Abstract in ovarian hormone production. Oestrogen deficiency and

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Abstract Background: Menopause is the permanent cessation of menstruation seen in womenbetween 40-61 years of age. Menopause is characterised by reduction in ovarianhormone production. Oestrogen deficiency and age related processes causedecrease in calcium levels in post menopausal women. Aims and Objectives: To study serum calcium levels in premenopausaland post menopausal women.Materialsand Methods: Crosssectional study was conducted.

35 pre menopausal and 30 post menopausal womenwere selected according to inclusion and exclusion criteria . Patients with medicalhistory of major systemic diseases, women on hormone replacement therapy, andwomen who had surgical menopause were not included in the study .Serum calcium levels were estimated inboth groups.For statistical analysis the value of laboratory parameters were presented asthe Mean±SD (standard deviation). A Student’s  t-test was used for cross-sectionalcomparisons of continuous variables between the groups.Results: Serum calcium levels weresignificantly lower in post menopausal women than in pre menopausal women.Conclusion: Post menopausal women are calciumdeficient.  Keywords:  Premenopausalwomen  , postmenopausal women ,Menopause, serum calcium .

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  Introduction:Menopauseis permanent cessation of menstruation , seen in women between 40-61 years ofage .It is characterised by the menstrual changes that reflect oocyte depletionand subsequent reduction in ovarian hormone production. Menopause typicallyoccurs in middle age , 40-61 years of age, signalling the end of the fertilephases of life1 .

Menopause is characterised by hot flushes, nightsweats and various other psychological and biochemical changes . It also leadsto metabolic bone disorders .With the onset of menopause , rapid bone lossoccurs which is believed to average 2 to 3 % over the following 5 to 10 years,being greatest in the early post menopausal years 2,3 .Calcium ionis an essential structural component of skeleton .Body cannot synthesize it.

Nutrition imbalance  with endocrineabnormalities may be involved in osteoporosis 4. Extracellularcalcium ion concentration is determined by the interaction of calcium   absorption from intestine , renal excretion ofcalcium and bone uptake and release of calcium , each of which is regulated by  parathormone , vitamin D and calcitonin 5. Estrogen deficiency is present in post menopausal women.

Estrogen deficiencyresults in longer life span of osteoclasts 6.This estrogendeficiency is reason for osteoporosis seen after menopause .The female sex hormonediminish to almost none after menopause .

Bone turnover increases to high levelsin women soon after menopause . The 2 main causes of bone loss are estrogendeficiency after menopause and age related process 7 . Intestinalcalcium absorption decreases in post menopausal women 8 .Osteoporosisis a late complication of menopause.It is a degenerative bone disorder wherethere is thinning and weakening of the bone and a general decrease in bone massand density .So susceptible to fractures .Fractures related to osteoporosis areestimated to affect around 30% of women in developed countries and are a majorhealth problem.

Normally bone will go through a process where old bone isreplaced by new bone cells .Our body’s ability to handle this process changeswith age. Estrogen is involved in the process of calcium absorption into thebones .During menopause there is a drop in estrogen levels .All women willexperience acceleration in bone density reduction as their estrogen levelsdrop. Menopause in elderly women is associated with accelerated loss ofcortical bone .Rapid bone loss occurs when the balance between formation andresorption is upset resulting in a negative remodelling balance and leads toosteoporosis. It is mainly due to imbalance in hormonal factors like estrogen,prolactin and changes in bone formation markers like calcium, phosphorus .

The decrease in the level of sex steroidhormones during menopause in women causes various somatic, vasomotor, sexualand psychological symptom. The risk of osteoporosis, cardiovascular disease,arterial hypertension, impairment of glucose metabolism, and degenerativecognition disease incidence rises. The impact of deficiency of female sexhormones after menopause on the trace minerals has not been widely studied butexpected menopause related changes in their status may have an impact on theabove pathologies. There are veryfew reports on the changes in serum calcium and magnesium levels in variousphases of the menstrual cycle in otherwise healthy women. Estrogen induceshypercalcemia through the action of the parathyroid gland. Withdrawal ofestrogen is reported to cause a significant loss of bone calcium.

Increase inserum calcium levels during the follicular and ovulatory phases could be due tothe effect of estrogen on the parathyroid glands. In addition to bone calciumcontent the level of serum calcium appears to be associated with blood pressure,and could be a metabolic risk factor for cardiovascular disease.The study was carried out to evaluate calcium status in pre and post menopausalwomen.Materials and Methods:  Crosssectional study was conducted in 35 pre menopausal women ( 25-45 years of age)and 30 post menopausal women(46-65 years of age) in department of Physiology.Subjects were selected from general population according to the inclusioncriteria  . Consent was taken fromsubjects and procedure was explained to subjects.

Inclusioncriteria   : Post menopausal women betweenage 46-65 years.Exclusioncriteria  : 1) Surgical menopause due tohysterectomy                                2) Postmenopausal women on estrogen therapy                                3) Womenhaving  Diabetes / Hypertension.Collectionof blood sample 5 ml of venous blood was drawn aseptically from each subject .It was centrifuged at 3000rpm for 10 minutes and serum was separated .

Serumcalcium levels were estimated by photocolorimetrymethod.StatisticsStudent t test was applied to see thesignificance of difference of  parametersbetween 2 groups .Mean and standard deviation of variables was determined  Correlation was done by using Pearson scorrelation coefficient.

