Browsing by Subject "Menopause"
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Item An exploration of women's current hormone discontinuation experiences, influences, decisions, and alternatives(2007) Kupferer, Elizabeth Mary, 1958-; Dormire, Sharon L.Findings released from recent pivotal clinical trials on hormone therapy (HT) benefits and risks have stimulated a growing trend towards lower doses and earlier discontinuation of HT for menopausal women. Yet, there is little knowledge regarding women's personal experiences with the resultant earlier and possibly abrupt withdrawal of HT. The purpose of this study was to explore postmenopausal women's vasomotor symptom experiences after discontinuing HT. The data for this study was collected from menopausal women who discontinued HT. The study questionnaire was created through an extensive review of the literature as well as an expert panel review. The questionnaire was also piloted with a small group of women prior to its use in this study. Data analysis consisted of descriptive analysis with means and standard deviations and/or frequency distributions with percentages for demographic data, health behaviors, factors influencing HT decisions, use of CAM and perceived efficacy. Chi-square analysis, Spearman Rho correlation, and logistic regression analysis were conducted for contextual factors and vasomotor symptom experiences. A McNemar test was performed to assess within group differences for vasomotor symptoms experiences pre and post HT. Questionnaires were received from 563 menopausal women throughout the United States. This study revealed that 80% of participants experienced vasomotor symptoms after discontinuing HT. The most common predictors which accounted for only 13% of variance in the occurrence of vasomotor symptoms were younger age, type of menopause and the occurrence of vasomotor symptoms prior to initiation of HT. Of the 563 women participating in the study, less than half reported the use of CAM to treat reemerging vasomotor symptoms. For the most part, less than half of the women felt their treatment choices were helpful in relieving their reemerging vasomotor symptoms Because a woman's experience of menopause can be highly individualized, an adaptation of Bronfenbrenner's ecological theory was used guide this exploratory study. The study findings supported the usefulness of the adaptation of Bronfenbrenner's ecological theory as a model through which to view the vasomotor experiences of menopausal women who have discontinued HT.Item Reproductive aging & long-term hormone replacement therapy in the rhesus macaque(2014-08) Naugle, Michelle Marie; Gore, Andrea C., 1964-Menopause is a natural transition heralded by the cessation of menstrual cycles and ovulation, and it occurs in all women at an average of about 50 years of age. While not a disease, menopause is often accompanied by symptoms that interfere with the quality of life and these symptoms are due to the relatively abrupt deprivation of E2 and P4 experienced during reproductive aging. Reproductive aging consists of changes in the synthesis and release of hormones from the hypothalamus, pituitary and gonad, which make up the HPG axis. Because gonadal hormones play critical roles in many systems throughout the body and brain, not just reproduction, treatment of menopausal symptoms to date largely involves hormone replacement therapy (HRT) with E2, P4 or their combination. While not intended to treat other neurobiological symptoms beyond hot flushes, HRT has the potential to exert widespread actions due to the abundance of hormone receptors throughout the nervous system. Thus, a fuller understanding of the neurobiology of menopause is badly needed. Although much of the research into the mechanisms that underlie reproductive aging focuses on ovarian failure and follicular atresia (cell death), there is evidence that there are significant alterations in the function of the neuroendocrine levels - the hypothalamus and pituitary - that also contribute to this process. As the mean age of the population increases, the number of post-menopausal women continues to grow with broad economic, healthcare and social costs. It is increasingly important to understand the complex mechanisms underlying reproductive aging and the effects of HRT. In this dissertation, I focus on the question of how the female non-human primate hypothalamus changes both with aging and in response to steroid hormone treatments.Item The timing and duration of estradiol on social behavior and gene expression in mature adult and aging female rats(2016-05) Garcia, Alexandra Nicole; Gore, Andrea C., 1964-; Dominguez, Juan; Lee, Hongjoo; Monfils , Marie; Fingerman, KarenMenopause causes declines in ovarian hormones such as estrogens and progesterone. During the menopausal transition, women may experience adverse symptoms such as anxiety, depression and lack of desire to interact. However, since the publication of the Women’s Health Initiative (WHI) many women have been left asking questions about whether, when, and how long to take hormone treatments for menopausal symptoms. This dissertation focuses on the effects of timing and duration of estradiol (E2) relative to loss of ovarian hormones (OVX) on the social brain and behavior in mature adult (MAT) and aging (AG) female rats. The results from these studies illustrated that in MAT rats, 3-months of E2 given immediately following OVX decreased communications and social interactions between cagemates, as assessed in a test quantifying the number of ultrasonic vocalizations emitted, as well as time spent interacting with one another. I interpret this result to mean that the E2 animals had improved social memory. In MAT rats gene expression of the neuropeptides (Oxt, Avp, Oxtr, Avpr1a) involved in regulating social behavior were also greater in the BNST, MeA, and SON of rats treated with estradiol compared to vehicle. Because menopause typically happens at middle age, I conducted a similar experiment in middle-aged rats to assess the influence of estradiol deprivation or replacement in aging rats. Aging animals were behaviorally characterized twice (at 3 and 6-months), groups were given different timing and duration of estradiol or vehicle treatments as a model for the WHI. Similar to the MAT animals, the estradiol-treated AG rats called less than their vehicle counterparts during an ultrasonic vocalization test conducted at the 3-month testing period. However, at the 6-month testing period no differences were observed, which could be the result of aging. Oxt, Oxtr, Avp and Avpr1a showed unique gene expression patterns that were dependent upon the timing and duration of estradiol in a region-specific manner in the AG rats. Most genes were up-regulated by estradiol treatment, irrespective of timing or duration. Overall this work may benefit the field of women’s health through new knowledge on consequences of age, and the timing and duration of estrogen treatment, on the social brain and behavior.Item Understanding the factors that influence women's decisions to use hormone replacement therapy during menopause using the Theory of Planned Behavior(2002-08) Adamus, Andrea Taylor; Shepherd, Marvin D.The purpose of this study was to determine the factors that influence women's decisions to use hormone replacement therapy (HRT) during menopause. Using the Theory of Planned Behavior and constructs of risk perception, this study was able to explore the beliefs and attitudes of women about HRT use during menopause. The study was also able to explore how risk perception of HRT and the conditions that affect women during midlife impact their decision to use HRT during that time. Focus groups were conducted to develop the questionnaire used in the larger study. A community-based sample of women from Houston area churches participated in the study. The major theme that emerged from the focus groups was the weighing of cancer risks and the protection benefits of HRT. The most interesting factor that emerged as a barrier to HRT use was "negative publicity" and myths toward taking HRT. Results from the larger study demonstrated that the construct of attitude was the predominate predictor of intention when direct measures were used in a model to predict intention. Meaning that women's attitudes towards HRT use during menopause (whether they are safe, wise to use, good or bad, beneficial, risky, pleasant, or valuable) played a significant role in their intention. In contrast when the belief-based measures were used in the model, subjective norm and perceived behavioral control were significant predictors of intention. Meaning that the intention to use HRT was based more on the influence of their husbands, physicians, and families. This also meant that the dosage form, cost, negative publicity, family history of cancer, personal fear of developing cancer, and education about HRT would affect their intention to use HRT during menopause more than the advantages and disadvantages of using HRT (advantages such as protection from osteoporosis, relief from hot flashes; or, disadvantages such as risk of breast cancer). Finally, women's perception of risk with regards to HRT was highest for breast cancer followed by heart disease, endometrial cancer, and osteoporosis. This study found that there are many factors that may affect the decision to use HRT during menopause and that overall these factors affect women’s attitudes towards HRT and their intention to use it.