Long-term effects of a combination of isoflavones, agnus castus and magnolia extracts on climacteric symptoms and cardiometabolic risk profile in postmenopausal women

OBJECTIVE

To evaluate the long-term effects of a combination of isoflavones, agnus castus and magnolia extracts (combined isoflavone compound [CIC]) on climacteric symptoms and cardiometabolic risk in symptomatic postmenopausal women.

METHODS

This interventional, prospective study evaluated climacteric symptoms, mood and sleep disorders using the 21-item Greene Climacteric Scale (GCS) and 7-item Insomnia Severity Index (ISI) questionnaires; and cardiovascular, metabolic and thrombotic risk markers at baseline (T0) and after 12 months of CIC treatment (T1).

RESULTS

In healthy postmenopausal women (N = 71), 12-month CIC treatment significantly reduced patient-reported vasomotor symptoms (100% vs. 17%), mood disorders (67% vs. 25%) and sleep disorders (89% vs. 19%%) (all p < .001) compared with baseline; and significantly improved GCS psychological, somatic, and vasomotor domain scores and ISI sleep disturbance scores (all p < .05). CIC significantly reduced systolic (p = .022) and diastolic blood pressure (p < .001), and heart rate (p < .001); glucose concentrations (p = .018), HOMA index (p = .013), and ALT (p = .035), homocysteine (p = .005) and NT-proBNP (p = .003) levels.

CONCLUSIONS

Long-term CIC therapy improved vasomotor symptoms, mood disorders, sleep disorders, hemodynamic measurements and cardiometabolic risk markers in healthy postmenopausal women.

CLINICALTRIALS.GOV IDENTIFIER

NCT03699150.

The effect of diet and exercise on climacteric symptomatology

BACKGROUND AND OBJECTIVES

This study aimed to explore the effects of health education, diet and exercise interventions on the climacteric symptoms of perimenopausal women.

METHODS AND STUDY DESIGN

A total of 78 perimenopausal women in a gynaecological clinic from June 2018 to August 2018 were recruited and divided randomly into the following three groups: A (centralised education alone), B (health education + per-sonalised diet guidance) and C (health education + personalised diet guidance + intensive resistance exercise). The changes in diet score, exercise habits and climacteric symptoms were observed after 3 months.

RESULTS

There was no difference between groups in food intake scores and total scores before the interventions. After the interventions, the total diet score of group C was higher than in groups A and B, and the red meat score decreased significantly (p<0.05). After the interventions, the number of resistance exercises per week in group B increased significantly. The number of aerobic exercises and resistance exercises per week in group C also increased significantly (p<0.05). The total score for climacteric symptoms in the three groups decreased significantly before and after the interventions (p<0.05), and the scores for insomnia and sexual disorders in group A decreased significantly (p<0.01). In group B, there was a significant effect on the improvement of moderate and severe climacteric symptoms (p<0.01), and the scores for seven other common symptoms (i.e. hot flushes, sweating, irritability, depression, suspicion, fatigue, joint pain, muscle pain, palpitations and sexual disorders) decreased significantly (p<0.05).

CONCLUSIONS

Centralised health education, personalised dietary guidance and intensive resistance exercise improved the menopausal symptoms experienced by peri-menopausal women; the most indicative changes of this improvement were obtained using combined health education and personalised dietary guidance.

Effects of peripheral oxytocin administration on body weight, food intake, adipocytes, and biochemical parameters in peri- and postmenopausal female rats

Recent studies have revealed that the administration of oxytocin has beneficial effects on the regulation of body weight, food intake, and metabolic functions, especially in obese individuals. Obesity is common in women after the menopause and drives many components of metabolic syndrome. Weight gain in menopausal women has been frequently reported. Although obesity and associated metabolic disorders are frequently observed in peri- and postmenopausal women, there are few medical interventions for these conditions. In this study, we evaluated the effects of chronic oxytocin administration on appetite, body weight, and fat mass in peri- and postmenopausal female rats. Sixteen naturally premenopausal or menopausal rats were intraperitoneally injected with oxytocin (1,000 μg/day) for 12 days. The daily changes in their body weight and food intake were measured at the same time as the oxytocin and vehicle injections. Intraperitoneally administering oxytocin for 12 days significantly reduced food intake, body weight, and visceral adipocyte size. In addition, oxytocin administration caused reductions in serum triglyceride and low-density lipoprotein-cholesterol levels, while it did not disturb hepatic or renal functions or locomotor activity. This is the first study to show the effects of oxytocin on the metabolic and feeding functions of peri- and postmenopausal female rats. Oxytocin might be a useful treatment for metabolic disorders caused by the menopause or aging.

