki SC, Schupf N. Hormonal influences on cognition and risk for Alzheimer’s disease. Curr Neurol Neurosci Rep. 2010;10:359–66.CrossRefGoogle Scholar
  5. 5.
    Wells G, Tugwell P, Shea B, Guyatt G, Peterson J, Zytaruk N, Robinson V, Henry D, O’Connell D, Cranny A, Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal. Endocr Rev. 2002;23:529–39.CrossRefGoogle Scholar
  6. 6.
    Marioribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2012;(7):CD004143.Google Scholar
  7. 7.
    Orentreich N, Brind JL, Vogelman JH, Andres R, Baldwin H. Long-term longitudinal measurements of plasma dehydroepiandrosterone sulfate in normal men. J Clin Endocrinol Metab. 1992;75(4):1002–4.PubMedGoogle Scholar
  8. 8.
    Orentreich N, Brind JL, Rizer RL, Vogelman JH. Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinol Metab. 1984;59(3):551–5.CrossRefGoogle Scholar
  9. 9.
    Arlt W. Dehydroepiandrosterone and ageing. Best Pract Res Clin Endocrinol Metab. 2004;18:363–80.CrossRefGoogle Scholar
  10. 10.
    Gartoulla P, Worseley R, Bell RJ, Davis SR. Moderate-severe vasomotor and sexual symptoms remain problematic for 60-65 years old women. Menopause. 2015;22(7):694–701.CrossRefGoogle Scholar
  11. 11.
    Davis SR, et al. Understanding weight gain at menopause. Climacteric. 2012;15:419–29.CrossRefGoogle Scholar
  12. 12.
    Huber J, Birkhäuser M, Metka M, Druckmann R, Rohr U, Winkler T. Europäische Gynäkologen analysieren die WHIStudie—Hormonstudie amerikanischer Kardiologen. J Menopause. 2002;9:7–13.Google Scholar
  13. 13.
    Huber J, Birkhäuser M, Metka M, Druckmann R, Rohr U, Winkler T, Schindler AE, Nelson HD, Walker M, Zakher B, Mitchell J. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the U.S. Services Task Force Recommendations. Ann Intern Med. 2012;157:104–10.CrossRefGoogle Scholar
  14. 14.
    Woods DC, White YA, Tilly JL. Purification of oogonial stem cells from adult mouse and human ovaries: an assessment of the literature and a view toward the future. Reprod Sci. 2013;20:7–15.CrossRefGoogle Scholar
  15. 15.
    Dunn JF, Nisula BC, Rodboard D. Transport of steroid hormones. Binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-steroid binding globulin in human plasma. J ClinEndocrinol Metab. 1981;53:58–68.CrossRefGoogle Scholar
  16. 16.
    MacLennan AH, Broadbent JL, Lester S, Moore V. Oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004;(4):CD002978.Google Scholar
  17. 17.
    Welton AJ, Vickers MR, Kim J, Ford D, Lawton B, MacLennan AH, WISDOMteam, et al. Health related quality of life after combined hormone replacement therapy: randomised controlled trial. BMJ. 2008;337:a1190.CrossRefGoogle Scholar
  18. 18.
    The North American Menopause Society. The 2012 Hormone Therapy Position Statement of the North American Menopause Society. Menopause. 2012;19:257–71.CrossRefGoogle Scholar
  19. 19.
    Olie V, et al. Hormone therapy and recurrence of venous thromboembolism among postmenopausal women. Menopause. 2011;18:488–93.CrossRefGoogle Scholar
  20. 20.
    Hoibraaten E, et al. Increased risk of recurrent venous thromboembolism during hormone replacement therapy—results of the randomized, double-blind, placebo-controlled estrogen in venous thromboembolism trial (EVTET). Thromb Haemost. 2000;84:961–7.CrossRefGoogle Scholar
  21. 21.
    Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric. 2014;17:1–14.Google Scholar
  22. 22.
    Roberts H, Hickey M, Lethaby A. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia Cochrane review summary. Maturitas. 2014;77:4–6.CrossRefGoogle Scholar
  23. 23.
    Davis SR, Lambrinoudaki I, Lumsden M, Mishra GD, Pal L, Rees M, Santoro N, Simoncini T. Menopause. Nat Rev Dis Primers. 2015;1:15004.Google Scholar
  24. 24.
