Concentrations of Follicle-Stimulating Hormone Correlate with Alkaline Phosphatase and a Marker for Vitamin K Status in the Perimenopause

Serum alkaline phosphatase (ALP), a gross marker of bone turnover, has been reported to be elevated after menopause, a period characterized by hallmark increases in follicle-stimulating hormone (FSH). Whether the ALP rise coincides with the perimenopausal transition when changes in FSH, estrogen levels, and menstrual cycles are first apparent is not known. The purpose of this cross-sectional study was twofold: (1) to characterize the influence of the perimenopausal transition on ALP activity and (2) to correlate ALP activity with more precise markers for bone, osteocalcin (OC), and vitamin K status assessed with undercarboxylated osteocalcin (ucOC). Thirty-eight studies of hourly FSH were conducted on cycle day 6 of the follicular phase in perimenopausal women volunteers, aged 40-54 years (mean body mass index [BMI] = 24.2 ± 0.5). Mean FSH was used to define the perimenopausal stage (early perimenopausal, mean FSH 15 IU/L, n = 27; late perimenopausal, mean FSH > 15 IU/L, n = 11). As expected, late perimenopausal women had irregular and longer menstrual cycles, lower estradiol (E2) and estrone (E1) levels, and a lower frequency of ovulations vs. the early group. ALP was higher (76.5 ± 8.3 vs. 58.3 ± 2.7 IU/L, p = 0.045) compared with the early perimenopausal group. In a subsample (n = 10), OC was associated with ALP (r = 0.69, p 40 pg/ml (46.3% ± 6.6% vs. 22.0% ± 3.1%, p < 0.006). Clinical markers of the perimenopause are associated with a nonspecific but inexpensive marker of enhanced bone turnover (i.e., higher ALP) and correlate well with more precise markers of bone activity. These findings suggest that health-promotion strategies for preserving bone should be instituted well before the last menstrual period.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63215/1/15246090050147709.pd

The surrogate mother as a high-risk obstetric patient

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29295/1/0000356.pd

Postmenopausal Symptoms in Female Veterans with Type 2 Diabetes: Glucose Control and Symptom Severity

Background: While type 2 diabetes mellitus (DM) is a common condition of midlife women, few studies have examined its influence on the symptom features of menopause. To explore this relationship, we conducted a study of symptom patterns of diabetic patients using a random sample of female veterans receiving care in the Veterans Affairs Healthcare system. Methods: A cross-sectional comparison was conducted with three groups of postmenopausal respondents (ages 45?60 years) to a mailed national survey who also consented to clinical data access: no diabetes (n=90), diabetes with better glucose control (hemoglobin A1c [HbA1c]≤7%, n=135) and diabetes with worse glucose control (HbA1c>7%, n=102). Results: Respondents, on average, were obese (body mass index: 33.9±0.4 kg/m2), 11.30±0.2 years postmenopause, with more than one chronic illness. Despite higher body mass index and increased comorbidities in women with diabetes compared with nondiabetic women, measures of mental health (anxiety, depressed mood, stress) were similar across groups. The pattern of menopause symptoms did not differ by group. Muscle aches/joint pain was the most prevalent symptom (78.6%), followed by vasomotor symptoms (74.4%). Respondents with elevated HbA1c demonstrated higher total menopausal symptom severity scores (DM-HbA1c>7: 15.4±0.8 vs. DM-HbA1c≤7%: 12.2±0.8 vs. No diabetes: 12.3±0.8; p=0.006) than the other two groups. Conclusions: In postmenopausal female veterans with diabetes, glucose control is associated with the severity of those symptoms commonly attributed to menopause. Joint pain is an important part of the postmenopausal symptom complex in this population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140130/1/jwh.2014.4863.pd

Midlife Women's Responses to a Hospital Sleep Challenge: Aging and Menopause Effects on Sleep Architecture

Objective: To distinguish aging from menopause effects on sleep architecture, we studied an episode of disturbed hospital sleep in asymptomatic midlife women during the follicular phase of an ovulatory cycle and three control groups differing by age or menopause status. Methods: Fifty-one studies were conducted in four groups of volunteers: young cycling (YC, 20-30 years, n = 14), older cycling (OC, 40-50 years, n = 15), ovariectomized receiving estrogen therapy (OVX, 40-50 years, n = 12), and spontaneously postmenopausal (PM, 40-50 years, n = 10). Subjects were admitted to the University Hospital General Clinical Research Center (GCRC) for a first-night sleep study conducted during a 24-hour, frequent blood sampling protocol. Results: Despite similar estrogen concentrations in the YC (28 ± 4 pg/ml) and OC (34 ± 6 pg/ml) groups, OC women had reduced sleep efficiency (79% ± 2%) vs. YC (87% ± 3%; p = 0.009). In the OVX and PM groups where estrogen concentrations were markedly different, sleep efficiency was also reduced vs. the YC group (OVX vs. YC, 79% ± 3% vs. 87% ± 3%, p = 0.05; PM vs. YC, 75% ± 3% vs. 87% ± 3%, p = 0.007). Wake time was longer in the three older groups (103 ± 10 minutes, 101 ± 12 minutes, 123 ± 12 minutes for OC, OVX, PM, respectively) vs. YC (63 ± 13 minutes, p < 0.05). The number of stage shifts was positively associated with advancing age (rho = 0.3, p < 0.03) but not with estrogen concentration. Conclusions: Aging-related sleep deficits in response to an experimental stressor occur in midlife women prior to menopause.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63173/1/154099904323016491.pd

