Saturday, December 2, 2023

Do men undergo menopause?

WELLNEWS

By Victor Romulo Gallardo Dumaguing MD

The title was intended to be stimulating, interesting, provocative, if not downright intriguing. Well, for one, despite the fact that the word " men" is in the word " menopause"- no pun intended, our article will emphasize the distinct difference in the physiology and reproductive capacity of women and men.
    Girls turn into a lady or a woman earlier than boys turning into men that is biologically speaking. The entry to womanhood for most girls occur at 9 years with their first menstrual flow called menarche, although physiology books say that some girls may have theirs at 7 and a few, believe it or not may be at 18, delayed for sure, but still considered within normal. The appearance of a spontaneous ejaculate, usually nocturnal or it occurred while the boy is asleep, signals his potential as being a father, biological father, although for obvious reasons, there are psychological , social, legal and probably religious hurdles and limitations.
    Females have a limited time for their reproductive capacity toward healthy fruition of offspring. Every month, one of her ovaries produce a mature egg called ovum, which if fertilized by the sperm of a male will produce another human baby. If not the unfertilized egg dies and is included in the menstrual flow of the woman every month ( 28-32 days) although some women may do so every 22 days while a few does it every 36 days. This sequence of events occurs with regularity for most healthy women until they reach a stage in their lives, as dreadful and fearful as being dumped by their first boyfriend, a reality in all women's live, menstruation.
    Menopause is the end of a woman's fertility. Heavy, strong and sad words indeed. It is the cessation, stoppage of the cyclic functioning of her ovaries, therefore no more eggs to be fertilized. Menopause actually occurs at the end of a woman's last period. Again, for most women, it occurs at 52 with a wide range of 48-55 years.
    With no more ovarian production of estrogen, 75% of women experience the so-called  hot flushes- feeling extremely hot even when it's cold weather, with the face and neck turning red, accompanied by profuse sweating. Cardiovascular signs and symptoms appear like palpitation, tachycardia, chest pain and easy fatigability with emotional outbursts so much so that it has become customary for many Filipino household to be saying " hayaan mo na siya, nagmemenopause sya" as a gentle, kind understanding of woman undergoing these troubling times.
    In contrast, the reproductive capacity of men is limitless, that is from the time he had his first ejaculate, until death, as long as he is healthy, particularly the seminiferous tubules of his testes which produces normal sperm cells which could fertilize a mature egg. 
    However, there is a part of his testes which may not be as normally productive as when he was younger. The interstitial cells of Leydig are the ones that produce the male hormone testosterone- the one that makes a man virile, strong, and aggressive and even the chemical that fires his ambitions and future plans
    Truth to tell, the word “andropause" was invented, so to speak, sparked by the need or the desire of some, mostly psychologists to have a male equivalent of menopause. Midlife for humans is at 40 years and men start having a decrease in the production of testosterone which become significant by the age of 50.
    Nonetheless, even experts urologist, and endocrinologists are agreed that the signs and symptoms of andropause are not as dramatic and clinically significant as that of menopause. There are no physical bodily deficit like decrease in the length and girth of the penis or the testicles- although some men confess there are.
    Of course, libido or sexual desire is much less but these can be attributed to the easy fatigability most old men complain about. Or a low back pain, arthritic spine and knees might just lessen whatever aroused sexual desire there is. On the emotional side, comments about grouchy, grumpy and don’t forget the paunchy old men could stem from the depression felt by men in their 50s going into their 60s
    Replacing testosterone in the blood is the most common treatment or management for men going through the signs and symptoms of andropause or male menopause, in the same way that HRT-hormone replacement therapy- is given to women after their menopause.
    However, it must be strongly emphasized that since this replacement involves hormones, which have a potential double-edged sword, i.e, risk-benefit effects, the doctor and the patient must have a very detailed discussion-genetics of family history of cancer, lifestyle- before treatment is initiated.
    In a nutshell, menopause impacts all women, ending their fertility while andropause does not affect all men, and as long as they are healthy, maintain their reproductive capabilities up to ripe (no pun intended) old age.
 

