251
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So ES. Weight control behaviors associated with early menopause among Korean women. Women Health 2021; 61:986-996. [PMID: 34818990 DOI: 10.1080/03630242.2021.2003499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigated weight control behaviors associated with early menopause among Korean women, utilizing cross-sectional Korean National Health and Nutrition Examination Survey (KNHANES) data obtained from 2014 to 2018 to analyze 3,591 women aged 20-64 years with complete responses to questions dealing with natural menopause status and age. The data were analyzed using multivariate ordinal logistic regression. After adjusting for confounding variables affecting weight control behaviors and the timing of menopause, not having lost weight (odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.50-0.97, p = .033) and less use of reducing and controlling food for weight control (OR = 0.67, 95% CI = 0.55-0.81, p < .001) were shown to be associated with earlier menopause. In a further analysis, higher fat intake and lower monounsaturated fatty acid intake were associated with earlier menopause (OR = 1.06, 95% CI = 1.02-1.11, p = .007; OR = 0.94, 95% CI = 0.89-0.99, p = .014, respectively). This study findings are applicable in policies or interventions aiming to prevent cardiovascular risks among those with different timing of menopause and possibly delay early menopause.
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Affiliation(s)
- Eun Sun So
- College of Nursing, Jeonbuk National University, Jeonju-si, Republic of Korea
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252
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Fiacco S, Arpagaus C, Mernone L, Ehlert U. Female Intrasexual Competition and Its Link to Menopausal Stage, Sex Hormone Levels, and Personality Characteristics. Front Glob Womens Health 2021; 2:740894. [PMID: 34816245 PMCID: PMC8594036 DOI: 10.3389/fgwh.2021.740894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Female intrasexual competition (ISC) represents a unique form of social interaction. It describes behaviors primarily applied to enhance a woman's ability to outcompete other women. Previous research suggests that female ISC is influenced by personality characteristics and sex hormones. Although these factors most likely interact to predict female ISC, no previous study has investigated those factors in parallel in order to link theories from social psychology and biology. Women at the end of the reproductive lifespan represent the ideal study population, as they allow for a controlled hormonal environment. Materials and Methods: Healthy pre- (N = 53) and postmenopausal (N = 56) women were classified according to the Stages of Reproductive Aging Workshop (STRAW+10) criteria. In the follicular phase (for premenopausal women) or on a random day (for postmenopausal women), questionnaires were administered to assess the general tendency to compete intrasexually and the tendency to compete on appearance, attention/interpersonal success, and competence. Additionally, personality characteristics (neuroticism, extraversion, openness, agreeableness, conscientiousness, and self-esteem) were assessed. On the same day, each subject provided an 8 a.m. saliva sample for estradiol, testosterone, progesterone, and dehydroepiandrosterone sulfate. T-tests tested for between-group differences and separate multiple linear regression models tested for an effect of continuous hormone levels and personality characteristics on ISC. Further models were run, testing for an interaction with menopausal stage. Results: No group differences in ISC were evident (all p > 0.05). In premenopausal women, estradiol levels positively predicted the competition for attention (β = 2.103, p = 0.022). In postmenopausal women, self-esteem predicted the tendency to compete overall (β = −0.208, p < 0.001), on appearance (β = −0.061, p = 0.01), on competence (β = −0.087, p < 0.001), and on attention/interpersonal success (β = −0.060, p = 0.01). Discussion: These results, though cross-sectional, suggest that women continue to compete intrasexually in postmenopause, giving rise to new questions about the function of female ISC. If confirmed, the findings will indicate that hormones guide competitiveness in fertile women, whereas self-esteem accounts for individual differences in competitiveness post-reproduction. Particularly the function of postmenopausal ISC warrants further investigation.
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Affiliation(s)
- Serena Fiacco
- Chair of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.,Stress, Health and Reproductive Research Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carla Arpagaus
- Chair of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zurich, Switzerland
| | - Laura Mernone
- Chair of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Chair of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Zurich, Switzerland.,University Research Priority Program Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
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253
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Metabolic disorders associated with early menopause in the female population of Eastern Siberia: results of a cross-sectional study. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.5.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Menopause is an independent predictor of the development of metabolic syndrome, in the pathogenesis of which insulin resistance plays a leading role. Early menopause occurs in 5 % of women and, according to several studies, is associated with an increased risk of cardiovascular disease (CVD), which is one of the leading causes of death. The features of the course of metabolic syndrome in women with early menopause have not been sufficiently studied.The aim: to establish the prevalence of early menopause and its metabolic complications in the female population of Eastern Siberia.Materials and methods. The study population included 2695 women aged 18 to 80 years, who underwent the annual medical examination. The period of the study was March 2016 – December 2019. Among the surveyed women of 41–45 years old, a group of patients with early menopause (n = 18) and controls (n = 25) were identified. The diagnosis was made according to the STRAW criteria. The study used clinical, instrumental and laboratory research methods, including the assessment of hormonal and biochemical parameters, as well as the assessment of questionnaire data and statistical analysis.Results. The examined women with early menopause have an increase in BMI, waist volume, arterial hypertension, and an increase in the level of triglycerides and gonadotropic hormones. These changes potentially underlie the relationship between menopause and cardio-metabolic disease.Conclusion. These findings indicate the need to monitor the hormonal and metabolic parameters in this category of women to ensure timely prevention and correction of long-term complications associated with early menopause.
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Kawakita T, Yasui T, Yoshida K, Matsui S, Iwasa T. Correlations of androstenediol with reproductive hormones and cortisol according to stages during the menopausal transition in Japanese women. J Steroid Biochem Mol Biol 2021; 214:106009. [PMID: 34571175 DOI: 10.1016/j.jsbmb.2021.106009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
Associations of androstenediol, which has both androgenic and estrogenic activities, with circulating reproductive hormones and stress hormone in women during the menopausal transition may be different depending on the menopausal stage. The aim of this study was to determine the changes in circulating androstenediol during the menopausal transition in Japanese women and the associations of androstenediol with estrogen, androgen and cortisol for each stage of the menopausal transition. We divided the 104 subjects into 6 stages by menstrual regularity and follicle-stimulating hormone level: mid reproductive stage, late reproductive stage, early menopausal transition, late menopausal transition, very early postmenopause and early postmenopause. Levels of dehydroepiandrosterone sulfate (DHEAS), estradiol, estrone, testosterone (T), free T, androstenedione and cortisol were measured. Serum androstenediol concentration was measured by using liquid chromatography mass spectrometry. There were no significant differences in androstenediol levels among the 6 stages. Levels of DHEA-S and testosterone showed significant and positive correlations with androstenediol in all stages. Estradiol levels showed negative correlations with androstenediol levels in the late menopausal transition and very early postmenopause (r=-0.452, p = 0.052 and r=-0.617, p = 0.006, respectively). Cortisol levels showed significant and positive correlations with androstenediol levels in the mid and late reproductive stages (r = 0.719, p = 0.003 and r = 0.808, p < 0.001, respectively).The associations of androstenediol with estradiol and cortisol were different depending on the stage of the menopausal transition. Androstenediol may play a compensatory role for estrogen deficiency from late menopausal transition to very early postmenopause.
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Affiliation(s)
- Takako Kawakita
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan.
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan
| | - Kanako Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan
| | - Sumika Matsui
- Department of Obstetrics and Gynecology, Tokushima Red Cross Hospital, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Japan
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255
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Liu HP, Wei JCC, Yip HT, Yeh MH. Association of Insomnia, Depressive Disorders, and Mood Disorders as Risk Factors With Breast Cancer: A Nationwide Population-Based Cohort Study of 232,108 Women in Taiwan. Front Oncol 2021; 11:757626. [PMID: 34707998 PMCID: PMC8542844 DOI: 10.3389/fonc.2021.757626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Insomnia, depressive disorders, and to a more general view, mood disorders are raising people’s concerns and causing disability of life. Herein, we try to seek the association of such illnesses with subsequent breast cancer. Methods This population-based, retrospective cohort study used data from the Taiwan National Health Insurance Research Database. This study included 232,108 women diagnosed with insomnia, depressive disorders, and mood disorders from January 1, 2000 to December 31, 2013. Physician diagnosed insomnia, depressive disorders, or mood disorders using outpatient and inpatient records before diagnosis of breast cancer. Cox proportional hazards regression analysis is adjusted for women with insomnia, depressive disorders, mood disorders, and other factors like insured amount, urbanization, and comorbidities such as having subsequent breast cancer. Results Sleep medication was associated with a significantly increased incidence rate of breast cancer (aHR = 1.23 (95% CI = 1.13, 1.35), p < 0.001). Insomnia was associated with significant increased hazard of breast cancer (aHR = 1.16 (95% CI = 1.07, 1.27), p < 0.001). Annual insured amount >20,000 (TWD), high urbanization area, and hyperlipidemia were associated with increased hazard of breast cancer (aHR = 1.13 (95% CI = 1.01, 1.27), p = 0.04; aHR = 1.41 (95% CI = 1.17, 1.71), p < 0.001; aHR = 1.14 995% CI = 1.02, 1.29), p = 0.02, respectively). There was a positive correlation between depressive disorders and increased incidence rate of breast cancer but not statistically significant (aHR = 1.11 (95% CI = 0.99, 1.25), p = 0.08). Mood disorders were not associated with increased hazard (aHR = 1.11 (95% CI = 0.91, 1.34), p = 0.31). Conclusion In this study, women with insomnia had increased risk of breast cancer, particularly those in high urbanization or with high insured amounts. Sleep medication (benzodiazepine (BZD) or non-BZD) and hyperlipidemia were independently associated with a higher hazard ratio of breast cancer. Insomnia along with sleep medication did not yield more hazards than each alone. Mood disorders appeared to be not associated with subsequent breast cancer. However, depressive disorders, the subgroups of mood disorders, could possibly increase the incidence rate of breast cancer though not statistically significant.
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Affiliation(s)
- Hui-Pu Liu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, Clinical Trial Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Hsin Yeh
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
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256
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Shariful Islam M, Ola O, Alaboson J, Dadzie J, Hasan M, Islam N, Mainali S, Saif‐Ur‐Rahman KM. Trends and socioeconomic factors associated with overweight/obesity among three reproductive age groups of women in Nepal. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | | | - Joan Alaboson
- Peak Integrated Wellness Centre, Mabushi Abuja Nigeria
| | - Jeffrey Dadzie
- Jackson F. Doe Memorial Regional Referral Hospital Nimba Liberia
| | - Md. Hasan
- Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Nazmul Islam
- Department of Public Health, College of Health Sciences Qatar University Doha Qatar
| | | | - KM Saif‐Ur‐Rahman
- Health Systems and Population Studies Division, icddr,b Dhaka Bangladesh
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257
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Triebner K, Bui D, Walters EH, Abramson MJ, Bowatte G, Campbell B, Dadvand P, Erbas B, Johns DP, Leynaert B, Lodge CJ, Lowe AJ, Perret JL, Hustad S, Gómez Real F, Dharmage SC. Childhood lung function as a determinant of menopause-dependent lung function decline. Maturitas 2021; 153:41-47. [PMID: 34654527 DOI: 10.1016/j.maturitas.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/22/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE The naturally occurring age-dependent decline in lung function accelerates after menopause, likely due to the change of the endocrine balance. Although increasing evidence shows suboptimal lung health in early life can increase adult susceptibility to insults, the potential effect of poor childhood lung function on menopause-dependent lung function decline has not yet been investigated. OBJECTIVES To study whether menopause-dependent lung function decline, assessed as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), is determined by childhood lung function. METHODS The Tasmanian Longitudinal Health Study, a cohort born in 1961, underwent spirometry at age seven. At ages 45 and 50 serum samples, spirometry and questionnaire data were collected (N = 506). We measured follicle stimulating and luteinizing hormones to determine menopausal status using latent profile analysis. The menopause-dependent lung function decline was investigated using linear mixed models, adjusted for anthropometrics, occupational level, smoking, asthma, asthma medication and study year, for the whole study population and stratified by tertiles of childhood lung function. MEASUREMENTS AND MAIN RESULTS The overall menopause-dependent lung function decline was 19.3 mL/y (95%CI 2.2 to 36.3) for FVC and 9.1 mL/y (-2.8 to 21.0) for FEV1. This was most pronounced (pinteraction=0.03) among women within the lowest tertile of childhood lung function [FVC 22.2 mL/y (1.1 to 43.4); FEV1 13.9 mL/y (-1.5 to 29.4)]. CONCLUSIONS Lung function declines especially rapidly in postmenopausal women who had poor low lung function in childhood. This provides novel insights into respiratory health during reproductive aging and emphasizes the need for holistic public health strategies covering the whole lifespan.