Validity and precision of the International Physical Activity Questionnaire for climacteric women using computational intelligence techniques

This study aimed to evaluate the validity and precision of the International Physical Activity Questionnaire (IPAQ) for climacteric women using computational intelligence techniques. The instrument was applied to 873 women aged between 40 and 65 years. Considering the proposal to regroup the set of data related to the level of physical activity of climacteric women using the IPAQ, we used 2 algorithms: Kohonen and k-means, and, to evaluate the validity of these clusters, 3 indexes were used: Silhouette, PBM and Dunn. The questionnaire was tested for validity (factor analysis) and precision (Cronbach's alpha). The Random Forests technique was used to assess the importance of the variables that make up the IPAQ. To classify these variables, we used 3 algorithms: Suport Vector Machine, Artificial Neural Network and Decision Tree. The results of the tests to evaluate the clusters suggested that what is recommended for IPAQ, when applied to climacteric women, is to categorize the results into two groups. The factor analysis resulted in three factors, with factor 1 being composed of variables 3 to 6; factor 2 for variables 7 and 8; and factor 3 for variables 1 and 2. Regarding the reliability estimate, the results of the standardized Cronbach's alpha test showed values between 0.63 to 0.85, being considered acceptable for the construction of the construct. In the test of importance of the variables that make up the instrument, the results showed that variables 1 and 8 presented a lesser degree of importance and by the analysis of Accuracy, Recall, Precision and area under the ROC curve, there was no variation when the results were analyzed with all IPAQ variables but variables 1 and 8. Through this analysis, we concluded that the IPAQ, short version, has adequate measurement properties for the investigated population.

Elevated leptin levels in healthy climacteric women from Northeastern Brazil: an effect of age or adiposity?

OBJECTIVE

Climacterium is associated with elevated leptin levels and increased risk of cardiovascular disorders. Conflicting data diverge on whether high leptin levels in climacterium reflect increasing adipose mass or, at least partially, age-related hormonal changes. This study addresses this issue in women from a Brazilian state with a low human development index.

SUBJECTS AND METHODS

A case-control study was conducted, enrolling 136 women from the state of Maranhão, 52 (38.2%) climacteric and 84 (61.8%) non-climacteric. Biometric, biochemical, hormonal and immunological parameters were analyzed.

RESULTS

Climacteric women showed a moderately increased waist/hip ratio (0.894 versus 0.834, p < 0.05), sustained body mass index (27.46 versus 28.68, p > 0.05) increased leptin levels (9.59 versus 7.13, p < 0.05) and no evidence of metabolic syndrome. No other parameters were altered. The climacteric cohort didn't show significant body fat gains but displayed a typical age-related redistribution of adipose tissue. Even so, leptin levels were significantly elevated compared with non-climacteric women.

CONCLUSIONS

Altogether, these data support the hypothesis that leptin is elevated, at least partially, as a function of age and climacterium and is not necessarily correlated with metabolic dysfunction and systemic inflammation. Further studies are needed to evaluate the impact of higher leptin levels on postmenopausal women. Arch Endocrinol Metab. 2020;64(3):276-81.

Hormonal therapy in menopausal transition: implications for improvement of health-related quality of life

The study aim was to assess scores of the Menopause Rating Scale (MRS) among women who use and desire to use hormonal therapy (HT), as well as to evaluate factors contributing to HT use and desire to use HT among women in menopausal transition. A total of 513 mid-aged women participated in the study. Data were collected using socio-demographic questionnaire, MRS and Beck Depression Inventory. The prevalence of current HT use was 9.7%, while 4.5% of women who did not use HT expressed a desire to start using HT. The MRS cutoff score for HT use was 10.5 and 11.5 among those who desire to use HT. Living in the central city districts, having lower body mass index, younger age at menopause, more gynecological illnesses, and worse MRS were associated with HT use. Living in the central city districts, having fewer births, more gynecological and chronic illnesses and having more depressive symptoms were associated with the desire to use HT. Mid-aged women who perceive their quality of life as poor due to climacteric symptoms should be advised to consider HT to improve their health status and everyday functioning.

