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Saturday, January 28, 2012

Study Finds Menopause Symptoms Can Be Predicted

The number of eggs left in a woman's ovaries are like the grains of sand in an hourglass, ticking away the hours on her biological clock.

Researchers now say they may be able to predict when that clock will wind down.

And while doctors can't actually count the number of eggs in an ovary, they can measure ovarian volume. British researchers say there's a direct correlation between the two, and by measuring ovarian volume with transvaginal ultrasound, doctors should be able to predict when menopause will set in and how many fertile years a woman has left.

According to the study authors, this information will revolutionize the care of women looking for assisted reproductive technologies, including those who were treated for childhood cancers as well as women who want to put off starting a family for whatever reason.

Although information still needs to be validated in clinical studies, its benefit is most likely to start with women who are being treated for cancer and women attending fertility clinics, said Tom Kelsey, co-author of the study appearing June 17 in the journal Human Reproduction.

"If women looking for some sort of assisted conception and their physicians know that they've got a long time till menopause, then you could plan for a range of treatments," said Kelsey, who is a senior research fellow at the University of St. Andrews in Scotland. "If you knew menopause was likely in four to five years, you'd plan a different set of IVF [in vitro fertilization] treatments."

 Others reiterate, however, that the findings should be treated with caution.

"Should a young woman who is 30 years old go for a test to figure out whether she's got three, five or 10 years left on her fertility? Should she make career decisions and life decisions? Are these data good enough to make those determinations?" asked Dr. Alan Copperman, director of reproductive medicine at Mount Sinai Medical Center in New York City. "The answer is obviously no to all of those questions. The predictive value of this test is not good enough to go and tell someone to change their life."

According to the article, eggs form in a female's ovary while she is still in the womb, peaking at several million about halfway through gestation and then starting a continuous decline. At birth, there are several hundred thousand and, when menstruation begins, about 300,000. At about age 37, a woman has about 25,000 eggs left, and at menopause only about 1,000.

The time at which menopause sets in is widely believed to be based on the number of eggs reaching a critically low threshold.

The authors of this study measured ovarian volume with transvaginal ultrasound, then looked at the relationship between ovarian volume -- ovaries shrink as a woman ages -- and number of eggs. They then applied mathematical and computer models to predict menopause. 

The study authors are negotiating with a medical school to set up clinical trials. The idea would be to follow women to see if their predictions were indeed correct.

While these authors have come up with a tool to potentially help women plan their lives, a second study in the same issue of Human Reproduction warned that women might not want to leave it too late. Assisted reproductive technology (ART) could not be relied upon to fully compensate for lack of natural fertility after the age of 35, the article stated.

The authors used a computer simulation model to determine that the overall success rate of assisted reproductive technology would be 30 percent for those attempting to get pregnant from age 30, 24 percent for those trying from age 35, and 17 percent from age 40.

 SOURCES: Tom Kelsey, Ph.D., senior research fellow, University of St. Andrews, St. Andrews, Scotland; Alan Copperman, M.D., director, reproductive medicine, Mount Sinai Medical Center, New York; June 17, 2004, Human Reproduction

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Recommended Blood Glucose Numbers

What are the Right Numbers?

Depending on where you look, recommended blood glucose levels can vary. The American Diabetes Association (ADA) numbers differ from the American College of Endocrinology (ACE) guidelines. The ACE recommendations are more strict than the ADA's. How do you know which to follow? Ask your healthcare provider which goals are right for you. The table below compares the two sets of guidelines for blood glucose, blood pressure and cholesterol.

How many times a day should you check your blood glucose levels?

Checking your blood glucose levels often through out the day will help you to figure out how to keep good control. First thing in the morning before breakfast, two hours after a meal and before bed are good times to test. Other recommended times include before, during and after an exercise session, especially if it is strenuous or if you are feeling like your blood sugar may be low or high.

What is the A1C?

It's a blood test that helps you and your doctor monitor your overall glucose control.

It gives an average of the amount of glucose in your blood over a few months' time. It is usually ordered 2 to 4 times a year. If you are newly diagnosed or having trouble maintaining good day-to-day control, it may be ordered more often.

Sources:

"Checking Your Blood Glucose." American Diabetes Association. ADA. 15 Dec 2006

American Association of Clinical Endocrinologists and the American College of Endocrinology, "The AACE System of Intensive Diabetes Self-Management - 2002 Update." The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus. Endocrine Practice Vol. 8. 2002.

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Problems With Premature Ejaculation

It's possible that your husband's rapid ejaculation has gotten him so down that he's withdrawing from sex. If so, that can be easily remedied. Quite often, when a man gains good ejaculatory control, he suddenly becomes much more interested in sex. And even if he doesn't, it might be nicer for both of you if he lasted longer.

Faced with involuntary ejaculation, most men try to distract themselves during intercourse, believing that by thinking about other things, they can trick themselves into lasting longer. Usually, that only makes things worse.

 Don't tune out your body. TUNE INTO IT. You need to become more familiar with your different levels of sexual arousal. You also need to recognize how you feel as you approach your point of ejaculatory inevitability, the "point of no return." Once you recognize how you feel close to your point of no return, it's not difficult to make small sexual adjustments that allow you to remain highly aroused without ejaculating. 

Sexual arousal is a four-phase process. In the Excitement Phase, breathing deepens and erection begins. In the Plateau Stage, erection becomes full and you feel highly aroused. When arousal builds to a certain point, the next phase occurs, Orgasm with Ejaculation. Then during the Resolution Phase, breathing returns to normal and erection subsides. The key to ejaculatory control is to extend the Plateau Phase, to maintain arousal without triggering Orgasm and Ejaculation. 

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