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Affiliation(s)
- Kai Triebner
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway; Core Facility for Metabolomics, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway
| | - Dinh Bui
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Eugene Haydn Walters
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic 3004, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Brittany Campbell
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - David P Johns
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | | | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Steinar Hustad
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway; Core Facility for Metabolomics, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway; Department of Gynecology and Obstetrics, Haukeland University Hospital, Jonas Lies veg 65, 5021 Bergen, Norway
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia; School of Medicine, University of Tasmania, Hobart, Tas, 7001, Australia.
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258
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Changes in body weight and metabolic risk during time restricted feeding in premenopausal versus postmenopausal women. Exp Gerontol 2021; 154:111545. [PMID: 34478825 DOI: 10.1016/j.exger.2021.111545] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Time restricted feeding (TRF) involves confining the eating window to a specific number of hours, and fasting for the remaining hours of the day. OBJECTIVE This study examined if changes in body weight and metabolic risk factors during TRF, differ between premenopausal and postmenopausal women. METHODS This is a secondary analysis of an 8-week TRF study (4-6 h eating window, 18-20 h fasting window daily) conducted in adults with obesity. Male participants were excluded, and female subjects were classified in two groups based on menstrual status: premenopausal (n = 13), or postmenopausal (n = 19). Perimenopausal women were excluded from the original study. RESULTS Body weight decreased by week 8 in premenopausal women (-3.3 ± 0.4%) and postmenopausal women (-3.3 ± 0.5%) (main effect of time, P < 0.001), with no difference between groups (no group × time interaction). Adherence was excellent in both groups, with premenopausal women adhering to their prescribed eating window on 6.2 ± 0.1 d/week, and postmenopausal women adhering to their window on 6.2 ± 0.2 d/week. Fat mass, lean mass, fasting insulin, insulin resistance, and 8-isoprostane (marker of oxidative stress) were reduced similarly in both groups (main effect of time, P < 0.05 for all comparisons). Visceral fat mass, relative skeletal muscle index (RSMI), blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, HbA1c, TNF-alpha and IL-6 remained unchanged in both groups by week 8. CONCLUSION These findings suggest that the weight loss and metabolic benefits of TRF do not differ between premenopausal and postmenopausal women with obesity.
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259
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Women's Health in/and Work: Menopause as an Intersectional Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010793. [PMID: 34682537 PMCID: PMC8536086 DOI: 10.3390/ijerph182010793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
This paper employs an intersectional lens to explore menopausal experiences of women working in the higher education and healthcare sectors in Australia. Open-text responses from surveys across three universities and three healthcare settings were subject to a multistage qualitative data analysis. The findings explore three aspects of menopause experience that required women to contend with a constellation of aged, gendered and ableist dynamics and normative parameters of labor market participation. Reflecting on the findings, the paper articulates the challenges of menopause as issues of workplace inequality that are rendered visible through an intersectional lens. The paper holds a range of implications for how to best support women going through menopause at work. It emphasizes the need for approaches to tackle embedded and more complex modes of inequality that impact working women’s menopause, and ensure that workforce policy both protects and supports menopausal women experiencing intersectional disadvantage.
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260
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Abstract
Menopause is the permanent cessation of menstrual cycles following the loss of ovarian follicular activity. Quality of life of postmenopausal woman is the result of a series of psychobiological transformations, that see in the reduction of sex hormones and steroids the etiopathogenetic determinant moment. Symptoms of menopause range from somatic side such as metabolic changes, increased cardiovascular disease, irregular vaginal bleeding, urogenital symptoms, vaginal dryness, osteoporosis and risk of bones fractures to changes of central nervous system as vasomotor symptoms, sleep disruption, mood changes, migraine, sexual dysfunctions. It is fundamental to know the mechanisms underlying changes in the central nervous system during menopause, related to hypoestrogenism, to be able to create appropriate target therapy for patients, improving their quality of life. In fact, the central nervous system is now one of the major targets of sex steroids that cannot be achieved disregard when dealing with the problem of choice of a particular type of MHT.
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261
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Abstract
PURPOSE OF REVIEW This review considers how reproductive aging may impact the trajectory of menstrually related mood disorders (MRMDs) such as premenstrual dysphoric disorder and considers how the treatment of MRMDs might require adjustment as patients approach midlife. RECENT FINDINGS The early menopause transition is accompanied by important hormonal changes that may exacerbate existing MRMDs. Indeed, recent research confirms that an important subset of women experiences depressive mood in response to perimenopausal elevations in ovarian hormones. In addition, a subset of women with an MRMD may exhibit an increased mood sensitivity to the ovarian hormone withdrawal that accompanies the late menopause transition and early postmenopausal phase. Though additional research is needed to clarify the trajectory of premenstrual dysphoria in the menopause transition, there is reason to believe that health care providers should be vigilant for a potential worsening of symptoms in perimenopause for women with past or current premenstrual dysphoric disorder.
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Affiliation(s)
- Bethany Sander
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada.
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262
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Zandoná J, Ferreira CF, de Oliveira PG, Ferreira FV, Vasconcelos AO, Wender MCO. Early decrease in lean mass and bone mass in postmenopausal women: a cross-sectional study. Climacteric 2021; 25:96-102. [PMID: 34608839 DOI: 10.1080/13697137.2021.1978970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The effect of menopause transition in body composition was evaluated in a cross-sectional study. METHOD The study was carried out in an outpatient clinic of Brazil enrolling premenopausal (n = 64) and postmenopausal (n = 42) women aged between 44 and 52 years, with weight stability (±2 kg) for at least 6 months before evaluation. Participants answered a sociodemographic semi-structured questionnaire, the Menopause Rating Scale, the International Physical Activity Questionnaire, 24-h dietary recall and a visual analogue scale of appetite. Blood biochemical, anthropometry and densitometry measurements were used for body composition estimation. RESULTS Most participants were overweight (31.4%) or obese (45.7%) and categorized as 'high active' in physical activity (65.7%). Lean mass and bone mass decreased in the first few years of menopause. A metabolic turn to an increase of lipids was observed, represented by greater total cholesterol and high-density lipoprotein cholesterol levels. Menopause transition did not alter body fat distribution. Total body fat, android fat and gynoid fat were positively related to smoking habit, and android fat was also positively related to waist circumference. CONCLUSION Taken together, early postmenopause can be considered a time window of opportunity for preventing ailments such as atherogenic profile, obesity, increased cardiovascular risk and osteoporosis.
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Affiliation(s)
- J Zandoná
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil.,Grupo de Pesquisa: Climatério e Menopausa, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
| | - C F Ferreira
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil.,Grupo de Pesquisa: Climatério e Menopausa, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
| | - P G de Oliveira
- Grupo de Pesquisa: Climatério e Menopausa, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil.,Programa de Pós-Graduação em Medicina: Ciências Médicas (PPGCM), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
| | - F V Ferreira
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil.,Grupo de Pesquisa: Climatério e Menopausa, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
| | - A O Vasconcelos
- Departamento de Nutrição, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
| | - M C O Wender
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil.,Grupo de Pesquisa: Climatério e Menopausa, Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil.,Programa de Pós-Graduação em Medicina: Ciências Médicas (PPGCM), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brasil
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CHEN(陈超) C, AI(艾艳珂) YK, LIU(刘保延) BY, HE(何丽云) LY. Analysis on the outcomes in randomized controlled trials of perimenopausal syndrome treated with acupuncture and moxibustion. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2021. [DOI: 10.1016/j.wjam.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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264
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Kusters CDJ, Paul KC, Folle AD, Keener AM, Bronstein JM, Bertram L, Hansen J, Horvath S, Sinsheimer JS, Lill CM, Ritz BR. Increased Menopausal Age Reduces the Risk of Parkinson's Disease: A Mendelian Randomization Approach. Mov Disord 2021; 36:2264-2272. [PMID: 34426982 PMCID: PMC8530889 DOI: 10.1002/mds.28760] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies of Parkinson's disease (PD) and the association with age at menarche or menopause have reported inconsistent findings. Mendelian randomization (MR) may address measurement errors because of difficulties accurately reporting the age these life events occur. OBJECTIVE We used MR to assess the association between age at menopause and age at menarche with PD risk. METHODS We performed inverse variant-weighted (IVW) MR analysis using external genome-wide association study (GWAS) summary data from the United Kingdom biobank, and the effect estimates between genetic variants and PD among two population-based studies (Parkinson's disease in Denmark (PASIDA) study, Denmark, and Parkinson's Environment and Gene study [PEG], United States) that enrolled 1737 female and 2430 male subjects of European ancestry. We, then, replicated our findings for age at menopause using summary statistics from the PD consortium (19 773 women), followed by a meta-analysis combining all summary statistics. RESULTS For each year increase in age at menopause, the risk for PD decreased (odds ration [OR], 0.84; 95% confidence interval [CI], 0.73-0.98; P = 0.03) among women in our study, whereas there was no association among men (OR, 0.98; 95% CI, 0.85-1.11; P = 0.71). A replication using summary statistics from the PD consortium estimated an OR of 0.94 (95% CI, 0.90-0.99; P = 0.01), and we calculated a meta-analytic OR of 0.93 (95% CI, 0.89-0.98; P = 0.003). There was no indication for an association between age at menarche and PD (OR, 0.75; 95% CI, 0.44-1.29; P = 0.29). CONCLUSIONS A later age at menopause was associated with a decreased risk of PD in women, supporting the hypothesis that sex hormones or other factors related to late menopause may be neuroprotective in PD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cynthia DJ Kusters
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Aline Duarte Folle
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA,Parkinson’s Disease Research, Education, and Clinical Center, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California, USA
| | - Jeff M. Bronstein
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA,Brain Research Institute, University of California, Los Angeles, CA, USA
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, University of Lübeck, Lübeck, Germany,Department of Psychology, Centre for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
| | - Johnni Hansen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA,Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janet S. Sinsheimer
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA,Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA,Department of Computational Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M. Lill
- Translational Epidemiology Group, Lübeck Interdisciplinary Platform for Genome Analytics, University of Lübeck, Lübeck, Germany,Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom
| | - Beate R. Ritz
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA,Department of Environmental Health, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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265
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Tanbo TG, Fedorcsak PZ. Can time to menopause be predicted? Acta Obstet Gynecol Scand 2021; 100:1961-1968. [PMID: 34546564 DOI: 10.1111/aogs.14253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 01/13/2023]
Abstract
Menopause represents the definite end of a woman's reproductive life and the onset of a persistent hypoestrogenic state. This postmenopausal period will for most women last several decades. Although mean menopausal age seems to have increased somewhat during the last century, there is a significant individual variation in age at natural menopause. With efficient contraception, women of reproductive age can now, to some extent, choose when they want to have children. As a consequence of this and other sociodemographic changes, age at first birth has increased significantly over the last 50 years. It is well documented that long before a woman enters the menopausal transition and subsequent menopause, fertility declines and finally ceases. Being able to predict when a woman will enter menopause would therefore, from a reproductive perspective, be of major interest. Several sociodemographic, morphometric, and endocrine factors are associated with age at menopause or time to menopause. Unfortunately the sensitivity and specificity of these in predicting time to or age at menopause are low. Therefore, with the exception of anti-Müllerian hormone measurements, either alone or in combination with chronological age close to menopause, there are as of now no reliable ways of predicting when a woman will enter menopause.
