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Morga A, Zimmermann L, Valluri U, Siddiqui E, McLeod L, Bender RH. Validation and Application of Thresholds to Define Meaningful Change in Vasomotor Symptoms Frequency: Analysis of Pooled SKYLIGHT 1 and 2 Data. Adv Ther 2024; 41:2845-2858. [PMID: 38775925 PMCID: PMC11213751 DOI: 10.1007/s12325-024-02849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Vasomotor symptoms (VMS), the characteristic symptoms of menopausal transition, are often the primary reason women seek treatment. Current treatment options for VMS include fezolinetant, a nonhormonal, selective neurokinin 3 receptor antagonist. This study aimed to define a clinically meaningful threshold for reduction of moderate-to-severe VMS in postmenopausal women treated with fezolinetant and then apply it in a responder analysis of the pooled trial data. METHODS This analysis pooled data from two identical phase 3, double-blind, placebo-controlled studies that randomized women with moderate-to-severe VMS to once-daily fezolinetant 30 mg, 45 mg, or placebo (SKYLIGHT 1 and 2). The frequency of VMS was collected daily using an electronic diary. Patients completed the Patient Global Impression of Change in VMS (PGI-C VMS) instrument, which assessed changes in hot flushes/night sweats at weeks 4 and 12 compared with baseline using a seven-point Likert scale. VMS frequency data were anchored to PGI-C VMS data; the anchor level for meaningful within-patient change in PGI-C VMS was "moderately better." RESULTS In the pooled population (N = 1022), the mean (standard deviation) estimated thresholds for a meaningful within-patient change in moderate-to-severe VMS frequency were - 5.73 (3.47) at week 4 and - 6.20 (5.18) at week 12. Applying the thresholds for meaningful within-patient change to responder analyses ("missing as non-responder" imputation method) indicated a favorable clinical benefit: greater proportions of responders were observed in the fezolinetant 30-mg and 45-mg groups compared with placebo at week 4 (odds ratio range 2.48-2.91; P < 0.001) and week 12 (odds ratio range 1.908-2.68; P < 0.001). CONCLUSION PGI-C VMS is sensitive to change and correlates with VMS frequency: a reduction of approximately six VMS episodes per day from baseline to week 12 was meaningful at the individual patient level. Fezolinetant provides a meaningful clinical benefit for women with moderate-to-severe VMS associated with menopause and represents an important nonhormonal treatment option. TRIAL REGISTRATION NUMBER NCT04003155 and NCT04003142.
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Affiliation(s)
- Antonia Morga
- Astellas Pharma Europe Ltd., 300 Dashwood Lang Road, Bourne Business Park, Addlestone, KT15 2NX, UK.
| | | | - Udaya Valluri
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Emad Siddiqui
- Astellas Pharma Europe Ltd., 300 Dashwood Lang Road, Bourne Business Park, Addlestone, KT15 2NX, UK
| | - Lori McLeod
- RTI Health Solutions, North Carolina, NC, USA
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Choudhry DN, Saleem S, Hatim S, Irfan R. The effect of resistance training in reducing hot flushes in post-menopausal women: A meta-analysis. J Bodyw Mov Ther 2024; 39:335-342. [PMID: 38876649 DOI: 10.1016/j.jbmt.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 02/03/2024] [Accepted: 03/06/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE The objective of this meta-analysis is to study the effect of different strengths of resistance training programs on the severity and frequency of hot flushes in postmenopausal women with vasomotor symptoms. BACKGROUND Menopause is defined as the state in which the menstrual cycle of a biological female spontaneously comes to a halt for a period of about 1 year. Through a detailed analysis of much of the research, it is found that the resistance training program is beneficial not only for reducing the severity as well as the frequency of hot flushes in postmenopausal women. MATERIALS AND METHODS Online research was conducted through databases such as PubMed, Cochrane Trial Register, and Google Scholar till the 20th of March 2023. The Review Manager (version 5.4.1) was used to statistically analyze the data from the studies. Studies meeting the inclusion criteria, comparing the vasomotor symptoms in resistance training groups as compared to control were used for this meta-analysis. The primary outcome of interest was the alleviation of hot flushes in the resistance training group. Random-effect model was used to pool the studies and the result was reported in SMD with 95% Confidence Interval (CI). RESULTS 5 studies were selected for this review. Statistical analysis shows that vasomotor symptoms were more common in the control group and decreased significantly in the resistance training group after the intervention (SMD = -1.31, 95% CI: -1.85 to -0.77, p = 0.002). CONCLUSION Resistance Training significantly affects vasomotor symptoms and can be considered for such symptoms in postmenopausal women.
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Affiliation(s)
| | - Sohair Saleem
- Dow University of Health Sciences, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
| | - Sohaiba Hatim
- Dow University of Health Sciences, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
| | - Rija Irfan
- Dow University of Health Sciences, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
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Macías-Cortés E. Understanding Why Homeopathic Medicines are Used for Menopause: Searching for Insights into Neuroendocrine Features. HOMEOPATHY 2024; 113:54-66. [PMID: 37399836 DOI: 10.1055/s-0043-1769734] [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: 07/05/2023]
Abstract
BACKGROUND Menopause is a physiological event that marks the end of a woman's reproductive stage in life. Vasomotor symptoms and changes in mood are among its most important effects. Homeopathy has been used for many years in treating menopausal complaints, though clinical and pre-clinical research in this field is limited. Homeopathy often bases its prescription on neuropsychiatric symptoms, but it is unknown if homeopathic medicines (HMs) exert a neuroendocrine effect that causes an improvement in vasomotor symptoms and mood during menopause. OBJECTIVES The study's objectives were to address the pathophysiological changes of menopause that could help in the understanding of the possible effect of HMs at a neuroendocrine level, to review the current evidence for two of the most frequently prescribed HMs for menopause (Lachesis mutus and Sepia officinalis), and to discuss the future directions of research in this field. METHODS An extensive literature search for the pathophysiologic events of menopause and depression, as well as for the current evidence for HMs in menopause and depression, was performed. RESULTS Neuroendocrine changes are involved in the pathophysiology of vasomotor symptoms and changes in mood during menopause. Gonadal hormones modulate neurotransmitter systems. Both play a role in mood disorders and temperature regulation. It has been demonstrated that Gelsemium sempervirens, Ignatia amara and Chamomilla matricaria exert anxiolytic effects in rodent models. Lachesis mutus and Sepia officinalis are frequently prescribed for important neuropsychiatric and vasomotor symptoms. Dopamine, a neurotransmitter involved in mood, is among the constituents of the ink of the common cuttlefish, Sepia officinalis. CONCLUSION Based on all the pathophysiologic events of menopause and the improvement in menopausal complaints that certain HMs show in daily practice, these medicines might have a direct or indirect neuroendocrine effect in the body, possibly triggered via an as-yet unidentified biological mechanism. Many unanswered questions in this field require further pre-clinical and clinical research.
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Affiliation(s)
- Emma Macías-Cortés
- Outpatient Homeopathy Service, Hospital Juárez de México, Secretaría de Salud, Mexico City, Mexico
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Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metab 2024; 36:240-262. [PMID: 38280383 PMCID: PMC10871592 DOI: 10.1016/j.cmet.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Metabolic health is characterized by optimal blood glucose, lipids, cholesterol, blood pressure, and adiposity. Alterations in these characteristics may lead to the development of type 2 diabetes mellitus or dyslipidemia. Recent evidence suggests that female reproductive characteristics may be overlooked as risk factors that contribute to later metabolic dysfunction. These reproductive traits include the age at menarche, menstrual irregularity, the development of polycystic ovary syndrome, gestational weight change, gestational dysglycemia and dyslipidemia, and the severity and timing of menopausal symptoms. These risk factors may themselves be markers of future dysfunction or may be explained by shared underlying etiologies that promote long-term disease development. Disentangling underlying relationships and identifying potentially modifiable characteristics have an important bearing on therapeutic lifestyle modifications that could ease long-term metabolic burden. Further research that better characterizes associations between reproductive characteristics and metabolic health, clarifies underlying etiologies, and identifies indicators for clinical application is warranted in the prevention and management of metabolic dysfunction.
