Download Menopause: Endocrinology and Management (Contemporary by David B. Seifer PDF

By David B. Seifer

Major researchers and skilled clinicians sign up for forces not just to light up ultra-modern figuring out of the endocrinology of menopause, but additionally to supply a valid foundation for its winning administration. those professional specialists evaluate intimately the cardiovascular, bone, mind, and genitourinary adjustments that accompany menopause and spell out the dangers, merits, and possible choices of traditional hormone alternative treatment. Selective estrogen receptor modulators (SERMs), androgen alternative, calcium supplementation, and the position of phytoestrogens also are absolutely reviewed. Menopause: Endocrinology and administration deals practising physicians a accomplished knowing of the menopause approach, in addition to an evidence-based method of optimizing remedy thoughts for the demanding clinical difficulties accompanying this crucial interval in women's lives.

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Clinical use of these models is currently limited by an inability to reliably detect the total number of remaining follicles in the ovary in a noninvasive or minimally invasive manner. Transvaginal ultrasonography may be useful for this purpose if the relationship between early antral follicle numbers and total remaining follicle numbers were clearly defined. Apoptosis and Ovarian Reserve In addition to the decline in follicular numbers that is manifested initially by low ovarian reserve and ultimately by menopause, qualitative changes occur in the granulosa cells of these follicles.

A genetic basis for menopausal age is supported by several recent case reports showing deletional abnormalities in the long arm of the X chromosome in families of women with premature ovarian failure (58,59). Further studies are necessary to determine whether genes in this area of the X chromosome also influence the timing of menopause when it occurs in the normal range. Various menstrual cycle characteristics have been reported to be associated with earlier age of menopause, including short menstrual cycle length at ages 2035 (51) and menstrual irregularity before age 25 (50).

Thus, this study supports the theory that accelerated follicular depletion to near exhaustion occurs as menopause approaches. Recently, apoptosis has been identified as the principal mechanism responsible for prenatal loss of the oogonia as well as prenatal and postnatal follicular atresia (122). Apoptosis is characterized by condensation and fragmentation of DNA by endonucleases, followed by phagocytosis. Thus, increasing apoptosis in oocytes or granulosa cells may herald menopause. Determining follicular numbers in vivo and assessing the incidence of apoptosis in oocytes or granulosa cells may useful anatomic predictors of ovarian reserve and/or onset of menopause (123).

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