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Affiliation(s)
- Tom G Tanbo
- Department of Reproductive Medicine, Oslo University Hospital, Oslo, Norway.,Reproductive Medicine, University of Oslo, Oslo, Norway
| | - Peter Z Fedorcsak
- Department of Reproductive Medicine, Oslo University Hospital, Oslo, Norway.,Reproductive Medicine, University of Oslo, Oslo, Norway
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266
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Cho Y, Chang Y, Jung HS, Kim CW, Oh H, Kim EY, Shin H, Wild SH, Byrne CD, Ryu S. Fatty liver disease and changes in dense breasts in pre- and postmenopausal women: the Kangbuk Samsung Health Study. Breast Cancer Res Treat 2021; 190:343-353. [PMID: 34529194 DOI: 10.1007/s10549-021-06349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE While increased breast density is a risk factor for breast cancer, the effect of fatty liver disease on breast density is unknown. We investigated whether fatty liver is a risk factor for changes in breast density over ~ 4 years of follow-up in pre- and postmenopausal women. METHODS This study included 74,781 middle-aged Korean women with mammographically determined dense breasts at baseline. Changes in dense breasts were identified by more screening mammograms during follow-up. Hepatic steatosis (HS) was measured using ultrasonography. Flexible parametric proportional hazards models were used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), and a Weibull accelerated failure time model (AFT) was used to determine the time ratios (TRs) and 95% CIs. RESULTS During a median follow-up of 4.1 years, 4022 women experienced resolution of the dense breasts. The association between HS and dense breast resolution differed by the menopause status (P for interaction < 0.001). After adjusting for body mass index and other covariates, the aHRs (95% CI) for dense breast resolution comparing HS to non-HS were 0.81 (0.70-0.93) in postmenopausal women, while the association was converse in premenopausal women with the corresponding HRs of 1.30 (1.18-1.43). As an alternative approach, the multivariable-adjusted TR (95% CI) for dense breast survival comparing HS to non-HS were 0.81 (0.75-0.87) and 1.19 (1.06-1.33) in premenopausal and postmenopausal women, respectively. CONCLUSION The association between HS and changes in dense breasts differed with the menopause status. HS increased persistent dense breast survival in postmenopausal women but decreased it in premenopausal women.
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Affiliation(s)
- Yoosun Cho
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, Republic of Korea. .,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Hyun-Suk Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan-Won Kim
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyungseok Oh
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Kim
- Department of General Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hocheol Shin
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Seungho Ryu
- Center for Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, Republic of Korea. .,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
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267
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Harrison GM, Medley NN, Carroll KN, Simms-Stewart DA, Wynter SH, Fletcher HM, Rattray CA. Mind the gap: primary care physicians and gynecologists' knowledge about menopause and their attitudes to hormone therapy use in Jamaica. Menopause 2021; 28:1385-1390. [PMID: 34469932 DOI: 10.1097/gme.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study objective was to evaluate physicians' knowledge, attitude, and practices toward menopause and hormone therapy. METHODS This study was a cross-sectional study using a stratified sample of physicians across the four health regions in Jamaica, between September and October 2017. A total of 145 physicians (75% response rate) completed a questionnaire to assess knowledge and attitudes toward menopause and prescribing hormonal therapy. Univariate and bivariate analyses were used to describe and compare the knowledge, attitudes, and practices in participants. RESULTS The majority of physicians (66%) self-reported a moderate level of knowledge of menopausal treatment options. Self-reported knowledge was associated with years in practice (P < 0.0001) and level of experience (P < 0.0001). Those who identified as having good and moderate knowledge were likely to discuss treatment options with patients (P < 0.005), while physicians with good knowledge were more likely to prescribe hormone therapy (P < 0.05). Correct responses regarding common menopause symptoms were noted in >60% physicians; however, there was a precipitous fall in correct responses regarding findings related to the Women's Health Initiative (<45%). More consultant grade physicians were confident and less confused about prescribing hormone therapy (P < 0.05) compared to junior grade physicians. When stratified by level of experience, knowledge level was the factor that discouraged physicians from seeing symptomatic menopausal patients (P < 0.05). CONCLUSIONS This study highlights the gaps in knowledge and practices and a need for carefully designed curricula to provide individualized, risk-mitigated training in menopause healthcare.
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Affiliation(s)
- Giselle M Harrison
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Natalie N Medley
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Kamali N Carroll
- Hugh Wynter Fertility Management Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Donnette A Simms-Stewart
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Shaun H Wynter
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Horace M Fletcher
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Carole A Rattray
- Department of Obstetrics and Gynecology, The University of the West Indies Mona Campus, Kingston, Jamaica
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268
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Matthews KA, Chen X, Barinas‐Mitchell E, Brooks MM, Derby CA, Harlow S, Jackson EA, Thurston RC, El Khoudary SR. Age at Menopause in Relationship to Lipid Changes and Subclinical Carotid Disease Across 20 Years: Study of Women's Health Across the Nation. J Am Heart Assoc 2021; 10:e021362. [PMID: 34482713 PMCID: PMC8649503 DOI: 10.1161/jaha.121.021362] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Younger age at final menstrual period (FMP) is associated with increased risk for cardiovascular disease events. This paper evaluated whether older age at FMP is associated with more favorable patterns of lipid changes during the menopause transition and whether these changes are associated with less subclinical carotid disease in the postmenopausal years. Methods and Results Lipids and lipoproteins were measured repeatedly among 1554 premenopausal women who had a natural menopause during follow-up years (median=18.8 years); a subset of 890 women also had measures of carotid intima media thickness, adventitial diameter, and plaque. Women who had an older FMP age had less adverse changes in cholesterol from 1 to 3 years after FMP, and in triglycerides from FMP to 3 years after FMP, but they had more adverse changes in ApoB and Apo A1 from 3 years before to 1 year after the FMP. Increasing cholesterol and ApoB from 1 to 3 years after FMP were associated with greater intima media thickness and adventitial diameter, and the greater likelihood of a plaque score >2 the older the age at FMP. Conclusions Despite the epidemiological literature showing early age at FMP is associated with elevated risk for cardiovascular disease events, older age at FMP had inconsistent associations with less adverse lipid changes in midlife, which did not translate into less risk for subclinical carotid disease and in some cases more risk. These findings are restricted to women who experience FMP in the normative age range for the menopausal transition.
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Affiliation(s)
- Karen A. Matthews
- Department of PsychiatryUniversity of PittsburghPA,Department of EpidemiologyUniversity of PittsburghPA
| | - Xirun Chen
- Department of EpidemiologyUniversity of PittsburghPA
| | | | | | - Carol A. Derby
- Departments of Neurology, and of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Sioban Harlow
- Department of EpidemiologyUniversity of MichiganAnn ArborMI
| | - Elizabeth A. Jackson
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of AlabamaBirminghamAL
| | - Rebecca C. Thurston
- Department of PsychiatryUniversity of PittsburghPA,Department of EpidemiologyUniversity of PittsburghPA
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269
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Ding N, Karvonen-Gutierrez CA, Herman WH, Calafat AM, Mukherjee B, Park SK. Perfluoroalkyl and polyfluoroalkyl substances and body size and composition trajectories in midlife women: the study of women's health across the nation 1999-2018. Int J Obes (Lond) 2021; 45:1937-1948. [PMID: 33986457 PMCID: PMC8384652 DOI: 10.1038/s41366-021-00848-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Perfluoroalkyl and polyfluoroalkyl substances (PFAS) have been suggested as obesogens but epidemiologic evidence is limited. We examined associations of serum PFAS concentrations with longitudinal trajectories of weight, waist circumference (WC), fat mass, and proportion fat in midlife women. SUBJECTS/METHODS This study included 1,381 midlife women, with a total of 15,000 repeated measures from the multi-racial/ethnic Study of Women's Health Across the Nation between 1999 and 2018. The average follow-up was 14.9 (range: 0-18.6) years. Body size (objectively measured weight and WC) and body composition from dual-energy X-ray absorptiometry were assessed at near-annual visits. Linear mixed models with piecewise linear splines were utilized to model non-linear trajectories of body size and composition. RESULTS After multivariable adjustment, PFAS concentrations were positively associated with weight, WC, fat mass, and proportion fat at baseline and during follow-up. Comparing the highest to the lowest tertiles of PFAS concentrations, adjusted geometric mean weight was 73.9 kg vs. 69.6 kg for PFOS (P < 0.0001), and 74.0 vs. 69.4 kg for linear PFOA (P < 0.0001) at baseline. Women with the highest tertile of PFOS had an annual increase rate of 0.33% (95% CI: 0.27%, 0.40%) in weight, compared to the lowest tertile with 0.10% (95% CI: 0.04%, 0.17%) (P < 0.0001). PFOS was also significantly related to higher increase rates in WC (difference = 0.12% per year, P = 0.002) and fat mass (difference = 0.25% per year, P = 0.0002). EtFOSAA and MeFOSAA showed similar effects to PFOS. Although PFHxS was not related to body size or fat at baseline, PFHxS was significantly associated with accelerated increases in weight (P < 0.0001), WC (P = 0.003), fat mass (P < 0.0001), and proportion fat (P = 0.0009). No significant results were found for PFNA. CONCLUSIONS Certain PFAS were positively associated with greater body size and body fat, and higher rates of change over time. PFAS may be an underappreciated contributing factor to obesity risk.
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Affiliation(s)
- Ning Ding
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - William H. Herman
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA,Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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270
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Abstract
Women with cystic fibrosis (CF) face several unaddressed concerns related to their health. These areas of concern include explanations and guidance on a sex disparity in outcomes, timing of puberty, effects of contraception, prevalence of infertility and impact of pregnancy, and prevention of urinary incontinence and osteoporosis. These understudied topics leave women with numerous unanswered questions about how to manage sexual and reproductive health in the setting of CF. Because people with CF are living longer and healthier lives, there is an increasing awareness of these important aspects of care and multiple ongoing studies to address these understudied topics.
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271
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Zhang J, Wang X, Ren Z, Shao S, Hou Z, Wang Z, Xi J, Bai W. Impact of age and menopausal stage on serum anti-Müllerian hormone levels in middle-aged women. Climacteric 2021; 24:618-623. [PMID: 34427163 DOI: 10.1080/13697137.2021.1965114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between age, menopausal stage and serum anti-Müllerian hormone (AMH) levels in middle-aged women. METHODS In this cross-sectional study, the serum AMH levels of 288 healthy women aged 40-55 years (divided into age groups: 40-44, 45-49 and 50-55 years) were evaluated. Stages of Reproductive Aging Workshop + 10 criteria were used to categorize these women into menopausal stages: late reproductive, menopausal transition and early postmenopausal stages. The impact of age, menopausal stage and hormone replacement therapy on serum AMH levels was analyzed using multi-factor analysis of variance. Effects of body mass index, smoking status and oral contraceptive use were simultaneously considered. RESULTS The median AMH level was 0.140 ng/ml. Log-AMH levels varied according to age group (variance = 20.113, F = 88.538, p < 0.001) and menopausal stage (variance = 5.543, F = 24.501, p < 0.001). An exponential model defined as AMH = 227,421.757 × e(-0.301 × age) was fit to describe the decline in AMH level with age. The 5th-95th percentiles of the AMH levels ranged from less than 0.020 to 3.150, less than 0.020 to 1.944 and less than 0.020 to 0.030 ng/ml in the aforementioned menopausal stages, respectively. CONCLUSION Age and menopausal stage were associated with AMH levels; age had a greater impact on AMH than menopausal stage in middle-aged women.
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Affiliation(s)
- J Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Department of Obstetrics and Gynecology, Ninth School of Clinical Medicine, Peking University, Beijing, China
| | - Z Ren
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - S Shao
- Medical Examination Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Z Hou
- Department of Obstetrics and Gynecology, Beijing Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Z Wang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - J Xi
- Department of Obstetrics and Gynecology, Beijing Xicheng Maternal and Child Health Hospital, Beijing, China
| | - W Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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272
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Kim H, Lee CW, Nam MJ, Choi YJ, Han K, Jung JH, Kim DH, Park JH. Association between body composite indices and vertebral fractures in pre and postmenopausal women in Korea. PLoS One 2021; 16:e0254755. [PMID: 34347809 PMCID: PMC8336842 DOI: 10.1371/journal.pone.0254755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
The association between obesity and vertebral fracture remains controversial. This study aimed to investigate the association between obesity/abdominal obesity and vertebral fracture according to menopausal status. This nationwide population-based epidemiologic study collected data from the Korean National Health Insurance Services to investigate the association between obesity/abdominal obesity and vertebral fracture in pre and postmenopausal women who underwent national cancer screening in 2009. We used three body composite indices of obesity, body mass index, waist circumference and waist-to-height ratio, to classify participants into obesity and abdominal obesity groups. In both pre and postmenopausal groups, participants with obesity showed a higher risk of vertebral fracture and the association was stronger in those with abdominal obesity (p < 0.001). Participants with obesity showed a high risk of vertebral fracture, and the association was stronger in participants with abdominal obesity (p < 0.001). In both pre and postmenopausal groups, participants with obesity showed a higher risk of vertebral fracture (adjusted HR, 1.24; 95% CI, 1.19–1.30), (adjusted HR, 1.04; 95% CI, 1.03–1.05, and those with abdominal obesity showed even higher risk of vertebral fractures (adjusted HR, 1.35; 95% CI, 1.27–1.43), (adjusted HR, 1.13; 95% CI, 1.11–1.14). Vertebral fracture risk is higher in pre and postmenopausal women with obesity and even higher in those with abdominal obesity. Therefore, weight management can prevent vertebral fractures.
