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Abstract
OBJECTIVE To update the evidence-based Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. METHODS An advisory panel of clinicians and research experts in women's health were selected to review and evaluate the literature published since the Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Topics were divided into five sections for ease of review: lifestyle; mind-body techniques; prescription therapies; dietary supplements; and acupuncture, other treatments, and technologies. The panel assessed the most current and available literature to determine whether to recommend or not recommend use based on these levels of evidence: Level I, good and consistent scientific evidence; Level II, limited or inconsistent scientific evidence, and Level III, consensus and expert opinion. RESULTS Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III). CONCLUSION Hormone therapy remains the most effective treatment for vasomotor symptoms and should be considered in menopausal women within 10 years of their final menstrual periods. For women who are not good candidates for hormone therapy because of contraindications (eg, estrogen-dependent cancers or cardiovascular disease) or personal preference, it is important for healthcare professionals to be well informed about nonhormone treatment options for reducing vasomotor symptoms that are supported by the evidence.
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Hashemzadeh M, Keramat A, Mollaahmadi L, Ghiasi A, Haseli A. The Role of Lifestyle in Developing and Maintaining Vasomotor Symptoms: A Cross-Sectional Study among Iranian Postmenopausal Women. J Midlife Health 2019; 10:184-191. [PMID: 31942154 PMCID: PMC6947723 DOI: 10.4103/jmh.jmh_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Lifestyle patterns are not only related to healthy life but also could be related to modifying menopausal symptoms. Considering the lack of data, the present study aimed to evaluate the relationship between lifestyle and vasomotor symptoms among Iranian postmenopausal women. MATERIALS AND METHODS The present cross-sectional questionnaire-based study was conducted among 302 eligible postmenopausal women referring to Shahroud health centers (Shahroud, Iran) during June 2017 and October 2018. The Iranian standard questionnaire on women health project (Saba questionnaire) was used for data collection. Our data were analyzed using the SPSS software (version 18). Descriptive statistics, Chi-square test, Fisher's exact test, and multiple logistic regression were used to address sociodemographic characteristics among our participants and the relations between lifestyle and vasomotor symptoms. RESULTS We found a significant relation between daily dairy units (P = 0.05), daily vegetable units (P = 0.01), weekly use of solid oils (0.01), and hot flush. The relation between daily vegetable units and urinary incontinence was also statistically significant (P = 0.02). When we use multiple logistic regression, we found significant predictive relations between daily vegetable unit status (P = 0.01), weekly use of solid oils (P = 0.04), body mass index (P = 0.03), and hot flush. CONCLUSION The study provided findings to support the probable relation between some of lifestyle-related variables and vasomotor symptoms in postmenopausal women.
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Affiliation(s)
- Mozhgan Hashemzadeh
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Ilam, Iran
| | - Afsaneh Keramat
- Reproductive Studies and Women's Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Leila Mollaahmadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Ilam, Iran
| | - Ashraf Ghiasi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Ilam, Iran
| | - Arezoo Haseli
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Lund KS, Siersma V, Brodersen J, Waldorff FB. Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study). BMJ Open 2019; 9:e023637. [PMID: 30782712 PMCID: PMC6501989 DOI: 10.1136/bmjopen-2018-023637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of a standardised brief acupuncture approach for women with moderate-to-severe menopausal symptoms. DESIGN Randomised and controlled, with 1:1 allocation to the intervention group or the control group. The assessor and the statistician were blinded. SETTING Nine Danish primary care practices. PARTICIPANTS 70 women with moderate-to-severe menopausal symptoms and nine general practitioners with accredited education in acupuncture. INTERVENTION The acupuncture style was western medical with a standardised approach in the predefined acupuncture points CV-3, CV-4, LR-8, SP-6 and SP-9. The intervention group received one treatment for five consecutive weeks. The control group was offered treatment after 6 weeks. MAIN OUTCOME MEASURES Outcomes were the differences between the randomisation groups in changes to mean scores using the scales in the MenoScores Questionnaire, measured from baseline to week 6. The primary outcome was the hot flushes scale; the secondary outcomes were the other scales in the questionnaire. All analyses were based on intention-to-treat analysis. RESULTS 36 participants received the intervention, and 34 participants were in the control group. Four participants dropped out before week 6. The acupuncture intervention significantly decreased hot flushes: Δ -1.6 (95% CI [-2.3 to -0.8]; p<0.0001), day-and-night sweats: Δ -1.2 (95% CI [-2.0 to -0.4]; p=0.0056), general sweating: Δ -0.9(95% CI [-1.6 to -0.2]; p=0.0086), menopausal-specific sleeping problems: Δ -1.8 (95% CI [-2.7 to -1.0]; p<0.0001), emotional symptoms: Δ -3.4 (95% CI [-5.3 to -1.4]; p=0.0008), physical symptoms: Δ -1.7 (95% CI [-3 to -0.4]; p=0.010) and skin and hair symptoms: Δ -1.5 (95% CI [-2.5 to -0.6]; p=0.0021) compared with the control group at the 6-week follow-up. The pattern of decrease in hot flushes, emotional symptoms, skin and hair symptoms was already apparent 3 weeks into the study. Mild potential adverse effects were reported by four participants, but no severe adverse effects were reported. CONCLUSIONS The standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention. No severe adverse effects were reported. TRIAL REGISTRATION NUMBER NCT02746497; Results.
