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Ultimate Guide To Solving Menopausal Symptoms Today

A Guide To Assist Women Going Through Menopause. The Guide Can Reduce And Even Eliminate Menopausal Symptoms. Proven solutions from around the world that can virtually eliminate your menopausal symptoms. You do not have to rely on conventional medicine to get you through menopause. This Ultimate Guide is delivered immediately as a downloadable e-book! You can read in your favorite electronic reader, computer or you can even print it out! Here are some the things we will cover: Solutions that conventional medicine professionals are not telling you about. Factual information that has worked for thousands of others. Easy to understand solutions that you can implement for you and your family. Yes, these solutions will help your whole family! Just imagine Reducing your hot flashes, increasing your energy, eliminating gas, bloating and other stomach issues, losing weight effortlessly, diminishing your joint pain, getting a restful night's sleep, reducing your risk of cancer and other ailments, being positive and upbeat each every day and living a fulfilled, balanced life. Don't you want that?

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Hormonal Changes In Menopause

Menopause is defined as cessation of menstruation and fewer remaining follicles causing infertility, generally at around 50 years of age. Perimenopause, the period of time leading into the menopause in women, is often characterized by irregularity in length of the menstrual cycle. Perimenopause is marked by dramatic changes in the hypothalamic-pituitary-ovarian axis. An early finding is a rise in circulating FSH levels unaccompanied by a rise in LH. It has been suggested that there is a decreased secretion of ovarian inhibin along with the decreasing follicular pool, which may be the primary cause of the rise in FSH. The resultant ovarian changes include short follicular phases with early ovulation, and ovarian insufficiency characterized by lower levels of estrogen and progesterone secreted for shorter periods of time compared with the luteal phase of younger women. The major significant endocrine event in women in the early perimenopausal phase is a fall in the circulating levels of...

North American Menopause Society Recommendations

The North American Menopause Society (NAMS) published a comprehensive review of postmenopausal osteoporosis in the journal Menopause in 2002 (14). Included in the review were recommendations for bone density testing in the specific context of osteoporosis prevention and management. NAMS noted that measurement of BMD is the preferred method for diagnosing osteoporosis and that DXA is the technological standard for measuring BMD. NAMS stated that the total hip was the preferred region of interest to evaluate, particularly when measuring bone density in women over 60 because of the increased likelihood of degenerative calcification in the spine that would affect spine measurements.3 Nevertheless, spine measurements were described as useful in early postmenopausal women because of the faster rate of bone loss at that site compared to the rate seen at the proximal femur. Citing a report from the International Osteoporosis Foundation (IOF) published in 2000 (15), NAMS stated that they...

Postmenopausal hormone replacement therapy HRT

HRT refers to the use of oestrogen treatment in order to reverse or prevent problems due to the loss of ovarian hormone secretion after the menopause, A popular alternative to oestrogen therapy is the drug tibolone (Livial), which is a synthetic steroid with weak oestrogenic, progestogenic and androgenic properties. It is administered as a daily oral dose of 2.5 mg to suppress vasomotor symptoms and to prevent postmenopausal osteoporosis. The main adverse effect is vaginal bleeding, which needs investigation if persistent. Vasomotor menopausal symptoms may occasionally be helped by low doses of clonidine (Dixarit). who needs to use HRT should take appropriate precautions. A woman is considered potentially fertile for 2 years after her last menstrual period if she is under 50 years, and for 1 year if she is over 50 years. A woman who is under 50 years and free of all risk factors for venous and arterial disease can use a low-oestrogen combined oral contraceptive pill to provide both...


Menopause is the permanent cessation of the menstrual periods that occurs around age 50 in most women. As a woman moves into her late 40s, her body's estrogen production slows down, and she gradually stops ovulating. Symptoms of the menopause include hot flashes, headaches, fatigue, vaginal irritation, mood swings, and depression. These symptoms can range from mild to severe about one in five women seek medical attention for symptoms of the menopause. A major concern at the menopause is the loss of bone mineral (mainly calcium) from the skeleton due to the loss of estrogens.21 Up to 20 of the bone mineral density can be lost at menopause, which can sharply increase risk of osteoporosis and bone fractures. The loss of estrogen at menopause also causes LDL cholesterol levels in the blood to rise and levels of HDLcho-

Diet Menopause

Women going through menopause should increase intake of rich food sources of calcium, magnesium, and vitamins D and K to maintain integrity of the skeleton.23,24 In addition, high amounts of phosphorus (found in red meat, processed foods, and cola drinks) should also be avoided too much phosphorus in the diet accelerates loss of minerals from bones. Reducing sodium, caffeine, and protein intake can also help maintain body stores of calcium. To keep levels of blood fats in the healthy range, the saturated fat content of the diet should be reduced (by eating less meat, eggs, and whole-fat milk products).

Caveats and Qualifications

Are more likely to suffer from inflammatory pain that is often more intense and longer lasting than that in men (159-161). While there are a number of mechanisms that may contribute to this difference, evidence from both clinical and preclinical studies suggests that gonadal hormones, in particular estrogen, may be a critical factor. Its mechanisms of action are complex, as estrogen has been shown to influence structures relevant to nociception throughout the body. Timing, with respect to estrogen cycling or the sustained application of estrogen (as in the case of hormone replacement therapy), site of action, and dependent measures of nociception all appear to be important factors when assessing the impact of estrogen on specific aspects of nociceptive processing (120).

The Role of Sex Hormones

The relationship between steroid hormones and cancer production introduces serious concerns regarding hormone replacement therapy, particularly for women, to minimize bone loss in the elderly. Hormone replacement therapy can alleviate some of the symptoms of osteoporosis in men and women, but it may do so at the risk of developing cancer. Similar concerns exist in the sporting world, where steroids are used to enhance performance. While such treatments seem to be effective, the athlete who uses hormone supplements will likely pay a heavy price for it in later life by developing prostate, breast, or uterine cancer.

Epidemiologic Risk Factors

In addition to age over 50 and Caucasian race, an increased number of ovulatory cycles appears to increase risk for ovarian cancer, reflected in an association with early menarche, late menopause, and nulliparity (Berek and Bast 2006). Conversely, factors that decrease the number of ovulatory cycles, including repeated pregnancies, prolonged breast feeding and use of oral contraceptives, decrease the risk of ovarian cancer. A protective effect from tubal ligation suggests that exogenous carcinogens might gain access to the ovary from the uterus through the fallopian tube. However, evidence for viral or strong chemical carcinogens has not been obtained, with the possible exceptions of the use of talc products in all histotypes and of cigarette smoking in mucinous cancers, but not in the more common serous histotype (Berek and Bast 2006). Approximately 10 of ovarian cancers are familial and are associated with mutations in BRCA1, BRCA2 or, less frequently, with the mismatch repair...