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Affiliation(s)
- HyunJin Kim
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan-si, Republic of Korea
| | - Chung-woo Lee
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan-si, Republic of Korea
| | - Myung Ji Nam
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan-si, Republic of Korea
| | - Yeon Joo Choi
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan-si, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan-si, Republic of Korea
- * E-mail: (DHK); (JHP)
| | - Joo-Hyun Park
- Department of Family Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan-si, Republic of Korea
- * E-mail: (DHK); (JHP)
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273
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Metcalf CA, Johnson RL, Freeman EW, Sammel MD, Epperson CN. Influences of the menopause transition and adverse childhood experiences on peripheral basal inflammatory markers. Brain Behav Immun Health 2021; 15:100280. [PMID: 34589780 PMCID: PMC8474428 DOI: 10.1016/j.bbih.2021.100280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To characterize the influence of early life stress on peripheral basal inflammatory markers across the menopause transition. METHODS Participants from the longitudinal Penn Ovarian Aging study were assessed for childhood adversity at study end (14 years) using the Adverse Childhood Experiences (ACE) questionnaire. Responses were categorized as low (0-1) or high (≥2) ACE exposure. The stored blood sample catalogue was reviewed to exclude those samples collected during use of medications that could impact immune status or medications suggestive of infection or allergies. Remaining blood samples (n = 640) from 167 participants were assayed for interleukin-6 (IL-6), interleukin 1-beta (IL-1β), high sensitivity C-reactive protein (hsCRP), and tumor necrosis factor alpha (TNF-α). Menopause staging (premenopause, early transition, late transition, and postmenopause) was determined by questionnaire and menstrual diaries at yearly assessments. Generalized linear models for repeated measures were used to quantify the association between outcomes of interest (i.e., IL-6, IL-1β, hsCRP, and TNF-α) and exposures (i.e., menopause stage, ACE status, their interaction) while controlling for relevant covariates (i.e., BMI, smoking, age at first blood sample, and race). Inflammatory marker levels were log-transformed for modeling. RESULTS Log IL-6 levels were higher in the late perimenopause versus premenopause (p = 0.035). Menopause stage × ACE interaction was observed for log IL-6, IL-1β, and TNF-α (p = 0.042, p = 0.054, p = 0.053, respectively); for individuals with high (≥2) ACE exposure, IL-6 was higher in the late perimenopause (p = 0.015) while IL-1β and TNF-α were lower in the postmenopause versus premenopause (p = 0.019 and p = 0.020). CONCLUSIONS Results from this investigation indicate that the late perimenopause stage may be a window of risk for inflammation, particularly for individuals with greater childhood adversity. Prospective studies designed to address childhood stress and inflammation across the menopause transition are needed to confirm these findings. Heightened inflammation, even if transitory, may have negative impact on healthy aging.
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274
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Urteaga I, Li K, Shea A, Vitzthum VJ, Wiggins CH, Elhadad N. A Generative Modeling Approach to Calibrated Predictions: A Use Case on Menstrual Cycle Length Prediction. PROCEEDINGS OF MACHINE LEARNING RESEARCH 2021; 149:535-566. [PMID: 35072087 PMCID: PMC8782440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We explore how to quantify uncertainty when designing predictive models for healthcare to provide well-calibrated results. Uncertainty quantification and calibration are critical in medicine, as one must not only accommodate the variability of the underlying physiology, but adjust to the uncertain data collection and reporting process. This occurs not only on the context of electronic health records (i.e., the clinical documentation process), but on mobile health as well (i.e., user specific self-tracking patterns must be accounted for). In this work, we show that accurate uncertainty estimation is directly relevant to an important health application: the prediction of menstrual cycle length, based on self-tracked information. We take advantage of a flexible generative model that accommodates under-dispersed distributions via two degrees of freedom to fit the mean and variance of the observed cycle lengths. From a machine learning perspective, our work showcases how flexible generative models can not only provide state-of-the art predictive accuracy, but enable well-calibrated predictions. From a healthcare perspective, we demonstrate that with flexible generative models, not only can we accommodate the idiosyncrasies of mobile health data, but we can also adjust the predictive uncertainty to per-user cycle length patterns. We evaluate the proposed model in real-world cycle length data collected by one of the most popular menstrual trackers worldwide, and demonstrate how the proposed generative model provides accurate and well-calibrated cycle length predictions. Providing meaningful, less uncertain cycle length predictions is beneficial for menstrual health researchers, mobile health users and developers, as it may help design more usable mobile health solutions.
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Affiliation(s)
- Iñigo Urteaga
- Department of Applied Physics and Applied Mathematics, Data Science Institute Columbia University, New York, NY, USA
| | - Kathy Li
- Department of Applied Physics and Applied Mathematics, Data Science Institute Columbia University, New York, NY, USA
| | - Amanda Shea
- Clue by BioWink, Adalbertstraße 7-8, 10999 Berlin, Germany
| | - Virginia J Vitzthum
- Kinsey Institute & Department of Anthropology Indiana University, Bloomington, IN, USA
| | - Chris H Wiggins
- Department of Applied Physics and Applied Mathematics, Data Science Institute Columbia University, New York, NY, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Data Science Institute Columbia University, New York, NY, USA
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275
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Depression and obesity, but not mild obstructive sleep apnea, are associated factors for female sexual dysfunction. Sleep Breath 2021; 26:697-705. [PMID: 34318402 DOI: 10.1007/s11325-021-02433-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/07/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Mild obstructive sleep apnea (OSA) is more prevalent than moderate and severe OSA and is more frequent in men than women. The association between OSA and female sexual dysfunction (FSD) is still poorly explored in published studies. Our aim was to investigate the prevalence of FSD in women with mild OSA and assess the impact of OSA on FSD, as well as to determine the predictors for FSD risk. METHODS The sample comprised 70 women aged 26-65 years: a control group (N = 28) with no sleep complaints, and a group with mild OSA (an apnea-hypopnea index of 5 or more and less than 15 events/hour, N = 42), who had been diagnosed using polysomnography performed in the sleep laboratory of a sleep research institute. All participants volunteered to take part in the study and completed the female sexual function index (FSFI), the Beck depression index (BDI), the Kupperman menopausal index (KMI), and the Epworth sleepiness scale (ESS). Their socioeconomic group was assessed using the Brazilian Economic Classification Criterion. Polysomnography and serum levels of free testosterone and total testosterone were analyzed. RESULTS We found low FSFI scores (< 26.55) in the mild OSA (18.1) and control (21.7) groups (p = 0.97). There was no statistically significant difference between the mild OSA group and the control group. However, a higher BMI (p = 0.04), a higher BDI (p = 0.02), and being sexuality inactive (p = 0.001) were risk factors for FSD. CONCLUSION There was a high prevalence of FSD in the entire sample. The presence of mild OSA did not affect sexual function in this sample. Depressive symptoms and a high BMI were associated risk factors for FSD. Being sexually active may protect female sexual function.
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276
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Luckey AM, Robertson IH, Lawlor B, Mohan A, Vanneste S. Sex Differences in Locus Coeruleus: A Heuristic Approach That May Explain the Increased Risk of Alzheimer's Disease in Females. J Alzheimers Dis 2021; 83:505-522. [PMID: 34334399 DOI: 10.3233/jad-210404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article aims to reevaluate our approach to female vulnerability to Alzheimer's disease (AD) and put forth a new hypothesis considering how sex differences in the locus coeruleus-noradrenaline (LC-NA) structure and function could account for why females are more likely to develop AD. We specifically focus our attention on locus coeruleus (LC) morphology, the paucity of estrogens, neuroinflammation, blood-brain barrier permeability, apolipoprotein ɛ4 polymorphism (APOEɛ4), and cognitive reserve. The role of the LC-NA system and sex differences are two of the most rapidly emerging topics in AD research. Current literature either investigates the LC due to it being one of the first brain areas to develop AD pathology or acknowledges the neuroprotective effects of estrogens and how the loss of these female hormones have the capacity to contribute to the sex differences seen in AD; however, existing research has neglected to concurrently examine these two rationales and therefore leaving our hypothesis undetermined. Collectively, this article should assist in alleviating current challenges surrounding female AD by providing thought-provoking connections into the interrelationship between the disruption of the female LC-NA system, the decline of estrogens, and AD vulnerability. It is therefore likely that treatment for this heterogeneous disease may need to be distinctly developed for females and males separately, and may require a precision medicine approach.
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Affiliation(s)
- Alison M Luckey
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Ian H Robertson
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Anusha Mohan
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sven Vanneste
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland
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277
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Coslov N, Richardson MK, Woods NF. Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Menopause 2021; 28:1012-1025. [PMID: 34313615 PMCID: PMC8549458 DOI: 10.1097/gme.0000000000001805] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the occurrence of a variety of symptoms, their frequency, bother, burden, and interference in the lives of women in the late reproductive stage (LRS) and compare their experiences to that of women in the menopausal transition (MT) stage. METHODS Women ages 35 to 55 years responded to an 82-question online survey offered by Women Living Better. Participants reported current menstrual patterns, recent changes and symptom frequency, bother, and interference. Women's cycles were classified as LRS or MT using Stages of Reproductive Aging Workshop +10 criteria. RESULTS Of 2,406 respondents, 946 met criteria for LRS and 583 for MT. Participants included 30% from outside the United States, 31% from diverse racial/ethnic groups, and 18% reported having difficulty paying for basics. A similar proportion of women in the LRS and MT+ groups reported each of the symptoms: there was a less than 10% difference for 54 of the 61 symptoms. Of mean bother ratings for all symptoms, only hot flashes differed significantly between the LRS and MT groups. LRS women experienced similar levels of symptom-related interference with personal relationships and daily living to those in the MT stage but did not anticipate these symptoms occurring until they were 50 years old. CONCLUSIONS Women in the LRS experience symptoms strikingly similar to those often associated with the MT. Women do not expect these changes until the age of 50 years or later and are surprised by such symptoms before cycle irregularity. Research about the epidemiology and management of LRS symptoms, anticipatory guidance for women, and education for clinicians who care for them warrant increased attention.
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Affiliation(s)
| | | | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
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278
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Khani S, Azizi M, Elyasi F, Kamali M, Moosazadeh M. The Prevalence of Sexual Dysfunction in the Different Menopausal Stages: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:439-472. [PMID: 38595744 PMCID: PMC10903585 DOI: 10.1080/19317611.2021.1926039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 04/11/2024]
Abstract
Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause. Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3-78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods.
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Affiliation(s)
- Soghra Khani
- Sexual and Reproductive Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marzieh Azizi
- Sexual and Reproductive Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Department of Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahsa Kamali
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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279
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Maki PM, Weber MT. A research primer for studies of cognitive changes across the menopause transition. Climacteric 2021; 24:382-388. [PMID: 34240671 DOI: 10.1080/13697137.2021.1905625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There has been a proliferation of studies demonstrating important sex differences in cognitive aging and dementia, and with this an increased interest in the role of menopause and sex steroid hormones in women's brain health. Foundational longitudinal studies of cognitive changes from the premenopause to perimenopause stage have shown reliable declines in verbal memory, with variable findings in processing speed, attention/working memory and verbal fluency. Continued research is needed to advance understanding of the range of cognitive domains affected, the duration of cognitive changes, the generalizability of these changes across cultures, the factors that account for such changes and the factors that can improve cognition at this time. In this article, we briefly review and draw on findings from large longitudinal studies of cognitive changes across the menopause transition to inform the design of future studies on this topic. We focus on key issues such as objective versus subjective cognitive measures; cognitive domains and tests; staging menopause; study design; mediators of cognitive effects (including hormones and menopause symptoms); and consideration of key covariates. We suggest that a more uniform and evidence-based approach to the investigation of these issues can advance the quality of the science in menopause and cognition.