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Affiliation(s)
- Amy R Nichols
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Prokai-Tatrai K, Prokai L. The impact of 17β-estradiol on the estrogen-deficient female brain: from mechanisms to therapy with hot flushes as target symptoms. Front Endocrinol (Lausanne) 2024; 14:1310432. [PMID: 38260155 PMCID: PMC10800853 DOI: 10.3389/fendo.2023.1310432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Sex steroids are essential for whole body development and functions. Among these steroids, 17β-estradiol (E2) has been known as the principal "female" hormone. However, E2's actions are not restricted to reproduction, as it plays a myriad of important roles throughout the body including the brain. In fact, this hormone also has profound effects on the female brain throughout the life span. The brain receives this gonadal hormone from the circulation, and local formation of E2 from testosterone via aromatase has been shown. Therefore, the brain appears to be not only a target but also a producer of this steroid. The beneficial broad actions of the hormone in the brain are the end result of well-orchestrated delayed genomic and rapid non-genomic responses. A drastic and steady decline in circulating E2 in a female occurs naturally over an extended period of time starting with the perimenopausal transition, as ovarian functions are gradually declining until the complete cessation of the menstrual cycle. The waning of endogenous E2 in the blood leads to an estrogen-deficient brain. This adversely impacts neural and behavioral functions and may lead to a constellation of maladies such as vasomotor symptoms with varying severity among women and, also, over time within an individual. Vasomotor symptoms triggered apparently by estrogen deficiency are related to abnormal changes in the hypothalamus particularly involving its preoptic and anterior areas. However, conventional hormone therapies to "re-estrogenize" the brain carry risks due to multiple confounding factors including unwanted hormonal exposure of the periphery. In this review, we focus on hot flushes as the archetypic manifestation of estrogen deprivation in the brain. Beyond our current mechanistic understanding of the symptoms, we highlight the arduous process and various obstacles of developing effective and safe therapies for hot flushes using E2. We discuss our preclinical efforts to constrain E2's beneficial actions to the brain by the DHED prodrug our laboratory developed to treat maladies associated with the hypoestrogenic brain.
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Affiliation(s)
- Katalin Prokai-Tatrai
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, United States
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Jalali R, Romaszko J, Dragańska E, Gromadziński L, Cymes I, Sokołowski JB, Poterała M, Markuszewski L, Romaszko-Wojtowicz AM, Jeznach-Steinhagen A, Glińska-Lewczuk K. Heat and cold stress increases the risk of paroxysmal supraventricular tachycardia. PLoS One 2024; 19:e0296412. [PMID: 38165960 PMCID: PMC10760728 DOI: 10.1371/journal.pone.0296412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia in adults. Its occurrence depends on the presence of the reentry circuit and the trigger of the paroxysm. Stress, emotional factors, and comorbidities favour the occurrence of such an episode. We hypothesized that the occurrence of PSVT follows extreme thermal episodes. The retrospective analysis was based on the data collected from three hospital emergency departments in Poland (Olsztyn, Radom, and Wroclaw) involving 816 admissions for PSVT in the period of 2016-2021. To test the hypothesis, we applied the Universal Climate Thermal Index (UTCI) to objectively determine exposure to cold or heat stress. The risk (RR) for PSVT increased to 1.37 (p = 0.006) in cold stress and 1.24 (p = 0.05) in heat stress when compared to thermoneutral conditions. The likelihood of PSVT during cold/heat stress is higher in women (RR = 1.59, p< 0.001 and RR = 1.36, p = 0.024, respectively) than in men (RR = 0.64 at p = 0.088 and RR = 0.78, p = 0.083, respectively). The susceptibility for PSVT was even higher in all groups of women after exclusion of perimenopausal group of women, in thermal stress (RR = 1.74, p< 0.001, RR = 1.56, p = 0.029, respectively). Females, particularly at the perimenopausal stage and men irrespective of age were less likely to develop PSVT under thermal stress as compared to thermoneutral conditions. Progress in climate change requires searching for universal methods and tools to monitor relationships between humans and climate. Our paper confirms that the UTCI is the universal tool describing the impact of thermal stress on the human body and its high usefulness in medical researches.
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Affiliation(s)
- Rakesh Jalali
- Department of Emergency Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Jerzy Romaszko
- Department of Family Medicine and Infectious Diseases, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Ewa Dragańska
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Iwona Cymes
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - Magdalena Poterała
- Department of Medicine, Faculty of Medical Sciences and Health Science, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Leszek Markuszewski
- Department of Medicine, Faculty of Medical Sciences and Health Science, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Anna Maria Romaszko-Wojtowicz
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - Katarzyna Glińska-Lewczuk
- Department of Water Management and Climatology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Witten T, Staszkiewicz J, Gold L, Granier MA, Klapper RJ, Lavespere G, Dorius B, Allampalli V, Ahmadzadeh S, Shekoohi S, Kaye AD, Varrassi G. Nonhormonal Pharmacotherapies for the Treatment of Postmenopausal Vasomotor Symptoms. Cureus 2024; 16:e52467. [PMID: 38371081 PMCID: PMC10870088 DOI: 10.7759/cureus.52467] [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: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
An average of 60-80% of all menopausal women experience bothersome vasomotor symptoms (VMSs), such as flushing and sweating, within the first seven years of onset. However, despite increasing prevalence, these hot flashes remain hard to treat and have a negative effect on the quality of life. Though hormone replacement therapy is commonly utilized as a standard treatment for VMSs, this therapy is not recommended for all women. Specifically, the oral form of hormone replacement therapy is associated with several contraindications, including a history of thromboembolic disease, migraine headache with aura, liver failure, heart disease, and hormone-dependent cancers. For women with these medical conditions, current literature indicates that nonhormonal therapies such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are suitable alternatives to reduce the frequency and intensity of VMSs. Currently, the only SSRI that is FDA-approved for the treatment of VMSs is paroxetine, but studies show that fluoxetine, citalopram, escitalopram, and sertraline are also proven to provide similar benefits. Similarly, the SNRI venlafaxine has also been well tolerated and has been shown to reduce the frequency and severity of hot flashes. The present investigation reviews the physiology of VMSs and examines the evidence for the use of nonhormonal pharmacologic therapies as treatment for women experiencing hot flashes. These interventions should be considered whenever hormone replacement therapy is contraindicated, with therapy individualized based on the severity of symptoms.
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Affiliation(s)
- Taylor Witten
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Julia Staszkiewicz
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Logan Gold
- School of Medicine, Louisiana State University Health New Orleans, New Orleans, USA
| | - Mallory A Granier
- School of Medicine, Louisiana State University Health New Orleans, New Orleans, USA
| | - Rachel J Klapper
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Gabriel Lavespere
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Bradley Dorius
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Varsha Allampalli
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Rasmussen VF, Schmeichel A, Thrysøe M, Nyengaard JR, Christensen AMR, Vestergaard ET, Kristensen K, Terkelsen AJ, Karlsson P, Singer W. Sweat gland nerve fiber density and association with sudomotor function, symptoms, and risk factors in adolescents with type 1 diabetes. Clin Auton Res 2023; 33:691-703. [PMID: 37682387 PMCID: PMC10751258 DOI: 10.1007/s10286-023-00973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE To quantify sweat gland nerve fiber density in adolescents with diabetes. Additionally, to investigate associations between sudomotor innervation, sweat responses, and possible risk factors for sudomotor neuropathy. METHODS Cross-sectional study where 60 adolescents with type 1 diabetes (duration > 5 years) and 23 control subjects were included. Clinical data, quantitative sudomotor axon reflex test, and skin biopsies were obtained. Skin tissue was immunostained and imaged by confocal microscopy. Quantification of the sweat gland volume and three-dimensional reconstruction of the nerve fibers was performed using a design-unbiased technique. RESULTS Adolescents with diabetes had a significant reduction of maximum and mean values of nerve fiber length and nerve fiber density in sweat glands compared to controls (p values < 0.05). No association between nerve fiber density and sweat responses was found (p = 0.21). In cases with reduced sweat gland nerve fiber length, nerve fiber density, and volume, the sweat response was reduced or absent. Height, systolic blood pressure, time in hypoglycemia, and total daily and basal/total insulin dose were positively correlated to sweat response, while low-density lipoprotein, and HbA1c were negatively correlated with sweat response (p values < 0.05). Other microvascular complications and high cholesterol levels increased the relative risk for reduced sweat gland nerve fiber density. CONCLUSION Our findings of reduced sweat gland innervation in a selected group of adolescents add new knowledge about the structural changes that occur in autonomic nerves due to diabetes. Evaluating both the sweat gland innervation and sweat gland volume was important for understanding the association with sweat responses. Further research is needed to understand its clinical relevance.
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Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Pediatrics and Adolescents, Randers Regional Hospital, Randers, Denmark.
