Hi Ellen,

Found the following three articles pertaining to
Parkinson's and menopause.  Note the third article
requests women with Parkinson's Disease going through
menopause to participate in a research study.  Since
there aren't too many of us out there, we should all
try to participate.

Mayo Clinic Researchers Find Estrogen May Provide
Protection from Parkinson’s Disease
ROCHESTER, MINN.—Mayo Clinic researchers have found
that women who underwent hysterectomy had a threefold
increased risk of developing Parkinson’s disease and
that women who received estrogen after menopause had a
50 percent reduced risk of developing Parkinson’s
disease.
The study is being published in the September 2001
edition of Movement Disorders.
“Our findings imply that early loss of estrogen may
increase a patient’s risk of developing Parkinson’s
disease,” says Demetrius Maraganore, M.D., a Mayo
Clinic neurologist and one of the study’s authors.
“Our belief is that estrogen may play a role in
preventing Parkinson’s disease.”
The study involved the review of medical records of 72
female patients who developed Parkinson’s disease
between 1976 and 1995 while they were residents of
Olmsted County, Minn. The research focused on the
association of Parkinson’s disease with type of
menopause (natural or surgical), age at menopause and
postmenopausal estrogen replacement therapy.
“I think women need to consider our findings in the
balance of all of the pros and cons of estrogen
replacement therapy,” says Dr. Maraganore. “This is
something they should discuss with their women’s
health specialist, whether that be a family physician
or gynecologist.”

Estrogen and Parkinson Disease
Estrogen Deprivation Leads To Death Of Dopamine Cells
In The Brain
Estrogen deprivation leads to the death of dopamine
cells in the brain, a finding by Yale researchers that
could have implications for post-menopausal women. The
cells can be regenerated if estrogen is administered
within 10 days, but by 30 days, the cells appear to be
permanently lost, said D. Eugene Redmond, Jr.,
professor of psychiatry and neurosurgery at Yale
School of Medicine and director of the Neural
Transplantation and Regeneration Program. Redmond is
co-investigator and spokesperson about the study
published in the December issue of The Journal of
Neuroscience.
The principal investigator was Csaba Leranth, M.D.,
professor of obstetrics and gynecology and
neurobiology.
“Without estrogen, more than 30 percent of all the
dopamine neurons disappeared in a major area of the
brain that produces the neurotransmitter, dopamine, “
Redmond said. “This finding is consistent with a lot
of observations for which there has been, until now,
no explanation. The results of the study shed light on
why men, who have less estrogen in their bodies and
more androgen to antagonize it, are more likely to
develop Parkinson’s Disease than pre-menopausal women,
and why post menopausal women are more likely then to
develop the disease.”
The discovery was made after the researchers removed
the ovaries of female monkeys, thereby depleting their
bodies of estrogen and other gonadal hormones. Within
10 days, key neurons in the brain that protect against
Parkinson’s Disease disappeared. Redmond said monkeys
were used in the study because, unlike usual
laboratory animals, they have real menstrual cycles
and many other close similarities to humans.
The researchers were interested in sexual differences
in dopamine neurons in the substantia nigra area of
the midbrain, whose destruction is associated with
Parkinson’s Disease and dementia. The researchers
first sought to determine whether circulating estrogen
might have long term effects by altering the number of
dopamine neurons. The density of dopamine neurons was
calculated in the substantia nigra of intact male and
female primates; in female primates whose ovaries had
been removed; and in female primates whose ovaries had
been removed but were receiving estrogen replacement
therapy.
“After both 10 and 30 days of estrogen deprivation,
apparently 30 percent of the total number of
substantia nigra dopamine cells are lost,” Redmond
said. “Furthermore, the density calculations showed
that brief estrogen replacement restores the density
of the total number of neurons in that area of the
brain 10 days after the ovaries have been removed, but
not 30 days later.”
“These observations show the essential role of
estrogen in maintaining the integrity of the nigral
dopamine system involved in muscle control and higher
brain functions. It suggests a new prevention or
treatment strategy for patients at risk of Parkinson’s
disease and certain forms of memory-impairing
disorders,”he said.
“This also provides another rationale for estrogen
replacement therapy for postmenopausal women. Thirty
percent is a very significant number of cells in this
system. Maintenance, restoration, or loss of that many
cells could make the difference between severe
parkinsonism and having no symptoms at all.” But
Redmond cautioned that women should not use the
results to make a decision about estrogen replacement
therapy until further studies look at the effects on
dopamine cells of much longer periods of estrogen
deprivation.
Redmond said the researchers also want to see if much
larger doses of estrogen or other hormones
administered at 30 days and beyond of estrogen
deprivation would resuscitate the cells. All of this
must be in the context of possible side effects of
hormone replacement that women should take into
account in consultation with their doctors.
Other investigators were Robert Roth, professor of
psychiatry and pharmacology; John Elsworth, senior
research scientist, psychiatry; Frederick Naftolin,
M.D., professor of obstetrics and gynecology and of
molecular, cellular and developmental biology, and
Tamas Horvath, associate professor of obstetrics and
gynecology and neurobiology.
The study was carried out at the St. Kitts Biomedical
Research Foundation in the West Indies.