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Affiliation(s)
- Kamma Sundgaard Lund
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Nasiri S. Severity of menopausal symptoms and related factors among 40 to 60 year-old women. Nurs Midwifery Stud 2015; 4:e22882. [PMID: 25830156 PMCID: PMC4377528 DOI: 10.17795/nmsjournal22882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/24/2014] [Accepted: 12/27/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Saeideh Nasiri
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Krishna K, Nimbargi V, Panda B. Desvenlafaxine succinate: Is it a new promise and hope for management of vasomotor symptoms in postmenopausal women? APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effects of physical activity on vasomotor symptoms: examination using objective and subjective measures. Menopause 2013; 19:1095-103. [PMID: 22735162 DOI: 10.1097/gme.0b013e31824f8fb8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Physical activity (PA) is essential for successful aging and for the prevention and management of common chronic diseases. The empirical support for the beneficial effects of PA on vasomotor symptoms has, however, been mixed. The purpose of this study was to assess the effects of acute aerobic exercise and daily PA on menopausal vasomotor symptoms. METHODS Community-dwelling midlife women (N = 121; age range, 40-60 y) not using hormone therapy were recruited for a 15-day daily diary study. Women completed psychological, cardiorespiratory fitness, body composition, and hormonal status screening followed by a 15-day prospective assessment in a "real-life" setting using a personal digital assistant. Participants also completed a 30-minute moderate-intensity aerobic exercise bout on a treadmill between days 5 and 8. Daily PA was assessed objectively through accelerometry, and all symptomatic women (n = 92) completed two 24-hour Biolog sternal skin conductance recordings of hot flashes (HFs)-one at baseline and one immediately after treadmill exercise. RESULTS Both total objective (P = 0.054) and total subjective (P < 0.05) HFs decreased after the acute exercise bout. At the between-person level, daily PA was not associated with self-reported HFs. However, at the within-person level, performing more moderate physical activity than usual was associated with more self-reported HFs in women with lower fitness levels. CONCLUSIONS Moderate aerobic exercise decreases objective and subjective HFs 24 hours after exercise; however, in women with lower fitness levels, more daily moderate PA leads to more self-reported symptoms.
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Umland EM, Falconieri L. Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine. Int J Womens Health 2012; 4:305-19. [PMID: 22870045 PMCID: PMC3410701 DOI: 10.2147/ijwh.s24614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Vasomotor symptoms (VMS), including hot flashes and night sweats, occur in as many as 68.5% of women as a result of menopause. While the median duration of these symptoms is 4 years, approximately 10% of women continue to experience VMS as many as 12 years after their final menstrual period. As such, VMS have a significant impact on the quality of life and overall physical health of women experiencing VMS, leading to their pursuance of treatment to alleviate these symptoms. Management of VMS includes lifestyle modifications, some herbal and vitamin supplements, hormonal therapies including estrogen and tibolone, and nonhormonal therapies including clonidine, gabapentin, and some of the serotonin and serotonin-norepinephrine reuptake inhibitors. The latter agents, including desvenlafaxine, have been the focus of increased research as more is discovered about the roles of serotonin and norepinephrine in the thermoregulatory control system. This review will include an overview of VMS as they relate to menopause. It will discuss the risk factors for VMS as well as the proposed pathophysiology behind their occurrence. The variety of treatment options for VMS will be discussed. Focus will be given to the role of desvenlafaxine as a treatment option for VMS management.
