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biology_of_perimenopause_websitev2c (1)

biology_of_perimenopause_websitev2c (1) - Biology of the...

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Biology of the Perimenopause: Impact on Health and Aging BETHESDA, MARYLAND MAY 26–27, 2004 SUMMARY OF AN NIH WORKSHOP WORKSHOP SPONSORS: National Institute on Aging Office of Research on Women’s Health National Institutes of Health
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Table of Contents Executive Summary .................................................................................................................. iii List of Acronyms ....................................................................................................................... x Introduction ................................................................................................................................ 1 Premenopausal Protection against Chronic Diseases of Aging: Re-thinking the Paradigm ......................................................................................................... 2 Neurobiology of Ovarian Steroids ............................................................................................ 4 Dynamics of the Female Reproductive System and Changes with Aging ............................ 7 Relating Aging and Outcomes of Menopause ......................................................................... 9 Animal Models Discussion Session ....................................................................................... 10 Rodent Models ......................................................................................................................... 11 Mouse Models .......................................................................................................................... 12 Rodent Models Discussion ..................................................................................................... 12 Macaque Models ...................................................................................................................... 12 Peri/postmenopausal Baboon Models ................................................................................... 13 Monkey Models Discussion .................................................................................................... 14 Adipose Discussion Session .................................................................................................. 14 Estrogen Insufficiency and the Metabolic Syndrome ........................................................... 15 Menopausal Changes in Body Fat Distribution and Metabolic Syndrome .......................... 15 Obesity and Premenopausal Risk Factors ............................................................................ 16 Interaction between GnRH and Diet ....................................................................................... 17 Discussion ............................................................................................................................... 17 Immune System Discussion Session ..................................................................................... 17 Hormonal Effects ..................................................................................................................... 18 Autoreactivity in the Immune System .................................................................................... 18 Inflammatory Markers and Mechanisms ................................................................................ 19 Discussion ............................................................................................................................... 20 Bone Discussion Session ....................................................................................................... 20 Menopause Transition ............................................................................................................. 21 Anti-Osteoporotic Effects of Sex Steroids ............................................................................. 21 Environment, Hormones, and Bones ..................................................................................... 21 Changes in Bone Mass with Age ............................................................................................ 22 Discussion ............................................................................................................................... 22 Cardiovascular Discussion Session ...................................................................................... 22 Epidemiological Factors ......................................................................................................... 23 Hormonal Effects ..................................................................................................................... 23 Longitudinal Effects ................................................................................................................ 24 Changes in Hemostasis with Menopause and with HT ......................................................... 25 Discussion ............................................................................................................................... 26 i
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Cognition, Mood and Brain Function Discussion Session ................................................... 26 Brain Organization Effects of Hormones ............................................................................... 27 Menstrual Cycle Studies ......................................................................................................... 27 Mood Alterations and Depression .......................................................................................... 28 CNS Effects of Estrogen ......................................................................................................... 28 Neural Targets of Estrogen and Underlying Mechanisms of Action ................................... 28 Altered CNS Mechanisms during Perimenopause ................................................................ 29 Discussion ............................................................................................................................... 29 A Paradigm on Staging the Menopause Transition .............................................................. 29 Wrap Up Session ..................................................................................................................... 30 Research Agenda Items presented by Discussion Session Chairs ..................................... 32 Adipose .................................................................................................................................... 32 Animal Models ......................................................................................................................... 32 Immune System ....................................................................................................................... 32 Bone ......................................................................................................................................... 32 Cognition, Mood and Brain Function ..................................................................................... 33 Cardiovascular ......................................................................................................................... 33 Research Agenda Items from Workshop Participants (presented either at the workshop or contributed following the workshop) ..................................................................................... 33 References ............................................................................................................................... 35 Subject Index…………………………………………………………………………………………...43 Author Index…………………………………………………………………………………………….52 ii
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EXECUTIVE SUMMARY Introduction The intricate and dynamic interplay of hypothalamic-pituitary-ovarian (HPO) hormones during the normal menstrual cycle may serve to protect women from a variety of health problems and conditions associated with the menopause, including cardiovascular disease, osteoporosis, loss of cognitive function, and menopausal symptoms. The role of aging certainly plays a role in this loss of protection as women traverse the menopause in middle- age. A workshop was convened to explore the current state of knowledge regarding the role of HPO axis hormones and their dynamic interrelationships during the normal menstrual cycle
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