Aging and the Incidence of Cancer

The increased incidence of cancer in those age 50 and older is also coincidental with the onset of sexual senescence in both men and women. It is quite possible that the hormonal changes that occur during this period contribute to our increased susceptibility to cancer. Age-related hormonal changes are primarily concerned with a shift in the ratio of estrogen to testosterone (ET ratio) in both men and women. Young women have a high estrogen testosterone ratio (a lot of estrogen, very little testosterone), whereas young men have a low estrogen testosterone ratio (a lot of testosterone, very little estrogen). Estrogen levels drop dramatically in women after menopause, and men show a similar decline in the level of testosterone at a corresponding age. As a consequence, men and women approach a similar ET ratio between the ages of 50 and 80, which is thought to influence the rate at which genetic instability occurs. In addition, many scientists believe the shift in the ET ratio is largely...

Sexual Development Reproductive Patterns and Sexual Behavior

The duration of hormonal exposure appears to play a role in the susceptibility to breast cancer in women. The carcinogenic effects ofhormones were first demonstrated in animals. In 1932, Lacassagne reported the induction of mammary carcinomas in mice injected repeatedly with an ovarian extract containing estrogen. Later, he also showed that the synthetic estrogen diethyl-stilbestrol produced mammary tumors in susceptible strains of mice.76 Furthermore, ovariecto-mized mice and rats have a decreased frequency of breast cancer, whereas rodents subjected to increased levels of estrogen, progesterone, and prolactin have an increased frequency of breast cancer, although timing of exposure to individual hormones appears to be crucial.77,78 Similarly in humans, a role of hormones in the development of breast cancer has been deduced from the known risk factors associated with the disease. These factors include early age of menar-che, delayed age of first pregnancy, and delayed menopause,...

Air and Water Pollutants

Establishing the fact that about two-thirds of all human cancers have an environmental cause and thus, theoretically at least, are preventable. This has led many people to believe that the environmental agents responsible for cancer are chemicals that we inhale or ingest. However, as Hig-ginson himself has reiterated,101,102 what he meant by the environment is the total milieu in which people live, including cultural habits, diet, exposure to various infectious agents, average age of menarche, number of children a woman bears, age of menopause in short, the cultural as well as the chemical environment.

Genomic Changes Induced by Pregnancy in Breast Epithelial Cells

Is postmenopausal women without breast cancer who are nulliparous. The selection of post-menopausal women must be those who are at least 1 year after their last menses if menopause occurred naturally or basal serum follicle stimulating hormone (FSH) greater than 40 ng ml if menopause was surgical and the participant is less than 60 years old. The age at menarche, day of last menstruation, number of miscarriages, year of first full-term pregnancy, number of pregnancies, and no replacement therapy or previous surgical procedures for benign or malignant diseases of the breast are important conditions for the selection of the samples to be analyzed and as a consequence limit the number of samples available for a large study.

Influence ofAge and Gender

Several noncardiac factors may influence the circulating levels of natriuretic peptides and potentially confound the relation to indices of cardiac function. Age has been shown to be an important determinant of circulating natriuretic peptide levels (216-218). Both increased release and decreased clearance may contribute to elevated circulating levels of BNP and NT-proBNP in advanced age, but the exact mechanisms remain to be elucidated. Subclinical reduction in renal function, increased LV mass, and LV diastolic dysfunction are factors that may be essential for the observed increments in BNP and NT proBNP levels with age. Population-based studies have convincingly shown that BNP and NT-proBNP levels not only increase with age but are also significantly higher in women than in men (216-218). The association between female gender and BNP may be owing to estrogen status, because BNP levels were found to be higher in women using hormone replacement therapy (217).

Bone Density in Premenopausal Women

Two other large cross-sectional studies have suggested that BMD in the proximal femur does decline in women prior to menopause. Rodin et al. (10) found a significant premenopausal decline in femoral neck BMD in a study of225 women who ranged in age from 18 to 52. Similarly, Bonnick et al. (11) found a decline in proximal femoral BMD after the age of 30 in a study of 237 premenopausal women ages 20 to 45. In this latter study, no increase in BMD in the spine or proximal femur was seen in any age group, suggesting that peak BMD in both regions was achieved prior to the age of 20. There was no significant change in spine BMD, again suggesting that spine BMD does not change.

Cancer and the North American Diet

The realization that fat cells have an endocrine function came as a surprise to physiologists and endocrinologists. Normally, hormone production is regulated by an area in the brain called the hypothalamus, which in turn controls the pituitary gland, the so-called master gland of the body. Stimulation of the pituitary gland by the hypothalamus leads to the production and release of pituitary hormones that regulate the activity of secondary glands and tissues throughout the body. A specific example is the control of the ovaries and the reproductive cycle. In this case, the pituitary gland releases follicle-stimulating hormone (FSH), resulting in the growth and development of ovarian follicle cells. These cells, under the influence of FSH, begin to synthesize and secrete large amounts of the hormone estrogen. The physiological role of estrogen is to stimulate the growth and development of the mammary glands for eventual lactation, and of the uterine lining, in preparation for...

Targets for Estrogen Deprivation Within the Breast

Available evidence suggests that the normal breast is highly responsive to ED and shuts down proliferative activity within lobules. In premenopausal women, this phenomenon is exemplified by a marked decline in epithelial proliferation during the ED of the follicular phase of the menstrual cycle (Fig. 2a Potten et al. 1988). The pro-liferative response of the breast declines before the menopause (Fig. 2a) and there is low proliferation in postmenopausal lobules (Fig. 2d). Low proliferative activity in postmenopausal lobules is surprising since many authors have demonstrated that the concentrations of estradiol and precursor steroids are similar in normal postmenopausal breast tissue and nipple aspirate fluid to the con

Bone Density in Perimenopausal Women

Changes in spine BMD in pre-, peri- and postmenopausal women were evaluated in a longitudinal study by Pouilles et al. (13). The subjects were 230 Caucasian women ranging in age from 45 to 66 years. Menopausal status was determined by menstrual history and estradiol and LH levels. Based on these determinants, 71 women ages 45-51 were premenopausal throughout the study, 42 women ages 47-57 experienced menopause during the study and were considered perimenopausal, and 117 women were postmenopausal throughout the study. BMD in the PA spine was assessed using DPA. The women were followed for an average of 27 months. Bone loss in the premenopausal women averaged 0.8 per year. In the perimenopausal women, bone loss was 2.3 per year. In the postmenopausal women, bone loss was again 0.5 per year. The authors noted that approximately half the bone loss observed in the first 10 years after menopause was seen in the first 3 years after menopause. There was no difference in the rates of bone loss...