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Affiliation(s)
- Elena M Umland
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
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Daily physical activity and menopausal hot flashes: applying a novel within-person approach to demonstrate individual differences. Maturitas 2012; 71:287-93. [PMID: 22226629 DOI: 10.1016/j.maturitas.2011.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/14/2011] [Accepted: 12/12/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Physical activity (PA) may be a useful tool in the management of menopausal hot flashes (HFs) but findings are generally inconsistent. There are few well-designed and sufficiently powered RCTs. Applying a longitudinal within-person approach offers an alternative way to examine the PA-HFs relationship which enables complete accommodation of inter-individual differences. OBJECTIVES Aprospective daily diary study which applied experience sampling methods and time series modeling techniques investigated, at the within-person level, the relationship between objectively measured daily PA of varying intensities and self-reported menopausal HFs. METHODS Twenty-four symptomatic middle-aged women (M age=50.4; SD=4.9) completed fitness, body composition and hormonal status screening, and reported on daily HFs using an electronic PDA device across one menstrual cycle or for 30 days (if postmenopausal). Daily PA and PA intensity was measured using accelerometry and subjects completed a battery of psychological measures. RESULTS Within person analysis identified significant relations between PA and HFs in 50% of subjects, although the specific PA indicators that predicted HFs varied, both in terms of direction and magnitude. Perceived control over HFs was the variable that most consistently differentiated between women for whom more PA was associated with fewer HFs as compared to those for whom more PA was associated with more HFs, but other individual difference characteristics such as affect, depressive symptoms, and anxiety were identified. CONCLUSIONS There is great individual variation in the way daily PA impacts self-reported HFs. Affective outcomes and perceived control may help potentially explain this variability.
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Morelli V. Toward a comprehensive differential diagnosis and clinical approach to fatigue in the elderly. Clin Geriatr Med 2011; 27:687-92. [PMID: 22062449 DOI: 10.1016/j.cger.2011.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article provides primary care physicians with an encompassing approach to fatigue to help generate a comprehensive differential diagnosis. Two-thirds of patients with fatigue will have an identifiable cause that can be elucidated with a careful history and appropriate laboratory tests. Accordingly, a wide range of differential diagnoses is presented.
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Affiliation(s)
- Vincent Morelli
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN 37208, USA.
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Guimarães ACDA, Baptista F. Atividade física habitual e qualidade de vida de mulheres na meia-idade. REV BRAS MED ESPORTE 2011. [DOI: 10.1590/s1517-86922011000500002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar a relação entre a atividade física habitual (AF) e a qualidade de vida (QV) de mulheres na meia-idade. MÉTODOS: Participaram do estudo 1.011 mulheres dos 45 aos 59 anos de idade, das quais 370 eram perimenopausadas e 641 pós-menopausadas, com índice de massa corporal (IMC) de 25 ± 4kg/m² e escolaridade entre um e 13 anos. A QV foi avaliada pelo WHOQOL-bref da WHO e a AF através do International Physical Activity Questionnaire. RESULTADOS: Após a divisão da amostra em três grupos, de acordo com a prática de AF total (A: < 30 min/dia; B: 30-60 min/dia; C: > 60 min/dia), a análise da variância ajustada para o IMC e menopausa (peri vs. pós), mostrou diferenças de QV entre os grupos A e B e o grupo C no domínio físico, e entre o grupo A e os grupos B e C nos domínios psicológico, social e ambiental (p ≤ 0,001). CONCLUSÃO: A prática de 30 min/dia de AF de intensidade pelo menos moderada parece estar associada a efeitos mais favoráveis aos níveis psicológico, social e ambiental, mas parecem ser necessários pelo menos 60 min/dia para influenciar o domínio físico. Estas associações podem, no entanto, refletir o impacto da QV na quantidade total de AF. Assim, a prática de 30 min/dia pode ser mais condicionada pelos domínios psicológico, social e ambiental, enquanto os 60 min/dia pelo domínio físico.