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
| | - Ann Schmeichel
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Ann-Margrethe Rønholt Christensen
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Pediatrics and Adolescents, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics and Adolescents, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics and Adolescents, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lello S, Paris I, Cagnacci A, Sartori D, Caruso S, Iop A. Vasomotor symptoms and management of women undergoing treatment for breast cancer: literature review with focus on the therapeutic potential of cytoplasmic pollen extract. Gynecol Endocrinol 2023; 39:2162035. [PMID: 36591791 DOI: 10.1080/09513590.2022.2162035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Effective management of vasomotor symptoms (VMS) in patients undergoing treatment for breast cancer (BC) represents a critical but frequent unmet need. This review summarizes the epidemiology, pathophysiology, and clinical features of VMS in patients with BC and provides a synopsis of the complementary and alternative medicine (CAM) approaches in relieving VMS with a focus on purified cytoplasm of pollen (PCP). METHODS The literature on VMS epidemiology, pathophysiology, clinical burden, and CAM treatment in healthy women and patients with BC was reviewed. RESULTS VMS are common in patients with BC undergoing hormonal treatment and negatively impact quality of life, leading to treatment discontinuation in up to 25% of patients with detrimental impact on risk of BC recurrence and overall survival. CAM approaches to treat VMS in patients with BC include vitamin E, phytoestrogens, and black cohosh, even if there is a lack of solid evidence to guide clinicians in the choice of treatment. PCP, obtained according to standards of good manufacturing practice, has a definite pharmacological mechanism of action, is devoid of estrogen activity, and has shown clinical efficacy on menopause-associated symptoms with a favorable safety profile and high compliance. As such, it appears to represent a valid management option to improve quality of life in patients with pre- and postmenopausal BC. CONCLUSIONS Physicians should actively investigate the presence and impact of VMS in patients receiving therapy for BC. Additional and appropriately sized randomized clinical trials are needed to provide clear evidence on how to best meet the needs of patients with BC suffering from menopause-associated symptoms.
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Affiliation(s)
- Stefano Lello
- Department of Woman and Child Health, Policlinico A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health, Policlinico A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Angelo Cagnacci
- Department of Obstetrics and Gynecology, San Martino Hospital, Genoa, Italy
| | | | - Salvatore Caruso
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Aldo Iop
- University Local Health Authority Giuliano Isontina ASUGI, Trieste,Italy
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Khan SJ, Kapoor E, Faubion SS, Kling JM. Vasomotor Symptoms During Menopause: A Practical Guide on Current Treatments and Future Perspectives. Int J Womens Health 2023; 15:273-287. [PMID: 36820056 PMCID: PMC9938702 DOI: 10.2147/ijwh.s365808] [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] [Received: 07/28/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Vasomotor symptoms affect as many as 80% of midlife women, but only about one in four women receive treatment due to many factors. Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms, and current professional guidelines conclude that the benefits of treatment typically outweigh the risks for healthy, symptomatic women under age 60 years and those within 10 years from their final menstrual period. For women with medical comorbidities, an individualized approach to treatment is recommended. For women who cannot use or choose not to use menopausal hormone therapy, there are many evidence-based non-hormonal options available including pharmacologic therapies. This review aims to summarize treatment options for bothersome vasomotor symptoms to guide clinicians caring for midlife women.
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Affiliation(s)
- Saira J Khan
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ekta Kapoor
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Juliana M Kling
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA,Correspondence: Juliana M Kling, Division of Women’s Health Internal Medicine, Mayo Clinic, 13737 N 92 23 nd St, Scottsdale, AZ, 85260, USA, Tel +1-480-614-6001, Fax +1-480-614-6021, Email
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11
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The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review. Sleep Med Rev 2022; 66:101710. [PMID: 36356400 DOI: 10.1016/j.smrv.2022.101710] [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: 05/02/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Sleep disturbance is a common clinical concern throughout the menopausal transition. However, the pathophysiology and causes of these sleep disturbances remain poorly understood, making it challenging to provide appropriate therapy. Our goal was to i) review the literature about the influence of ovarian hormones on sleep in perimenopausal women, ii) summarize the potential underlying pathophysiology of menopausal sleep disturbances and iii) evaluate the implications of these findings for the therapeutic approach to sleep disturbances in the context of menopause. A systematic literature search using the databases Embase, MEDLINE and Cochrane Library was conducted. Keywords relating to ovarian hormones, sleep disturbances and menopause were used. Ultimately, 86 studies were included. Study Quality Assessment Tools of the National Institutes of Health were used for quality assessment. Results from good-quality studies demonstrated that the postmenopausal decline in estrogen and progesterone contributes to sleep disturbances in women and that timely treatment with estrogen and/or progesterone therapy improved overall sleep quality. Direct and indirect effects of both hormones acting in the central nervous system and periphery, as well as via secondary effects (e.g. reduction in vasomotor symptoms), can contribute to improvements in sleep. To strengthen external validity, studies examining neurobiological pathways are needed.
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Citalopram improves vasomotor syndrome and urogenital syndrome of menopause in Mexican women: a randomized clinical trial. Arch Gynecol Obstet 2022; 306:2035-2045. [PMID: 35997971 DOI: 10.1007/s00404-022-06732-9] [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: 04/11/2022] [Accepted: 07/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed to determine the efficacy of non-hormonal therapy with citalopram vs fluoxetine for treating vasomotor syndrome (VMS) and urogenital syndrome of menopause (GSM) in Mexican women. METHODS A parallel prospective randomized clinical trial was conducted in 91 postmenopausal women with a total score on the Menopause Rating Scale (MRS) ≥ 17 and with the clinical diagnosis of VSM and GSM. Patients were randomly assigned to receive citalopram (n = 49) or fluoxetine (n = 42). Follow-up was carried out at 3 and 6 months. RESULTS The citalopram group experienced a significant improvement compared to the fluoxetine group in the MRS total score (p < 0.01), as well as in the psychological (p < 0.001) and somatic (p < 0.0001) domains at 3 and 6 months of follow-up. After 6 months of follow-up, the group that received citalopram decreased the relative risk (RR) to present VMS symptoms (RR = 0.30, CI 0.19-0.5, p = 0.0001), depressed mood (RR = 0.31, CI 0.15-0.6, p = 0.0002), irritability (RR = 0.40, CI 0.22-0.73, p = 0.002), anxiety (RR = 0.30, CI 0.13-0.69, p = 0.003), physical and mental exhaustion (RR = 0.35, CI 0.18-0.67, p = 0.001), sexual problems (RR = 0.18, CI 0.06-0.48, p = 0.0001), vaginal dryness (RR = 0.34, CI 0.14-0.80, p = 0.01), and urinary problems (RR = 0.36, CI 0.14-0.92, p = 0.043). CONCLUSION We conclude that citalopram tends to improve VSM and GSM symptoms in postmenopausal Mexican women. Thus, we recommend the daily use of citalopram 20 mg. However, further studies will be required to support the results of the present work. These should include a larger number of patients and a placebo group. CLINICAL TRIAL REGISTRATION This clinical trial was retrospectively registered by the United States National Library of Medicine in the www. CLINICALTRIALS gov database on 04/20/2022. The given test Registration Number is NCT05346445.
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Booyens RM, Engelbrecht AM, Strauss L, Pretorius E. To clot, or not to clot: The dilemma of hormone treatment options for menopause. Thromb Res 2022; 218:99-111. [PMID: 36030662 DOI: 10.1016/j.thromres.2022.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022]
Abstract
Untreated menopause may have serious health implications, but treatments can have dangerous side effects. We evaluate menopausal symptoms as well as available treatments -the routes of administration and their effect on blood coagulation. Menopausal females may experience hot flushes, vulva- and vaginal atrophy and osteoporosis. Many treatments are available to relieve these symptoms such as Conjugated Equine Estrogen and bioidentical hormones. The routes of administration include oral and transdermal. Hormones that are administered orally undergo a hepatic first pass metabolism. The by-products have a lower efficacy and possibly enhanced side effects. Furthermore, hormone treatments influence the coagulation cascade through coagulation factors or their regulators. Increased coagulation poses a risk for venous thromboembolism. Currently a definite conclusion on whether the side effects from hormone treatments exceed the risk of untreated menopause cannot be made. However, a more individualised approach to hormone treatments may be the most feasible solution to this dilemma.
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Affiliation(s)
- Renata M Booyens
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Anna-Mart Engelbrecht
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Ledivia Strauss
- Functional Medicine Practice, A1 Polo Village Offices, Kliprug Minor Rd, Val De Vie Winelands Lifestyle Estate, 7646, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa.
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14
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Hormonal Agents for the Treatment of Depression Associated with the Menopause. Drugs Aging 2022; 39:607-618. [PMID: 35908135 PMCID: PMC9355926 DOI: 10.1007/s40266-022-00962-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Perimenopause marks the transition from a woman’s reproductive stage to menopause. Usually occurring between 42 and 52 years of age, it is determined clinically by the onset of irregular menstrual cycles or variable cycle lengths. Women are at an increased risk of depression and anxiety during perimenopause and the menopausal transition. Depressive symptoms experienced in perimenopause are often more severe compared to pre- and post-menopause. During menopausal transition, the impact of fluctuating estrogen in the central nervous system (CNS) can have negative psychological effects for some women. Traditional first-line management of menopausal depression involves antidepressants, with modest outcomes. The positive effects of estrogen treatment in the CNS are becoming increasingly recognised, and hormonal therapy (HT) with estrogen may have a role in the treatment of menopausal depression. In this review we will outline the prevalence, impact and neurochemical basis of menopausal-associated depression, as well as hormone-based approaches that have increasing promise as effective treatments.
