Mirjam Furuhjelm

Changes in Bone Mineral Content in Women with Natural Menopause During Treatment with Female Sex Hormones

Abstract. The bone mineral content was determined in eleven women with a natural menopause by X‐ray spectrophotometry during treatment with a combination of estrogens and a gestagen. During a three‐year follow‐up period the hormone treated women significantly increased (P<0.05) their mineral content by 3% a year on average, as compared with a control group. Even in patients who had passed the menopause several years previously, the increase occurred and was particularly great during the first year of treatment.

The relationship between the peaks in the excretion of estrogenic substances and the phases of the endometrial cycle in normal women

This study examined the relationship between peaks in the excretion of estrogenic substance and phases of the endometrial cycle in 5 healthy women. 4 subjects were followed during 1 ovarian cycle; the 5th subject was followed for 4 consecutive cycles. The curves for the excretion of estrogenic substance showed a pronounced peak at about the middle of the cycle and a general rise in excretion at the end of the cycle. Maximal excretion occurred at the same time as the endometrium passed from the proliferative to the secretory phase. Ovulation appeared to take place earlier in women with short cycles and later in women with long ones. It is concluded that the corpus luteum has a constant span of life in different individuals. In 13 of 17 cases examined previously by the author the peak in excretion of estrogenic substance occurred 14 days before the onset of menstruation at the same time as ovulation. (Summary in GER FRE)

METABOLISM OF ESTRONE SULFATE IN POSTMENOPAUSAL VAGINAL MUCOSA

Although estrogen deficiency usually transforms the postmenopausal vaginal mucosa into an atrophic condition, a proliferated vaginal epithelium can sometimes be observed several years after the menopause, even in patients with low peripheral estrogen levels (1). One explanation for this may be individual differences in the estrogen receptor (ER) content of the target tissue. Another explanation may be elevated intracellular formation in the target tissue of the terminal biologically active estrogen estradiol-17-0 (E,) from other steroids. This may lead to local E, concentrations sufficiently high to cause estrogenic stimulation, despite low peripheral E, levels. Estrone sulfate (E3) is the major peripheral estrogen in non-pregnant women and considerable serum levels, i.e. 1-3 nM, are present even after the menopause (cf 2). We have previously demonstrated an association between the conversion of E,S into E, and various signs of estrogenic activity in endometrial samples and in mammary carcinomas obtained from postmenopausal women with normal peripheral estrogen levels (3,4). The present communication describes the metabolism of I ’H I E,S in vitro by vaginal mucosae showing varying degrees of proliferation, obtained from postmenopausal women.

Intravaginal Administration of Conjugated Estrogens in Premenopausal and Postmenopausal Women

Daily doses of 0.625 mg of conjugated estrogens were administered intravaginally for 14 days to 12 postmenopausal women (six with highly atrophic and six with slightly atrophic vaginal mucosa), resulting in vaginal mucosae similar to those found in premenopausal women in all 12 subjects. In a second experiment, serum estrogens, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were determined before and hourly for six hours after a single intravaginal dose of 0.625 mg of conjugated estrogens was given to five postmenopausal women and to five premenopausal women on cycle days 6-8. Serum levels of unconjugated immunoreactive estrogens and total estrone increased rapidly in four of five postmenopausal women. Luteal phase values were found after only two hours, but there were no effects on serum FSH and LH. One of the postmenopausal women who had an unatrophied vaginal mucosa, showed a considerable lower resorption of estrogens. There were no significant changes in the serum estrogen levels of the premenopausal women. Thus, we conclude that daily vaginal administration of 0.625 mg of conjugated estrogens for 14 days is sufficient to restore an atrophic vaginal mucosa to a premenopausal condition. Furthermore, the condition of the vaginal mucosa seems to influence the resorption, thus indicating an inbuilt mechanism of protection against overdosage of intravaginally applied estrogens.