Parkinson’s Disease: Estrogen Could Help
Replacing Lost Estrogen Improves Symptoms

Aug. 7, 2001 (Quebec City) -- The debate over whether
the female hormone estrogen boosts brainpower
continues to rage, although recent evidence suggests
that it can be helpful for memory in postmenopausal
women. Now, a recent finding shows that it may also be
helpful in protecting postmenopausal women from the
devastating effects of Parkinson’s disease.
Parkinson’s disease is a condition that usually
affects older adults in which the part of the brain
responsible for coordinating movement starts to break
down. People with the disease thus suffer from
difficulty with movement, stiffness, and
uncontrollable tremors.
There’s much discussion among healthcare professionals
about whether women who undergo menopause should take
female hormones, including estrogen, to replace those
that are no longer being produced by the body.
Hormone replacement therapy is effective in treating
the uncomfortable effects that often accompany
menopause, such as hot flashes and sexual problems.
Recent research suggests it might not have the
beneficial effects on the heart many experts hoped it
did, but there is good evidence that it does help the
brain.
Expert Rachel Saunders-Pullman, MD, and her colleagues
looked at the health records of 138 women with
Parkinson’s disease who had passed menopause.
Thirty-four of these women had taken hormone
replacement therapy; 102 had not.
Not surprisingly, the longer the women had been
suffering from Parkinson’s disease, the worse their
symptoms were. However, women who had taken hormone
replacement therapy had less severe symptoms than
those who had never taken estrogen. The older the
women were, the bigger the difference in symptoms was
between those who had and had not taken estrogen.
According to the researchers, their findings suggest
that estrogen might actually help protect the brain
from the breakdown that occurs with Parkinson’s
disease.
Saunders-Pullman is an assistant professor of
neurology at Albert Einstein College of Medicine and
Beth Israel Medical Center in New York City. She
presented the current knowledge of estrogen and
Parkinson’s disease this week at a medical conference
held here.
“At this point ... we can’t translate this to
recommending that someone should or shouldn’t take
hormone replacement therapy,” Saunders-Pullman tells
WebMD. However, women who have Parkinson’s disease and
start or stop taking hormone replacement therapy for
other reasons should be aware that doing so could
affect their Parkinson’s symptoms.
More evidence that estrogen plays a role in
Parkinson’s disease comes from studies showing that
menopausal women with this condition tend to respond
better to treatment if they are taking estrogen. Also,
women with Parkinson’s disease tend to have more
difficulty with their symptoms a few days before and
during their menstrual period, which suggests that the
hormone does have a role.
There is also good evidence that taking estrogen after
menopause helps prevent other brain problems that
women with Parkinson’s disease often suffer from,
including memory problems and depression.
Saunders-Pullman expects future research will help
clarify the role of estrogen in preventing brain
diseases like Parkinson’s and that drugs that affect
estrogen and other hormones could be used to prevent
or treat this condition in both women and men.
© 2001 WebMD Corporation. All rights reserved.

Clinical features of Parkinson’s Disease:

Parkinson’s disease is a disease which generally
begins in adult life. The average age of onset is 55
tp 60 years old. The symptoms of Parkinson’s disease
include tremor when the affected limb is at rest,
slowness of initiation and carrying-out of movement,
rigidity of the neck, arms or legs and impairments in
walking and balance. Parkinson’s disease is a slowly
progressive disease which usually begins with symptoms
in one arm or leg and which over time progressively
worsen and lead to difficulties with independent
walking. The diagnosis of Parkinson’s disease requires
differentiation from other related neurodegenerative
disorders such as Alzheimer’s disease, “Parkinson’s
Plus,” progressive supranuclear palsy and others.