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Tang R, Luo M, Fan Y, Peng Y, Wang Y, Liu G, Wang Y, Lin S, Chen R. Menopause-specific quality of life during ovarian aging among Chinese women: A prospective cohort study. Maturitas 2022; 157:7-15. [DOI: 10.1016/j.maturitas.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
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Neff AM, Laws MJ, Warner GR, Flaws JA. The Effects of Environmental Contaminant Exposure on Reproductive Aging and the Menopause Transition. Curr Environ Health Rep 2022; 9:53-79. [PMID: 35103957 PMCID: PMC8988816 DOI: 10.1007/s40572-022-00334-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Menopause marks the end of a woman's reproductive lifetime. On average, natural menopause occurs at 51 years of age. However, some women report an earlier age of menopause than the national average. This can be problematic for women who delay starting a family. Moreover, early onset of menopause is associated with increased risk of cardiovascular disease, depression, osteoporosis, and premature death. This review investigates associations between exposure to endocrine-disrupting chemicals (EDCs) and earlier onset of menopause. RECENT FINDINGS Recent data suggest exposure to certain EDCs may accelerate reproductive aging and contribute to earlier onset of menopause. Human and rodent-based studies identify positive associations between exposure to certain EDCs/environmental contaminants and reproductive aging, earlier onset of menopause, and occurrence of vasomotor symptoms. These findings increase our understanding of the detrimental effects of EDCs on female reproduction and will help lead to the development of strategies for the treatment/prevention of EDC-induced reproductive aging.
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Affiliation(s)
- Alison M Neff
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, 2001 South Lincoln Avenue, 3223 Vet Med Basic Sciences Bldg, Urbana, IL, 61802, USA
| | - Mary J Laws
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, 2001 South Lincoln Avenue, 3223 Vet Med Basic Sciences Bldg, Urbana, IL, 61802, USA
| | - Genoa R Warner
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, 2001 South Lincoln Avenue, 3223 Vet Med Basic Sciences Bldg, Urbana, IL, 61802, USA
| | - Jodi A Flaws
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, 2001 South Lincoln Avenue, 3223 Vet Med Basic Sciences Bldg, Urbana, IL, 61802, USA.
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Papazisis G, Tsakiridis I, Apostolopoulou A, Papaefstathiou E, Bellali T, Liozidou A, Pappa A, Ainatzoglou A, Tzitiridou M, Billis A, Dagklis T. The Greek translation and validation of the electronic version of the Meno-D rating scale for post-menopausal depression. Health Informatics J 2022; 28:14604582221080100. [PMID: 35435749 DOI: 10.1177/14604582221080100] [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: 11/17/2022]
Abstract
Menopausal transition and post-menopause constitute windows of increased vulnerability to depression. Recently, the Meno-D was introduced, a novel 12-item, with five distinct subscales. The aim of our study was to translate and validate the electronic version of the Meno-D among Greek post-menopausal women. Translation and back-translation were performed by an expert group, while face validity was assessed by five experts. Along with the Beck Depression Inventory-II, the Meno-D scale was distributed online to 502 post-menopausal women. A confirmatory factor analysis was performed to investigate construct validity and both convergent and discriminant validity were evaluated. The data analysis was performed using Statistical Package for Social Sciences and AMOS. The 5-factor model of Meno-D achieved adequate levels of goodness-of-fit indices, scoring lower values in discriminant validity examined with heterotrait-monotrait ratio and composite reliability. The significant correlation with the Beck Depression Inventory-ΙΙ revealed for all subscales was indicative of good convergent validity. An exploratory factor analysis was additionally performed, suggesting a 12-item tool comprising two subscales: (i) psychological and (ii) biological and achieving good levels of fit. Our data confirmed that the electronic version of Meno-D is a valid tool that can be used for screening and evaluation of depression in Greek post-menopausal women.
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Affiliation(s)
| | - Ioannis Tsakiridis
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Aikaterini Apostolopoulou
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Efstathios Papaefstathiou
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Thalia Bellali
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Athanasia Liozidou
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Athanasia Pappa
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Alexandra Ainatzoglou
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Maria Tzitiridou
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Antonis Billis
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
| | - Themistoklis Dagklis
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, 30133Aristotle University of Thessaloniki, Greece
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McCarthy EA, Dischino D, Maguire C, Leon S, Talbi R, Cheung E, Schteingart CD, Rivière PJM, Reed SD, Steiner RA, Navarro VM. Inhibiting Kiss1 Neurons With Kappa Opioid Receptor Agonists to Treat Polycystic Ovary Syndrome and Vasomotor Symptoms. J Clin Endocrinol Metab 2022; 107:e328-e347. [PMID: 34387319 PMCID: PMC8684497 DOI: 10.1210/clinem/dgab602] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent evidence suggests that vasomotor symptoms (VMS) or hot flashes in the postmenopausal reproductive state and polycystic ovary syndrome (PCOS) in the premenopausal reproductive state emanate from the hyperactivity of Kiss1 neurons in the hypothalamic infundibular/arcuate nucleus (KNDy neurons). OBJECTIVE We demonstrate in 2 murine models simulating menopause and PCOS that a peripherally restricted kappa receptor agonist (PRKA) inhibits hyperactive KNDy neurons (accessible from outside the blood-brain barrier) and impedes their downstream effects. DESIGN Case/control. SETTING Academic medical center. PARTICIPANTS Mice. INTERVENTIONS Administration of peripherally restricted kappa receptor agonists and frequent blood sampling to determine hormone release and body temperature. MAIN OUTCOME MEASURES LH pulse parameters and body temperature. RESULTS First, chronic administration of a PRKA to bilaterally ovariectomized mice with experimentally induced hyperactivity of KNDy neurons reduces the animals' elevated body temperature, mean plasma LH level, and mean peak LH per pulse. Second, chronic administration of a PRKA to a murine model of PCOS, having elevated plasma testosterone levels and irregular ovarian cycles, suppresses circulating levels of LH and testosterone and restores normal ovarian cyclicity. CONCLUSION The inhibition of kisspeptin neuronal activity by activation of kappa receptors shows promise as a novel therapeutic approach to treat both VMS and PCOS in humans.
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Affiliation(s)
- Elizabeth A McCarthy
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Daniel Dischino
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Caroline Maguire
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Silvia Leon
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rajae Talbi
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Eugene Cheung
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | | | | | - Susan D Reed
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Robert A Steiner
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA 98195, USA
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Victor M Navarro
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Program in Neuroscience, Boston, MA 02115, USA
- Correspondence: Victor M. Navarro PhD, Brigham and Women’s Hospital, Division of Endocrinology, Diabetes and Hypertension, 221 Longwood Ave, Boston, MA 02115, USA.
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Thakur J, Goswami M, Roy S. Do vasomotor and genitourinary symptoms of menopause vary between sedente and migrant groups? A study on the Oraon tribal populations of Eastern India. Am J Hum Biol 2021; 34:e23710. [PMID: 34883536 DOI: 10.1002/ajhb.23710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/25/2021] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Human reproductive characteristics are embedded within local ecological contexts. A shift in the local ecology is likely to offer challenges in reproductive outcome. We aimed to investigate sedente-migrant variation in experiencing vasomotor and genitourinary symptoms at perimenopausal and postmenopausal stages and its concomitants. METHODS Four hundred Oraon tribal populations living in Eastern India (sedente [100 each from perimenopausal and postmenopausal groups] and migrants [100 each from perimenopausal and postmenopausal groups]) were studied. Data on vasomotor and genitourinary symptoms, socio-demographic and reproductive history, body compositions, lifestyle variables, and energy intake were compared between sedente and migrant independently for perimenopausal and postmenopausal groups. Principal component analysis (PCA) was used to identify the principal components (PCs) of menopausal symptoms. A two level multilevel linear regression was applied independently for perimenopausal and postmenopausal groups to identify the concomitants of menopausal symptoms and estimate sedente-migrant variance. RESULTS Bivariate analysis showed significant (p ≤ .05) sedente-migrant differences in socio-demographic, reproductive, body composition, energy intake, and lifestyle variables and in some of the vasomotor and genitourinary symptoms. In multilevel analyses, random effect did not show significant heterogeneity between sedente and migrant groups in experiencing menopausal symptoms; however, fixed effect showed that region from which participants were recruited (Gram Panchayat [GP]) and individual level characteristics were concomitants (p ≤ .05) for menopausal symptoms, irrespective of menopausal status. CONCLUSION Variability at GP levels and individual level characteristics of sedente and migrant groups predominantly determined menopausal symptoms of the study populations, but not the migration status.
