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Abstract
Method: Observational analytic with cross sectional design was done for this study. It is
conducted in Obstetrics and Gynecology Sanglah Denpasar Hospital starting from January
2016 until November 2016. This study was done to prove the difference in elastin expression
of utetusacral ligament in premenopausal and postmenopausal women. The study samples
were all 40 to 75 year old menopausal women patients, who performed a total hysterectomy
at Sanglah Hospital Denpasar. They were selected with consecutive sampling of the
affordable population who fulfilled the inclusion and exclusion criteria. After signing the
informed consent, a total hysterectomy surgery was performed to them. The tissue sample
was taken from the premenopausal and postmenopausal uterosacral ligaments along 1.5 cm
from the cervix. This sample was kept in paraffin blocks and made for immunohistochemical
preparations. Immunohistochemical examination was performed to assess the elastin
expression then analyzed and reported. Investigation of elastin expression in the Laboratory
of Veterinary Medicine of Udayana University. Test with SPSS 17 for windows version.
Result: There were 60 women under this study, 30 postmenopausal women and 30
premenopausal women. Based on the results of the analysis with t-independent test it was
found that there was a significant difference of elastin expression in premenopausal women
compared with postmenopausal women (p <0.05).
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Conclusion: Based on the results of this study, it is known that there are differences in elastin
expression in premenopausal and postmenopausal women. The difference is that elastin
expresion in postmenopausal women is lower than elastin expression in premonopausal
women. Examination of elastin expression was done at the Laboratory Pathobiology of
Veterinary Medicine of Udayana University.
INTRODUCTION
irregular cycles and anovulatory cycles. Estrogen deficiency has traditionally been an
important part of menopause1. WHO (2003), the number of women experiencing menopause
worldwide is estimated to reach 1.2 billion people. Based on population cencus in 2010,
Indonesian was in the top five countries with the most abundant elderly population as many
as 18.1 million people or 9.6% of the population. Based on the projection of Bappenas, the
elderly population age of 60 years or more is expected to increase from 18.1 million (2010)
to 29.1 million (2020) and 36 million (2025). The increasing number of elderly, will be
followed by increasing problems mainly in the health sector, one of which is the menopause.
At the age of 40 years the function of the ovaries undergoes a change in the progressive
This causes a decrease in estrogen formation in the ovaries2. For long-term disorders can be
osteoporosis, cardiovascular disease, Alzheimer's disease, stroke and pelvic organ prolapse
(POP) women. Most menopausal status characteristics are found in decreasing estradiol
levels in the uterosacral ligaments as in pelvic organ prolapse cases. This hypothesis is a
secondary cause of various factors involved, such as decreased estradiol during the
postmenopausal period. Proteins that play a role in strengthening the uterosacral ligament,
collagen and elastin. Elastin is an extracellular matrix protein that converts biochemical
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materials to lengthening and recoil of a tissue. Elastin plays a role in elastic extensibility and
recoil3. Elastin proteins alter during the menopausal to postmenopausal transition period.
Elastin proteins in the female reproductive organ go along with reproductive period in
woman life cycle. Hypoestrogen is a factor that increase postmenopausal incidence. Elastin
plays an important role in supporting pelvic organs in the genetic disorders of elastin
METHOD
Observational analytic with cross sectional design was done for this study. It is
conducted in Obstetrics and Gynecology Sanglah Denpasar Hospital starting from January
2016 until November 2016. This study was done to prove the difference in elastin expression
were all 40 to 75 year old menopausal women patients, who performed a total hysterectomy
at Sanglah Hospital Denpasar. They were selected with consecutive sampling of the
affordable population who fulfilled the inclusion and exclusion criteria. After signing the
informed consent, a total hysterectomy surgery was performed to them. The tissue sample
was taken from the premenopausal and postmenopausal uterosacral ligaments along 1.5 cm
from the cervix. This sample was kept in paraffin blocks and made for immunohistochemical
expression then analyzed and reported. Investigation of elastin expression in the Laboratory
of Veterinary Medicine of Udayana University. Test with SPSS 17 for windows version.