WELLNEWS

Hormonal changes during menopause related to decline in cardiovascular health

Victor Romulo Gallardo Dumaguing MD

SOPHIA-ANTIPOLIS, France -- Levels of bad cholesterol rise during menopause, and 10% of this increase is due to shifts in sex hormones. That’s the finding of research published in the European Journal of Preventive Cardiology, a journal of the ESC.
    Women usually undergo menopause at the age of 48 to 52 years, leading to a decline in oestrogen and increase in follicle-stimulating hormone (FSH). Menopause is thought to predispose women to heart disease since it typically develops 10 years later than in men, and risk rises after menopause. Previous studies have shown that menopause is associated with heart disease-promoting levels of metabolites, but this study is the first to link this shift with changes in female sex hormones. The metabolite shifts were partially ameliorated with hormone replacement therapy (HRT).
    “Menopause is unavoidable but it is possible that the negative metabolite shift can be diminished by eating healthily and being physically active,” said study author Dr. Eija K. Laakkonen of the University of Jyväskylä, Finland. “In particular, women should pay attention to the quality of fat in their diet and getting sufficient exercise to maintain cardiorespiratory fitness. HRT is an option that women should discuss with healthcare providers at this point in their lives.”
    The analysis included 218 perimenopausal women not using HRT at baseline. Levels of 180 metabolites (lipids, lipoproteins and amino acids) and two hormones (estradiol and FSH) were obtained from blood samples at baseline and every three to six months until early postmenopause. The menopausal state was assessed using menstrual diaries and blood FSH levels.
    Early postmenopause was defined as no periods for over six months and elevated FSH levels on at least two consecutive occasions. A total of 35 women (15%) started HRT during the study.
    Dr. Laakkonen explained: “Our study investigated whether the menopausal hormonal change modulates the metabolite profile measured in blood samples taken before and after menopause. Because the menopausal transition, i.e. the time with variable hormone levels and irregular menses, varies tremendously from person to person, the time points for assessment were individualized.”
    The researchers carried out detailed statistical analyses to determine what changes occur in metabolite levels during the menopausal transition and whether these changes related to the shift in sex hormone levels. They also tested whether the metabolite trajectory varied between HRT users and non-users.
    The average age at baseline was 51.7 years and the median follow up was 14 months. Menopause was associated with a statistically significant change in levels of 85 metabolites. An exploratory analysis showed that the menopausal hormonal shift directly explained the change in 64 of the 85 metabolites, with effect sizes ranging from 2.1% to 11.2%. These included low-density lipoprotein (LDL) cholesterol, triglycerides, and fatty acids. and amino acids. The analyses were adjusted for age at baseline, duration of follow up, education level, smoking status, alcohol use, physical activity, and diet quality. A second exploratory analysis revealed that HRT was associated with increases in high-density lipoprotein (“good”) cholesterol and reductions in LDL (“bad”) cholesterol.
    Dr. Laakkonen said: “This study links hormonal changes during menopause to metabolic alterations that promote heart disease. Previous studies did not confirm menopausal status with hormone measurements, meaning that they could not differentiate menopausal effects from ageing. Our results should be interpreted with caution, since the links with sex hormones and HRT were found in exploratory analyses and need confirmation.”
    She added: “Regarding HRT, very strong conclusions cannot be drawn solely based on our observational study since the number of women starting therapy was small and the type of drug was not controlled. Nevertheless, our findings indicate that initiating HRT early into menopause, i.e. during the menopausal transition, offers the greatest cardioprotective effect. Women considering HRT should discuss it with their healthcare professional since there are numerous choices and some potential contraindications such as cancer or stroke history that need to be considered
    This article is a follow-up of the immediate past articles related to breast cancer and the reality that women have a three-fold risk of heart attacks and stroke after menopause- which is NOT stoppage of menstruation as some folks think- but rather stoppage of ovulation, meaning the two ovaries are no longer secreting the physiologic amounts of estrogen.
 