The interpretation of P value are as follow P>0.05 – not significantP<0.05 - significantP<0.01 - highly significant.Findings :Thetable shows that age of pre menopausal women was 36.73± 3.8 years (Mean± SD).

Age of post menopausal women was 53.64±6.30 years (Mean± SD).Serum calcium levels inpost menopausal women were less as compared to premenopausal women and this wasstatistically significant(P=0.037). Bar diagram shows mean serum calcium levelsin pre and post menopausal women.

It is observed that serum calcium levels arelow in post menopausal as compared to pre menopausal women.Table :Serum calcium levels in pre-menopausal and postmenopausal women Parameter Pre menopausal women n = 35 Post menopausal women n = 30 P value Age(years) 36.73 ± 3.8  years 53.64 ± 6.30 years —- Serum Calcium(mg/dl) 10..

07 ± 0.66  (mg/dl/) 8.4 ± 0.076 (mg/dl) 0.037  Bardiagram: Comparison of serum calcium in pre-menopausal andpostmenopausal women  DiscussionCalciumion is an essential structural component of the skeleton. Estrogen deficiencyafter menopause induces calcium loss by indirect effects on extra skeletalcalcium homeostasis as well as decreased intestinal calcium absorption.

Whenestrogen is deficient, there is an increase in the activation of new boneremodeling units. Both formation and resorption are altered with the resultthat resorption exceeds formation, producing a negative balance. Estrogendeficiency may induce calcium loss due to decreased intestinal calciumabsorption and decreased renal calcium conservation. The results of the presentstudy indicated that the level of serum calcium declined significantly in postmenopausal women. In this study serumcalcium was evaluated in premenopausal and postmenopausal women. Serum calciumwas significantly lower in postmenopausal women as compared to premenopausalwomen. Lower calcium levels after menopause lead to osteoporosis.

Osteoporosisis late complication of menopause. Osteoporosis causes thinning and weakeningof bone and general decrease in bone mass and density. So  menopausal women are susceptible to fractures.Fractures related to osteoporosis are estimated to affect around 30% of womenboth in developing and developed countries and are major health problem  9 . During menopause there is dropin estrogen levels which caused decreased calcium levels in postmenopausalwomen. All women will experience acceleration in bone density reduction astheir estrogen levels drop.

Thus serum calcium could be used as indicator ofincreased bone turnover , to enable early intervention so as to minimizefractures due to osteoporotic changes 10. The variation of serum calcium with age is proposedto be explained by alterations in levels of serum albumin to whichapproximately 40% of circulating calcium is bound and which was not adjustedfor the study along with the modification of the resorption, excretion andreabsorption of calcium. Studies have demonstrated that in addition to lowestrogen levels, osteoporotic postmenopausal women had kidneys that did notreabsorb as much calcium as the kidneys of women without osteoporosis.Comparable to few other study series our study also had significantly reducedserum calcium in the postmenopausal group when compared to the premenopausalgroupConclusionSerum calcium levelsare decreased in postmenopausal women. Thesimilar results have been found in many other studies11-15. We have used cross-sectional analyses to comparepostmenopausal women with premenopausal women. Although cross-sectionalinvestigations may provide clues regarding the effects of the menopause on thephysiological and biochemical changes, confounding factors such as age,ethnicity, average energy intake, physical activity, serum albumin levels etc.,have to be adjusted for statistical procedures to find out the changes in thevariables independent of these factors.

The present study revealed that thedifferences between the mean values and standard deviations of the variables inthe premenopausal and postmenopausal groups were small; thus making largesamples necessary to detect these differences. Our premenopausal group includedfew perimenopausal subjects also. Thus in order to establish standard referencevalues and formulate predictive equations, a representation of the wholepopulation needs to be studied. Further large scale multicentric andlongitudinal studies are required to further determine the actual changes inBMI, serum levels of magnesium and calcium, and correlation or independentassociation between them for their clinical implications in various disorderswith transition of age, and passage of menopause which is inevitable in everywoman’s life. It can be recommended that calcium supplementationcan be given as prophylaxis to prevent the long term bone loss and to decreasethe risk of fracture and osteoporosis in postmenopausal women .

Acknowledgement We are thankfull to subjects who participated in this study ,and also tolab technicians who gave full cooperation in this study .Conflicts of Interest  :There are no conflicts of interest.Source of funding      :Self funded.

Ethical clearance        : DoneReferences1) Howkins and Bourne.Shaws textbook of gynecology 13th ed, Elsevier ,chapter 5, p 57-61.2) Susan A calciumsupplementation in postmenopausal women.From Medscape Ob/Gy and womenhealth,2003:8(2).3) Gupta A.

Osteoporosisin India –the nutritional hypothesis.Natl med J Ind 1996:9(6):268-74.4) Sheweita S, Khosal K.Calcium metabolismand oxidative stress in bone fractures: role of antioxidants.Curr Drug metab 2007;8:519-25.5) Guyton AC ,Hall JE.

Parathroid hormone , calcitonin and phosphate metabolism, Vitamin D, bone andteeth. Textbook of physiology 11th ed Philadelphia: ElsevierSaunders; 2006.pp.901,940,978-95.

6) Garneo P, Delmas PD.Bhone turnover markers. In: Encyclopedia of endocrine Diseases .Eds Martin L.California : Elsevier Inc; 2004.pp 401-13.7) Riggs BL, melton LJ.Medical progress series  in voluntaryosteoporosis N Engl J Med 1986 ;314:1676-86.

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