RESULT
In this cross-sectional study, t-independent test was done to age, parity, and BMI
variable. As shown in Table 1.1, value for parity and BMI, variable was > 0.05, respectively
suggested no difference between the two groups. While the p value for age variable was
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<0.05, suggested the significantly difference between the age of pre menopausal and
postmenopausal women.
Table 1.1
Characteristic Distibution of age parity and BMI in both group
Pre Menopausal
Postmenopausal Group
Group
Risk Factor (n=30) P
(n=30)
Mean SD Mean SD
Age (year) 55,07 9,55 42,77 6,37 0,001
Parity 2,20 1,54 2,00 1,26 0,584
BMI 23,90 3,53 24,16 2,86 0,752
T-independent test was done to determine differences in elastin expression in pre menopausal
women compared with postmenopausal. The results are presented in Table 1.2.
Tabel 1.2
Differences in Elastin Expression in Pre Menopausal Women Compared to Post
Menopausal Women
Elastin
Subject Group n Expression SB t p
Mean
Table 1.2 above showed the elastin expression in pre menopausal women compared
DISCUSSION
The study result showed mean age of postmenopausal women was 55,07 9,55 year
and mean age pre menopausal women was 42,77 6,37 year, p value = 0,001. The mean age
of postmenopausal woman was significantly different with the pre menopausal women. The
mean postmenopausal parity was 2.20 1.54 and the mean pre menopausal parity was 2.00
1.26, p = 0.584. There was no difference in parity between postmenopausal and pre
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menopausal women. The mean BMI postmenopausal women was 23.90 3.53 and mean
BMI pre menopausal woman was 24.16 2.86, p = 0.752. There was no difference in BMI
between postmenopausal and pre menopausal women. By t-independent test it was found that
with postmenopausal women (p <0.05). The elastin expression of the sacrouterinal ligament
This result could be explained that the uterosacral ligament consists of cells
proteins, Fibromodulin, Osteopontin) where fibroblasts are the most dominant connective
tissue in uterosacral ligament and play an important role in extracellular matrix synthesis
with specific changes in organs and tissues including atrophy of the labia, vagina and uterus6.
After menopause, the major secretions of the ovaries are androstenedione and testosterone.10
The circulating levels of androstenedione are about one and a half more during post-
menopausal than at menopause. Androstenedione derived from adrenal gland and only
derived from the adrenal glands, decrease with age. With loss of follicles and estrogens,
increased gonadotropin hormone triggers the ovaries secreting testosterone. Ovarian cells can
no longer produce steroid hormones when it is shrink and steroid capability decreases7.
Elastin plays a role in extensibility, tissue flexibility and elastic recoil, whereas
microfibrils composed by different proteins are stable structures and not extensible. Several
studies have shown a decrease in elastin levels in the uterosacral ligaments in pelvic organ
prolapse8. The molecular mechanism of the human elastin gene under most conditions was
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widely unknown. Elastin fibers consist of elastin rubber-like proteins formed over the
microfibril ladders. A number of elastin are required for the incorporation of elastic fibers in
order to attain a particularly stretching and circular ability. The mechanical properties of
tissue also depend on the proportion of elastin, a soluble polymer formed by a tropo-elastin
Elastin allows the tissue to stretch and return to its original form without energy input.
expansion in pregnancy and involution after childbirth. Elastin production is very unique
among buffer tissue proteins. In most organs, elastin biosynthesis is limited to a brief period
of growth. The maturation elastin fibers occurred when tropo-elastin synthesis has ceased. It
was found that LOX is very important for elastic fibers hemostasis in the tissues, including
female pelvic organs. Elastin allows the tissue to stretch and return to its original form
ligaments was decreased compared with premenopausal women. Further study is suggested to
REFERENCES
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