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Affiliation(s)
- Joyeeta Thakur
- Department of Anthropology, University of Calcutta, Kolkata, West Bengal, India
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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [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: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Mosconi L, Berti V, Dyke J, Schelbaum E, Jett S, Loughlin L, Jang G, Rahman A, Hristov H, Pahlajani S, Andrews R, Matthews D, Etingin O, Ganzer C, de Leon M, Isaacson R, Brinton RD. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep 2021; 11:10867. [PMID: 34108509 PMCID: PMC8190071 DOI: 10.1038/s41598-021-90084-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/06/2021] [Indexed: 01/25/2023] Open
Abstract
All women undergo the menopause transition (MT), a neuro-endocrinological process that impacts aging trajectories of multiple organ systems including brain. The MT occurs over time and is characterized by clinically defined stages with specific neurological symptoms. Yet, little is known of how this process impacts the human brain. This multi-modality neuroimaging study indicates substantial differences in brain structure, connectivity, and energy metabolism across MT stages (pre-menopause, peri-menopause, and post-menopause). These effects involved brain regions subserving higher-order cognitive processes and were specific to menopausal endocrine aging rather than chronological aging, as determined by comparison to age-matched males. Brain biomarkers largely stabilized post-menopause, and gray matter volume (GMV) recovered in key brain regions for cognitive aging. Notably, GMV recovery and in vivo brain mitochondria ATP production correlated with preservation of cognitive performance post-menopause, suggesting adaptive compensatory processes. In parallel to the adaptive process, amyloid-β deposition was more pronounced in peri-menopausal and post-menopausal women carrying apolipoprotein E-4 (APOE-4) genotype, the major genetic risk factor for late-onset Alzheimer's disease, relative to genotype-matched males. These data show that human menopause is a dynamic neurological transition that significantly impacts brain structure, connectivity, and metabolic profile during midlife endocrine aging of the female brain.
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Affiliation(s)
- Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA.
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - Valentina Berti
- Department of Nuclear Medicine, University of Florence, Florence, Italy
| | - Jonathan Dyke
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Lacey Loughlin
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Grace Jang
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Aneela Rahman
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | | | - Orli Etingin
- Department of Internal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Christine Ganzer
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, NY, USA
| | - Mony de Leon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Roberta Diaz Brinton
- Departments of Pharmacology and Neurology, College of Medicine, University of Arizona, Tucson, AZ, USA
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22
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Kang EY, Kim HK, Jung JY, Kim JH, Woo TK, Choi JI, Kim JH, Ahn C, Lee HG, Go GW. Combined Extract of Leonurus japonicus Houtt, Eclipta prostrata L., and Pueraria lobata Ohwi Improved Hot Flashes and Depression in an Ovariectomized Rat Model of Menopause. Foods 2021; 10:foods10010180. [PMID: 33477405 PMCID: PMC7829883 DOI: 10.3390/foods10010180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Menopause leads to ovarian hormone loss, which causes symptoms such as weight gain, hot flashes, and depression. Exploring nutraceuticals is important for treating menopausal symptoms that extensively impact women's quality of life. We hypothesized that a combination of Leonurus japonicus Houtt, Eclipta prostrata L., and Pueraria lobata Ohwi (LEPE) would alleviate menopausal symptoms in an ovariectomized menopausal rat model. Bilateral ovariectomy was performed and animals were assigned to five groups: (1) Sham, (2) Vehicle, (-) Control, (3) LEPE (100 mg/kg bw), (4) LEPE (200 mg/kg bw), and (5) Estradiol (3 μg/kg bw). LEPE was orally administered daily for 12 weeks. LEPE supplementation did not affect growth performance (body weight and feed intake) or body composition (lean mass and fat in tissue). LEPE did not cause deviations in aspartate aminotransferase, alanine aminotransferase, estradiol, and follicle-stimulating hormone levels, indicating no hepatotoxicity or endocrine disturbance. LEPE decreased type I collagen (CTX-1) but did not affect bone mineral density or osteocalcin. LEPE decreased tail temperature and increased rectal temperature, improving menopause-related vasomotor symptoms. Furthermore, LEPE ameliorated depression-related behavior, including in forced swimming and tail suspension tests. Thus, LEPE may improve menopausal symptoms by enhancing vasomotor symptoms and depression in an ovariectomized rat menopause model.
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Affiliation(s)
- Eun Young Kang
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea; (E.Y.K.); (H.K.K.); (J.Y.J.); (J.H.K.); (T.K.W.)
| | - Hyun Kyung Kim
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea; (E.Y.K.); (H.K.K.); (J.Y.J.); (J.H.K.); (T.K.W.)
| | - Ji Yeon Jung
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea; (E.Y.K.); (H.K.K.); (J.Y.J.); (J.H.K.); (T.K.W.)
| | - Ji Hyun Kim
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea; (E.Y.K.); (H.K.K.); (J.Y.J.); (J.H.K.); (T.K.W.)
| | - Tan Kyung Woo
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea; (E.Y.K.); (H.K.K.); (J.Y.J.); (J.H.K.); (T.K.W.)
| | - Jeong In Choi
- Research and Development Center, Nong Shim Co., Ltd., Seoul 07057, Korea; (J.I.C.); (J.H.K.); (C.A.)
| | - Jong Hoon Kim
- Research and Development Center, Nong Shim Co., Ltd., Seoul 07057, Korea; (J.I.C.); (J.H.K.); (C.A.)
| | - Changwon Ahn
- Research and Development Center, Nong Shim Co., Ltd., Seoul 07057, Korea; (J.I.C.); (J.H.K.); (C.A.)
| | - Hyeon Gyu Lee
- Korean Living Science Research Center, Hanyang University, Seoul 04763, Korea
- Correspondence: (H.G.L.); (G.-W.G.); Tel.: +82-2-2220-1201 (H.G.L.); +82-2-2220-1206 (G.-W.G.)
| | - Gwang-Woong Go
- Department of Food and Nutrition, Hanyang University, Seoul 04763, Korea; (E.Y.K.); (H.K.K.); (J.Y.J.); (J.H.K.); (T.K.W.)
- Correspondence: (H.G.L.); (G.-W.G.); Tel.: +82-2-2220-1201 (H.G.L.); +82-2-2220-1206 (G.-W.G.)
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Abstract
Phytoestrogens are a group of non-steroidal polyphenolic plant-based substances, commonly used for the treatment of menopause-related conditions. They have both genomic and non-genomic effects, displaying weak affinity for estrogen receptors (ER) and preferentially binding to ER-B over ER-A. However, evidence for the benefits of phytoestrogen consumption has been limited. We conducted a review of recent literature, focusing on systematic reviews and meta-analyses reporting on postreproductive health effects of phytoestrogens. While many trials concerning dietary and supplementary phytoestrogens have been conducted, evidence of clinical efficacy is heterogeneous and inconclusive. There appears to be reduction in the vasomotor symptoms of menopause with phytoestrogen intake; however, it is likely small and slow in onset. Phytoestrogens also appear to improve bone mineral density and markers of cardiovascular risk; however, there is inadequate research regarding long-term outcomes. There appear to be no harmful effects of phytoestrogens on breast, endometrial cancer or colorectal cancer and phytoestrogens intake may in fact be protective. Research regarding the effect of phytoestrogens on cognition is mixed, with most studies reporting no significant association. Overall, individual variations in the metabolism of phytoestrogens and age-related genomic effects may account for the considerable variability in the measured effects of phytoestrogens.
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Affiliation(s)
- I J Rowe
- Northern Clinical School, Sydney Medical Programme, Royal North Shore Hospital, Sydney, Australia
| | - R J Baber
- University of Sydney Faculty of Medicine and Health, The Royal North Shore Hospital Division of Women and Child Health, Sydney, Australia
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Lee CS, Kim JY, Kim BK, Lee IO, Park NH, Kim SH. Lactobacillus-fermented milk products attenuate bone loss in an experimental rat model of ovariectomy-induced post-menopausal primary osteoporosis. J Appl Microbiol 2020; 130:2041-2062. [PMID: 32920885 DOI: 10.1111/jam.14852] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
AIM In this study, we investigated the anti-osteoporotic effect of two fermented milk products (FMPs) fermented by Lactobacillus plantarum A41 and Lactobacillus fermentum SRK414 on a rat model of ovariectomy-induced post-menopausal primary osteoporosis. METHODS AND RESULTS The two Lactobacillus FMPs increased the bone volume and bone mineral density (BMD) in ovariectomized (OVX) rats, and normalized the bone biomarkers in the serum. Additionally, they altered the gene expression levels of bone-metabolism-related markers. Furthermore, the two Lactobacillus FMPs downregulated bone-apoptosis-related genes stimulated by ovariectomy. Interestingly, the Lactobacillus FMPs decreased the levels of inflammation markers in the serum, bone, ileum and colon of the rats. Gut bacterial populations were also affected upon FMP treatment due to increase in the abundance of the genus Lactobacillus and Faecalibacterium prausnitzii. CONCLUSIONS Milk products fermented by L. plantarum A41 and L. fermentum SRK414 can exhibit anti-osteoporotic effects on post-menopausal osteoporosis via regulating the expression of bone-metabolism-related markers. SIGNIFICANCE AND IMPACT OF THE STUDY The two Lactobacillus FMPs used in the study can be an ideal method that has its potential of treating post-menopausal osteoporosis instead of drug treatments.