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Affiliation(s)
- P M Maki
- Department of Psychiatry, Psychology and OB/GYN, University of Illinois College of Medicine, Chicago, IL, USA
| | - M T Weber
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
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280
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Kim C. Management of Cardiovascular Risk in Perimenopausal Women with Diabetes. Diabetes Metab J 2021; 45:492-501. [PMID: 34352986 PMCID: PMC8369221 DOI: 10.4093/dmj.2020.0262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/10/2021] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease is the primary cause of mortality in women and men with diabetes. Due to age and worsening of risk factors over the menopausal transition, risk of coronary heart disease events increases in postmenopausal women with diabetes. Randomized studies have conflicted regarding the beneficial impact of estrogen therapy upon intermediate cardiovascular disease markers and events. Therefore, estrogen therapy is not currently recommended for indications other than symptom management. However, for women at low risk of adverse events, estrogen therapy can be used to minimize menopausal symptoms. The risk of adverse events can be estimated using risk engines for the calculation of cardiovascular risk and breast cancer risk in conjunction with screening tools such as mammography. Use of estrogen therapy, statins, and anti-platelet agents can be guided by such calculators particularly for younger women with diabetes. Risk management remains focused upon lifestyle behaviors and achieving optimal levels of cardiovascular risk factors, including lipids, glucose, and blood pressure. Use of pharmacologic therapies to address these risk factors, particularly specific hypoglycemic agents, may provide some additional benefit for risk prevention. The minimal benefit for women with limited life expectancy and risk of complications with intensive therapy should also be considered.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, Ann Arbor, MI, USA
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281
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Huang W, Jiang S, Geng L, Li C, Tao M. Correlation between menopausal symptoms and everyday cognition in Chinese (peri)menopausal women. Gynecol Endocrinol 2021; 37:655-659. [PMID: 33645380 DOI: 10.1080/09513590.2021.1892629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between the severity of menopausal symptoms and everyday cognitive decline in Chinese peri and postmenopausal women. METHODS The peri and postmenopausal Chinese Han female who first visited the menopausal clinic of Shanghai Jiao Tong University Affiliated Sixth People's Hospital was selected as the study participants. The general questionnaire was used to obtain the sociodemographic characteristics of the study participants. The menopausal rating scale (MRS) was used to assess the severity of menopausal symptoms. The short version of the Everyday Cognition (ECog-12) scales was used to assess everyday cognitive performance. RESULTS A total of 295 women were included, with an average age of 51.12 ± 5.15 years. The average ECog scores were 1.51 ± 0.49 and the average MRS scores were 6.89 ± 4.77. In multiple linear regression analysis, after adjusting for confounding factors age, body mass index (BMI), monthly income, occupational status, education level, menopausal status, parity, regular exercise, and history of chronic diseases, complaints of anxiety and physical/mental fatigue were positively correlated with everyday cognitive decline. CONCLUSIONS Menopausal anxiety and physical/mental fatigue were the independent predictors of everyday cognition.
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Affiliation(s)
- Wenjun Huang
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Susu Jiang
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Lulu Geng
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Changbin Li
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Minfang Tao
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
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282
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Jansen EC, Stern D, Monge A, O'Brien LM, Lajous M, Peterson KE, López-Ridaura R. Healthier dietary patterns are associated with better sleep quality among midlife Mexican women. J Clin Sleep Med 2021; 16:1321-1330. [PMID: 32329434 DOI: 10.5664/jcsm.8506] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVES To evaluate whether dietary patterns are associated with sleep quality in Mexican midlife women. METHODS The study population included 4,467 Mexican women from a longitudinal study of teachers. In 2008, a semiquantitative food frequency questionnaire was administered. Principal components analysis identified 3 dietary patterns: Fruits and Vegetables, Western (meat and processed), and Modern Mexican (tortillas and soda, low in fiber and dairy). Starting in 2012, follow-up questionnaires included the Pittsburgh Sleep Quality Index, which yields a score ranging from 0 to 21 (higher scores = worse quality). Modified Poisson regression analyses examining the association between dietary patterns (categorized into quartiles) and poor sleep quality (score > 5) were conducted, adjusting for socio-demographic and lifestyle confounders and baseline comorbid conditions. RESULTS Women were 41.0 ± 7.1 years at baseline, with an average follow-up of 5.5 ± 0.7 years. In fully adjusted models, women in the least-healthy quartile of the Fruits and Vegetables pattern compared with the most were 21% more likely to have poor quality sleep at follow-up (95% confidence interval 1.06, 1.42), while those in the highest quartiles of the Modern Mexican pattern were 23% more likely to have poor quality sleep compared with the lowest quartiles (95% confidence interval 1.06 to 1.43, respectively). CONCLUSIONS A fruit and vegetable-based dietary pattern was associated with higher sleep quality, while an unhealthier diet pattern was associated with worse sleep quality in midlife women.
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Affiliation(s)
- Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.,Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Dalia Stern
- CONACyT-Center for Research on Population Health, National Institute of Public Health, Cuernevaca, Morelos, Mexico
| | - Adriana Monge
- Center for Research on Population Health, National Institute of Public Health, Cuernevaca, Morelos, Mexico
| | - Louise M O'Brien
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Cuernevaca, Morelos, Mexico.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ruy López-Ridaura
- National Center of Disease Control and Prevention, Ministry of Health, Mexico City, Mexico
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283
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Jakubowski KP, Barinas-Mitchell E, Chang YF, Maki PM, Matthews KA, Thurston RC. The Cardiovascular Cost of Silence: Relationships Between Self-silencing and Carotid Atherosclerosis in Midlife Women. Ann Behav Med 2021; 56:282-290. [PMID: 34124743 DOI: 10.1093/abm/kaab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals engage in a range of behaviors to maintain close relationships. One behavior is self-silencing or inhibiting self-expression to avoid relationship conflict or loss. Self-silencing is related to poor mental health and self-reported physical health in women but has not been examined in relation to cardiovascular health, particularly using direct measures of the vasculature. PURPOSE To test associations between self-silencing and carotid atherosclerosis in midlife women; secondary analyses examined moderation by race/ethnicity. METHODS Women (N = 290, ages 40-60) reported on self-silencing in intimate relationships and underwent physical measurements, blood draw, and ultrasound assessment of carotid intima-media thickness (IMT) and plaque. Associations between self-silencing and mean IMT and plaque index (0, 1, ≥2) were tested in linear regression and multinomial logistic regression models, respectively, followed by interaction terms between self-silencing and race, adjusted for demographic factors, CVD risk factors, partner status, depression, physical activity, and diet. RESULTS Forty-seven percent of women demonstrated carotid plaque. Greater self-silencing was related to increased odds of plaque index ≥2 (e.g., for each additional point, odds ratio [95% confidence interval] = 1.16 [1.03-1.31], p = .012), relative to no plaque). Moderation analyses indicated that self-silencing was related to odds of plaque index ≥2 in non-white women (1.15 [1.05-1.26], p = .004), but there was no significant relationship in white women (1.01 [0.97-1.06], p = .550). No associations emerged for IMT. CONCLUSIONS Among midlife women, self-silencing was associated with carotid plaque, independent of CVD risk factors, depression, and health behaviors. Emotional expression in relationships may be important for women's cardiovascular health.
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Affiliation(s)
| | | | - Yue-Fang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pauline M Maki
- Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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284
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Matthews KA, Lee L, Kravitz HM, Joffe H, Neal-Perry G, Swanson LM, Evans MA, Hall MH. Influence of the menopausal transition on polysomnographic sleep characteristics: a longitudinal analysis. Sleep 2021; 44:6291662. [PMID: 34081126 PMCID: PMC8598193 DOI: 10.1093/sleep/zsab139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/08/2021] [Indexed: 01/28/2023] Open
Abstract
STUDY OBJECTIVES To evaluate how change in menopausal status related to spectral analysis and polysomnographic measures of sleep characteristics. METHODS The Study of Women's Health Across the Nation (SWAN) Ancillary Sleep Study evaluated sleep characteristics of 159 women who were initially pre- or early perimenopausal and repeated the assessment about 3½ years later when 38 were pre- or early perimenopausal, 31 late perimenopausal, and 90 postmenopausal. Participants underwent in-home ambulatory polysomnography for two to three nights. Average EEG power in the delta and beta frequency bands was calculated during NREM and REM sleep, and sleep duration, wake after sleep onset (WASO), and apnea hypopnea index (AHI) were based on visually-scored sleep. RESULTS The women who transitioned to postmenopause had increased beta NREM EEG power at the second assessment, compared to women who remained pre-or early premenopausal; no other sleep measures varied by change in menopausal status. In multivariate models the associations remained; statistical controls for self-reported hot flashes did not explain findings. In secondary analysis, NREM beta power at the second assessment was greater among women who transitioned into the postmenopause after adjustments for initial NREM beta power. CONCLUSIONS Sleep duration and WASO did not vary by menopause transition group across assessments. Consistent with prior cross-sectional analysis, elevated beta EEG power in NREM sleep was apparent among women who transitioned to postmenopause, suggesting that independent of self-reported hot flashes, the menopausal transition is associated with physiological hyperarousal during sleep.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA,Corresponding author. Karen A. Matthews, 3811 O’Hara St, Pittsburgh, PA 15213.
| | - Laisze Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Hadine Joffe
- Connors Center for Women’s Health and Gender Biology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marissa A Evans
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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285
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Reeves AN, Elliott MR, Brooks MM, Karvonen-Gutierrez CA, Bondarenko I, Hood MM, Harlow SD. Symptom clusters predict risk of metabolic-syndrome and diabetes in midlife: the Study of Women's Health Across the Nation. Ann Epidemiol 2021; 58:48-55. [PMID: 33631313 PMCID: PMC8165007 DOI: 10.1016/j.annepidem.2021.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Women's cardio-metabolic risk increases in midlife. Previous work relating menopause symptoms to diabetes/Metabolic Syndrome (MetS) does not consider the adverse impact of multiple concurrent physical and psychological symptoms in midlife. METHODS Data are from 3097 participants in the Study of Women's Health Across the Nation, a cohort of midlife women followed for over 20 years. Baseline latent symptom classes (LSC) were derived from 58 questions assessing physical, psychological and menopausal symptoms. Six identified LSCs ranged from 1 (most symptoms present at high severity) to 6 (few symptoms present at low severity). Accelerated failure time models estimated time to onset of type 2 diabetes and MetS for each LSC. RESULTS Women with multiple high/moderate severity symptoms had an earlier onset of diabetes (13.2%, 14.1% and 20.8% earlier onset in LSCs 1, 2, 3, respectively) and MetS (15.5%, 13.0% and 19.7% earlier onset in LSCs 1, 2, 3, respectively) than women with few/low severity symptoms. CONCLUSIONS Having multiple concurrent moderate to high intensity physical and psychological symptoms in midlife are associated with early onset of diabetes and MetS. Monitoring and subsequent intervention on a broad range of symptoms in midlife may significantly mitigate cardio-metabolic risk during this critical life stage.