Pulsatile LH secretion in women with premenstrual syndrome (PMS): Evidence for normal neuroregulation of the menstrual cycle

The premenstrual syndrome (PMS) has been proposed to result from excessive exposure to and/or withdrawal of brain opioid activity during the luteal phase. Because hypothalamic opioids are believed to modulate GnRH secretion, in part under the influence of ovarian steroids, we performed longitudinal studies of gonadotropin and ovarian steroid secretion across ovulatory, symptomatic cycles of 17 PMS patients and 8 normal volunteers. Pulsatile LH secretion was measured every 10 min for 8 hr at times when central opioid activity was expected to be low (early follicular phase), high (mid-luteal phase; ML), and declining (late luteal phase). In both subject groups, a cycle-phase effect was observed for LH pulse frequency (p=p=0.002), and for the transverse mean concentrations of LH (p=0.05), FSH (p2) (p=p=p=&lt;0.05). The similar changes in luteal LH pulse frequency fail to provide evidence that GnRH secretion is impaired, thus challenging the view that the neuroregulation of the menstrual cycle in women with PMS is markedly altered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30073/1/0000443.pd

Informed Consent Issues in Assisted Reproduction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71431/1/j.1552-6909.1999.tb01998.x.pd

Health-Related Quality of Life Issues in Women With Polycystic Ovary Syndrome

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74396/1/0884217504272945.pd

Differential Contributions of the Reproductive and Metabolic Features of Polycystic Ovary Syndrome (PCOS) to Psychological Symptoms

Objective: Although women with PCOS have elevated levels of psychological distress, findings regarding which aspects of PCOS contribute to psychological symptoms are inconsistent. The purpose of this study was to investigate the independent and differential contributions of the previously identified key PCOS manifestations (infertility, hirsutism, obesity, menstrual problems) to multiple psychological symptoms. Methods: Participants were 126 endocrinology patient volunteers diagnosed with PCOS who completed a cross-sectional study of key manifestations of PCOS (including the PCOSQ) and psychological symptoms (BSI). Results: Participants had significantly elevated scores on all nine BSI subscales of psychological symptoms. Menstrual problems were significantly associated with all symptom subscales as well as the global indicator, while hirsutism and obesity were significantly related to five or more subscales. Neither infertility status nor infertility concerns significantly predicted any of the psychological symptoms. After controlling for demographic factors, menstrual problems remained the strongest predictor of psychological symptoms. Conclusions: Findings suggest that for women with PCOS, the features of excess body hair, obesity and menstrual abnormalities are especially troubling and carry unique risks for serious adverse psychologic symptoms including depression, anxiety, somatization and interpersonal sensitivity. Specific manifestations of PCOS were differentially related to psychological symptoms suggesting that the predictive value of PCOS for depression and other mental health problems may vary according to the specific symptoms experienced. Menstrual problems may be the most salient of these features and deserve particular attention as a marker for psychological risk among women with PCOS

Risk Factors for Psychological Distress and Impaired Quality of Life In Women with Polycystic Ovary Syndrome: Implications for Providing Effective Nursing Care

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder characterized by at least two of the following three features: hyperandrogenism, ovulatory dysfunction and/or polycystic ovaries. Prevalence is estimated at 5-10 % of women of reproductive age worldwide and may impact between five and ten million women in the U.S. alone. Rather than a distinct disease entity, PCOS is characterized as a clustering of clinical concerns which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. Our intent was to examine how these three PCOS characteristics impact psychological symptoms (e.g., depression, anxiety, interpersonal sensitivity) and PCOS health related quality of life concerns (weight, hair, infertility, menstrual, emotions). Design: Cross-sectional, correlational Setting: Women were recruited from private endocrinology practices in the rural Southeastern U.S. Patients/Participants: The study sample consisted of 126 women with PCOS. Half of these women were currently attempting to conceive in addition to being treated for their PCOS. The average woman in the study was 30 years of age (M=30.3, range=18-48), White (98 %) and married (79%). On average, participants weighed over 200 pounds (M=213.6 lbs, 116-361 lbs). Methods: During the seven-month enrollment period, women diagnosed with PCOS were invited to participate. Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Insulin level predicted increased levels of symptoms related to somatization, psychoticism, and a global symptom severity index. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to have a baby had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life. Future attention might focus on screening and possible referring to mental health services for women not trying or no longer trying to conceive