Dissimilar Spine and Femoral BMDs in Perimenopausal Women

Eighty-five Caucasian women between the ages of 45 to 60 who were within 6 months to 3 years past menopause underwent spine and proximal femur bone density testing using DXA (Lunar DPX) (15). These values were compared with reference values (mean and SD) from a group of 30 healthy women between the ages of 40 to 45. Thirty-nine women had both spine and femoral neck z-scores that were better than -1. Seventeen women had both spine and femoral neck z-scores that were both poorer than -1. Out of the 85 women, 22 (26 ) had dissimilar spine and femoral neck z-scores. Eight had spine z-scores that were better than -1 but femoral neck z-scores that were poorer than -1. Fourteen had femoral neck z-scores that were better than -1 but spine z-scores that were poorer than -1. In a similar study, Lai et al. (16) evaluated 88 Caucasian women, ages 44 to 59, who were within 5 years past menopause. BMD measurements of the lumbar spine and proximal femur were made using DXA (Hologic QDR-1000). The...

Resistance to Estrogen Deprivation

Although ED at the menopause or associated with early menopause or treatment with AIs reduces the incidence of breast cancer, it is clear that only a proportion of tumours are prevented (Fig. 1). The protective effect of the menopause appears to be declining in many parts of the world, particularly in the West. Reduction is exemplified by data from the United States collected as part of the SEER programme. Figure 5a shows the age incident curves for breast cancer for the period 1973-1977 compared with those from 1993-1995 for whites, blacks and other races (Karagas et al. 2000). Irrespective of ethnic group, there was a reduction in the angle of the age incidence curve at the menopause in the latter time period, indicating an increase in the numbers of postmenopausal breast cancers. This change may, in part, be related to differences in methods of cancer detection, but increases in postmenopausal breast cancer are also seen in non-screened populations. Yasui and Potter (1999)...

Lifespan Of Galactocele

Fibrocystic changes, the most common of the benign breast conditions, are described as multiple, irregular, lumpiness of the breast. It is not a disease per se but rather an exaggerated response to ovarian hormones. Fibrocystic changes are very common in premenopausal women but are rare following menopause. The clinical presentation is cyclic, painful, engorged breasts, more pronounced just before menstruation, and occasionally associated with serous or green breast discharge. Fibrocystic changes usually can be differentiated from the three-dimensional dominant mass suggestive of cancer, but occasionally FNA or core-needle biopsy must be performed to establish the diagnosis. Treatment includes decreasing caffeine ingestion and adding nonsteroidal antiinflammatory drugs, a tight-fitting bra, oral contraceptives, or oral progestin therapy. With severe cases, danazol (a weak antiestrogen and androgenic compound) or even mastectomy is considered.

Organochlorine Compounds Polycyclic Aromatic Hydrocarbons and Breast Cancer

Finally, it is worth noting that a careful analysis of all risk factors for breast cancer must be done before one can conclude that a cluster of breast cancer cases is related to some local environmental factor. For example, a study done in the San Francisco Bay area, involving both Caucasian and African-American women, found that the elevated breast cancer incidence in the Bay area could be completely accounted for by regional differences in known risk factors, e.g., parity, age at first pregnancy, months of breast feeding, and ages at menarche and menopause.180

Estrogen Deficiency Postmenopausal

Ninety-three healthy women who had experienced a natural menopause 6 to 60 months earlier were followed prospectively for two consecutive 22-month periods (38). BMD was measured in the spine and proximal femur using DXA (Lunar DPX). The average decline in BMD in the spine was 1.46 per year (+2.6 to -6.9 ) in the first period and 1.28 per year (+2.8 to -5.3 ) in the second period. In the proximal femur, the average decline in the first period was 1.41 per year (+4.8 to -6.8 ) and 1.35 per year (+1.8 to -7.0 ) in the second. Individual rates of bone loss were not stable over time. Only 20-30 of women retained their initial classification as fast, intermediate, or slow losers during both observation periods. Of 24 women classified as fast losers during the first observation period, 5 remained fast, 12 became intermediate, and 5 became slow losers during the second period. The mean rate of loss in the fast loser group initially was -3.9 . Women who were originally classified as slow...

Gluten Sensitive Enteropathy

Was used to calculate T- and z-scores for the study populations. This reference database is reported as similar to the reference database for Caucasian women in the United States. The mean T-score for the osteoporotic population was -3.2 and -3.0 for spine and femoral neck, respectively. The prevalence of celiac disease in these osteoporotic women was compared to 747 women, with a mean age of 29, recruited for a population-based study. Screening for celiac disease was done using IgA and IgG antigliadin antibodies (AGA) in all patients. This was followed by antiendomysial antibodies (EmA) and total IgA in the patients testing positive for AGA. Intestinal biopsy was performed in patients with positive EmA and total IgA results. Only 1 of the 127 osteoporotic women was eligible for jejunal biopsy, which did show the characteristic flat mucosa of celiac disease. Celiac disease was diagnosed in 6 of 747 women in the control group. The prevalence of celiac disease was calculated as 7.9 per...

Chemotherapy Regimens Mopp and MOPP derivatives

Long-term toxicities were of even more serious concern. Most patients experienced infertility after treatment with MOPP. Males had at least an 80 risk of permanent azospermia after MOPP, while 50 of females experienced gonadal failure.4748 The risk appeared lower with patients younger than 25 years of age however, accelerated early menopause seemed to be the case in every female who did recover her menses after treatment.46 At a time when sperm banking and oocyte cryopreservation were in their early stages, many young patients, though cured, experienced significant psychological repercussions due to their infertility.

Why Women And Men Experience Different Risk For Heart Attacks

The Food and Drug Administration (FDA) and American Heart Association suggest that women are protected from heart attacks due to lipid plaque before they reach menopause. Estrogen levels in younger women are typically a factor causing them to maintain high levels of HDL in most situations. Once menopause occurs, women experience a reduction in HDL as their estrogen levels decline. Post-

Cytotoxic Chemotherapy

Compromise in peri-menopausal women with breast cancer who received adjuvant treatment. At least in part, this finding might have been a consequence of chemotherapy-precipitated menopause. In any case, the study of the cognitive effects of chemotherapy, and their potential reversal is a major priority in the management of older cancer patients.