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Affiliation(s)
- Alexis N Reeves
- Epidemiologic Science, School of Public Health, University of Michigan, Ann Arbor, MI.
| | - Michael R Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | - Irina Bondarenko
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Michelle M Hood
- Epidemiologic Science, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Siobán D Harlow
- Epidemiologic Science, School of Public Health, University of Michigan, Ann Arbor, MI; Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Kim GU, Son HK, Kim MY. Factors affecting suicidal ideation among premenopausal and postmenopausal women. J Psychiatr Ment Health Nurs 2021; 28:356-369. [PMID: 32738174 DOI: 10.1111/jpm.12679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Pre- and postmenopausal women (PPW) experience changes in physical, psychological and social health. South-East Asia's female suicide rate is the highest compared with other countries, and the suicide rate of PPW in these countries continues to increase. The most influential factor in Asian women's suicidal ideation is family conflict; specifically, if PPW in South Korea cannot express their anger, it results in a culture-bound syndrome called "Hwa-Byung." However, there is a lack of research on Asian PPW. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study found differences in individual- and community-level factors affecting suicidal ideation between pre- and postmenopausal women. Individual factors that commonly affected suicidal ideation were experiencing violence, stress and depression. Individual factors that affected the suicidal ideation of premenopausal women more than postmenopausal women were religious beliefs, alcohol use and chronic disease. Community level factors affecting suicidal ideation were locational depression and locational counselling for stress in premenopausal women and locational counselling for depression in postmenopausal women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses could help prevent suicide by developing and applying community-based programmes for PPW, considering the specific socio-economic and cultural context and characteristics of Asian women. Mental health nurses could help PPW participate in programmes by preparing various interventions such as case management, personal counselling, physical activity, home-based mental health services, cognitive behavioural therapy and digital interventions for self-management. Mental health nurses need to prepare various methods such as online, offline, individual and group methods to work effectively in any social situation. ABSTRACT: Introduction Pre- and postmenopausal women (PPW) experience physical and psychological changes with hormonal changes. Among Asian middle-aged women, family and culture affect suicidal ideation, and the suicide rate among this population is increasing. There are few existing research on suicidal ideation among Asian PPW. Aim We examined individual- and community-level factors that predict suicidal ideation among PPW. Method Large-scale panel data from 5,154 South Korean PPW aged 35-64 years were used in a series of multilevel logistic regression analyses to examine factors associated with suicidal ideation at individual and community levels. Results Among premenopausal women, religious beliefs, alcohol use, chronic disease, experience of violence, stress and depression were individual-level factors. Locational depression and locational counselling for stress were community-level factors. Among postmenopausal women, experience of violence, stress, depression and perceived health status were individual level factors, and locational counselling for depression was a community level factor. Discussion Suicidal ideation among PPW is affected by both individual and community level factors. Nurses must comprehensively determine what risk factors affect suicidal ideation through various intervention methods-including online, offline, individual and group methods-while considering socio-economic situations. Implications for Practice Mental health nurses should provide targeted biopsychosocial interventions targeting psychosocial and physical problems and promoting the use of community resources to reduce PPW's suicidal ideation.
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Affiliation(s)
- Go-Un Kim
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Hae Kyoung Son
- College of Nursing, Eulji University, Gyeonggi-do, South Korea
| | - Mi-Young Kim
- College of Nursing, Woosuk University, Jeollabuk-do, South Korea
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Yang PL, Heitkemper MM, Kamp KJ. Irritable bowel syndrome in midlife women: a narrative review. Womens Midlife Health 2021; 7:4. [PMID: 34059117 PMCID: PMC8166071 DOI: 10.1186/s40695-021-00064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
Midlife women between the ages of 40 and 65 years have reported multiple challenges due to menopausal, developmental, and situational transitions from younger to older adulthood. During the midlife period, many women seek health care for gastrointestinal symptoms and irritable bowel syndrome (IBS). Multiple factors including stress, poor sleep, diet, and physical inactivity may contribute to IBS or gastrointestinal symptoms in midlife women. As such, a comprehensive assessment and treatment approach is needed for midlife women suffering gastrointestinal symptoms. This article reviews the main aspects of the menopausal transition, sex hormonal changes, abdominal and pelvic surgery, psychosocial distress, behavioral factors, and gut microbiome, as well as their relevance on IBS and gastrointestinal symptoms in midlife women. Also, management strategies for IBS in midlife women are discussed. To date, gastrointestinal symptoms during midlife years remain a critical area of women’s health. Additional research is needed to better understand the contributors to gastrointestinal symptoms in this group. Such efforts may provide a new window to refine or develop treatments of gastrointestinal symptoms for midlife women.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, National Defense Medical Center, No. 161, Section 6, Minquan E Rd, Neihu District, Taipei, 114, Taiwan.
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Kendra J Kamp
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, WA, 98195, USA
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288
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Younis JS, Iskander R, Fauser BCJM, Izhaki I. Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis. Hum Reprod Update 2021; 26:904-928. [PMID: 32514566 DOI: 10.1093/humupd/dmaa013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regular menstrual cycling during the reproductive years is an indicator of spontaneous ovulation but sometimes falsely perceived as an indicator of preserved fertility. In contrast, menstrual cycle shortening, a physiologic occurrence preceding the menopausal transition, is not usually perceived as an indicator of decreased ovarian reserve in the general population. OBJECTIVE AND RATIONALE The individual decrease in menstrual cycle length (MCL) might represent a sensitive biomarker of diminishing ovarian reserve. The aim of this systematic review and meta-analysis is to examine the possible association between MCL in regularly cycling women (21-35 days) and ovarian reserve tests (ORT), fecundability in natural cycles and IVF outcomes. SEARCH METHODS An electronic database search employing PubMed, Web of Science, Trip, EBSCO, ClinicalTrials.gov and the Cochrane library was performed to identify research articles, only on human, published between January 1978 and August 2019. Search terms were pregnancy OR fertility OR fecundity OR fecundability, anti-Müllerian hormone OR AMH OR antral follicle count OR AFC OR ovarian reserve OR ovarian reserve test, in vitro fertilization OR ART OR assisted reproductive therapy OR assisted reproductive treatment OR assisted reproductive technology OR IVF OR ICSI, menstrual cycle length OR menstrual cycle characteristics. We combined these terms to complete the search. All prospective and retrospective studies exploring an association between MCL and proxies of ovarian reserve were included. The exclusions included studies of PCOS, ovarian failure, oral contraception treatment, prior chemotherapy and/or radiotherapy or ovarian surgery. The Newcastle-Ottawa scale was used to assess the quality of studies that were eligible for meta-analysis. OUTCOMES Eleven studies were eligible for meta-analysis, including 12 031 women. The included studies had a low risk of bias. Short MCL (21-27 days) was associated with lower ORT values as compared to normal (28-31 days), long (32-35 days) and all other (28-35 days) MCL sets. The estimated weighted mean difference (WMD) of AMH level was -1.3 ng/mL (95% CI: -1.75 to -0.86, P < 0.001) between the short and normal MCL sets. The estimated WMD of AFC values was -5.17 (95% CI: -5.96 to -4.37, P < 0.001) between the short and normal MCL sets. The weighted overall odds ratio (OR) of fecundability in natural cycles between women with short versus normal MCL sets was statistically significant (overall OR 0.81; 95% CI 0.72-0.91, P < 0.001). In the IVF setting, fewer oocytes were retrieved in short MCL in comparison to normal, long and all other MCL sets, with an estimated WMD of -1.8 oocytes (95% CI: -2.5 to -1.1, P < 0.001) in the short versus normal MCL sets. The weighted overall OR of clinical pregnancy rate between women with short versus all other MCL sets was statistically significant (overall OR 0.76; 95% CI: 0.60 to 0.96, P = 0.02). Low levels of heterogeneity were found in most meta-analyses of MCL and qualitative ovarian reserve biomarkers, while heterogeneity was high in meta-analyses performed for quantitative measures. WIDER IMPLICATIONS MCL in regularly cycling women is closely related to ovarian reserve biomarkers during the reproductive years. A short MCL, as compared to normal, is significantly associated with lower ORT values, reduced fecundability and inferior IVF outcomes, independent of age. The results imply that short MCL may be a sign of ovarian aging, combining the quantitative and qualitative facets of ovarian reserve. Educational efforts ought to be designed to guide women with short MCL at a young age, who desire children in the future, to seek professional counselling.
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Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel.,Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Safed, Israel
| | - Rula Iskander
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology, University of Utrecht and University Medical Center Utrecht, 3508 TC, Utrecht, The Netherlands
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa 3498838, Israel
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Wang S, Pei L, Hu T, Jia M, Wang S. Protective effect of goserelin on ovarian reserve during (neo)adjuvant chemotherapy in young breast cancer patients: a prospective cohort study in China. Hum Reprod 2021; 36:976-986. [PMID: 33411897 DOI: 10.1093/humrep/deaa349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/15/2020] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Does goserelin, a GnRH agonist, have a protective effect in young breast cancer patients in terms of ovarian reserve markers anti-Müllerian hormone (AMH) and antral follicle count (AFC) during chemotherapy? SUMMARY ANSWER Compared with chemotherapy alone, concurrent goserelin is associated with a higher probability of ovarian reserve recovery at 1 year after chemotherapy. WHAT IS KNOWN ALREADY Previous studies on the administration of goserelin to protect ovarian function during chemotherapy have produced conflicting results because of the endpoint used, namely, chemotherapy-induced amenorrhoea. Reproductive medicine specialists consider AMH and AFC as the most sensitive ovarian reserve markers; however, they have never been used as biomarkers to assess the potential protective effects on ovarian reserve of goserelin during chemotherapy. STUDY DESIGN, SIZE, DURATION This was a prospective cohort study in which patients were assigned to receive (neo)adjuvant chemotherapy with goserelin (the goserelin group) or without goserelin (the control group) according to each patient's preference. Of 242 breast cancer patients enrolled between December 2015 and November 2019, 76 in control group and 73 in goserelin group were able to be assessed at 1 year after chemotherapy. PARTICIPANTS/MATERIALS, SETTING, METHODS Premenopausal patients with a regular menstrual cycle and aged 18-45 years were eligible for enrolment if they were newly diagnosed with stages I-III breast cancer for which treatment with adjuvant or neoadjuvant chemotherapy was planned. Each patient in the goserelin group was given a subcutaneous dose of 3.6 mg at least 1 week before the first cycle of chemotherapy and then every 4 weeks for the duration of chemotherapy. Ovarian reserve markers and menstrual status were evaluated before and after chemotherapy in the two treatment groups. The primary endpoint was the AMH recovery rate, the secondary endpoints were the recovery rates of AFC, estradiol (E2), follicle-stimulating hormone (FSH) and menstruation. MAIN RESULTS AND THE ROLE OF CHANCE Among 149 patients (76 in the control group and 73 in the goserelin group) with complete data at 1 year after chemotherapy, the adjusted recovery rate of AMH was 46.5% and 21.8% in the goserelin group and control group, respectively (odds ratio: 3.08; P = 0.002). The trends in AFC and FSH recovery rates were consistent with that in AMH recovery rate. Notably, AMH levels remained low in 41.3% of patients whose menstrual activity had resumed. LIMITATIONS, REASONS FOR CAUTION Randomisation was not performed because of ethical considerations, so selection bias was inevitable, although propensity score weighting was done. The study was also underpowered because 21.5% (52/242) of enrolled patients received GnRH agonist-containing endocrine therapy and could not be analysed at 1 and 2 years after chemotherapy. WIDER IMPLICATIONS OF THE FINDINGS Our results indicate that co-administration of goserelin with chemotherapy provides obvious ovarian reserve protection in these young breast cancer patients. We expect that these results will be applicable in clinical practice for young breast cancer patients. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Key R&D Program of China No. 2016YFC0901302, by the Research and Development Fund of Peking University People's Hospital No. RD2014-13, RDY2017-19 and by AstraZeneca. The authors have no disclosures. TRIAL REGISTRATION NUMBER NCT02430103.
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Affiliation(s)
- Siyuan Wang
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Lin Pei
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Taobo Hu
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Mei Jia
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Shu Wang
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
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Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6649242. [PMID: 34122604 PMCID: PMC8169273 DOI: 10.1155/2021/6649242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
Objective This survey was designed and conducted with an aim to present data on sexual desire and activity in Chinese women. Methods Between October 2013 and December 2013, we surveyed 3000 women (aged 40–65 years) at Beijing No. 2 Hospital and the Yuetan Community Health Service Center using a questionnaire. The primary outcomes included determination of sexual desire in the past 4 weeks, reasons for stopping sexual activity, and postmenopausal syndrome. The secondary outcome was determination of factors for low sexual desire. Results A total of 2400 women (mean age 54.33 ± 6.25 years; mean menopausal age 50.11 ± 3.31 years) returned the questionnaire, with 58% of women reporting lowered sexual desire and 39.3% reporting stoppage of sexual activity. Compared with the postmenopausal group, the incidence of anxiety, depressive, somatic, and vasomotor symptoms was higher in the perimenopausal group. Muscle and joint pain (45.8%) and vaginal pruritus (21.5%) were the most commonly reported menopausal and vulvovaginal symptoms, respectively. The odds of decrease in sexual desire were significantly higher with older age, menopause, presence of gynecological disease, menopausal depression symptoms, menopausal vasomotor symptoms, and vulvovaginal atrophy; only cesarean delivery (odds ratio = 0.887, P=0.018) was associated with lesser reduction in sexual desire compared with the aforementioned factors. Conclusion This survey showed that a high proportion of Chinese middle-aged and old women have lowered sexual desire and activity. Lack of sexual desire is associated with multiple factors and affects the quality of life of women.
