NEWSLETTER Issue 5 December, 2011 Holistic, Compassionate and Quality HealthcareAdvisory Group Predicting Age at MenopauseProf. U Thein Aung Dr. Nyein Moe ThawProf. U Khin Maung Aye M.B.,B.S, M.Med.Sc (OG), Dr. Med.Sc (OG)Dr. Tin NyuntProf. U Saw Win P redicting age at menopause and ovarian reserve is of great interest in women who wish to delay childbearing and who wish to know their ovarian reserve. Age at menopause mayProf. Daw Mya Thidar also be of relevance because many health conditions are linked to age at menopause. LowerProf. U Ne Win age at menopause is linked to an increased risk for cardiovascular disease and osteoporosis. Older age at menopause is linked to an increased risk for breast cancer, endometrial cancer,Editorial Board and possibly ovarian cancer. So, women may be able to target certain interventions forDr. Myint Lwin reducing risk earlier in life if they have this information about when they are likely to goDr. Shwe Baw through menopause.Dr. Zay Ya Aye A valid prediction of the time to menopause is still a challenge for a practisingDr. Tin Moe Phyu physician. Ovarian aging is dictated by decreasing quantity and quality of the resting folliclesDr. Khin Than Htay and depletion in the oocyte stock, after which menopause occurs. Because it is not feasibleDr. Thidar Oo to directly assess the oocyte or follicle pool, endocrinologic and sonographic markers are used as an indirect measure. A woman’s fertility ends ten years prior to the ﬁnal menstrualDr. Nyein Moe Thaw period (FMP) and can even occur around the age of thirty. With regard to family planningDr. Hnin Thuzar Aung and a career, it is extremely valuable for women to know the expected length of their fertility.Contact Us This knowledge will enable women who are predicted to become infertile at an early age to No-60, G-1, choose the option of having their eggs frozen. This means that they will still be able to have New Parami Road, children if it turns out that they can no longer get pregnant spontaneously. Mayangone Tsp, Prediction of age at menopause can be enhanced by using markers of ovarian reserve; Yangon, Myanmar. estradiol, follicular stimulating hormone (FSH), inhibin , and antimüllerian hormone (AMH).Tel : 651674, 660083, While one cannot use a single test to determine time to FMP, the menstrual cycle pattern and 657228 to 657232 hormonal characteristics can be used to generate rough estimates for counseling patients. info@paramihospital. The reproductive stage is generally characterized by regular menstrual cycles, early Free Distribution follicular phase FSH levels less than 10 mIU/mL, and AMH levels greater than 0.3 ng/mL. The contents of the The early menopausal transition begins approximately 7 to 8 years prior to the FMP. FSH newsletter are not to be values are generally greater than 10 mIU/mL, and AMH levels are less than 0.4 ng/mL in reproduced in any form this group of women.1,2 The late menopausal transition begins approximately 3 to 4 years without prior written prior to the FMP. Occurrence of the late menopausal transition stage is conﬁrmed when approval of the early follicular phase estradiol levels are greater than 100 pg/mL or FSH values are greater editorial board. (To Page - 2 _____) >
Issue - 5, December 2011 Page - 2 Parami Hospital - Yangon, NewsletterContinued from Predicting Age At Menopause (Page - 1) Picture Quiz Dr. Tin Moe Phyuthan 30 to 40 mIU/mL.1,3 AMH values are generally less M.B.,B.S, MMedSc ( Paediatrics ), MRCPCH (UK), 4 Assistant Lecturer, Department of Paediatrics,than 0.1 ng/mL (or below assay sensitivity). While theterm Menopause appears easy to deﬁne as “12 months of Yangon Children Hospital, University of Medicine ( 1 ) Yangonamenorrhoea,” differentiating women in the late menopausaltransition from those in early postmenopause can be difﬁcult A n eight years old boy, body weight 21 kg, came to Parami Hospital-Yangon OPD with the complaintwithin the ﬁrst 12 months following the FMP. of gradual increase in weakness of lower limbs since 3 Among these various markers, serum AMH has years ago. He also had history of frequently falls duringseveral unique characteristics that emphasize its robustness playing. He was previously well and there was no historyas a biologic marker of ovarian aging. AMH is secreted of hospitalization. Birth history (Including both antenatalexclusively in ovarian follicles and is independent of the and natal history) was uneventful.menstrual cycle; its level remains almost constant from one There was no similar problem among familycycle to another. 5 AMH seems to regulate the early follicular members . His developmental milestones are normal. Hedevelopment,6 and its serum concentration decreases with started to walk at about 1 year and 3 months. He is currently attending 4th standard and he is doing well in school lessonsadvancing age before changes in other markers such as and examinations. Immunization history was said to befollicular-stimulating hormone and inhibin B become complete.apparent.7,8 On examination, currently he is well, alert andReferences f happy. He does not have any dysmorphic feature. However,1. Burger HG, Dudley EC, Hopper JL, et al. The endocrinology of the his legs are big compared to his upper limbs. The following menopausal transition: a crosssectional study of a population-based sample. pictures showed his funny big legs and his activities in trying J Clin Endocrinol Metab. 1995;80 (12):3537-3545.2. Gracia CR, Sammel MD, Freeman EW, et al. Deﬁning menopause status: to stand up from lying position. creation of a new deﬁnition to identify the early changes of the menopausal transition. Menopause. 