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Affiliation(s)
- C S Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea.,Institute of Animal Molecular Biotechnology, Korea University, Seoul, Republic of Korea
| | - J-Y Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - B K Kim
- Probiotic Research Laboratory, CKD Bio Research Institute, Ansan, Republic of Korea
| | - I O Lee
- Probiotic Research Laboratory, CKD Bio Research Institute, Ansan, Republic of Korea
| | - N H Park
- Probiotic Research Laboratory, CKD Bio Research Institute, Ansan, Republic of Korea
| | - S H Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea.,Institute of Animal Molecular Biotechnology, Korea University, Seoul, Republic of Korea
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Efficacy and Safety of Kudzu Flower-Mandarin Peel on Hot Flashes and Bone Markers in Women during the Menopausal Transition: A Randomized Controlled Trial. Nutrients 2020; 12:nu12113237. [PMID: 33105861 PMCID: PMC7690627 DOI: 10.3390/nu12113237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
This randomized controlled study aimed to assess the efficacy and safety of an extract mixture of kudzu flower and mandarin peel (KM) on hot flashes (HFs) and markers of bone turnover in women during the menopausal transition. Healthy women aged 45–60 years with the menopausal HFs were randomly assigned in a 1:1 ratio to either KM (1150 mg/day) or placebo arms for 12 weeks (n = 84). The intent-to-treat analysis found that compared with the placebo, the KM significantly attenuated HF scores (p = 0.041) and HF severities (p < 0.001), with a mean difference from baseline to week 12. The KM also improved bone turnover markers, showing a significant reduction in bone resorption CTx (p = 0.027) and a tendency of increasing bone formation OC relative to the placebo. No serious adverse events and hormonal changes were observed in both groups. These findings suggest that KM consumption may improve the quality of life in ways that are important to symptomatic menopausal women.
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Soares JM, Branco-de-Luca AC, da Fonseca AM, Carvalho-Lopes CM, Arruda-Veiga EC, Roa CL, Bagnoli VR, Baracat EC. Acupuncture ameliorated vasomotor symptoms during menopausal transition: single-blind, placebo-controlled, randomized trial to test treatment efficacy. ACTA ACUST UNITED AC 2020; 28:80-85. [PMID: 32898024 DOI: 10.1097/gme.0000000000001651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effects of acupuncture on women with vasomotor symptoms during the menopausal transition with the aid of the Kupperman-Blatt Menopausal Index. METHOD Crossover, single-blind, sham-controlled trial with 100 women randomly divided into two groups of 50 participants each: G1 and G2. During the first 24 weeks of treatment, the G1 women received acupuncture and the G2 women were given sham acupuncture. The crossover was then applied: the G1 participants were given sham acupuncture, and the G2 participants received acupuncture for 24 more weeks. RESULTS The mean score of hot flashes of the group who first experienced acupuncture (G1) was statistically higher than that of the group that started with sham acupuncture (G2, P = 0.020). Also, both groups had similar mean scores in the middle of the study (both were receiving acupuncture). During the last 6 months of the study, after crossover, the values of G2 (acupuncture) were lower than those of G1 (sham acupuncture). CONCLUSIONS Acupuncture treatment may mitigate hot flashes and other climacteric symptoms during the menopausal transition.
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Affiliation(s)
- Jose M Soares
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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27
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Wu T, Yue R, He M, Xu C. Effect of Fenugreek on vasomotor symptoms in menopausal women: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20526. [PMID: 32502006 PMCID: PMC7306339 DOI: 10.1097/md.0000000000020526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Vasomotor symptoms (hot flashes or night sweats) are closely related to the impaired quality of life in menopausal women. Fenugreek is the ripe seed of Trigonella foenum graecum Linn. In China, this plant is used to relieve menopausal symptoms in women. Although recent studies have shown that fenugreek may have a good effect on the menopausal symptoms, there is no meta-analysis to systematically evaluate its efficacy in improving menopausal vasomotor symptoms. METHODS Randomized controlled trials that met the inclusion criteria will be retrieved in 5 English online databases and 4 Chinese online databases. The primary outcomes are changes in frequency and intensity of vasomotor symptoms that measured by validated scales. The secondary outcomes will include quality of life, blood hormone parameters, blood biochemical parameters, and adverse events. Heterogeneity of data will be assessed by I and Cochrane Q statistics. Sensitivity analysis and subgroup analysis will be performed to explore the sources of heterogeneity. Egger test and Begg test will be used to assess the publication bias. Finally, we will evaluate the quality of evidence by the GRADE approach. All the data statistics will be performed using the STATA 15.0 software. RESULTS All the results of will be published in a peer-reviewed journal. CONCLUSIONS This meta-analysis will systematically evaluate the efficacy and safety of fenugreek in the treatment of menopausal vasomotor symptoms. OSF REGISTRATION NUMBER 10.17605/OSF.IO/3BCY8.
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28
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Anderson DJ, Chung HF, Seib CA, Dobson AJ, Kuh D, Brunner EJ, Crawford SL, Avis NE, Gold EB, Greendale GA, Mitchell ES, Woods NF, Yoshizawa T, Mishra GD. Obesity, smoking, and risk of vasomotor menopausal symptoms: a pooled analysis of eight cohort studies. Am J Obstet Gynecol 2020; 222:478.e1-478.e17. [PMID: 31705884 PMCID: PMC7196035 DOI: 10.1016/j.ajog.2019.10.103] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/16/2019] [Accepted: 10/26/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Frequent and severe vasomotor symptoms during menopause are linked with adverse health outcomes. Understanding modifiable lifestyle factors for the risk of vasomotor menopausal symptoms is important to guide preventive strategies. OBJECTIVE We investigated the associations between body mass index and smoking, their joint effects with the risk of vasomotor symptoms, and whether the associations differed by menopausal stage. STUDY DESIGN The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events pooled data on 21,460 midlife women from 8 studies (median age, 50 years; interquartile range, 49-51 years) for the cross-sectional analysis. Four studies provided data for the prospective analysis (n=11,986). Multinomial logistic regression models with 4 categories of frequency/severity for the outcome of vasomotor symptoms were used to estimate relative risk ratios and 95% confidence intervals that were adjusted for within-study correlation and covariates. RESULTS At baseline, nearly 60% of the women experienced vasomotor symptoms. One-half of them were overweight (30%) or obese (21%), and 17% were current smokers. Cross-sectional analyses showed that a higher body mass index and smoking more cigarettes with longer duration and earlier initiation were all associated with more frequent or severe vasomotor symptoms. Never smokers who were obese had a 1.5-fold (relative risk ratio, 1.52; 95% confidence interval, 1.35-1.73) higher risk of often/severe vasomotor symptoms, compared with never smokers who were of normal-weight. Smoking strengthened the association because the risk of often/severe vasomotor symptoms was much greater among smokers who were obese (relative risk ratio, 3.02; 95% confidence interval, 2.41-3.78). However, smokers who quit at <40 years of age were at similar levels of risk as never smokers. Prospective analyses showed a similar pattern, but the association attenuated markedly after adjustment for baseline vasomotor symptoms. Furthermore, we found that the association between body mass index and vasomotor symptoms differed by menopausal status. Higher body mass index was associated with increased risk of vasomotor symptoms in pre- and perimenopause but with reduced risk in postmenopause. CONCLUSION High body mass index (≥25 kg/m2) and cigarette smoking substantially increased women's risk for experiencing frequent or severe vasomotor symptoms in a dose-response manner, and smoking intensified the effect of obesity. However, the effect of body mass index on the risk of vasomotor symptoms was opposite among postmenopausal women. Maintaining a normal weight before the menopausal transition and quitting smoking at <40 years of age may mitigate the excess risk of vasomotor symptoms in midlife.