Gender Differences in Coronary Heart Disease

It is also known that smoking women reach their menopause 2-3 years earlier probably because of the proposed lowering of endogenous estrogen levels induced by smoking. A risk factor specific to women is ovarian hormone status, for example oral contraceptives, pregnancy, and menopause and hormone replacement therapy. Polycystic ovarian syndrome, gestational diabetes or hypertension, pregnancy toxicosis and birth complications are also claimed to be important hormonal cardiovascular risk factors. Menopause, including premature menopause, is associated with negative changes in several cardiovascular risk factors. Meta-analyses of observational studies, mostly conducted in the United States, showed a risk reduction of CHD events of 35-50 with hormone replacement therapy. The epidemiological evidence was supported by clinical and experimental studies reporting beneficial effects of estrogens on lipids and lipoproteins, carbohydrate metabolism, hemosta-sis, vasomotor effects, and atheroma...

Theoretical And Practical Considerations 821 Choice of Study Population

It is also important to match the cohorts for phenotypic or environmental variables that may otherwise confound any genetic analysis for example, hormone replacement therapy (HRT) has a large impact on bone mineral density (BMD) and it would be necessary to account for this in a search for genetic factors influencing BMD using a cohort of post-menopausal women.

Guidelines from the European Foundation for Osteoporosis and Bone Disease

In contrast to the 1996 AACE guidelines, the EFFO guidelines do not direct the physician to perform a baseline measurement at the hip regardless of the reason for the measurement. The EFFO guidelines, like the ISCD guidelines, noted that the site of the measurement should be determined by the intent of the measurement. Although the EFFO observed that the hip may be less affected by changes of osteoarthrosis in the elderly and was the preferred site for a site-specific hip fracture risk assessment, they also observed that changes in BMD from therapeutic interventions were more likely to be documented in the spine. The EFFO also noted that the hip, wrist, or spine sites could be used for global fracture risk assessments in women around the time of menopause. Although the EFFO recommended scanning only one site initially, they acknowledged a. Premature menopause (< 45 years)

Other Methods Of Contraception

Copper intrauterine devices are widely used and highly effective (> 99 at one year ) for 5 and some for 10 years. They are especially useful in the over-40s in whom oral contraceptives may become progressively contraindicated and for whom one IUD will last into the menopause. The IUD prevents implantation of the fertilised ovum, and has an additional antifertilisation effect enhanced by the toxic effect of copper ions on the gametes.

Gonadal Toxicity Following Malignancy Treatment

Unlike male germ cells, female germ cells proliferate only during prenatal life after birth, these progressively decrease in number due to apoptosis, and ovulation. Germ cells inside the female gonad do not proliferate, whereas the somatic cells do. Radiation and chemotherapy induce oocytes to undergo apoptosis, which reduces the number of germ cells,18 resulting in estrogen insufficiency. Therefore, when follicles are destroyed by cytotoxic therapy, the frequency of menses decreases and amenorrhea commonly occurs. Irreversible ovarian failure and menopause occur if the number of follicles falls below that is required for menstrual cyclicity.

Scientific Evaluation and Clinical Applications

The prominence of the Bupleurum species cannot be overstated. Across China and Japan, it serves as a main or supplementary ingredient in over two thirds of traditional medications. For over 2000 years, it has been used to treat fevers, intestinal maladies, malaria, and countless other afflictions. Modern research indicates that it may possess anti-tumor qualities, and researchers continue to report its impact on a wide range of ailments, from hepatitis and epilepsy, to irregularity and menopause, as well as psychosis and schizophrenia.

Practical Examples of Immunostaining in Bone Sections

We have successfully used the aforementioned procedures to immuno-localize estrogen receptors (ERs) in cryosections of human neonatal bone (2) and transforming growth factor-p (TGF-P) in sections from wax-embedded samples of adult human iliac crest bone (3). The former study investigated the differential protein expression of ERa and ERp in developing human rib (Fig. 2). Intense ER expression was observed in osteoblasts and osteocytes in cortical bone. In contrast, ER-p was seen to be most highly expressed in osteoblasts and osteocytes in cancellous bone. The latter study provided quantitative data on the expression of TGF-p, TGF-p receptors, platelet-derived growth factor (PDGF), and osteoclast activity in wax-embedded sections of adult human iliac crest bone samples. Bone sections from women treated with long-term highdose estradiol were compared to those from women who had received no hormone replacement therapy. The results demonstrated that high-dose estrogen treatment is...

Lifetime Risk of Fracture

In 1992, Black et al. (11) proposed a method for calculating a woman's lifetime risk for hip fracture. The prediction was based on the woman's bone mass at menopause expressed as a percentile for her age, estimations of bone mass at subsequent ages and then estimating her risk for hip fracture at each age. The risk of hip fracture at each age was based on two factors the risk of fracture at a particular age derived from population-based data and the risk of fracture at a particular bone mass from prospective fracture trials. Based on a review of the literature at the time, an increase in relative risk for hip fracture of 1.65 for each SD decline in bone mass at the radius was used in the calculation of risk based on the level of bone mass. Using this method, the lifetime risk of hip fracture for a 50-year-old Caucasian woman whose midradial bone mass was at the 10th percentile was 19 . If her bone mass was at the 90th percentile, her lifetime risk of hip fracture was 11 . The gradient...

Historical Context

Cancer is a leading cause of death in Americans, second only to heart disease. While breast cancer kills the most women, many gynecological cancers are part of the overall cancer statistic. Ovarian cancer, the so-called whispering disease because of its insidious nature, is detected in one in 70 predominantly perimenopausal and postmenopausal American women and often metastasizes undetected. Risk factors include family history of ovarian and breast cancer, high dietary fat, delayed menopause, and no or late childbearing. The use of oral contraceptives appears to decrease risk. Ovarian cancer often presents itself with a cluster of three persistent and severe symptoms a swollen abdomen, a bloated feeling, and urgent urination. Other symptoms associated with the disease include gas pains, anorexia, backache, and indigestion. Unfortunately most women seek medical advice when their ovarian cancer is in the advanced stage because the symptoms might be associated with other gynecological...