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291
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Ganz PA, Cecchini RS, Fehrenbacher L, Geyer CE, Rastogi P, Crown JP, Thirlwell MP, Ellison DM, Boileau JF, Flynn PJ, Jeong JH, Mamounas EP, Wolmark N. NRG Oncology/NSABP B-47 menstrual history study: impact of adjuvant chemotherapy with and without trastuzumab. NPJ Breast Cancer 2021; 7:55. [PMID: 34016989 PMCID: PMC8137688 DOI: 10.1038/s41523-021-00264-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
The NRG Oncology/NSABP B-47 menstrual history (MH) study examined trastuzumab effects on menstrual status and associated circulating reproductive hormones. MH was evaluated by questions related to hysterectomy, oophorectomy, and reported menstrual changes. Pre/perimenopausal women were assessed at entry, 3, 6, 12, 18, 24, 30, and 36 months. Consenting women had estradiol and FSH measurement at entry, 3, 6, 12, 18, and 24 months. Logistic regression determined predictors of amenorrhea and hormone levels at 12, 24, and 36 months. Between 2/8/2011 and 2/10/2015, 3270 women with node-positive/high-risk node-negative HER2-low breast cancer were enrolled. There were 1,458 women enrolled in the MH study; 1231 consented to baseline blood samples. Trastuzumab did not contribute to a higher amenorrhea rate. Amenorrhea predictors were consistent with earlier studies; however, to our knowledge, this is the largest prospective study to include serial reproductive hormone measurements to 24 months and clinical amenorrhea reports to 36 months. These data can help to counsel patients regarding premature menopause risk.
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Grants
- U10 CA180820 NCI NIH HHS
- U10 CA180868 NCI NIH HHS
- FUNDING/SUPPORT: NCI U10CA180868, -180822, UG1-189867; U10CA180820 and -21115 (ECOG/ACRIN); and Genentech, a Member of the Roche Group, through the NCI
- NCI U10CA180868, -180822, UG1-189867; U10CA180820 and -21115 (ECOG/ACRIN); Genentech, a Member of the Roche Group, through the NCI
- NCI U10CA180868, -180822, UG1-189867; U10CA180820 and -21115 (ECOG/ACRIN); Genentech, a Member of the Roche Group, through the NCI; and F. Hoffmann-La Roche, Ltd (JPC - ICORG)
- NCI U10CA180868, -180822, UG1-189867; U10CA180820 and -21115 (ECOG/ACRIN); Genentech, a Member of the Roche Group, through the NCI.
- NCI U10CA180868, -180822, UG1-189867; U10CA180820 and -21115 (ECOG/ACRIN); Genentech, a Member of the Roche Group, through the NCI,
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Affiliation(s)
- Patricia A Ganz
- NSABP/NRG Oncology, Pittsburgh, PA, USA.
- University of California at Los Angeles, Los Angeles, CA, USA.
| | - Reena S Cecchini
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Louis Fehrenbacher
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Kaiser Permanente Oncology Clinical Trials Northern CA, Novato, CA, USA
| | - Charles E Geyer
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Houston Methodist Cancer Center, Houston, TX, USA
| | - Priya Rastogi
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- The University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - John P Crown
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Irish Cooperative Oncology Research Group/Cancer Trials Ireland, Dublin, Ireland
| | - Michael P Thirlwell
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Montréal General Hospital, McGill University Health Centre, Montréal, Canada
| | - David M Ellison
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Roper St Francis Healthcare, Charleston, SC, USA
| | - Jean-Francois Boileau
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Jewish General Hospital Segal Cancer Centre McGill University, Montréal, Québec, Canada
| | - Patrick J Flynn
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Minnesota Community Oncology Research Consortium (MSORC), Stone Lake, WI, USA
| | - Jong-Hyeon Jeong
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Eleftherios P Mamounas
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- Orlando Health UF Health Cancer Center, Orlando, FL, USA
| | - Norman Wolmark
- NSABP/NRG Oncology, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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292
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Savukoski SM, Niinimäki MJ, Pesonen PRO, Auvinen JP, Männistö T, Puukka KS, Ebeling T, Suvanto ETJ. Is climacterium by the mid-40s associated with thyroid dysfunction or autoimmunity? A population-based study. Menopause 2021; 28:1053-1059. [PMID: 34010935 DOI: 10.1097/gme.0000000000001800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated whether more advanced climacteric stage in the mid-40s is associated with thyroid autoimmunity and dysfunction. METHODS This cross-sectional cohort study included 2,569 46-year-old women. Thyroid hormone, thyroid peroxidase antibodies, and follicle-stimulating hormone levels were determined. Using menstrual history and follicle-stimulating hormone levels, the participants were divided into climacteric (n = 340) and preclimacteric (n = 2,229) groups. Women diagnosed with premature ovarian insufficiency (menopause by 40 y of age) were excluded. The use of thyroid medication was evaluated from the medication reimbursement register. The prevalence of thyroid medication use, laboratory-based thyroid dysfunction, and thyroid peroxidase antibody positivity was compared between the two groups. The association between climacteric status and thyroid disorders was investigated using a logistic regression model including smoking and thyroid antibody status. RESULTS At 46 years old, climacteric women used thyroid medication more often than preclimacteric women (9.1% vs 6.1%; P = 0.04). There was no difference in the prevalence of subclinical or clinical hypothyroidism and hyperthyroidism in nonmedicated participants (5.5% vs 5.0%; P = 0.7) or thyroid peroxidase antibody positivity (14.0% vs 15.0%, P = 0.7). In the regression model, being climacteric (OR = 1.6; 95% CI 1.1-2.3; P = 0.02) and antibody positivity (OR 4.9; 95% CI 3.6-6.6; P < 0.001) were associated with a higher prevalence of thyroid dysfunction. CONCLUSIONS More advanced climacteric stage in the mid-40s was slightly associated with thyroid dysfunction but not thyroid autoimmunity.
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Affiliation(s)
- Susanna M Savukoski
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maarit J Niinimäki
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula R O Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha P Auvinen
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Tuija Männistö
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- NordLab Oulu, Oulu University Hospital, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Katri S Puukka
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- NordLab Oulu, Oulu University Hospital, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Tapani Ebeling
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Internal Medicine, Oulu University Hospital and University of Oulu, OYS, Finland
| | - Eila T J Suvanto
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, OYS, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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293
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Coronado PJ, Monroy M, Fasero M, Baquedano L, Mendoza N, Llaneza P, Rejas J, Ruiz MA. Predictive and criterion validity of the Cervantes-SF menopause quality of life questionnaire. Menopause 2021; 28:935-942. [PMID: 33973543 DOI: 10.1097/gme.0000000000001790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the predictive and criterion-based validity of the Cervantes-SF scale that measures the impact of menopause on Health-Related Quality of Life. METHODS We recruited a noninstitutionalized sample of peri/postmenopausal women aged 40 to 65 years, who had their last menstrual cycle 12+ months prior to inclusion in the study of the psychometric validity of the Cervantes-SF scale. Predictive validity of the scale was confirmed for various health outcome measures administered concomitantly (years of disability-free life expectancy, work productivity and impact on daily activities, economic impact arising from loss of work productivity, hours of undisturbed sleep each day, and the utilization of healthcare facilities), whilst criterion validity was determined by the likelihood of identifying a moderate-to-severe vasomotor or genital syndrome requiring specific treatment. RESULTS A sample of 308 peri/postmenopausal women with a mean age of 55.7 years (SD: 5.3 y) was analyzed in this study. A score >25 points on the dimension of vasomotor problems (or menopausal health) showed values of sensitivity and specificity > 80% for identifying women with moderate-severe vasomotor syndrome requiring pharmacological treatment. Predictive validity was confirmed for menopause-related health outcomes. A change of 6.7 points in the scale score, equivalent to the value of its minimal difference, is indicative of a significant increase in the degree of disability regarding work/day-to-day activities, greater economic loss due to decreased work productivity, fewer years of life expectancy without disability, fewer hours of undisturbed sleep, and more visits to the physician per year due to menopausal symptoms. CONCLUSIONS These results confirm the criterion and predictive validity of the Cervantes-SF scale in peri/postmenopausal women.
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Affiliation(s)
- Pluvio J Coronado
- Women's Health Institute, San Carlos Clinic Hospital, IdISSC, Complutense University, Madrid, Spain
| | - Manuel Monroy
- Faculty of Psychology, Autonoma University of Madrid, Madrid, Spain
| | - María Fasero
- Department of Obstetrics and Gynecology, Sanitas La Zarzuela Hospital, Francisco de Vitoria University, Madrid, Spain
| | - Laura Baquedano
- Department of Obstetrics and Gynecology, Miguel Servet Hospital, Zaragoza, Spain
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, School of Medicine, University of Granada, Spain
| | - Plácido Llaneza
- Department of Obstetrics and Gynecology, Central Hospital of Asturias, University of Oviedo, Spain
| | - Javier Rejas
- Department of Pharmacoeconomics and Health Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain
| | - Miguel A Ruiz
- Faculty of Psychology, Autonoma University of Madrid, Madrid, Spain
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Barghandan N, Dolatkhah N, Eslamian F, Ghafarifar N, Hashemian M. Association of depression, anxiety and menopausal-related symptoms with demographic, anthropometric and body composition indices in healthy postmenopausal women. BMC WOMENS HEALTH 2021; 21:192. [PMID: 33962601 PMCID: PMC8105920 DOI: 10.1186/s12905-021-01338-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
Background The termination of the menstrual cycle is correlated with a number of physiological alterations and symptoms that can negatively impact emotion and mood. We aimed to investigate the association of anxiety, depression, and menopausal related symptoms with demographic, anthropometric, and body composition indices in healthy postmenopausal women. Methods A total of 320 menopausal women were selected randomly from referrals of health centers between January and June 2018 in Tabriz/Iran. All participants completed a demographic questionnaire. Bioelectrical impedance analysis was applied to evaluate body fat mass (BFM), soft lean mass (SLM), and lean body mass (LBM) of participants. The modified Kupperman index, Beck's depression inventory-II, and Spielberger’s state-trait anxiety inventory were applied to measure the severity of menopausal-related symptoms, the frequency, and severity of the symptoms of depression and state (SA) and trait anxiety (TA), respectively. Results Finally, 245 postmenopausal women with age of 55.33 ± 4.48 years and body mass index (BMI) of 27.96 ± 3.22 kg/m2 were studied. Women with the age of 55 years and older (OR 3.928, 95% CI 1.504–10.256) and also women with mild physical activity (OR 10.104, 95% CI 3.785–26.976) had a greater possibility of having mild and moderate depression in comparison with women less than 50 years old and women with moderate and severe physical activity. Moderate and severe physical activity was correlated with a lower possibility of having medium upward, relatively severe and severe TA in comparison with participants with mild physical activity in these women (OR 0.372, 95% CI 0.151–0.917). Women with higher BMI and BFM had and more severe menopause-related symptoms (r = 0.143, p = 0.025 and r = 0.139, p = 0.030, respectively) and more severe TA symptoms (r = 0.198, p = 0.018 and r = 0.151, p = 0.021, respectively). Women with lower LBM (r = − 0.139, p = 0.031) and lower SLM (r = − 0.128, p = 0.047) had more severe depressive symptoms. Conclusion Postmenopausal women with higher age and lower physical activity had a greater possibility of having mild and moderate depression. Lower physical activity was also correlated with a greater possibility of having medium upward to severe TA symptoms. Postmenopausal women with higher BMI and BFM had more severe menopause-related and TA symptoms. Women with lower LBM and SLM had more severe depressive symptoms.