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Affiliation(s)
- Debra J Anderson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Charrlotte A Seib
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Annette J Dobson
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sybil L Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ellen B Gold
- Department of Public Health Sciences, University of California, Davis, CA
| | - Gail A Greendale
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Ellen S Mitchell
- Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA
| | - Nancy F Woods
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
| | - Toyoko Yoshizawa
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Menopausal symptoms, physical activity level and quality of life of women living in the Mediterranean region. PLoS One 2020; 15:e0230515. [PMID: 32208445 PMCID: PMC7093012 DOI: 10.1371/journal.pone.0230515] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The main purpose of this study is to investigate the relationship between menopause related discomforts and the quality of life of Lebanese women correlated with the physical activity level, anthropometric, medical, sociodemographic and lifestyle variables, during mid-life. MATERIALS AND METHODS This cross-sectional study was conducted among 1113 women, recruited from different Lebanese regions. The Menopause-Specific Quality of Life Questionnaire (MENQOL) was used to assess menopause related symptoms. Menopausal status was classified according to the World Health Organization's definition of menopause. The International Physical Activity Questionnaire was used to evaluate the physical activity level of participants. Anthropometric measurements were taken by the research team. RESULTS Participants were 49.53 ± 5.74 years old and had a mean body mass index of 26.69 ± 5.37 Kg/m2. The highest mean scores of MENQOL were found in the physical and psychosocial domains (p<0.001). Peri-menopausal women had the highest mean scores in the vasomotor, physical and psychosocial domains (p<0.001), while postmenopausal and menopausal women in the sexual domain (p<0.001). Almost half the participants (45.4%) had low physical activity level, which was significantly and inversely correlated with vasomotor, psychosocial, physical and sexual MENQOL subdomains (p<0.001). Menopausal status, educational level, crowding and body mass indexes, marital status, smoking and alcohol intake were among the factors that were significantly associated with the frequency and the severity of menopause related symptoms. CONCLUSION Physical activity may play a protective role in attenuating climacteric symptoms and hence improve the quality of life of women during mid-life.
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Costanian C, Zangiabadi S, Bahous SA, Deonandan R, Tamim H. Reviewing the evidence on vasomotor symptoms: the role of traditional and non-traditional factors. Climacteric 2020; 23:213-223. [DOI: 10.1080/13697137.2019.1711051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- C. Costanian
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - S. Zangiabadi
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - S. A. Bahous
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - R. Deonandan
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - H. Tamim
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
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Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials. ACTA ACUST UNITED AC 2019; 55:medicina55090554. [PMID: 31480427 PMCID: PMC6780738 DOI: 10.3390/medicina55090554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.
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Age-related changes in luteal dynamics: preliminary associations with antral follicular dynamics and hormone production during the human menstrual cycle. Menopause 2019; 25:399-407. [PMID: 29112593 DOI: 10.1097/gme.0000000000001021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the study was to test the hypothesis that the development of luteal phase dominant follicles (LPDFs) as women age is associated with abnormal luteal function. METHODS Luteal and antral follicle diameter were quantified in ovulatory women of midreproductive age (MRA; 18-35 y; n = 9) and advanced reproductive age (ARA; 45-55 y; n = 16) every 1 to 3 days during one complete interovulatory interval. Blood was drawn at each visit and assayed for progesterone, estradiol, inhibin A, follicle-stimulating hormone, and luteinizing hormone. Luteal diameter and hormone profiles were compared within MRA and ARA women with versus without LPDFs. RESULTS Luteal growth and regression profiles were similar in MRA women with typical versus no LPDFs (13.9, 14.8 mm; P > 0.1); however, luteal phase estradiol and progesterone were greater in MRA women with typical (91.1 ng/L, 8.81 μg/L) versus no (48.8 ng/L, 7.32 μg/L) LPDFs, respectively (LPDF effect, P < 0.1). In the ARA group, mean luteal diameter was lowest in women with atypical LPDFs (12.3 mm), greatest in those with typical LPDFs (16.0 mm), and moderate in those with no LPDFs (13.6 mm), (P < 0.1). Reduced luteal growth in ARA women with atypical versus typical and/or no LPDFs occurred simultaneously to greater luteal phase estradiol (199 vs 69.0, 78.4 ng/L) lower progesterone (7.38 vs 10.7, 13.8 ug/L), and lower inhibin A (36.3, 35.6, 51.2) (P < 0.1). CONCLUSIONS The development of LPDFs as women age was associated with reduced luteal growth, greater estradiol, lower progesterone, and lower inhibin A. These findings provide preliminary evidence that variations in antral folliculogenesis contribute to luteal insufficiency during the menopausal transition.
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Maleki N, Cheng YC, Tu Y, Locascio JJ. Longitudinal course of vasomotor symptoms in perimenopausal migraineurs. Ann Neurol 2019; 85:865-874. [PMID: 30937949 DOI: 10.1002/ana.25476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/27/2019] [Accepted: 03/31/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the longitudinal course of vasomotor symptoms (VMS) in women with a history of migraine in comparison to women without a history of migraine disease. METHODS The study sample consisted of 467 women with a self-reported prior migraine diagnosis and 2,466 women without prior migraine diagnosis who were assessed longitudinally during menopausal transition as part of the Study of Women's Health Across the Nation. Linear mixed regression models with backward elimination were used to evaluate longitudinal associations between VMS and migraine while adjusting for baseline and time-varying demographic, socioeconomic, psychological, and reproductive factors. Additional analyses were performed to further assess the specificity of the association between migraine and VMS that included evaluating the association between migraine and vaginal dryness and between back pain and VMS. RESULTS A history of migraine predicted an increased frequency of VMS but not vaginal dryness during menopausal transition. Significant interaction between history of migraine and menopausal status for the prediction of VMS was also identified. Burden of VMS was found to be higher during late-stage perimenopause in women with migraine. In contrast, the history of back pain did not predict the frequency of VMS. INTERPRETATION This is the first study to delineate that a history of migraine predicts an increased frequency of VMS in women during menopausal transition. Hypothalamic abnormalities and thermoregulatory dysfunction against a milieu of decreasing estradiol concentrations during menopausal transition may explain the increased frequency of VMS in migraineurs during menopausal transition. ANN NEUROL 2019;85:865-874.
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Affiliation(s)
- Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yu-Chen Cheng
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Neurology, Fu Jen University Hospital, Taipei, Taiwan
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Odai T, Terauchi M, Hirose A, Kato K, Akiyoshi M, Miyasaka N. Severity of hot flushes is inversely associated with dietary intake of vitamin B 6 and oily fish. Climacteric 2019; 22:617-621. [PMID: 31104511 DOI: 10.1080/13697137.2019.1609440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: This study investigated the links between the severity of vasomotor symptoms (VMS) and the dietary consumption of a variety of nutrients. Method: A cross-sectional analysis of the first-visit records of 262 women aged 40-65 years was conducted. The severity of their hot flushes (HF) and night sweats (NS) and their dietary consumption of nutrients were evaluated using the Menopausal Health-Related Quality of Life Questionnaire and the brief-type self-administered Diet History Questionnaire, respectively. The relationships between severity of HF/NS and dietary intake were analyzed separately for 43 major nutrients. We then evaluated different food items as sources of the nutrients. Results: After adjustment for age, body mass index, menopausal status, and background factors significantly related to VMS, only vitamin B6 (VB6) was significantly related to severity of HF (adjusted odds ratio per 10 μg/MJ in VB6 intake, 0.92; 95% confidence interval, 0.86-0.97). Moreover, a significant inverse relationship was found between the consumption of oily fish as a source of VB6 and the severity of HF. Conclusions: VB6 and oily fish intake is inversely associated with the severity of HF in middle-aged women. Therefore, increased intake of VB6 could help attenuate HF.
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Affiliation(s)
- T Odai
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan
| | - M Terauchi
- Department of Women's Health, Tokyo Medical and Dental University , Tokyo , Japan
| | - A Hirose
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan.,Department of Women's Health, Tokyo Medical and Dental University , Tokyo , Japan
| | - K Kato
- Department of Women's Health, Tokyo Medical and Dental University , Tokyo , Japan
| | - M Akiyoshi
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan
| | - N Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University , Tokyo , Japan
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Hestiantoro A, Jasirwan SO, Wiwie M, Shadrina A, Ibrahim N, Astuti BPK. Low estradiol levels escalate menopausal symptoms leading to mild cognitive impairment in postmenopausal women. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i1.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Women in menopause experience dramatic alterations in gonadal hormone concentrations, including diminished estradiol levels. It has been hypothesized that these hormonal changes may be responsible for the occurrences of menopausal symptoms, such as hot flushes, sleep disruption, night sweats, and irritability, as well as mild cognitive impairment (MCI) in postmenopausal women. Therefore, this study was aimed to determine if there is any association between hormonal changes and menopausal symptoms, including MCI in postmenopausal women.METHODS A total of 245 postmenopausal women were recruited for this cross-sectional study and classified into 2 groups; MCI and non-MCI groups. Diagnosis of MCI was made using the modified Petersen criteria. Variables such as subjects’ age, duration of menopause, menopausal symptoms, anthropometric status, hormone levels, and cognitive status were assessed and statistically analyzed.RESULTS Of the 245 subjects enrolled in this study, 53.9% had MCI. Multivariate analysis found that sleep disruption and estradiol levels were independent risk factors of MCI in postmenopausal women. No significant correlation was found between menopausal symptoms and estradiol concentration.CONCLUSIONS Low estradiol levels were associated with higher risks of experiencing menopausal symptoms and MCI. Sleep disruption and estradiol levels were the most influential factors in the development of MCI in postmenopausal women.