Jade W M Chow 1 Introduction

Estrogen is known to be one of the major hormonal influences in bone remodeling and bone mass. Estrogen deficiency after the menopause is one of the leading causes of osteoporosis, and currently estrogen replacement is the first line management for postmenopausal osteoporosis. The bone loss associated with estrogen deficiency is due to increased bone resorption and a relative deficiency in bone formation. Although estrogen is thought to prevent bone loss mainly by suppressing bone resorption (1,2), there is also recent evidence to suggest that estrogen may exert an anabolic effect in bone in humans (3,4). Estrogen receptors (ER) are present in osteoblasts (5), and oestradiol has been shown to increase type I collagen and alkaline phosphatase production by osteoblasts in vitro (6). Animal models have proved invaluable in the study of the role of estrogen in bone metabolism. There is a large body of evidence that the cancellous bone of the secondary spongiosa of adult female rats has...

Rapid changes in weight over a few days suggest changes in body fluids not tissues

In the overweight patient, for example, when did the weight gain begin Was the patient heavy as an infant or a child Using milestones appropriate to the patient's age, inquire about weight at the following times birth, kindergarten, high school or college graduation, discharge from military service, marriage, after each pregnancy, menopause, and retirement. What were the patient's life circumstances during the periods of weight gain Has the patient tried to lose weight How With what results Feelings of heat and sweating also accompany menopause. Night sweats occur in tuberculosis and malignancy.

Genetic And Environmental Associations With Breast Cancer Subtypes

There may also be differences in environmental risks for development of different subtypes of breast cancer. Much of the evidence at this time is indirect and based on observed differences by hormone receptor status. For example, large epidemiological studies suggest that the risk factors for ER-negative breast cancers, which are comprised primarily of basal-like and HER2-subtypes, differ from those of ER-positive, or luminal breast cancers. Investigators from the Nurses' Health Study have found that the traditional hormonal risk factors are far more useful in predicting ER-positive breast cancer than ER-negative (23) and hormone replacement therapy is associated only with increases in ER-positive breast cancer (24). Chemoprevention with the selective estrogen receptor modulator tamoxifen reduces only ER-positive breast cancer (25). Alcohol consumption appears to correlate with increased risk of development of ER-positive, but not ER-negative tumors in some studies (26). Conversely,...

Musculoskeletal Symptoms

The pathogenesis of this postchemotherapy syndrome remains unclear. Various suggestions have included a steroid withdrawal effect or a chemotherapy induced menopause 7 , However, not all patients received corticosteroids in their chemotherapy regimen and some patients were postmenopausal or male making the latter hypothesis unlikely. One common factor to all the cases so far appears to be the use of cyclophosphamide and its place in combination chemotherapy regimens 8 . However, intravenous cyclophosphamide, often in high doses is used in the treatment of severe connective tissue diseases and this syndrome of arthralgia and myalgia has not been observed. Admittedly, it would be difficult to distinguish arthralgia from cyclophosphamide and that from the underlying connective tissue disease in these patients.

Approach To Diseases Of The Breast Palpable Breast Mass

Laboratory testing is usually unnecessary in the evaluation of mastalgia, although a pregnancy test should be performed in reproductive-age women. Hormonal contraceptives or hormone replacement therapy may be causes of breast pain and consideration should be given to discontinuation or reduction of estrogen dosages. An appropriately fitted supportive bra and lifestyle changes, such as tobacco cessation, caffeine elimination, and stress reduction techniques, are often successful in alleviating symptoms. Evening primrose oil is available over the counter, is well tolerated, and often provides relief. For women with unrelenting pain in spite of the above modifications, danazol, an antigonadotropin, is Food and Drug Administration (FDA) approved for the treatment of breast pain, but is relatively expensive and has numerous side effects (hair loss, acne, weight gain, irregular menses). D. Discontinuation of her hormone replacement therapy

Ghb With Synthetic Glycogen For Cancerous Cells

376-378, 377f Female infertility causes of, 442-444 endocrine glands involved in, 438 menopause and, 442, 443 physiology of, 438-441, 439f, 441f sex steroids involved in, 436-437, 437f treatment of, 443 FEn (fractional excretion of sodium), 214 Ferritin, 181-182 in perimenopause, 442, 443 source of, 390t synthesis of, 436-437 Follicular phase, of menstrual cycle, 440-441, 441f 148 Inhibins, 437 versus gestational age, 451t in menstrual cycle, 440-441, 441f perimenopause, 442 Inhibitors, of enzyme activity, 23 measurement of, 49t, 280-281 menopause and, 291-292 physiological changes in, 280 role of, 277 intermediate-density biochemistry of, 15, 17 elevated, 289 lipoprotein (a), 296 low-density (LDL, bad)

Solid Tumors Incidence And Risk Factors

Decreased risk of breast cancer after alkylating chemotherapy exposure.45 The relationship was dose related, with decreasing breast cancer risk with additional cycles of chemotherapy. Other data suggest the risk of breast cancer is significantly reduced in women who had premature menopause the younger the age at menopause, the lower the risk of breast cancer.4 These studies do report that the radiation-related risk of breast cancer, however, does not diminish in the longest follow-up, again suggesting a need for lifetime surveillance and programs of patient and physician awareness.

The Effects of Estrogen Deprivation on Mammary Tumour Development

Estrogen deprivation occurs naturally at the menopause because of the cessation of ovarian function. This results in a reduction in the rate of increase of the incidence of breast cancer, producing an inflection on the age-incidence curve. In the absence of the menopause, we assume the age-incidence curve would continue to be log-linear, as it is in male breast cancer (Thomas 1993 Pike et al. 1983). Thus, the ED of the menopause reduces breast cancer risk, but this varies according to country (Fig. 1a). In the example shown, the approximate reductions in risk for a 65-year-old with a menopause at age 50 is 20 for a woman in Connecticut, 50 in Finland and 60 in a Japanese woman. Thus, the menopause is less preventive in the USA. We will explore the potential reasons for this resistance to ED later in this article. An early menopause, whether natural or artificial, results in greater reductions in risk. Epi-demiological studies indicate that a menopause between ages 35 and 45 is...