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Abstract
BACKGROUND Evidence suggests that many perimenopausal and early postmenopausal women will experience menopause symptoms, hot flushes being the most common. Symptoms caused by fluctuating levels of oestrogen may be alleviated by HRT but there has been a marked global decline in its use due to concerns about the risks and benefits of HRT; consequently many women are now seeking alternatives. As large numbers of women are choosing not to take HRT, it is increasingly important to identify evidence based lifestyle modification interventions that have potential to reduce vasomotor menopausal symptoms. OBJECTIVES To examine the effectiveness of any type of exercise intervention in the management of vasomotor menopausal symptoms (hot flushes and night sweats) in perimenopausal and postmenopausal women. SEARCH STRATEGY Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials (RCTs): Cochrane Menstrual Disorders and Subfertility Group Specialised trials register; Cochrane Library (CENTRAL) (Wiley Internet interface), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Science Citation Index and Social Science Citation Index (Web of Science), CINAHL (Ovid) and SPORT Discus. Searches included dates up until 16-24 March 2010. SELECTION CRITERIA RCTs in which any type of exercise intervention were compared no treatment/control or other treatments in the management of menopausal vasomotor symptoms in symptomatic perimenopausal/postmenopausal women. DATA COLLECTION AND ANALYSIS Six studies were deemed eligible for inclusion. Three authors independently extracted data from eligible studies. Three meta-analyses according to comparator the group were performed. MAIN RESULTS In the comparison of exercise versus no treatment/control (three studies), the non-significant effect size Standardised Mean Difference (SMD) for vasomotor symptoms was -0.14 (95% CI: -0.54 to 0.26); SMD was -0.04, -0.25, -0.38. For the analysis of exercise versus HRT (three studies), the non-significant SMD was 0.49 (95% CI: -0.27 to 1.26); SMD across studies was 0.13, 0.19 and 1.52, with all studies favouring HRT. In the comparison of exercise versus yoga (two studies), the non-significant SMD was -0.09 (95%CI:-0.64 to 0.45); SMD was -0.37 and 0.19. All comparisons were based on small samples. One small study reported data that could not be included in the meta-analysis; in this study hot flush scores were significantly lower in the exercise plus soy milk group (83%) than soy milk only group (72%). AUTHORS' CONCLUSIONS The existing studies provided insufficient evidence to determine the effectiveness of exercise as a treatment for vasomotor menopausal symptoms, or whether exercise is more effective than HRT or yoga.
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Affiliation(s)
- Amanda Daley
- Primary Care Clinical Sciences, College of Medicine and Dentistry, Learning Centre Building, Universitiy of Birmingham, Birmingham, England, UK, B15 2TT
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Choquette S, Riesco É, Cormier É, Dion T, Aubertin-Leheudre M, Dionne IJ. Effects of soya isoflavones and exercise on body composition and clinical risk factors of cardiovascular diseases in overweight postmenopausal women: a 6-month double-blind controlled trial. Br J Nutr 2011; 105:1199-209. [PMID: 21205384 DOI: 10.1017/s0007114510004897] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Results from a pilot project indicate that isoflavones and exercise could have an additive effect on body composition and clinical risk factors of CVD in postmenopausal women. The objective of the present study was to assess the combined effect of exercise and isoflavones in overweight-to-obese postmenopausal women. In this double-blind randomised controlled trial, 100 overweight-to-obese (BMI 29·9 (sd 3·2) kg/m2) postmenopausal women were assigned to four groups: (1) placebo (PLA); (2) isoflavones (ISO); (3) exercise and placebo (Ex+PLA); (4) exercise and isoflavones (Ex+ISO). The supplementation contained 70 mg/d of isoflavones. Exercise consisted of three weekly sessions of resistance training and aerobics. Outcome measures included fat mass (FM), lean body mass (LBM), bone mineral density, lipid profile, fasting glucose, fasting insulin and insulin resistance (homeostasis assessment model). The main effects of exercise were observed for total FM (P = 0·02), FM% (P < 0·01), trunk FM% (P = 0·05), arm FM% (P < 0·01), leg FM% (P = 0·02), arm LBM (P < 0·01), leg LBM (P = 0·02) and C-reactive protein (P < 0·01). A main effect was detected for isoflavones in improving leg FM% (P = 0·05). No interactions were observed between isoflavones and exercise. In conclusion, it was observed that 6 months of exercise brought favourable changes in total FM, FM% and LBM in overweight postmenopausal women. No synergistic effects were observed between exercise and isoflavones. However, isoflavones could have a beneficial effect on leg FM%.
