Pregnancy, Oral Contraception, Hormone Replacement Therapy and the Occurrence of Varicose Veins: Edinburgh Vein Study
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Objective: To determine the relationship between varicose veins and duration of menstrual life, age of menopause, pregnancy, oral contraceptive use and hormone replacement therapy (HRT). Design: Cross-sectional study. Setting: City of Edinburgh, UK. Participants: Eight hundred and sixty-seven women aged 18–64 years randomly selected from 12 general practices. Methods: After completing a questionnaire, which included questions on reproductive history, the women underwent a comprehensive clinical examination including the assessment of varicose veins (trunk, hyphenweb and reticular varices), followed by duplex scanning of their legs. Results: Women who had been pregnant at least once were more likely to have minor hyphenweb or reticular varices than women who had never been pregnant ( p ≤ 0.05). Women aged 35–54 years who were current users or ex-users of the oral contraceptive pill had a lower prevalence of trunk varicose veins than women who had never taken the pill ( p ≤ 0.10). HRT was also associated with a lower prevalence of trunk varices ( p ≤ 0.05). Conclusions: These results suggest that alterations in the balance of the sex hormones may have a role in the aetiology of varicose veins.Keywords:
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Abstract Background: Menopause is a natural phase of life, but it can bring about physical problems for women. It seems that hormone replacement therapy (HRT) can be helpful in preventing problems at this stage of life. Patient and physician attitudes regarding menopause and HRT may affect decisions about the use of HRT. This study was conducted to determine attitudes about the importance of sex in menopausal women and examine the relationship between HRT and sex life after menopause. Methods: This is a comparative study that was done in the year 2000. The questionnaire used had two main parts. One hundred and fifty‐four women receiving HRT were chosen from private gynecology clinics north of Tehran city and 130 women who were not receiving HRT were chosen from the neighborhood of the HRT group. The sex lives and attitudes towards sex of the women before and after menopause were then compared, and the results were tabulated in 55 tables. Descriptive and inferential statistical methods were used. Results: The average age in the HRT group was 53 years and that in the non‐HRT group was 56 years. There was a significant difference in the average age between the two groups ( P < 0.001). The average number of years post‐menopause was 3.9 in the HRT group and 5.9 in the non‐HRT group. In the HRT group, 91.9% of the women used the hormone as prescribed by their physician. In this group, 85.7% of the women were of the opinion that sex was important, but this proportion in the non‐HRT group was 25.4%. There was a significant difference between the HRT and non‐HRT groups ( P < 0.001). Compared to the attitudes before menopause, the attitudes about the importance of sex in 56.5% of the HRT group and 19.2% of the non‐HRT group did not change after menopause. Women receiving HRT fared better in all aspects of their sex life, including libido, sexual activity, sexual satisfaction, sexual pleasure, frequency of orgasms and sexual importance at the time of the study. There were significant differences between the HRT and non‐HRT groups ( P < 0.001). With respect to sexual pleasure, 6.5% of the HRT group and 4.6% of the non‐HRT group experienced greater pleasure; 68.5% of the HRT group and 11.5% of the non‐HRT group experienced no change; and 83.8% of the non‐HRT group experienced less pleasure. There was a significant difference between the two groups with respect to the change in sexual pleasure ( P < 0.001). Conclusion: Although the importance of sex decreased for elderly women in both the HRT group and non‐HRT group, HRT affected their attitudes about the importance of sex. There was a significant difference between the HRT group and non‐HRT group in this area ( P < 0.001). The importance of sex in the HRT group did not change much after menopause, compared to the non‐HRT group. There was a significant difference between the two groups ( P < 0.001). There were fewer changes in all aspects of sex life after menopause for those in the HRT group compared to those in the non‐HRT group. In the month before the interview, 30.5% of the HRT group and 10.8% of the non‐HRT group had experienced complete sexual satisfaction. The difference was significant between the two groups ( P < 0.001). On the basis of the importance of sex during post‐menopausal life, counseling on the benefits of HRT might be recommended.
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AIM The advanced CEAP classification allows one to differentiate between isolated varicose veins (C2) and complicated varicose veins (C2, 3 - C2, 3, 4 - C2, 4 or C2, 3, 4, 5 etc) named (C2+). METHODS The main objective of this study was to identify when using the advanced classification the prevalence of isolated varicose veins (C2) and complicated varicose veins (C2+) among patients consulting vascular specialists and to compare their symptomatic status and the data issued from the advanced CEAP including also the headings, Anatomy (A), Etiology (E) and Pathophysiology (P). RESULTS 171 patients were evaluated, 100 in France and 71 in Italy. The prevalence of C2 and C2+ was the same in both countries: 64.4% in France and 63.3% in Italy. Also no difference was found in the prevalence of other descriptors: etiology, anatomy or pathophysiology. The time to complete the advanced form was less than 5 minutes for 65% of the investigators. CONCLUSION The advanced CEAP is easy to use in daily pratice. We have the same prevalence of patients in France and in Italy, who consulted for isolated varicose veins or associated with other signs of chronic venous disorders.
Etiology
Chronic Venous Insufficiency
Pathophysiology
Varix
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An examination was made of 10 samples of the great saphenous vein, removed from persons without varices and serving as the control group. A further 20 samples of typical varices, as well as 20 samples of normal veins obtained from persons with varices, were examined. The venous walls were tested for activities of certain hydrolytic enzymes and dehydrogenase systems. In both the varicose veins and the normal veins obtained from persons with varices it was found that structural changes occur and histochemical tests show a marked increase in the activity of acid phosphatase and decreased activities of malate dehydrogenase, non-specific esterase, ATPase, and 5-nucleotidase. An increased activity of the lactate dehydrogenase was found only in 55 % of the cases. In normal veins obtained from persons with varices, these changes were less pronounced. The layer of the circular muscle cells of the media is the zone of a varicose vein which sustains the heaviest damage.