Effect of symptoms of climacteric syndrome, depression and insomnia on self-rated work ability in peri- and post-menopausal women in non-manual employment

OBJECTIVE

The aim of the study was evaluation of the relationship between severity of symptoms of climacteric syndrome, depressive disorders and sleep problems, and the self-rated work ability of peri-menopausal and post-menopausal women in non-manual employment.

MATERIAL AND METHODS

The study included 287 women aged 45-60 years, employed in various institutions as non-manual workers. Work Ability Index, Greene Climacteric Scale, Beck Depression Inventory, and Athens Insomnia Scale were used.

RESULTS

The examined peri-menopausal and post-menopausal women in non-manual employment obtained good work ability on the Work Ability Index. The severity of menopausal syndrome, according to the Greene Climacteric Scale, was moderate, placing the examined women between results for the general population of women and the pattern for menopausal women. Depressive disorders ranked between low mood and moderate depression. No depression was observed in 59% of the women, whereas moderate depression was observed in 39%, and severe depression in only 2%. Sleep disorders were on the border of normal range. As many as 46% of the women had no sleep problems, which was on the border of normal range in 36%. Only 19% of the examined women suffered from insomnia. Work ability correlated negatively with depression and insomnia severity, as well as with psychological and vasomotor symptoms of climacteric syndrome, but not to its somatic symptoms.

CONCLUSIONS

Preventing the occurrence and treatment of menopausal symptoms, sleep and mood disorders may contribute to maintaining the work ability of women in peri- and post-menopausal age.

Metabolic syndrome and sexual function in postmenopausal women

OBJECTIVE

The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women.

SUBJECTS AND METHODS

This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participant's sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data.

RESULTS

The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01).

CONCLUSION

We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.

Abdominal adiposity change in white and black midlife women: The study of women's health across the nation

OBJECTIVE

The principal objective of this investigation was to compare the naturalistic intra-abdominal adipose tissue (IAAT) change among black and white women during midlife.

METHODS

A cohort of 222 (56%) white and 171 (44%) black midlife women were investigated in the Fat Patterning Study at the Chicago site of the Study of Women's Health Across the Nation. The subjects' total body fat was assessed by dual-energy X-ray absorptiometry and IAAT by a planimetric computed tomography (at the level of L4 -L5 ) annually over up to 4 years.

RESULTS

The total body fat at initial evaluation was higher in black women (45.1% ± 8.2%) when compared with white women (41.3% ± 8.7%, P < 0.001) and did not significantly change over the longitudinal follow-up. No significant racial differences were found in the mean annualized gain of IAAT (4.4% ± 0.5%) in models adjusted for total body fat, initial IAAT, age, race, time and race interaction, physical activity, depressive symptoms, menopausal status, and menopausal hormone therapy.

CONCLUSIONS

During a naturalistic observation, black and white midlife women had similar abdominal fat gain adjusted for differences in baseline adiposity. These data inform future research aimed to prevent IAAT gain during the critical midlife period of rising cardiovascular risk.

Is it andropause?

In primary care practice, it is not unusual to encounter male patients in their 50s or older who report having loss of libido, erectile dysfunction, fatigue, and depression. Such signs and symptoms may signal an age-related decline in androgen levels, which commonly begins after age 40. However, psychologic problems and medical illness often confound the diagnosis. Drs Tan and Pu, who are currently conducting research on androgen deficiency, discuss the diagnostic difficulties of the physiologic phenomenon of andropause and offer a comprehensive approach to clinical assessment and laboratory evaluation.

Detection of Golden apples' climacteric peak by laser biospeckle measurements

In this paper, we report a study in which a laser biospeckle technique is used to detect the climacteric peak indicating the optimal ripeness of fruits. We monitor two batches of harvested Golden apples going through the ripening phase in low- and room-temperature environments, determine speckle parameters, and measure the emitted ethylene concentration using gas chromatography as reference method. Speckle results are then correlated to the emitted ethylene concentration by a principal component analysis. From a practical point of view, this approach allows us to validate biospeckle as a noninvasive and alternative method to respiration rate and ethylene production for climacteric peak detection as a ripening index.

Potential health benefits of continuous LNG-IUS combined with parenteral ERT for seamless menopausal transition and beyond--a commentary based on clinical experience

OBJECTIVE

To comment on the acceptability and potential health benefits of the continuous use of the levonorgestrel-releasing intrauterine system (LNG-IUS), combined with estrogen substitution, for seamless transition through the menopause, in women with climacteric symptoms.