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Affiliation(s)
- Stéphane Choquette
- Faculty of Physical Education and Sports, University of Sherbrooke, Sherbrooke, QC, Canada J1K 2R1
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Daley A, Stokes-Lampard H, Wilson S, Rees M, Roalfe A, MacArthur C. What women want? Exercise preferences of menopausal women. Maturitas 2011; 68:174-8. [DOI: 10.1016/j.maturitas.2010.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 11/11/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Short-term exercise approaches on menopausal symptoms, psychological health, and quality of life in postmenopausal women. Obstet Gynecol Int 2010; 2010. [PMID: 20814541 PMCID: PMC2931380 DOI: 10.1155/2010/274261] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 07/13/2010] [Indexed: 11/28/2022] Open
Abstract
Objective. This study was designed to determine the effects of different short-term exercise programs on menopausal symptoms, psychological health, and quality of life in postmenopausal women.
Material and Methods. Forty-two women were chosen from volunteering postmenopausal women presenting to the Department of Obstetrics and Gynecology of Bayındır Hospital between March and December 2009. The women aged 45–60 years and experiencing menopause naturally were included in the study. They were randomly divided into aerobic (n = 18) and resistance (n = 18) exercise groups. The women exercised 3 days per week for 8 weeks under the supervision of a physiotherapist. Aerobic exercise training was performed through a bicycle ergometer. Before and after the training, lipid profiles were measured and menopausal symptoms, psychological health, depression, and the quality of life were assessed through questionnaires. Results. In both exercise groups, no significant changes in lipid profiles were observed. In the resistance exercise group, excluding the urogenital complaints, there were significant improvements in all subscales of Menopausal Rating Scale (MRS). In the resistance exercise group, excluding the phobic anxiety, there were significant improvements in all subscales of The Symptom Checklist. Depression levels significantly decreased in both groups. Improvements were observed in all subscales of menopause-specific quality of life questionnaire in both groups except for sexual symptoms. Conclusion. Resistance exercise and aerobic exercise were found to have a positive impact on menopausal symptoms, psychological health, depression, and quality of life.
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Pachman DR, Jones JM, Loprinzi CL. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions. Int J Womens Health 2010; 2:123-35. [PMID: 21072305 PMCID: PMC2971731 DOI: 10.2147/ijwh.s7721] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 12/21/2022] Open
Abstract
Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block.
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Effects of long-term aerobic exercise on physical fitness and postmenopausal symptoms with menopausal rating scale. Sci Sports 2010. [DOI: 10.1016/j.scispo.2009.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Elavsky S, Gold CH. Depressed mood but not fatigue mediate the relationship between physical activity and perceived stress in middle-aged women. Maturitas 2009; 64:235-40. [PMID: 19781878 DOI: 10.1016/j.maturitas.2009.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 09/02/2009] [Accepted: 09/03/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether depressed mood and fatigue mediate the relationships between physical activity, body mass index, menopausal hot flashes, and perceived stress. METHOD This study is a secondary analysis of data obtained from a sub-sample of peri- and postmenopausal women (N=212) from the TREMIN Research Program on Women's Health. RESULTS The hypothesized mediational model was tested using path analysis within a structural equation modeling framework in Mplus Version 5.1. In unadjusted analysis, the relationships between physical activity, menopausal hot flashes, and perceived stress were mediated by depressed mood; fatigue mediated the relationships between hot flashes, body mass index, and perceived stress. When adjusting for age, insomnia, menopausal and hormone use status, the mediational effects of depressed mood on stress remained significant only for physical activity, and fatigue mediated the relationship between hot flashes and stress. The adjusted model explained 70% of variance in perceived stress, 82% of variance in depressed mood, and 81% of variance in fatigue. CONCLUSION Depressed mood may partially explain the relationship between physical activity and perceived stress in middle-aged women, however further studies are needed to corroborate causality.
