Doğal ve cerrahi menopozlu kadınlarda serum androjen düzeyleri ve seksüel fonksiyon bozuklukları
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Date
2007
Authors
Haytoğlu, Demet
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Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Cinsel fonksiyon bozuklukları (CFB), cinsel yanıt siklusu’nun istek, uyarılma, orgazm gibi çeşitli evrelerinde ortaya çıkabilen psiko-fizyolojik sorunları ve cinsel eyleme bağlı ağrıyı kapsar. CFB detaylı bir klinik psiko-seksüel sorgulama ile tanımlanabilir. Geniş çaplı araştırmalarda, tanısal amaçla, CFB’nun çeşitli boyutlarını skorlayarak ortaya koyan anketlerden de yararlanılabilir. Kadınlarda sık rastlanan CFB çeşitli biyolojik, psikolojik ve duygusal belirleyicileri olan karmaşık bir tablodur. CFB üzerinde etkili olan biyolojik faktörler arasında fiziksel sağlıkla birlikte yer alan en önemli fizyolojik etkenler yaş ve androjen düzeyleridir. Gerek yaş, gerekse androjen düzeyleri ile bağlantılı olan menopoz dönemi ise kadınlarda CFB’na daha sık rastlanan bir evredir. Overlerin menopoz sonrasında da önemli bir androjen kaynağı olduğu kabul edilirse, overlerin çıkarılmış olduğu cerrahi menopozda CFB sıklığının artabileceği düşünülebilir. Bu çalışmanın amacı doğal ve cerrahi menopozlu kadınlarda CFB’nı karşılaştırmak ve androjenlerin CFB üzerindeki olası etkilerini araştırmaktır. Bu çalışmaya katılan doğal menopozlu 83 ve cerrahi menopozlu 35 kadın demografik ve obsterik özellikleri, vücut yapısı indeksleri, total ve serbest testosteron ile FAİ (serbest androjen indeksi – free androgen index), androstendion, dehidroepiandrosteron sülfat (DHEAS), estradiol ve prolaktini kapsayan hormon ve seks hormon bağlayıcı globulin (SHBG) düzeyleri ve CFB sıklığı açısından karşılaştırıldı. CFB toplam FSFI (Kadın Cinsel Fonksiyonu İndeksi – Female Sexual Function Index) skorunun 23’ün altında olması ile tanımlandı. CFB doğal menopoz grubuna (%44.6) göre, cerrahi menopoz grubunda (%65.7) daha sık (p=0.036), total testosteron düzeyleri [ng/dL] ise CFB olan kadınlarda (49.3 ± 21.0) olmayanlardan (58.8 ± 23.6) daha düşüktü (p=0.022). Diğer değişkenler açısından CFB olan ve olmayan kadınlar arasında hiçbir farklılık saptanmadı. Cerrahi menopoz grubunda menopoz süresi daha uzun (85.6 ± 57.8’ya karşılık 63.3 ± 50.8 ay; p=0.039), doğal menopoz grubunda ise toplam gebelik sayısı daha fazlaydı (3.9 ± 1.9’ya karşılık 3.1 ± 1.3; p=0.022). Regresyon analizine göre, total testosteronun bağımsız belirleyicileri androstendion (B=2.253; p=0.039), DHEAS (B=0.222; p<0.001) ve menopoz süresiydi (B=-0.064; p=0.040). CFB’nun bağımsız belirleyicileri ise oluşturulan iki modelden birincisinde menopoz şekli (B=- 0.923; p=0.033) ve total testosterondu (B=0.021; p=0.023). Bu modelden menopoz şekli çıkarıldığında yerini DHEAS (B=-0.009; p=0.046) alıyordu. İkinci modelde ise CFB’nun belirleyicileri menopoz şekli (B=-0.986; p=0.028), FAİ (B=0.236; p=0.005) ve SHBG (B=0.036; p=0.006) idi. Bu modelden SHBG çıkarıldığında yerini DHEAS (B=-0.009; p=0.046) alıyordu. Küme analizi ile, doğal menopozlu kadınlar içerisinde, total testosteron veya FAİ (ve SHBG) düzeylerine göre CFB olan ve olmayan alt grupları tanımlanabilirken, cerrahi menopozlu kadınlar arasında bu alt gruplara işaret edecek bir değişken belirlenemedi. Sonuç olarak bu çalışma, CFB ile androjenler arasındaki ilişkiyi bir kez daha vurgulamış ve cerrahi menopozun CFB üzerindeki –androjenlerden bağımsız– olumsuz etkisini ortaya koymuştur. Çalışmamızın sonuçları, CFB ile ilişkili bağımsız bir anlam taşıdığı gösterilen SHBG’nin ve özellikle cerrahi menopozlu kadınlarda önem taşıyabileceği düşünülen DHEAS’ın daha fazla araştırılması gerektiğine işaret etmektedir.