Esterase
Varix
Hepatic veins
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Although women frequently associate skin issues with menopause and hormone replacement therapy (HRT), little work has been done to investigate a possible relationship. A questionnaire was given to women attending a specialist menopause clinic; 87 women responded. Skin problems generally were common, with over 64% of respondents reporting past problems. Around half felt that the menopause had resulted in skin changes; dry skin was the predominant complaint at this stage. However, use of HRT in the short term did not result in any conclusive trends in skin condition in the majority of users.
Hormone Therapy
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We incidentally hypothesized that placing Kinesio tapes over the bulging varicose veins patients had immediate clinical benefit. Refilling Time prolongation after taping seems the explanation of this effect. Fifteen patients were investigated via a clinical questionnaire and photoplethysmography trying to demonstrate the possibility of this type of temporary selective varices compression as a conservative treatment of varicose veins incompetence syndrome. The results were very encouraging suggesting a rapid divulgation of this simple and cheap method.
Photoplethysmogram
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Background: Women all over the world now have to spend almost 1/3rd of their lives in menopausal years. Therefore, menopause now is a concerning matter to maintain and improve women’s health. Hormone replacement therapy (HRT) is an effective treatment for menopausal symptoms. This study was conducted to determine knowledge, attitude and practice toward menopause HRT among women. Objective of the study was to determine the level of knowledge, attitude, and practice related to menopause and HRT among women.Methods: This cross-sectional study was carried out in May 2020 to July 2020 in a rural area of Ernakulam district of Kerala, India. 150 women were interviewed using a predesigned, pretested questionnaire.Results: In the present study, 42.6% of menopausal women had knowledge of menopausal symptoms. 31.3%, 38% and 26% knew that menopause increases risk of cardiovascular, osteoporosis and breast cancer respectively. 16.6% think menopausal women should consult a physician, only 42% of menopausal women are aware of HRT. 60.6% think menopausal symptoms affect quality of life. 50.6% think that menopause means end of sexual life. 42.6% think that absence of menstruation is a relief. 48.6% think physical changes of menopause are inevitable, hence acceptable. 35.3% had consulted a physician at the onset of menopause. 80% preferred natural approaches when compared to HRT. 76% and 86% think that HRT has many complications and side effects hence should be avoided respectively.Conclusions: The study concluded that the knowledge and attitude of the participants towards menopause and HRT was poor in the study population.
Menstruation
Surgical Menopause
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The female population comprises 48.66% of our total population, of which 10.30% are above the age of 49, many of whom are post-menopausal. Menopause is associated with bone-loss and its consequences. Hormone replacement therapy (HRT), particularly replacement of estrogen, prevents bone-loss. We undertook this prospective case-controlled study to find out whether or not HRT is beneficial to our women. A total of 106 patients were studied, amongst them 60 were cases and 46 were controls. The women in the first group were given either conjugated equine estrogen alone (surgical menopause group) or conjugated equine estrogen plus cyclical progesterone (natural menopause group). Results showed that there was 4.29% increase in bone mineral density in women who received hormone replacement therapy (HRT). This increase was 5.23% in early and 3.56% in late menopause group. Women with natural menopause gained more bone mass (4.22%) than women with surgical menopause (3.9%). Our results also showed that women who denied HRT (controls) lost bone mass (5.26%), the loss was more in those with surgical menopause (6.24%) than those with natural menopause (4.87%). Therefore it can be concluded that post-menopausal hormone replacement therapy prevents bone-loss. However, to evaluate the beneficial effect of long-term HRT, further studies with larger samples are recommended.
Surgical Menopause
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Hormone Therapy
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Varicose veins are one of mankind's commonest afflictions. Physicians are confronted frequently by varices and their complications. Varicosities of pregnancy have a distinct pattern which is quite different from the varices in nonpregnant individuals. The varicose veins usually appear during the second or third month of pregnancy and become progressively larger until the last trimester. They may be unilateral or scattered over both thighs and legs. They frequently involve the vulva. The importance of pregnancy is emphasized by the fact that 62% of the women attending a varicose vein clinic first sought medical advice because of pregnancy, and the varicosities were diagnosed as incidental findings.1Susceptible individuals develop progressively larger varices with each succeeding pregnancy. The veins have a characteristic scattered distribution and give the appearance of multiple incompetent perforators. Varices can become huge after multiple pregnancies. If the varicose veins of pregnancy are effectively compressed, all symptoms and
Varix
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The objective of this study is to assess the actual experiences of menopause in menopaused women without hormone replacement therapy. A cross-sectional study was conducted among 342 women who had natural menopause. The target population was recruited from subjects attending the Departement of Gynécologie-Obstétrique du CHU TOKOIN from November 1996 to October 1997. All women investigated presented clinical signs related to menopause. 51.5% found its symptoms embarrassing. 53.8% of the women enjoyed their menopause. The difference between the two groups of women having accepted their menopausal status or not, where the menstrual period were embarrassing or not (p = 0.0001) and were the climateric symptoms were embarrassing or not (p = 0.0001) were significant. Agreement to undertake a hormone replacement therapy were given by 29.8% of women. In spite of the climateric symptoms, menopaused women hardly accept their status and few were available for a hormone replacement therapy.
Surgical Menopause
Hormone Therapy
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