Regarding personal aspects, menopause occurs during the time in life when women are actively involved in raising a family and/or full-time work, during which time women may also be responsible for caring for elderly parents. ![]() The fluctuations during this period are more severe than those during the menstrual cycle ( 10). ![]() There are three stages of perimenopause in the executive summary of the Stages of Reproductive Aging Workshop: “early menopausal transition (early perimenopause), characterized by irregularities in the menstrual cycle, late menopausal transition (late perimenopause), characterized by an interval of more than 60 days of amenorrhea in the previous 12 months and early postmenopause, which is the first year following the last menstrual period ( 9).” Physiologically, estrogen declines sharply during this period, which occurs over several years and is characterized by marked fluctuations in sex hormone levels. Therefore, the present study will review the current state of knowledge on BPPV risk factors specific to women. Further understanding of possible contributors to the predominance of BPPV in women could make a significant contribution to our understanding of the causes of BPPV and may provide new methods for prevention. In particular, hormonal changes, external estrogens, and pregnancy exposure are only experienced by women. BPPV increases with age, especially during menopause, in a ratio of 2-3.2:1 for women and men aged 40–60 years ( 3– 8). Known as the most common cause of recurrent vertigo ( 1), benign paroxysmal positional vertigo (BPPV) is an important health problem affecting more than 420 million adults worldwide, based on an international consensus that BPPV has a lifetime prevalence of 10% ( 2). Future studies are necessary to validate the effects of hormonal replacement therapy and phytoestrogen in women with recurrent BPPV. The studies describe 2 lines of evidence regarding the association of perimenopause in women and the development of BPPV: (1) experimental evidence: the existence of estrogen receptors in the inner ear, otoconial malformations in osteopenic/osteoporotic rats, changes in otoconin 90 caused by hormone replacement therapy, and impaired calcium absorption following estrogen deprivation corrected by estrogen replacement therapy and (2) clinical evidence: epidemiological aspects, osteoporosis and estrogen deficiency. ![]() This review will discuss appropriate gender-based considerations of BPPV based on experimental and clinical evidence. Therefore, knowledge about neurochemicals and their involvement with BPPV is imperative for the management of neurological issues in women. Many investigations have found common occurrences of benign paroxysmal positional vertigo (BPPV) in women, and clinical experience has shown that BPPV can develop due to increased hormonal fluctuations, especially during menopause. Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
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