The cause of Parkinson’s disease:

PD relates to death of a population of brain cells
whose important functions include the manufacture and
release of the brain chemical messenger dopamine. The
reasons for this degeneration are unknown. Current
theories suggest that the development of Parkinson’s
disease may relate to exposure to environmental toxins
in a genetically sensitive individual.

The treatment of Parkinson’s disease:

PD treatment is presently divided into “protective”
and “symptomatic” therapies. Protective therapies are
those which hope to retard the degenerative process in
the brain. Symptomatic therapies are those which
improve the symptoms of the degenerative process
without directly affecting cell degeneration.
“Protective” therapies: There are no proven drug
treatments for the degenerative process of Parkinson’s
disease. At Rush, we have participated in research on
candidate protective drugs including selegiline,
vitamin C and lazabemide. There have been interesting
developments regarding the use of trophic factors in
PD. Trophic factors are naturally produced chemicals
which may prevent or reverse cell degeneration. Human
research on trophic factors at Rush is in the very
preliminary stages.
Symptomatic therapies: Levodopa (usually taken as the
combination drug carbidopa-levodopa—Sinemet) is the
mainstay of symptomatic therapy for Parkinson’s
disease. While it dramatically improves the symptoms
of Parkinson’s disease, chronic therapy may have its
pitfalls including unpredictability, intermittent over
medication effects and a number of side effects.
Careful adjustment of levodopa and the judicious use
of other agents in combination with levodopa can lead
to many years of good benefit.
Dopamine agonists: Dopamine agonists may be used as
the sole agent for the treatment of PD, but more often
is used in combination with levodopa. Available
dopamine agonists are bromocriptine, pergolide,
pramipexole, and ropinirole.
COMT Inhibitors: COMT inhibitors (tolcapone, Tasmar)
enhance the effectiveness of levodopa by inhibiting
the degradation of levodopa and dopamine.
Other symptomatic therapies: Other medications used in
the treatment of PD include selegiline,
trihexyphenidyl, benztropine, amantadine and others.

Current research projects in Parkinson’s disease:
Genetic study: Sibling pairs with diagnosed
Parkinson’s disease are being sought for a study of
genetic factors in PD. Study candidates will be
interviewed about their family history and both
siblings will be examined in the office and have their
blood drawn for genetic analysis.

Memory functions:: Unmedicated persons with diagnosed
Parkinson’s disease are being sought for tests of
thinking and memory. Study involvement involves a
single visit lasting up to three hours at which pencil
and paper and other tests are conducted.

Sleep disorders in PD: This study involves spending
one to two nights in a laboratory in which sleep
patterns are monitored.

New drug trials: Several trials of promising new
agents for the treatment of Parkinson’s disease are
underway or in the planning stages.

Surgical studies: Studies of implantation of
electrical stimulators into the brain to treat tremor
or slowness in Parkinson’s disease are also underway.

Transplantation surgery for Parkinson’s disease: Rush
has a long history of interest in the treatment of
Parkinson’s disease with transplantation surgery. A
small number of patients are being studied with newer
transplantation strategies.

Hallucinations: Hallucinations are a common side
effect of symptomatic Parkinson’s disease therapy.
Physicians at Rush are doing several studies
addressing the causes and treatment of hallucinations
in drug-treated Parkinson’s disease.

Brain donation in Parkinson’s disease: Brains of
persons dying with Parkinson’s disease are a very
valuable research resource. Rush maintains a brain
bank for Parkinson’s disease. Information can be
obtained by phoning Kimberly Janko, B.S.N. at (312)
942-4500.

Parkinson’s disease in women: The effects of female
hormones (estrogen) on the clinical manifestations of
Parkinson’s disease are being studied. Research
participants complete diaries about motor function and
make clinic visits at which blood samples for estrogen
and progesterone levels are obtained.

If you are interested in participating in one of these
research projects, please contact the study
coordinator at (312) 942-4500.

Best Regards,
Vicky Lynn

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