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Exercise to reduce vasomotor and other menopausal symptoms: A review. Maturitas 2009; 63:176-80. [DOI: 10.1016/j.maturitas.2009.02.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 02/05/2009] [Indexed: 11/20/2022]
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MacGregor EA. Headache and hormone replacement therapy in the postmenopausal woman. Curr Treat Options Neurol 2009; 11:10-7. [PMID: 19094831 DOI: 10.1007/s11940-009-0002-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Headache and migraine are common symptoms of the menopause, often associated with irregular periods, hot flashes, and night sweats. Perimenopausal women should routinely be asked about headache and migraine, so that they can be offered appropriate advice. If attacks are infrequent, it may be sufficient to optimize acute treatment strategies. Lifestyle changes, alone or combined with a nonprescription treatment such as isoflavones, may be considered, although evidence of efficacy is limited. In women with migraine and more severe menopause symptoms, continuous hormone replacement therapy should be considered, using a nonoral route and the lowest dose effective in controlling symptoms. For women who have contraindications to estrogen therapy or do not wish to use it, compounds that inhibit serotonin reuptake, such as venlafaxine, fluoxetine, and paroxetine, have all shown efficacy for the control of hot flashes and prevention of migraine. Gabapentin is another nonhormonal option that has clinical trial evidence of effectiveness in treating hot flashes and reducing the frequency and severity of migraine attacks. Although clonidine is licensed in several countries for migraine prophylaxis and treatment of vasomotor symptoms, any benefit from treatment is often offset by adverse events. There is evidence that hysterectomy can increase the frequency of migraine and menopause symptoms, with added morbidity and risk of mortality. Therapy should regularly be evaluated to assess its ongoing need, as hormonal triggers are self-limiting and abate after menopause.
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Affiliation(s)
- E Anne MacGregor
- E. Anne MacGregor, MB, BS, MD, MFSRH The City of London Migraine Clinic, 22 Charterhouse Square, London EC1M 6DX, United Kingdom.
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Abstract
OBJECTIVE Physical activity has been shown to enhance quality of life (QOL); however, few investigations of these effects exist in women undergoing the menopausal transition. The present study examined the long-term effects of physical activity on menopause-related QOL and tested the mediating effects of physical self-worth and positive affect in this relationship. METHODS Middle-aged women previously enrolled in a 4-month randomized controlled trial involving walking and yoga, and a control group completed a follow-up mail-in survey 2 years after the end of the trial. The survey included a battery of psychological and physical activity measures, including measures of menopausal symptoms and menopause-related QOL. Longitudinal linear panel analysis was conducted within a covariance modeling framework to test whether physical self-worth and positive affect mediated the physical activity-QOL relationship over time. RESULTS At the end of the trial, physical activity and menopausal symptoms were related to physical self-worth and positive affect, and in turn, greater levels of physical self-worth and positive affect were associated with higher levels of menopause-related QOL. Analyses indicated that increases in physical activity and decreases in menopausal symptoms over the 2-year period were related to increases in physical self-worth (betas = 0.23 and -0.52, physical activity and menopausal symptoms, respectively) and, for symptoms, also to decreased positive affect (beta = -0.47), and both physical self-worth (beta = 0.34) and affect (beta = 0.43) directly influenced enhancements in QOL (R = 0.775). CONCLUSIONS The findings support the position that the effects of physical activity on QOL are mediated, in part, by intermediate psychological outcomes and that physical activity can have long-term benefits for women undergoing the menopausal transition.
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Affiliation(s)
- Steriani Elavsky
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 , USA.
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Elavsky S, McAuley E. Personality, Menopausal Symptoms, and Physical Activity Outcomes in Middle-Aged Women. PERSONALITY AND INDIVIDUAL DIFFERENCES 2009; 46:123-128. [PMID: 20046213 DOI: 10.1016/j.paid.2008.09.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The menopausal transition is characterized by increased reporting of various symptoms, however, little is known about what underlies individual differences in their reporting. The present study examined the contribution of personality factors to the reporting of menopausal symptoms in the context of a 4-month randomized controlled exercise trial. Symptomatic middle-aged women (N = 164 M age = 49.9, SD = 3.6) completed measures of menopausal symptoms, personality, physical activity, fitness and body composition assessment at the beginning and end of a 4-month randomized controlled trial involving walking and yoga. After controlling for baseline values, psychological symptoms at the end of the trial were associated with trait anxiety (beta = .47, p < .001) and changes in fitness (beta = -.20, p < .01); vasomotor symptoms with optimism (beta = -.18, p < .05) and changes in fitness (beta = -.15, p = .053); and sexual symptoms were associated with changes in fitness (beta = -.16, p < .05). Personality characteristics partially explain symptom reports during menopause however improvements in physical parameters such as fitness may reduce reported symptomatology.