DESIGN AND METHOD

Evaluation of the recent hormone replacement therapy literature and the acceptability of the combined parenteral estrogen and intrauterine LNG-IUS regimen in a group of approximately 100 women, above 48 years of age, using LNG-IUS for contraception, who developed climacteric symptoms requiring estrogen substitution.

MAIN OUTCOME MEASURES

acceptability and continued use of the method for the treatment of climacteric symptoms and for prevention.

RESULTS

The combination of intrauterine progestogen delivery to suppress the endometrium, in combination with systemic estrogen, is highly acceptable resulting in a high continuation of use due to the absence of side effects and erratic bleeding in the large majority of women.

CONCLUSION

The study suggests that parenteral estrogen replacement therapy combined with intrauterine progestogen delivery for endometrial suppression in the perimenopause is highly practical and beneficial, providing enhanced quality of life. There are strong arguments to categorize the regimen as probably the most effective, safest and best accepted route resulting in high patient compliance as well as potentially providing maximal benefits for peri- and postmenopausal women.

The "Aging Males' Symptoms" Scale (AMS): predictive value for lowered circulating androgens

BACKGROUND

Symptoms of the "male climacteric" are often at least in part referred to an age-dependent decline of serum androgen levels. Therefore, we evaluated the relationship of climacteric symptoms as assessed by the "Aging Males' Symptoms" (AMS) Questionnaire with circulating androgen levels.

METHODS

146 ambulatory men (age, 27-85 years) were surveyed with the AMS Questionnaire and sampled for serum values of total testosterone (tT) and sexual hormone binding globulin (SHBG). Free testosterone (fT) was calculated from tT and SHBG. A total AMS score ≥37 was considered pathological; the lower limits for tT and fT were set to 8 nmol/l and 180 pmol/l, respectively.

RESULTS

A significant deficit in tT and fT was shown in 25 (17.1%) and 34 (24.5%) men, respectively; the AMS Questionnaire showed pathological results for 66 (45.2%) men. In predicting a tT deficit, the AMS Questionnaire rendered a sensitivity of 76% and a specificity of 61.6%, only. However, multiple regression analysis revealed a significant correlation of lowered tT with a pathological somatovegetative and psychological AMS subscore (p = 0.042 and p = 0.01) and a correlation of lowered fT with a pathological sexual subscore (p = 0.039).

CONCLUSION

In predicting hypogonadism the AMS Questionnaire in total did not render a sufficient diagnostic efficiency.

Reproductive depression

Reproductive depression is the depression in women that is related to the hormonal changes of the menstrual cycle, pregnancy and the menopause and is manifested clinically as premenstrual depression, postnatal depression and climacteric depression. These three components occur in the same vulnerable women in that a woman with depression in the menopausal transition will usually have a history of premenstrual syndrome (PMS; premenstrual dysphoric disorder [PMDD]), would have been in a good mood during pregnancy and then develop postnatal depression. When the periods return the depression becomes cyclical as PMS. These three conditions are effectively treated with transdermal estrogens which should be the first-choice therapy rather than antidepressants. Estrogens can be used together with antidepressants. The critical time to prevent long-term mood problems is the correct treatment of postnatal depression. In women with low energy and libido, often a side effect of antidepressants, the addition of transdermal testosterone is useful. These women with reproductive depression are often progesterone/progestogen intolerant and a smaller dose or duration of progestogen is a necessary compromise. Alternatively a Mirena IUS or rarely a hysterectomy is required.

[Climacteric complaints?]

Three women are presented with climacteric bleeding problems, typical climacteric complaints and atypical climacteric complaints. The importance of a taking a careful case history is discussed. An overview of diagnostic and therapeutic options is presented.

Use of venlafaxine in psychiatric disorders and climacteric syndrome: is a therapeutic bridge?

OBJECTIVE

To verify the efficacy of the double-action mechanism of venlafaxine for depression and climacteric symptoms.

METHODS

A group of 20 postmenopausal women (age range 40-60 years) with diagnosis of major depressive disorder, generalized anxiety disorder and climacteric symptoms was enrolled. All participants received venlafaxine (75 mg/day) for 2 months. Clinical checkup and evaluation test were repeated every 2 weeks for 2 months of treatment.