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Affiliation(s)
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Emam Reza Hospital, Tabriz University of Medical Sciences, Golgasht, Azadi Ave., Tabriz, Iran.
| | - Fariba Eslamian
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nahal Ghafarifar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Hashemian
- Department of Biology, School of Art and Science, Utica College, Utica, NY, USA
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295
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Lefferts WK, Lefferts EC, Hibner BA, Smith KJ, Fernhall B. Impact of acute changes in blood pressure and arterial stiffness on cerebral pulsatile haemodynamics in young and middle-aged adults. Exp Physiol 2021; 106:1643-1653. [PMID: 33938052 DOI: 10.1113/ep089319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/28/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does cerebrovascular pulsatility respond differently to acute increases in arterial stiffness in middle-aged compared with young adults? What is the main finding and its importance? Compared with young adults, middle-aged adults exhibited similar changes in cerebral pulsatile damping despite attenuated changes in carotid diameter and cerebrovascular pulsatility during blood pressure-dependent, but not blood pressure-independent, increases in large artery stiffness. ABSTRACT Acute manipulation of arterial stiffness through interventions that increase sympathetic activity might provoke cerebral pulsatility and damping and reveal whether cerebrovascular haemodynamics respond differently to transient elevations in arterial stiffness in middle-aged compared with young adults. We compared cerebral pulsatility and damping in middle-aged versus young adults during two different sympathetic interventions [cold pressor test (CP) and lower-body negative pressure (LBNP)] that increase arterial stiffness acutely. Cerebrovascular haemodynamics were assessed in 15 middle-aged (54 ± 7 years old; 11 female) and 15 sex-matched young adults (25 ± 4 years old) at rest and during the CP test (4 min, 6.4 ± 0.8°C) and LBNP (6 min, -20 mmHg). Mean blood pressure was measured continuously via finger photoplethysmography. Carotid-femoral pulse wave velocity (cfPWV) and carotid stiffness were measured via tonometry and ultrasound. Blood velocity pulsatility index (PI) was measured at the middle cerebral (MCA) and common carotid artery (CCA) using Doppler, with pulsatile damping calculated as CCA PI divided by MCA PI. Increases in cfPWV were driven by changes in mean pressure during CP but not during LBNP in both groups (P < 0.05). Pulsatile damping decreased in both groups (P < 0.05) despite reductions in MCA PI and greater carotid dilatation during CP in young compared with middle-aged adults (P < 0.05). Pressure-independent increases in cfPWV during LBNP did not alter pulsatile damping but decreased MCA PI in both young and middle-aged adults (P < 0.05). These data suggest that changes in carotid diameter and cerebrovascular pulsatility differ between young and middle-aged adults despite similar changes in cerebral pulsatile damping during blood pressure-dependent, but not blood pressure-independent, increases in large artery stiffness.
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Affiliation(s)
- Wesley K Lefferts
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Kinesiology, Iowa State University, Ames, Iowa, USA
| | - Elizabeth C Lefferts
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brooks A Hibner
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kurt J Smith
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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296
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Lumme JE, Savukoski SM, Suvanto ETJ, Pesonen PRO, Auvinen JP, Sebert S, Hyppönen E, Järvelin MR, Puukka KS, Herzig KH, Oura P, Ojaniemi M, Niinimäki M. Early-onset climacterium is not associated with impaired vitamin D status: a population-based study. Menopause 2021; 28:899-908. [PMID: 33950031 DOI: 10.1097/gme.0000000000001781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate vitamin D status in women with the onset of the climacteric phase by age 46 as both early menopause and inadequate vitamin D status may increase the risk of adverse health outcomes. METHODS A cross-sectional study included 2,544, 46-year-old women from a birth cohort. Women were divided into the following two groups according to their menstrual history and follicle-stimulating hormone (FSH) concentration: 1) climacteric (FSH ≥25 IU/L and amenorrhea ≥4 mo, n = 351) and 2) preclimacteric women (FSH <25 IU/L and having regular/irregular menstrual cycles, n = 2,193). Serum 25-hydroxyvitamin D (25(OH)D) concentrations were compared between the groups. A linear regression model was performed to investigate which factors are associated with 25(OH)D status. RESULTS Mean serum 25(OH)D concentrations were higher in climacteric compared with preclimacteric women (68.1 ± 19.8 nmol/L vs 65.2 ± 19.3 nmol/L, P = 0.01). However, in the linear regression model, climacteric status was not associated with 25(OH)D status (multivariable adjusted mean difference 4.5 nmol/L, 95% confidence interval -1.4 to 10.4, P = 0.137). A total of 76 of the climacteric women were using systemic estrogen hormone therapy (HT). In a subanalysis, including only climacteric women, the use of HT was associated with higher 25(OH)D status (multivariable adjusted mean difference 5.9 nmol/L, 95% confidence interval 1.3-10.5, P = 0.013). CONCLUSIONS The onset of the climacteric phase by age 46 was not associated with inadequate 25(OH)D concentrations, whereas HT use was associated with higher 25(OH)D status in women with early-onset climacterium.
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Affiliation(s)
- Johanna E Lumme
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Susanna M Savukoski
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eila T J Suvanto
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula R O Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha P Auvinen
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Oulunkaari Health Center, Ii, Finland
| | - Sylvain Sebert
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College, London, UK
| | - Elina Hyppönen
- Australian Centre for Precision Health, University of South Australia, Cancer Research Institute, Adelaide, Australia
- Unit of Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Marjo-Riitta Järvelin
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College, London, UK
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London Kingston Lane, Uxbridge, Middlesex, UK
| | - Katri S Puukka
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- NordLab Oulu, Oulu University Hospital, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Karl-Heinz Herzig
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Institute of Biomedicine, University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Petteri Oura
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Marja Ojaniemi
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
| | - Maarit Niinimäki
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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297
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Süss H, Willi J, Grub J, Ehlert U. Estradiol and progesterone as resilience markers? - Findings from the Swiss Perimenopause Study. Psychoneuroendocrinology 2021; 127:105177. [PMID: 33676150 DOI: 10.1016/j.psyneuen.2021.105177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/12/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
While resilience seems to be associated with a variety of biological markers, studies assessing such correlates in women during the perimenopause are lacking. The perimenopause constitutes a phase of major biopsychosocial changes, during which the sex hormones estradiol (E2) and progesterone (P4) eventually decrease significantly. The aim of this study was to examine the extent to which the declining levels of E2 and P4 serve as resilience markers in perimenopausal women. In 129 healthy perimenopausal women aged 40-56 years, saliva samples were collected on every fourth day over a period of four weeks in order to investigate E2 and P4 levels. All participants completed psychosocial questionnaires including variables related to resilience, well-being, and mental health. Perimenopausal status was determined using the Stages of Reproductive Aging Workshop (STRAW) criteria. The results indicate that P4 is linked to psychosocial resilience. More precisely, women with higher P4 levels seem to be more resilient than women with lower P4 levels, irrespective of the perimenopausal status. No such relation was found for E2 levels. Further analyses revealed that women with higher P4 levels experience significantly higher life satisfaction, lower perceived stress, and lower depressive symptoms than women with lower P4 levels. Accordingly, P4 can be considered as a biological marker of resilience in perimenopause.
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Affiliation(s)
- Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
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298
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Jaeger MDB, Miná CS, Alves S, Schuh GJ, Wender MC, Manfro GG. Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:277-284. [PMID: 33053044 PMCID: PMC8136388 DOI: 10.1590/1516-4446-2020-0871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Vasomotor symptoms affect 60-80% of women during the menopausal transition. Anxiety, depression, and anxiety sensitivity can have an important role in the distressful experience of vasomotor symptoms. Our aim was to evaluate the prevalence and association of vasomotor and negative affect symptoms. METHODS A cross-sectional study was conducted with 89 perimenopausal women aged 45-55 years. Broad psychiatric and clinical evaluations were carried out. The primary outcome was the vasomotor symptom problem rating and the main study factor was anxiety sensitivity. Linear regression analyses were conducted to examine the associations between the study factors and the primary outcome, and a multiple regression model was created to assess which variables were independently associated with vasomotor symptom problem rating. RESULTS The prevalence of anxiety, depression, and vasomotor symptoms were 58, 62, and 73%, respectively. Negative affect symptoms were positively associated with vasomotor symptom problem rating. The association of anxiety sensitivity and vasomotor symptom problem rating remained significant after controlling for perimenopausal stage, thyrotropin, follicle-stimulating hormone levels, and psychotropic medication use (β = 0.314, p = 0.002). CONCLUSION A better understanding of the experience of vasomotor symptoms is needed, especially the role of negative affect symptoms and anxiety sensitivity. New strategies focusing on related thoughts and behaviors could improve the quality of life of perimenopausal women.
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Affiliation(s)
- Marianna de B. Jaeger
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Camila S. Miná
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde (ICBS), UFRGS, Porto Alegre, RS, Brazil
| | - Sofia Alves
- Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil
| | | | - Maria C. Wender
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, UFRGS, Porto Alegre, RS, Brazil
| | - Gisele G. Manfro
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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299
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Impact of nulliparity, hypertensive disorders of pregnancy, and gestational diabetes on vasomotor symptoms in midlife women. ACTA ACUST UNITED AC 2021; 27:1363-1370. [PMID: 32796290 DOI: 10.1097/gme.0000000000001628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether women with a history of nulliparity, hypertensive disorders of pregnancy (HDP), or gestational diabetes mellitus (GDM) have a higher odds of reporting vasomotor symptoms (VMS) at midlife. METHODS A longitudinal analysis was performed with 2,249 women with pregnancy history data in the Study of Women's Health Across the Nation. Women were classified as nulliparous, no HDP/GDM, or a history of HDP/GDM. VMS (hot flashes, night sweats) were assessed separately at baseline and at each follow-up visit. VMS was recorded as any versus none; 0 , 1-5 , 6+ days in past 2 weeks. Pregnancy history was examined in relation to each VMS (hot flashes, night sweats) using generalized estimating equations adjusting for age (time-varying), site, race/ethnicity, education, financial strain, smoking, and body mass index. Models excluded women with hysterectomy/bilateral oophorectomy and observations with hormone therapy use. RESULTS Women in the HDP/GDM group (n = 208, 9%) were more likely to be Black, financially strained, and overweight. Compared to women with no HDP/GDM, women with HDP/GDM had greater odds of reporting any hot flashes (OR:1.27; 95% CI:1.05-1.53). Nulliparous women had lower odds of any hot flashes (OR:0.64; 95% CI:0.51-0.80) and night sweats (OR:0.73; 95% CI:0.58-0.93) in age-adjusted models. Similar patterns were observed for frequency of hot flashes and night sweats; associations were attenuated to nonsignificance after adjusting for covariates. CONCLUSIONS History of HDP/GDM may be associated with more VMS and nulliparity with fewer VMS, but not independently of sociodemographic factors. Our findings underscore the importance of social and economic disparities in both reproductive outcomes and VMS. VIDEO SUMMARY:: http://links.lww.com/MENO/A631.
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300
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Accelerated progression of waist-to-hip ratio but not body mass index associated with lower socioeconomic position: a cohort study of nonobese early postmenopausal Chinese women. ACTA ACUST UNITED AC 2021; 27:550-558. [PMID: 32068683 DOI: 10.1097/gme.0000000000001503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Menopausal changes are linked to increase in body fat mass and central fat distribution; nonetheless, the impact of socioeconomic position on such changes has rarely been examined. This cohort study assessed the temporal associations of socioeconomic position with changes in body mass index (BMI) and waist-to-hip ratio (WHR) among early postmenopausal women. METHODS Between 2002 and 2004, 518 Hong Kong Chinese women aged 50 to 64 and within 10 years since menopause were recruited and followed up at 3 and 5 years. Weight, height, and waist and hip circumferences were measured by trained interviewers at baseline and follow-up interviews. Socioeconomic positions including educational attainment, economic activity status and household income level, and other baseline demographic characteristics, lifestyle behaviors, and mental health status were collected based on a structured questionnaire. In total, 287 and 267 women with no general and abdominal obesity, respectively, at baseline were included in multiple regression analyses. RESULTS Mean intrapersonal increases in BMI and WHR between baseline and 5-year interview were 0.46 kg/m and 2.80%, respectively. Women with no secondary education were 75% more likely to have a greater than-mean WHR increase than their more educated counterparts (P = 0.039). Also, having no secondary education (P = 0.041) and being a homemaker (P = 0.034) had accelerated surge in WHR. Nonetheless, baseline socioeconomic positions were not significantly associated with BMI changes. CONCLUSIONS Socioeconomic patterning was observed for the progression of WHR among nonobese Chinese women soon after menopause. Early postmenopausal stage may be a critical window for prevention of abdominal obesity among women with a lower educational attainment.
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