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Johansen OE, Qvigstad E. Rationale for low-dose systemic hormone replacement therapy and review of estradiol 0.5 mg/NETA 0.1 mg. Adv Ther 2008; 25:525-51. [PMID: 18568306 DOI: 10.1007/s12325-008-0070-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The menopausal transition is associated with several symptoms, for which both non-pharmacological and pharmacological measures are available to provide relief. However, present knowledge indicates that the former is not highly effective, and that the latter, in terms of systemic oestrogen and progestogen-based hormone replacement therapy (HRT), although being effective (e.g. on vasomotor symptoms, bleeding control, bone mineral density, vaginal atrophy and quality of life), can be associated with some caveats. Amongst these are an increased risk for coronary heart disease, breast cancer, venous thromboembolism and stroke. In recent years, literature has indicated a dose dependency for HRT on some of the caveats, hence authorities (Food and Drug Administration, and the European Medicines Agency) and menopause societies (International Menopause Society and North American Menopause Society) now recommend that women deemed in need of HRT should receive the lowest possible dose without compromising the effect of symptom relief. Estradiol 0.5 mg/norethisterone acetate (NETA) 0.1 mg, despite being a lower dose than conventional hormones, is a compound, among a few other low-dose options, that can be used in such therapy. As a first-line oral option, it has demonstrated its effectiveness (which seems comparable to other compounds), with high tolerability and, apparently, no safety concerns, in a 6-month study. Further long-term clinical trials and observational studies are mandatory in order to capture any potential harm as well as to elucidate this compound's full potential. Following a thorough literature search using PubMed and MEDLINE from the earliest publication dates through to January 2008, including results from various types of clinical trials and statements on HRT, we review the rationale for these recommendations. We also review the effects and safety of a novel 'ultra-low-dose' oral continuous combined HRT tablet, estradiol 0.5 mg/NETA 0.1 mg.
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Reinhard-Hennch B, von Hagens C, Strowitzki T. Klassische Naturheilverfahren und Lebensführung im Klimakterium. GYNAKOLOGISCHE ENDOKRINOLOGIE 2008. [DOI: 10.1007/s10304-008-0250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Evidence suggests that a high proportion of perimenopausal and early postmenopausal women will experience some menopause symptoms, hot flushes being the most common. The effects caused by falling levels of estrogen may be alleviated by hormone replacement therapy (HRT) but there has been a marked global decline in the prescription and use of HRT due to concerns about the risks and benefits of HRT; consequently many women are now seeking alternatives. As large numbers of women are choosing not to take HRT, it is increasingly important to identify evidence based lifestyle modifications, which can have a positive effect on menopausal symptoms. OBJECTIVES To examine the effectiveness of any type of exercise intervention in the management of vasomotor menopausal symptoms (hot flushes and night sweats) in perimenopausal and postmenopausal women. SEARCH STRATEGY Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials: The Cochrane Library (CENTRAL) (Wiley Internet interface) 2006 Issue 2, MEDLINE (Ovid) 1966-May week 4 2006, EMBASE (Ovid) 1980-week 21 2006, PsycINFO (Ovid) 1967-May week 5 2006, Science Citation Index and Social Science Citation Index (Web of Science) 1900-June 2006 and 1956-June 2006 respectively, CINAHL (Ovid) 1982-May week 4 2006, SPORT Discus (ERL WebSPIRS) 1830-2006/04. SELECTION CRITERIA Randomised controlled trials (RCTs) in which any type of exercise intervention was compared to other treatments or no treatment in the management of menopausal vasomotor symptoms in symptomatic perimenopausal and postmenopausal women. DATA COLLECTION AND ANALYSIS Nineteen reports were deemed potentially eligible, but of these only one met the inclusion criteria and three authors independently extracted data from this trial. MAIN RESULTS Only one very small trial, which compared exercise with HRT, was available for inclusion in this review. Based on within-group analyses the study authors concluded that both interventions were effective in reducing vasomotor symptoms. Between-group trial analyses conducted by reviewers showed that the HRT group experienced significantly fewer hot flushes compared to the exercise group at follow-up. AUTHORS' CONCLUSIONS Only one very small trial involving symptomatic women has assessed the effectiveness of exercise in the management of vasomotor menopausal symptoms. Exercise was not as effective as HRT in this trial. We found no evidence from randomised controlled trials on whether exercise is an effective treatment relative to other interventions or no intervention in reducing hot flushes and or night sweats in symptomatic women. No conclusions regarding the effectiveness of exercise as a treatment for vasomotor menopausal symptoms could be made due to a lack of trials.
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Affiliation(s)
- A Daley
- Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK.
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