    Schindler AE. The “newer” progestogens and postmenopausal hormone therapy (HRT). J Steroid Biochem Mol Biol. 2014;142:48–51.CrossRefGoogle Scholar
  25. 25.
    Rymer J, Robinson J, Fogelman I. Ten years of treatment with tibolone 2.5 mg daily: 283 effects on bone loss in postmenopausal women. Climacteric. 2002;5:390–8.CrossRefGoogle Scholar
  26. 26.
    Valdivia I, Campodonico I, Tapia A, Capetillo M, Espinoza A, Lavin P. Effects of 287 tibolone and continuous combined hormone therapy on mammographic breast density and 288 breast histochemical markers in postmenopausal women. Fertil Steril. 2004;81:617–23.CrossRefGoogle Scholar
  27. 27.
    Constantine G, Graham S, Portman DJ, Rosen RC, Kingsberg SA. Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial. Climacteric. 2015;18:226–32.CrossRefGoogle Scholar
  28. 28.
    Pinkerton JV, et al. Evaluation of the efficacy and safety of bazedoxifene/conjugated estrogens for secondary outcomes including vasomotor symptoms in postmenopausal women by years since menopause in the Selective Estrogens, Menopause and Response to Therapy (SMART) trials. J Womens Health (Larchmt). 2014;23:18–28.CrossRefGoogle Scholar
  29. 29.
    Pickar JH, Yeh IT, Bachmann G, Speroff L. Endometrial effects of a tissue selective estrogen complex containing bazedoxifene/conjugated estrogens as a menopausal therapy. Fertil Steril. 2009;92:1018–24.CrossRefGoogle Scholar
  30. 30.
    Genazzani AR, Komm BS, Pickar JH. Emerging hormonal treatments for menopausal symptoms. Expert Opin Emerg Drugs. 2015;20(1):31–46.CrossRefGoogle Scholar
  31. 31.
    Palacios S, Castelo-Branco C, Currie H, et al. Update on management of genitourinary syndrome of menopause: a practical guide. Maturitas. 2015;82:308–13.CrossRefGoogle Scholar
  32. 32.
    Pluchino N, Carmignani A, Cubeddu A, Santoro A, Cela V, Errasti T. Androgen therapy in women: for whom and when. Arch Gynecol Obstet. 2013;288:731–7.CrossRefGoogle Scholar
  33. 33.
    Shufelt C, Bretsky P, Almeida CM, et al. DHEA-S levels and cardiovascular disease mortality in postmenopausal women: results from the National Institutes of Health – National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE). J Clin Endocrinol Metab. 2010;95:4985–92.CrossRefGoogle Scholar
  34. 34.
    Davis SR, Shah SM, McKenzie DP, Kulkarni J, Davison SL, Bell RJ. Dehydroepiandrosterone sulfate levels are associated with more favorable cognitive function in women. J Clin Endocrinol Metab. 2008;93:801–8.CrossRefGoogle Scholar
  35. 35.
    Genazzani AR, Stomati M, Valentino V, et al. Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality. Climacteric. 2011;14:661–8.CrossRefGoogle Scholar
  36. 36.
    Pluchino N, Ninni F, Stomati M, et al. One-year therapy with 10mg/day DHEA alone or in combination with HRT in postmenopausal women: effects on hormonal milieu. Maturitas. 2008;59:293–303.CrossRefGoogle Scholar
  37. 37.
    Pluchino AR, Genazzani N. DHEA replacement for postmenopausal women: have we been looking in the right direction? Climacteric. 2015;18:1–3.Google Scholar
  38. 38.
    Goldstein S. An efficient tool for the primary care management of menopause. Can Fam Physician. 2017;63:295–8.PubMedPubMedCentralGoogle Scholar

Copyright information

© IAHR (International Academy of Human Reproduction) 2018

Authors and Affiliations

  • Marta Caretto
    • 1
  • Andrea Giannini
    • 1
  • Tommaso Simoncini
    • 2
  • Andrea R. Genazzani
    • 3
  1. 1.Division of Obstetrics and Gynecology, Department of Experimental and Clinical MedicineUniversity of PisaPisaItaly
  2. 2.Division of Obstetrics and Gynecology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  3. 3.International Society of Gynecological EndocrinologyPisaItaly

Personalised recommendations