2005;12(2):128-135.3. Santoro N, Brockwell S, Johnston J, et al. Helping midlife women predict the onset of the ﬁnal menses: SWAN, the Study of Women’s Health Across the Nation. Menopause. 2007;14(3 pt 1):415-424.4. Sowers MR, Eyvazzadeh AD, McConnell D, et al. Anti-mullerian hormone and inhibin B in the deﬁnition of ovarian aging and the menopause transition. J Clin Endocrinol Metab. 2008;93(9):3478- 3483.5. Hehenkamp WJ, Looman CW, Themmen AP, de Jong FH, Te Velde ER, Broekmans FJ. Antimüllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab 2006;91:4057–4063.6. Durlinger AL, Visser JA, Themmen AP. Regulation of ovarian function: the role of antimüllerian hormone. Reproduction 2002; 124:601–609.7. Van Rooij IA, Broekmans FJ, Scheffer GJ, et al. Serum antimüllerian hormone levels best reﬂect the reproductive decline with age in normal women with proven fertility: a longitudinal study. Fertil Steril 2005;83:979–987. l8. de Vet A, Laven JS, de Jong FH, Themmen AP, Fauser BC. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril 2002;77:357–362. (To Page - 3 _____) >
Issue - 5, December 2011 Page - 3 Parami Hospital - Yangon, Newsletter Continued from Picture Quiz Leisure Reading (Page -2) Control of You r Your Respiratory system, cardiovas- Heartcular system and locomotor systemexaminations are normal. His A wise and understanding heart does not repay a hurt with a hurt.neurological examination is normal In doing so, the heart is diminished.apart from slight decrease in tone of Fissures form. Love leaks out. Everyboth lower limbs and difﬁculty to stand pain given in return for one received,up from sitting and lying position. changes the contents of the heart. It All laboratory investigations is no longer deﬁned by love, wisdom( CP, U&E, Calcium ) are within normal and understanding. It is redeﬁned byrange. However, serum creatine kinase the bearers of hurt and hate, pain and( CK ) is 15632 IU/L ( normal <160 prejudice, meanness and madness,IU/L ). Chest X-ray and ECG are sorrow and sadness. You give awaynormal. control of your very own heart. The despair of being hurt is healed by overcoming it, not clingingQQuestion to the hurt and inﬂicting more of it on1. What is the abnormality of his the world. When darkness is added to legs? darkness, no one can see, no one can2. What is the important physical love. Everyone loses. sign shown in the photograph ? Love is not always warm and fuzzy. Sometimes it’s the integrity we Answers To Page ( 4 ) hold on to when we’re tempted to strike back. Sometimes it’s the honour that keeps us from exchanging the valuable contents of our heart for the harsh satisfaction of lashing back. No, the way of love is not always easy, but when night falls, dawn is assured. The integrity and honour of a wise and understanding heart, rises with the sun of a new day. ( Ref : Morning Reading Classics )
Issue - 5, December 2011 Page - 4 Parami Hospital - Yangon, Newsletter.... to our Beloved Customers …. Picture Quiz Answers Answer If special healthcare 1. Calves pseudohypertrophy Is what you desire, 2. Gower sign Ready to help you — 3. Duchenne muscular dystrophy ( D/Dx Becker Is our team Parami! " . muscular dystrophy). Should consultation by appointment, Duchenne muscular dystrophy is the most common Is what you seek, hereditary neuromuscular disease . Its characteristic clinical Just give us a call features are progressive weakness, intellectual impairment, And express your needs — d hypertrophy of the calves, and proliferation of connective Your choice of doctors, r tissue in muscle. The incidence is 1 : 3,600 liveborn infant Your choice of time ………. boys. This disease is inherited as an X-linked recessive trait. The abnormal gene is at the Xp21 locus. Becker muscular to receive our healthcare : dystrophy is the same fundamental disease as Duchenne well-specialized and highly standardized! dystrophy, with a genetic defect at the same locus, but For our most valued customers, clinically it follows a milder and more protracted course. Our team “Parami” The serum CK level is consistently greatly elevated, Will create an atmosphere even in presymptomatic stages, including at birth. Always warm and friendly Cardiomyopathy and respiratory muscle weakness are And fulﬁll your needs readily complications of disease progress. Echocardiography, electrocardiography (ECG), and radiography of the To make you feel at ease chest are essential and should be repeated periodically. And clear you of your disease Electromyography (EMG) shows characteristic myopathic in next to no time, indeed! features. Blood polymerase chain reaction (PCR) for the dystrophic gene mutation and muscle biopsy are diagnostic Dr. Khin Than Htay tests. There is no specific treatment. Multidisplinary team approach including physiology is an essential part of management. Oral prednisolone therapy may have improvement in short term and long term prognosis. Because of progressive muscle weakness, some patients become wheelchair users around 7 years of age. Death occurs usually at about 18–20 years of age. The causes of death are respiratory failure in sleep, intractable heart failure, pneumonia, or occasionally aspiration and airway obstruction. Oralon Mouth Rinse Minolac 10 mg Tablet (Chlorhexidine Gluconate Solution 1.0%) (Ketorolac Tromethamine)Wincetam Syrup, 400 mg Capsule and 800 mg Caplet Lefora 10 mg and 20 mg Tablet (Piracetam) (Leﬂunomide) This Newsletter is supported by Network Marketing LTD.