provide a summarization of the following paragraph(s) in bullet points Age-related decline in menopausal endocrinology signifi-cantly underlies HSDD. In addition, unhappy life events, psy-chosocial dysfunctions, depression, drugs, medical and gynecologic disorders, and natural or iatrogenic disruptions to androgen production—singly or in combination—can pre-cipitate HSDD. Situational, psychiatric, psychosocial dysfunctions. Nor-mal female sexual desire requires a safe environment, self-esteem, and an attractive and available partner. In the author's experience, HSDD occurring with a broken relation- ship or death of a partner is a common event. Drugs. Drugs associated with HSDD are listed in Table 3(24–26). Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are associated with HSDD and also probably inhibit orgasm. The effects are dose related. Commonly, SSRIs are given to depressed patients who complain of HSDD. SSRIs make the HSDD worse (24–26). Oral estrogens commonly used for menopausal replacement increase SHBG and bind circulating T and impair T effect (27). Loss of T effect can aggravate HSDD in women taking oral estrogens. Transdermal estrogens do not affect SHBG (27, 28). Glucocorticoids suppress adrenal androgen production and may therefore be associated with HSDD. Because it induces atrophy of the zona reticularis, androgen suppression can be permanent in women who have been on long-term corticoid suppression. Chronic illnesses. Decreased sexual desire can result from inadequate or ongoing treatment of chronic diseases such as diabetes, hypertension, obesity, hypopituatarism, hypothy- roidism, and breast cancer (21, 29, 30). Depletion of estrogens. In perimenopausal and postmeno- pausal women, vasomotor symptoms, insomnia, mood swings, depression, irritability, and memory lapses commonly lead to sexual aversion and lost sexual desire (1). Atrophic vaginitis, because it may cause severe dyspareunia, may ‘‘shut out the lights’’owing the discomfort and anxiety it causes (1). Depletion of androgens. Female aging is associated with decline of endogenous androgen production (9, 10). In parallel, sexual desire also declines with age (9, 10). It is logical to link these events. Decreased sexual desire has long been associated with endocrine disruptions that accelerate age-related loss (‘‘reverse adrenarche’’) of endog-enous androgen: oophorectomy, oral estrogen therapy that increases T binding, adrenal insufficiency, corticoste- roid adrenal suppression, and hypopituitarism (9, 10, 20).In reverse logic, pharmacologic androgens may induce intense sexual desire in women, even if they are chronically ill. Bilateral oophorectomy is associated with a 40%–50% drop in serum T (19). Because HSDD frequently follows bilateral oophorectomy and because several chronic dis-eases are accelerated by oophorectomy, current opinion is not to remove ovaries at the time of hysterectomy unless there is indication for their removal. In most cases, hysterectomy without oophorectomy has no effect on sexual desire. Premature ovarian failure results in loss of the mid-cycle T surge and the increase in sexual desire that occurs in association of ovulation in reproductive-age women (20). In younger women, this may not be a major complaint, because these women are still at the height of their adrenal androgen production.
provide a summarization of the following paragraph(s) in bullet points
Age-related decline in menopausal endocrinology signifi-cantly underlies HSDD. In addition, unhappy life events, psy-chosocial dysfunctions, depression, drugs, medical and gynecologic disorders, and natural or iatrogenic disruptions to androgen production—singly or in combination—can pre-cipitate HSDD. Situational, psychiatric, psychosocial dysfunctions. Nor-mal female sexual desire requires a safe environment, self-esteem, and an attractive and available partner. In the author's experience, HSDD occurring with a broken relation-
ship or death of a partner is a common event. Drugs. Drugs associated with HSDD are listed in Table 3(24–26). Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are associated with HSDD and also probably inhibit orgasm. The effects are dose related. Commonly, SSRIs are given to depressed patients who complain of HSDD. SSRIs make the HSDD worse (24–26). Oral estrogens commonly used for menopausal replacement increase SHBG and bind circulating T and impair T effect (27). Loss of T effect can aggravate HSDD in women taking oral estrogens. Transdermal estrogens do not affect SHBG (27, 28). Glucocorticoids suppress adrenal androgen production and may therefore be associated with HSDD. Because it induces atrophy of the zona reticularis, androgen suppression can be permanent in women who have been on long-term corticoid suppression.
Chronic illnesses. Decreased sexual desire can result from inadequate or ongoing treatment of chronic diseases such as diabetes, hypertension, obesity, hypopituatarism, hypothy- roidism, and breast cancer (21, 29, 30). Depletion of estrogens. In perimenopausal and postmeno- pausal women, vasomotor symptoms, insomnia, mood
swings, depression, irritability, and memory lapses commonly lead to sexual aversion and lost sexual desire (1). Atrophic vaginitis, because it may cause severe dyspareunia, may ‘‘shut out the lights’’owing the discomfort and anxiety it causes (1). Depletion of androgens. Female aging is associated with decline of endogenous androgen production (9, 10). In parallel, sexual desire also declines with age (9, 10). It is logical to link these events. Decreased sexual desire has long been associated with endocrine disruptions that accelerate age-related loss (‘‘reverse adrenarche’’) of endog-enous androgen: oophorectomy, oral estrogen therapy that increases T binding, adrenal insufficiency, corticoste- roid adrenal suppression, and hypopituitarism (9, 10, 20).In reverse logic, pharmacologic androgens may induce intense sexual desire in women, even if they are chronically ill. Bilateral oophorectomy is associated with a 40%–50% drop in serum T (19). Because HSDD frequently follows bilateral oophorectomy and because several chronic dis-eases are accelerated by oophorectomy, current opinion is not to remove ovaries at the time of hysterectomy unless there is indication for their removal. In most cases, hysterectomy without oophorectomy has no effect on sexual desire. Premature ovarian failure results in loss of the mid-cycle T surge and the increase in sexual desire that occurs in association of ovulation in reproductive-age women (20). In younger women, this may not be a major complaint, because these women are still at the height of their adrenal androgen production.
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