WELLNEWS

Women more likely to die after heart attack than men

Victor Dumaguing

PRAGUE, Czechia -- Women are more than twice as likely to die after a heart attack than men, according to research presented at Heart Failure 2023, a scientific congress of the European Society of Cardiology (ESC).
    “Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis,” said study author Dr. Mariana Martinho of Hospital Garcia de Orta, Almada, Portugal. “These women need regular monitoring after their heart event, with strict control of blood pressure, cholesterol levels and diabetes, and referral to cardiac rehabilitation. Smoking levels are rising in young women and this should be tackled, along with promoting physical activity and healthy living.”
    Previous studies have found that women with ST-elevation myocardial infarction (STEMI) have a worse prognosis during their hospital stay compared to men, and that this may be due to their older age, increased numbers of other conditions, and less use of stents (percutaneous coronary intervention; PCI) to open blocked arteries.2 This study compared short- and long-term outcomes after STEMI in women and men, and examined whether any sex differences were apparent in both premenopausal (55 years and under) and postmenopausal (over 55) women.
    This was a retrospective observational study which enrolled consecutive patients admitted with STEMI and treated with PCI within 48 hours of symptom onset between 2010 and 2015. Adverse outcomes were defined as 30-day all-cause mortality, five-year all-cause mortality and five-year major adverse cardiovascular events (MACE; a composite of all-cause death, reinfarction, hospitalization for heart failure and ischemic stroke).
    The study included 884 patients. The average age was 62 years and 27% were women. Women were older than men (average age 67 vs. 60 years) and had higher rates of high blood pressure, diabetes and prior stroke. Men were more likely to be smokers and have coronary artery disease. The interval between symptoms and treatment with PCI did not differ between women and men overall, but women aged 55 and below had a significantly longer treatment delay after arriving at the hospital than their male peers (95 vs. 80 minutes).
    The researchers compared the risk of adverse outcomes between women and men after adjusting for factors that could influence the relationship including diabetes, high cholesterol, hypertension, coronary artery disease, heart failure, chronic kidney disease, peripheral artery disease, stroke and family history of coronary artery disease. At 30 days, 11.8% of women had died compared to 4.6% of men, for a hazard ratio (HR) of 2.76. At five years, nearly one-third of women (32.1%) had died versus 16.9% of men (HR 2.33). More than one-third of women (34.2%) experienced MACE within five years compared with 19.8% of men (HR 2.10).
    Dr. Martinho said: “Women had a two to three times higher likelihood of adverse outcomes than men in the short- and long-term even after adjusting for other conditions and despite receiving PCI within the same timeframe as men.”
    The researchers conducted a further analysis in which they matched men and women according to risk factors for cardiovascular disease including hypertension, diabetes, high cholesterol and smoking. Adverse outcomes were then compared between matched men and women aged 55 years and under, and between matched men and women over 55 years old.
There were 435 patients in the matched analysis. In matched patients over 55 years of age, all adverse outcomes measured were more common in women than men. Some 11.3% of women died within 30 days compared with 3.0% of men, for an HR of 3.85. At five years, one-third of women (32.9%) had died compared with 15.8% of men (HR 2.35) and more than one-third of women (34.1%) had experienced MACE compared with 17.6% of men (HR 2.15). In matched patients aged 55 years and below, one in five women (20.0%) experienced MACE within five years compared to 5.8% of men (HR 3.91), while there were no differences between women and men in all-cause mortality at 30 days or five years.
    Dr. Martinho said: “Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age. Premenopausal women had similar short-term mortality but a poorer prognosis in the long-term compared with their male counterparts. While our study did not examine the reasons for these differences, atypical symptoms of myocardial infarction in women and genetic predisposition may play a role. We did not find any differences in the use of medications to lower blood pressure or lipid levels between women and men.”
    She concluded: “The findings are another reminder of the need for greater awareness of the risks of heart disease in women. More research is required to understand why there is gender disparity in prognosis after myocardial infarction so that steps can be taken to close the gap in outcomes.
    Your columnist would like to add that the risk of heart attack and stroke increases 3x that of men, after menopause, a fact strongly emphasized by cardiology associations all over the world, with the American Heart Association encouraging attendees to wear anything red- dress or neckties every Wednesday of its annual one week convention to commemorate Women Hearts Day

 
 
 

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