RESULTS

Before treatment, the mean scores for the clinical evaluation scales (Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale) were 13.9 and 18.7, respectively (mild-moderate severity). The general level of psychopathology was not particularly high (Symptomatology Checklist-90, mean total 103), the most common psychopathological dimensions were depression and somatization. The sample suffered from mild climacteric syndrome (Kupperman Index Score, mean = 19.1). Clinical improvement was visible after 2 weeks of treatment and continued until the last checkup, 2 months after the start of treatment (final Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores: 5.1 and 6.3, respectively). Kupperman Index Scores at the end of the treatment period demonstrated complete resolution of the climacteric syndrome (mean score = 6.57).

CONCLUSION

Venlafaxine is efficacy in treating both psychiatric disorders and climacteric symptomatology.

Relationship between estrogen, vasomotor symptoms, and heart rate variability in climacteric women

The present study investigated resting cardiac autonomic function in Japanese climacteric women using heart rate variability (HRV) power spectral analysis to evaluate the relationship between HRV indices and estrogen, as well as the ability of each HRV index to predict vasomotor symptoms. Forty-five peri- and postmenopausal women completed a questionnaire about the presence of vasomotor symptoms (hot flashes, sweating). To analyze the relationship between HRV and hot flashes or sweating, we classified subjects into groups based on symptoms and combinations of symptoms: no hot flashes (H1), hot flashes (H2), non-sweating (S1), sweating (S2), neither hot flashes nor sweating (V1), either hot flashes or sweating (V2), and both hot flashes and sweating (V3). Values for total power and the low-frequency component of HRV were significantly lower in the H2 group than in H1 (p < 0.05); values for total power and the high-frequency and low-frequency components of HRV were significantly lower in group S2 than S1 (p < 0.05); and values for total power and the high-frequency and low-frequency component of HRV were significantly lower in groups V2 and V3 compared to V1 (p < 0.05). Clinical diagnosis of climacterium relies upon subjective complaints of patients. Our findings suggest that HRV indices may help to evaluate vasomotor symptoms.

Comparative study of climacteric symptoms in perimenopausal and postmenopausal women in Tabriz, Islamic Republic of Iran

The aim of this cross-sectional study was to describe menopausal symptoms in Iranian women in Tabriz, north-west Islamic Republic of Iran. A total of 200 women aged 45-55 years completed a Farsi version of the Greene climacteric scale. The mean total Greene scores for 20 items (1 item was excluded) were 29.34 (SD 9.84) for perimenopausal and 28.14 (SD 10.15)for postmenopausal women. Perimenopausal and postmenopausal women did not differ significantly in any of the subscales or individual items, except on 2 items: "difficulty in sleeping" and "parts of the body feeling numb or tingling". Comparisons with studies in other countries show that women in Tabriz suffer more menopausal symptoms than European woman.

[Official position of the Chilean Society of Climacteric on the management of climacteric women]

The health of many women is affected in the climacteric period, either by symptoms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most efficient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed according to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

A longitudinal population study of climacteric symptoms and their treatment in a random sample of Swedish women

OBJECTIVES

To assess, first, the prevalence and severity of symptoms associated with the climacteric period and their treatment and, second, the prevalence of exercise, smoking and body weight in a population-based sample of Swedish women.

MATERIAL AND METHODS

Prospective, longitudinal cohort study, initiated in 1992, in women aged 46, 50, 54, 58 and 62 years with a follow-up 6 years later. Information was obtained from the same women (n=3816) on both occasions using a postal questionnaire regarding sociodemographic variables, general and reproductive health, the occurrence of climacteric symptoms and their severity, and the use of hormone replacement therapy (HRT).

RESULTS

The prevalences of climacteric symptoms were as follows (1992/1998): vasomotor symptoms, 52%/62%; depression/irritability, 57%/65%; sleeping disturbances, 51%/69%; muscle/joint pain, 55%/70%; and loss of libido, 38%/57%. HRT with medium-potency estrogens was currently being used by 34% (1992: 14%), and 12% (1992: 8%) were using low-potency estrogens. The maximum prevalence of HRT (medium-potency estrogens) use was found in the 56-year-old group, at 46% (1992: 25% in the 54-year-old group). Body mass for the whole group had increased from 66.3 to 68.9 kg. Exercise was more frequent in all age groups in 1998 compared to 1992. There was a decrease in current smokers from 32 to 26% between the two periods. Compared with 1992, the women in all five birth cohorts considered themselves to be less healthy and quality of life had decreased for the whole group.

CONCLUSIONS

The prevalence of symptoms associated with the climacteric period and the use of HRT had increased markedly in this longitudinal study of the same women followed between 1992 and 1998. During the same period, smoking decreased, while body weight and exercise frequency increased.