Estrogen Hormone Replacement

The effects of cyclic hormone replacement therapy (HRT) with either transdermal estrogen or oral estrogen on BMD in the spine and proximal femur were compared to controls by Hillard et al. (126). Ninety-six Caucasian women between 6 months and 7 years postmenopausal participated in this study. Thirty women served as controls. Sixty-six women received either 0.05 mg transdermal 17-P estradiol continuously and 0.25 mg per day of norethisterone for 14 days of each cycle or oral conjugated equine estrogen 0.625 mg daily and 0.15 mg of dl-norgestrel daily for 12 days of each cycle. BMD measurements of the PA spine and proximal femur were obtained every 6 months for 3 years with DPA (Lunar DP3). In the control group, BMD in the spine declined by 4 and in the femoral neck by 5 at the end of 3 years. BMD increased at both sites in the two groups receiving some form of HRT with no significant difference between the two groups. The average increase in BMD at the spine in the transdermal...

Clinical Pearl

Chief complaint What is it that brought the patient into the hospital or office Is it a scheduled appointment or an unexpected symptom, such as abdominal pain or vaginal bleeding in pregnancy The duration and character of the complaint, associated symptoms, and exacerbating and relieving factors should be recorded. The chief complaint engenders a differential diagnosis, and the possible etiologies should be explored by further inquiry. For example, if the chief complaint is postmenopausal bleeding, the concern is endometrial cancer. Thus, some of the questions should be related to the risk factors for endometrial cancer, such as hypertension, diabetes, anovulation, early age of menarche, late age of menopause, obesity, infertility, nulliparity, and so forth.

Proprietary Names

It is reasonable to use proprietary names when dosage, and therefore pharmaceutical bioavailability, are critical so that small variations in the amount of drug available for absorption can have big effects on the patient, e.g. drugs with low therapeutic ratio, digoxin, hormone replacement therapy, adrenocortical steroids (oral), antiepileptics, cardiac antiarrhythmics, warfarin. Also, with the introduction of complex formulations, e.g. sustained-release, it is important clearly to identify these, and use of proprietary names has a role.


A 66-year-old woman comes in for a routine physical examination. Her menopause occurred at age 51 years, and she currently is taking an estrogen pill along with a progestin pill each day. The past medical history is unremarkable. Her family history includes one maternal cousin with ovarian cancer. On examination, her blood pressure is 120 70, heart rate 70 bpm, and temperature 98 F. She weighs 140 lb and is 5 feet 4 inches tall. The thyroid is normal to palpation. Breast examination reveals no masses or discharge. Abdominal, cardiac, and lung evaluations are within normal limits. Pelvic examination shows a normal, multiparous cervix, a normal-sized uterus, and no adnexal masses. She had undergone mammography 3 months earlier.


This 49-year-old woman complains of irregular menses, feelings of inadequacy, and intermittent sensations of warmth and sweating. This constellation of symptoms is consistent with the perimenopause, or climacteric. Between the ages of 40 and 51 years, the majority of women begin to experience symptoms of hypoestrogenemia, primarily hot Hushes. Hot Hushes, which are the typical vasomotor change due to decreased estrogen levels, are associated with skin temperature elevation and sweating lasting for 2 to 4 min. The low estrogen concentration also has an effect on the vagina by decreasing the epithelial thickness, leading to atrophy and dryness. Elevated serum FSH and LH levels are helpful in confirming the diagnosis of the perimenopause. Treatment for hot Hushes includes estrogen replacement therapy with progestin. When a woman still has her uterus, the addition of progestin to estrogen replacement is important for preventing endometrial cancer.


Menopause The point in time in a woman's life when there is cessation of menses due to follicular atresia occurring after age 40 years (mean age 51 years). Perimenopause (climacteric) Transitional 2- to 4-yr period spanning from immediately before to immediately after the menopause.


Immediately after the egg cell has left the ovary, the activity of collagen-digesting enzymes is blocked by the body's own enzymatic blocks. This shifts the balance toward collagen-producing mechanisms, which dominate over the collagen-destroying process. Using this mechanism the tissue of the ovary wall can quickly heal and close itself. Four weeks later, during the next cycle, the whole process repeats itself, taking place in the body of every healthy woman until menopause.

First Visit

Abnormal bleeding tendencies such as nosebleeds, prolonged bleeding from minor cuts, spontaneous ec-chvmoses, tendency toward excessive bruising, and excessive menstrual bleeding should be cited. 7. History of allergy should be taken, including hay fever, asthma, sensitivity to foods, or sensitivity to drugs such as aspirin, codeine, barbiturates, sulfonamides, antibiotics, procaine, and laxatives, to dental materials such as eugenol or acrylic resins. < S. Information is needed regarding the onset of puberty and, for females, menopause, menstrual disorders, hysterectomy, pregnancies, and miscarriages. 9. Family medical history should be taken, including bleeding disorders and diabetes.


As noted earlier, the risk factors associated with breast cancer include age at menarche, age at the time of the first full-term pregnancy, and age at menopause. These factors suggest a role for estrogens and progesterone in breast cancer. Production of these hormones increases near menarche and starts to decrease in the perimenopausal period. Prolactin levels have been reported to decrease in women after full-term pregnancy125 and this may provide some protective effect. Some studies indicate that the rate of cell proliferation is greater in nulliparous women than in parous women (reviewed in Reference 125), and this may reflect the lower hormonal levels in the latter group. Moreover, mitotic activity of breast epithelium varies during the menstrual cycle and peaks during the luteal phase, suggesting that progesterone also has a role in regulating the mitotic rate in breast tissue. Presumably, these hormones could act as promoters for cells initiated by some carcinogens, and the...

Fat Tissue

Only 2 of mature adipocytes undergo mitosis, under appropriate stimulation. Therefore, adipocyte hypertrophy, rather than an increase in their number, seems responsible for the diffuse or localised increases in fatty masses 99 . There is, however, a pool of quiescent or immature adipocytes that can differentiate into mature adipocytes under hormonal and vitamin stimulation 98, 100 . During differentiation, markers such as LPL mRNA, glyc-erol triphosphate dehydrogenase (GPDH), hormone-susceptible lipase (HSL), perilipin, a glucose carrier (GLUT4), and p-3 receptors are acquired. Triglycerides comprise 90 of the mature adipocyte and provide a source of easily available energy through their hydrolysis to fatty acids and glycerol. Mature adipocyte expresses a-2 -adrenergic receptors (a2AR) and adipsin 98 . Adipose tissue secretes LPL, adipsin, complement C3 and B fractions, P450 aromatase, leptin, and growth factors 94, 101 . Its main metabolic functions are...