Sexual dysfunction (SD) implies psycho-physiological problems and pain encountered during any phase of the sexual response cycle, including libido, arousal and orgasm. Clinically, SD can be diagnosed by detailed psychosexual questionning. For large-scale clinical studies, questionnaires which use scoring systems to define various dimensions of SD can also be employed for diagnostic purposes. SD, common in women, is a complex picture, affected by various biological, psychological and emotional inputs. Among biological factors that affect SD, age and androgen levels are physiologically the most important, along with physical well-being. SD is more prevalent during the menopausal period, which itself is integrated with aging and changes in androgen levels, Removal of the ovaries, considered to be an important source of androgens after natural menopause, can be expected to cause an increase in the prevalence of SD in surgically menopausal women. The aim of the current study was to investigate the prevalence of SD in naturally and surgically menopausal women, and to explore the possible effects of androgens on SD. Eighty-three naturally menopausal and 35 surgically menopausal women who took part in this study were compared for demographic and obstetric characteristics, indices of body mass, levels of hormones, incluing total and free testosterone, free androgen index (FAI), androstenedion, dehydroepiandrosterone sulfate (DHEAS), estradiol and proolactin, and of sex hormone-binding (SHBG), and for the prevalence of SD. SD was defined as a total Female Sexual Function Index (FSFI) score of less than 23. SD was more common in surgically menopausal wome (65.7%) compared with naturally menopausal women (44.6%; p=0.036). Levels of total testosterone [ng/dL] were lower in women with SD (49.3 ± 21.0) in comparison to functionally normal women. No difference was encountered between women with or without SD for any other variable studied. The mean duration of menopause was longer in surgically menopausal women (85.6 ± 57.8 vs 63.3 ± 50.8 months; p=0.039), whereas the mean number of previous pregnancies was higher in naturally menopausal women (3.9 ± 1.9 vs 3.1 ± 1.3; p=0.022). Regression analysis revealed androstenedion (B=2.253; p=0.039), DHEAS (B=0.222; p<0.001) and duration of menopause (B=- 0.064; p=0.040) to be independent predictors of total testosterone. Of the two models built to define the independent predictors of SD, the first one included type of menopause (B=-0.923; p=0.033) and total testosterone (B=0.021; p=0.023). When type of menopause was excluded from this model, it was replaced by DHEAS (B=-0.009; p=0.046). The second model included type of menopause (B=-0.986; p=0.028), FAI (B=0.236; p=0.005) and SHBG (B=0.036; p=0.006) as independent predictors of SD. When SHBG was removed from this model, it was replaced by DHEAS (B=-0.009; p=0.046). Using total testosterone or FAI (and SHBG) levels, cluster analysis could define subsets of women with or without SD among naturally menopausal women. Similar subsets of surgically menopausal women could not be defined by any predictive variable. In conclusion, this study underscores the relationship between SD and androgens, and reveals the unfavorable effect of surgical menopause on SD, independent of androgens. Our findings warrant an in-depth evaluation of SHBG, shown to be independently associated with SD, and of DHEAS, thought possibly to play a more important role in surgically menopausal women.
Sexual dysfunction (SD) implies psycho-physiological problems and pain encountered during any phase of the sexual response cycle, including libido, arousal and orgasm. Clinically, SD can be diagnosed by detailed psychosexual questionning. For large-scale clinical studies, questionnaires which use scoring systems to define various dimensions of SD can also be employed for diagnostic purposes. SD, common in women, is a complex picture, affected by various biological, psychological and emotional inputs. Among biological factors that affect SD, age and androgen levels are physiologically the most important, along with physical well-being. SD is more prevalent during the menopausal period, which itself is integrated with aging and changes in androgen levels, Removal of the ovaries, considered to be an important source of androgens after natural menopause, can be expected to cause an increase in the prevalence of SD in surgically menopausal women. The aim of the current study was to investigate the prevalence of SD in naturally and surgically menopausal women, and to explore the possible effects of androgens on SD. Eighty-three naturally menopausal and 35 surgically menopausal women who took part in this study were compared for demographic and obstetric characteristics, indices of body mass, levels of hormones, incluing total and free testosterone, free androgen index (FAI), androstenedion, dehydroepiandrosterone sulfate (DHEAS), estradiol and proolactin, and of sex hormone-binding (SHBG), and for the prevalence of SD. SD was defined as a total Female Sexual Function Index (FSFI) score of less than 23. SD was more common in surgically menopausal wome (65.7%) compared with naturally menopausal women (44.6%; p=0.036). Levels of total testosterone [ng/dL] were lower in women with SD (49.3 ± 21.0) in comparison to functionally normal women. No difference was encountered between women with or without SD for any other variable studied. The mean duration of menopause was longer in surgically menopausal women (85.6 ± 57.8 vs 63.3 ± 50.8 months; p=0.039), whereas the mean number of previous pregnancies was higher in naturally menopausal women (3.9 ± 1.9 vs 3.1 ± 1.3; p=0.022). Regression analysis revealed androstenedion (B=2.253; p=0.039), DHEAS (B=0.222; p<0.001) and duration of menopause (B=- 0.064; p=0.040) to be independent predictors of total testosterone. Of the two models built to define the independent predictors of SD, the first one included type of menopause (B=-0.923; p=0.033) and total testosterone (B=0.021; p=0.023). When type of menopause was excluded from this model, it was replaced by DHEAS (B=-0.009; p=0.046). The second model included type of menopause (B=-0.986; p=0.028), FAI (B=0.236; p=0.005) and SHBG (B=0.036; p=0.006) as independent predictors of SD. When SHBG was removed from this model, it was replaced by DHEAS (B=-0.009; p=0.046). Using total testosterone or FAI (and SHBG) levels, cluster analysis could define subsets of women with or without SD among naturally menopausal women. Similar subsets of surgically menopausal women could not be defined by any predictive variable. In conclusion, this study underscores the relationship between SD and androgens, and reveals the unfavorable effect of surgical menopause on SD, independent of androgens. Our findings warrant an in-depth evaluation of SHBG, shown to be independently associated with SD, and of DHEAS, thought possibly to play a more important role in surgically menopausal women.
Description
Keywords
Cinsel fonksiyon bozukluğu, Menopoz, Cerrahi, Androjen, Seks hormon bağlayıcı globulin, Sexual dysfunction, Menopause, Surgical, Androgen, Sex hormone-binding globulin
Citation
Haytoğlu, D. (2007). Doğal ve cerrahi menopozlu kadınlarda serum androjen düzeyleri ve seksüel fonksiyon bozuklukları. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.