Future Directions

As far as target lesions are concerned, we have highlighted the view that this may be the HELU since they are relatively common within the breast and show transitional histological features of near normality in some to approaching DCIS in others. Wellings has given us some indication that there are good HELU (or his ALA) which may regress after the menopause, whereas there may be breasts with bad HELU which have the propensity to continue proliferation after the menopause. However, tumours may arise directly from TDLU without having to go through a HELU phase and may arise by the known genotoxic effects of estrogen metabolites (Yager and Davidson 2006). We do not know whether they are responding to the predominant estradiol concentration or whether some or many of them have autonomous growth, nor do we know whether high tissue estradiol concentrations seen in tumours are found in HELU. Our knowledge of the potential mechanisms of resistance of potential target lesions for ED...

Andre the Giant

Growth hormone was discovered in the 1920s. About thirty years later, scientists figured out how to remove growth hormone from the human pituitary gland. They gave it to children with growth hormone deficiencies and discovered it helped them grow. This discovery led to the development of growth hormone replacement therapy. The first growth hormone replacement therapy medicine was taken from the pituitary glands of dead bodies (cadavers). It was given through a shot (injection). Between 1958 and 1985, the medicine was used to treat more than 8,000 children with growth hormone deficiencies.

The Fossil Record

Darwinian Fitness, Longevity, and Menopause Mortality seems to have worked very well as a characteristic of life as witness mortality's presence in all categories of eukaryotic organisms but one is hard pressed to think of any adaptive advantage death has for individuals (other than relief from pain).99 Typically, biologists suggest that death helps the group by making room at the top where a new generation may have access to limited resources. Explanations of this sort raise the specter of group selection positing a selective advantage for the group and are generally thought to be flawed, since Darwinism requires a selective advantage for individuals rather than groups.


Immature teratomas contain all three germ layers, as well as immature or embryonal structures. They are uncommon and comprise less than I of ovarian cancers. They occur primarily in the first and second decades of life and are basically unknown after menopause. Malignant teratomas contain immature neural elements, and that quantity alone determines the grade. They almost always are unilateral. The prognosis is directly related to the stage and the cellular immaturity. The treatment is a unilateral salpingo-oophorectomy with wide sampling of peritoneal implants. If the primary tumor is grade 1 and all peritoneal implants are grade 0. no further treatment is warranted. However, if the primary tumor is grade 2 or 3 and if there are implants or recurrences, combination chemotherapy usually is effective.


Thirty-three postmenopausal women with mild primary hyperparathyroidism were followed prospectively for 2 years with BMD measurements of the total body, PA lumbar spine, proximal femur, and proximal forearm by DXA (Lunar DPX-L) (52). Seventeen of the women received hormone replacement therapy and 16 received a placebo. In the women receiving placebo with untreated mild hyperparathyroidism, BMD decreased at all sites over the 2 years. Total body BMD decreased 2.3 . BMD in the lumbar spine decreased 1.4 , although this change was not statistically significant. BMD decreased 3.5 in the proximal forearm and 1.4 in the femoral neck.

Some Physiology

The detrusor, whose smooth muscle fibres comprise the body of the bladder, is innervated mainly by parasympathetic nerves which are excitatory and cause the muscle to contract. The internal sphincter, a concentration of smooth muscle at the bladder neck, is well developed only in the male and its principal function is to prevent retrograde flow of semen during ejaculation. It is rich in o -adrenoceptors, activation of which causes contraction. There is an abundant supply of oestrogen receptors in the distal two-thirds of the female urethral epithelium which degenerates after the menopause causing loss of urinary control.


Menopause, sex hormones and the immune system Menopause Mgl *(MH) < ) , 18 Paiodontat Therapy in the Female Patient iPuherlv. Menses, Pregnancy, ami Menopause) < MAPTKK 17 525 89. Vinco L, Prallet B, Chappard 1), et al Contributions of c hronological age, age at menarche and menopause and of anthropometric parameters to axial and peripheral bone densities. Osteoporosis Int 1992 2 153. 93. Whitehear Ml, Whitcrott SI J. Millard l( An Atlas of the Menopause New York. Parthenon, 1993.

Thalassemia Major

2 were hormone deficient and not receiving sex-steroid replacement. A control group consisting of 20 healthy subjects was matched for age, sex, height, and weight. Bone density was measured by DXA (SOPHOS L-XR-A) at the PA lumbar spine and proximal femur. In this cross-sectional study, bone density at the PA lumbar spine was reduced in groups 1 and 2 compared to the control group. The reduction was greater in group 2 than in group 1. Proximal femoral bone density was reduced in group 2 only in comparison to the control group. The authors suggested that the treatment of hypogonadism with sex hormone replacement therapy was beneficial in the prevention and treatment of osteoporosis in thalassemics.

Alkylating Agents

Systemic adverse effects of alkylating agents include nausea and vomiting, and bone marrow depression (delayed with carmustine and lomustine), cystitis6 (cyclophosphamide, ifosfamide) and pulmonary fibrosis (especially busulfan). Male infertility and premature menopause may occur. Myelodysplasia and secondary neoplasia are particularly associated with alkylator therapy (due to sublethal damage to normal cells) especially when accompanied by radiotherapy. These agents are used widely in the treatment of both haemato-logical and nonhaematological cancers, with varying degrees of success.


Aging bones tend to lose minerals and density, gradually becoming thinner and more fragile. In osteoporosis, loss of bone mineral has progressed to the point where fractures can occur with minimal or no trauma. Although both men and women can develop osteoporosis, it is much more common in older women. This is because loss of endogenous estrogens during menopause sharply accelerates bone loss. In severe cases, up to 20 of the mineral content of the skeleton can be lost in the 3-5 years of the menopause. Osteoporosis progresses silently, and often the first indication of its presence is a fracture of the hip or spine. Optimum nutrition can substantially reduce risk of osteoporosis.19


At approximately 47 years of age, most women experience peri menopausal symptoms due to impending failure of the ovaries. Symptoms include irregular menses due to anovulatory cycles vasomotor symptoms, such as hot flushes and decreased estrogen and androgen levels. Because ovarian inhibin levels are decreased, FSH levels rise even before estradiol levels fall. The decreased estradiol concentrations lead to vaginal atrophy, bone loss, and vasomotor symptoms. Although most clinicians agree that estrogen replacement therapy currently is the best treatment for vasomotor symptoms and prevention of osteoporosis, recent published data raises concerns about the risks of this therapy. The Women's Health Initiative Study of continuous estrogen-progestin treatment reported a small but significant increased risk of breast cancer, heart disease, pulmonary embolism, and stroke. Women on hormone replacement therapy had fewer fractures and a lower incidence of colon cancer. It should be noted that...

Female Infertility

Around the time of menopause, impairment of ovulation may cause infertility with adverse effect on follicle size and oocyte quality despite regular ovulation and normal gonadotropin levels. These factors are considered when treating older women with infertility. Serum levels of LH, FSH, and inhibin A and B may be helpful in assessing infertility and treatment options.18,19 Infertility diagnostic testing is as varied as treatment options. The patient workup for infertility includes a careful, detailed history, which can help to limit the number of laboratory tests required. Availability of tests varies from center to center, so availability is one of the considerations for infertility testing. Typical laboratory tests ordered are FSH on day three of the ovulatory cycle, LH, estradiol, prolactin, and TSH levels. Measurement of ovarian and adrenal androgens such as testosterone and DHEAS should be decided on the basis of ovulatory status of the patient and the clinical picture.


The efficacy of risedronate in increasing lumbar spine BMD was studied in 648 postmenopausal women for 18 months by McClung et al. (150). The average age of the women was 62 years and all were at least 1 year postmenopausal with an average duration of menopause of16 years. At entry into the study, the lumbar spine T-score was -2 or less. BMD was measured by DXA at the PA lumbar spine, proximal femur, and at the distal and midradius. The women received either 2.5 mg or 5 mg of risedronate daily or placebo. All of the women received 1 g of calcium daily. Risedronate increased BMD at the lumbar spine, femoral neck, and trochanter and at the distal radius in a dose-dependent fashion.


Tibolone is a synthetic compound with estrogenic, progestational, and androgenic activity. Its potential utility in preventing postmenopausal bone loss was reported 20 years ago (169). In 1994, Rymer et al. (170) reported the results of a 2-year nonrandomized prospective study in which women between 6 and 36 months after menopause received either 2.5 mg of tibolone or no medication. BMD was measured in the PA lumbar spine and proximal femur with DXA (Hologic QDR-1000) at baseline, and again at 6, 12, and 24 months. Forty-six women in the tibolone group completed the study and 45 women in the control group completed the study. The average age of the subjects was 49.5 years. At the end of 2 years, women in the tibolone group had significant increases in bone density at the lumbar spine and the femoral neck, Ward's area, and the trochanter, whereas women in the placebo group had significant losses at those sites. On an individual basis, 39 of the women receiving tibolone increased bone...

Important aspects

Major surgery (in patients taking oestrogen-progestogen contraceptives and postmenopausal hormone replacement therapy). Because of the added risk of venous thromboembolism (surgery causes a fall in antithrombin) it has been advised that these oral contraceptives should be withdrawn, if practicable, 4 weeks before all lower limb operations or any major elective surgery (and started again at the first menstruation to occur more than 2 weeks after surgery). But increase in clotting factors may persist for many weeks and there is also the risk of pregnancy to be considered (plainly, alternative contraception should be used). An

Menstrual disorders

Medical treatments for endometriosis have focused on the hormonal alteration of the menstrual cycle in an attempt to produce a pseudo-pregnancy, pseudo-menopause, or chronic anovulation. Each of these situations is believed to cause a suboptimal milieu for the growth and maintenance of endometrium and, by extension, of implants of endometriosis. Danazol 600 to 800 mg per day causes anovulation by attenuating the midcycle surge of luteinising hormone secretion, inhibiting multiple enzymes in the steroidogenic pathway, and increasing serum free testosterone concentrations.

Gonadal Shielding

Hormone replacement therapy (HRT) should be considered in young pre-menopausal women who have developed ovarian failure due to malignancy or cancer treatment.75 Even with the use of HRT, though, uterine size can decrease by 40 .24 Importantly, any residual ovarian function remaining after chemotherapy is considered a good prognostic sign because the ovaries may be stimulated with steroid hormones and or gonadotropins.76

Cervical Cancer

About 190,000 new cases and 114,000 deaths from ovarian cancer occur annually in the world.24 The highest case loads are in Scandinavia, Eastern Europe, the United States, and Canada. Low incidence rates occur in Africa and Asia. As with most cancers, the risk increases with age. Risk factors include obesity, a history of pelvic inflammatory disease, polycystic ovary syndrome, and endometriosis. Hormone replacement therapy increases risk, whereas oral contraceptives and tubal ligation decrease risk. A family history of breast or ovarian cancer also increases risk and involves mutations in brca1 and brca2 genes. Hereditary non-polyposis colon cancer has also been associated with ovarian cancer. Cancers of the uterine corpus are the seventh-most common cancer of women worldwide, with 189,000 new cases and 45,000 deaths annually worldwide. Sixty percent of these cases are in developed countries, with the United States and Canada having the greatest prevalence.24 The etiology is linked to...


In a subsequent publication (10), Weinstein et al. extended these observations to an additional 264 women. The addition of these 264 women increased the total number of women studied to 1610 but did not change the average age or years postmenopausal. Multivariate regression analysis was again performed to determine which independent variables were significant predictors of osteoporosis. Age and years past menopause were positive predictors, whereas weight was a negative predictor. Lack of either postmenopausal estrogen use or oral conceptive use for at least 6 months was also a significant predictor of osteoporosis. Ninety-five percent confidence intervals were calculated for age and weight to determine the best cutpoints for screening purposes. Based on these analyses, Weinstein and colleagues suggested that postmenopausal women greater than 65 years of age who weigh less than 140 lb at menopause or have never used estrogens for more than 6 months be referred for bone density...

Producing Egg Cells

Oogenesis, the formation and development of female gametes, occurs in the ovaries and results in the production of egg cells (Figure 12.8a). A small percentage of these egg cells will be ovulated, and an even smaller percentage may be fertilized. While spermatogenesis begins at puberty, oogenesis actually begins while the female is still in utero, then pauses until puberty when it continues each month until menopause. Amazingly, the egg cell that helped produce you started developing inside your mother while she was developing inside your grandmother's uterus

The Endocrine System

Respond to FSH and LH by secreting estrogen, which regulates menstruation, maturation of egg cells, breast development, pregnancy, and menopause. Ovaries The paired ovaries are about the size and shape of almonds in the shell. They produce and secrete estrogen. Estrogen regulates many functions in the female body, including menstruation, the maturation of egg cells, breast development, pregnancy, and the cessation of menstruation after reproductive age called menopause. Inside the ovaries are all of the cells that can mature into the egg cells that will be ovulated. The production of egg cells begins while a female is in utero, pauses at birth, resumes at puberty, and continues until menopause.