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Thakur M, Kaur M, Sinha AK. Assessment of menopausal symptoms in different transition phases using the Greene Climacteric Scale among rural women of North India. Ann Hum Biol 2019; 46:46-55. [PMID: 30822155 DOI: 10.1080/03014460.2019.1587508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Menopause is the universal physiological process of women's midlife and exhibits a wide variety of symptoms. However, there is little data on the menopausal symptoms and factors associated with their severity among rural Indian women. AIM To evaluate the prevalence of menopausal symptoms during the different transition phases of menopause among rural women of North India. SUBJECTS AND METHODS This cross-sectional study consisted of 351 women aged 35-55 years (mean age 44.6 years) residing in rural areas of North India. A structured questionnaire was used to collect data regarding menopausal status, demographic profile and reproductive history of the participants. Frequency and severity of menopausal symptoms were evaluated using the Greene Climacteric Scale in different stages of menopause. All statistical procedures were accomplished using SPSS version 19.0. RESULTS In the present study the mean ages of attainment of menarche and menopause were 14.3 years and 47.2 years, respectively. Mean score of total Greene Climacteric Scale was highest among perimenopausal women (16.12 ± 8.1) over post-menopausal (14.78 ± 7.3) and pre-menopausal women (11.08 ± 6.1). Logistic regression analysis revealed that advancing age, low educational attainment, low socioeconomic status, menopausal status, later age at menarche and higher BMI were all associated with more severe menopausal symptoms. CONCLUSION The climacteric symptoms were more prevalent among women who were perimenopausal followed by post-menopausal women and were the lowest in pre-menopausal women. Age, menopausal status, socio-economic status, and reproductive factors significantly influenced the severity of menopausal symptoms.
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Affiliation(s)
- Monika Thakur
- a Department of Anthropology , Panjab University , Chandigarh , India
| | - Maninder Kaur
- a Department of Anthropology , Panjab University , Chandigarh , India
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Grenacher-Horn D. [Night sweats]. MMW Fortschr Med 2019; 161:40-44. [PMID: 30887329 DOI: 10.1007/s15006-019-0272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Sakaue A, Adachi H, Enomoto M, Fukami A, Kumagai E, Nakamura S, Nohara Y, Kono S, Nakao E, Morikawa N, Tsuru T, Hamamura H, Yoshida N, Fukumoto Y. Association between physical activity, occupational sitting time and mortality in a general population: An 18-year prospective survey in Tanushimaru, Japan. Eur J Prev Cardiol 2018; 27:758-766. [PMID: 30396293 DOI: 10.1177/2047487318810020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS It is well known that a decline in physical activity is associated with an increase of all-cause death including cardiovascular events and cancer. Few studies have examined the association between occupational sitting time and mortality. Therefore, we investigated this issue in a general population. METHODS Physical activity and occupational sitting time were measured using the Baecke physical activity questionnaire in 1999. The questionnaire generated indices in three physical activity categories: work, sport and leisure-time. A total physical activity index was calculated by adding these three indices. The Baecke physical activity questionnaire was able to evaluate occupational sitting time. Hazard ratios and 95% confidence intervals (CIs) were calculated using Cox's proportional hazard regression models. RESULTS We enrolled a total of 1680 participants, who were followed up for 15.9 ± 3.8 years. The final follow-up rate was 93%. During the follow-up period, 397 subjects died. A significant inverse association (p < 0.0001) was found between physical activity and mortality after adjustment for age and sex. Compared with lower levels of physical activity, the adjusted hazard ratio for mortality at higher levels of physical activity was 0.85 (95% CI: 0.78-0.92). Longer occupational sitting time was also significantly associated with higher mortality (p < 0.01). The adjusted hazard ratio for mortality at longer occupational sitting time was 1.16 (95% CI: 1.05-1.27). These findings were observed in males, but not in females. CONCLUSIONS Our data demonstrated that higher levels of physical activity are associated with a reduced risk of cancer and cardiovascular death. Further, longer occupational sitting time is associated with increased mortality.
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Affiliation(s)
- Akiko Sakaue
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Hisashi Adachi
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan.,Department of Community Medicine, Kurume University School of Medicine, Japan
| | - Mika Enomoto
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Ako Fukami
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Eita Kumagai
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Sachiko Nakamura
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Yume Nohara
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Shoko Kono
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Erika Nakao
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Nagisa Morikawa
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Tomoko Tsuru
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Hitoshi Hamamura
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
| | - Noriko Yoshida
- Department of Sports Medicine and Science, Faculty of Human Health, Kurume University, Japan
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan
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Ryu KJ, Park H, Kim YJ, Yi KW, Shin JH, Hur JY, Kim T. Moderate to severe vasomotor symptoms are risk factors for non-alcoholic fatty liver disease in postmenopausal women. Maturitas 2018; 117:22-28. [PMID: 30314557 DOI: 10.1016/j.maturitas.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/22/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the association between vasomotor symptoms (VMS) and non-alcoholic fatty liver disease (NAFLD) in postmenopausal women. METHODS This cross-sectional study included 1793 Korean postmenopausal women aged 45-65 years who attended a routine health check at a Korean institution from January 2010 to December 2012. Their scores on the Menopause Rating Scale were used to assess VMS. Moderate to severe VMS included ratings of moderate, severe, and very severe. NAFLD was diagnosed by abdominal ultrasound among those who indicated that their ethanol intake was less than 70 g/week. RESULTS The mean age of these participants was 54.51 ± 4.74 years and the mean duration of menopause was 5.36 ± 4.41 years. A total of 602 (33.6%) women reported mild VMS while 435 (24.3%) reported moderate to severe VMS. The prevalence of NAFLD differed significantly according to the severity of VMS (none, 31.7%; mild, 34.9%; moderate to severe, 39.1%; p = 0.037). Levels of the liver enzymes alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase were significantly higher in women with moderate to severe VMS than in those without VMS. Logistic regression analysis revealed that moderate to severe VMS were significantly associated with the risk of NAFLD (OR: 1.50, 95% CI: 1.10-2.03) after adjusting for age, years since menopause, central obesity, alcohol use, smoking, exercise, and insulin resistance. CONCLUSIONS Moderate to severe VMS are associated with NAFLD and worse liver function profiles in otherwise healthy postmenopausal women. Further longitudinal studies are needed to investigate casual relationships and underlying mechanisms.
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Affiliation(s)
- Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Hyuntae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea.
| | - Yong Jin Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Jun Young Hur
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
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Jansen LE, Teft WA, Rose RV, Lizotte DJ, Kim RB. CYP2D6 genotype and endoxifen plasma concentration do not predict hot flash severity during tamoxifen therapy. Breast Cancer Res Treat 2018; 171:701-708. [PMID: 29980881 DOI: 10.1007/s10549-018-4876-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/01/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Tamoxifen is frequently prescribed to prevent breast cancer recurrence. Tamoxifen is a prodrug and requires bioactivation by CYP2D6. Tamoxifen use is often limited by adverse effects including severe hot flashes. There is paucity of prospectively collected data in terms of CYP2D6 genotype and measured tamoxifen, 4-hydroxytamoxifen and endoxifen concentrations in relation to hot flash severity during tamoxifen therapy. METHODS We conducted a longitudinal prospective study of breast cancer patients on tamoxifen (n = 410). At each visit, blood samples were collected, and patients completed a standardized hot flash survey (n = 1144) that reflected hot flash severity during the 7 days prior to the visit. Plasma concentrations of tamoxifen, 4-hydroxytamoxifen, and endoxifen were measured using liquid chromatography-tandem mass spectrometry and genotyping was carried out for CYP2D6. A linear mixed-effects regression analysis assessed the association of covariates in relation to the hot flash severity score (HFSS). RESULTS Median age at first assessment was 50 years with 61.9% of patients considered peri-menopausal. Most patients (92.2%) experienced hot flash symptoms with 51.0% having low HFSS (0-4) and 7.32% experiencing HFSS > 25. Age was significantly associated with hot flash severity, with patients aged 45-59 more likely to have higher HFSS. Neither duration of tamoxifen therapy nor observed tamoxifen, endoxifen and 4-hydroxy tamoxifen plasma concentration predicted hot flash severity. Genetic variation in CYP2D6 or CYP3A4 was not predictive of hot flash severity. CONCLUSIONS Hot flash severity during tamoxifen therapy can not be accounted for by CYP2D6 genotype or observed plasma concentration of tamoxifen, 4-hydroxytamoxifen, or endoxifen.
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Affiliation(s)
- Laura E Jansen
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, N6A 5K5, Canada
| | - Wendy A Teft
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, N6A 5K5, Canada
| | - Rhiannon V Rose
- Department of Epidemiology and Biostatistics, Western University, London, ON, N6A 5K5, Canada
| | - Daniel J Lizotte
- Department of Epidemiology and Biostatistics, Western University, London, ON, N6A 5K5, Canada
| | - Richard B Kim
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, N6A 5K5, Canada. .,Department of Oncology, Western University, London, ON, N6A 5K5, Canada. .,Department of Medicine, LHSC-University Hospital, Room A-LL-152, 339 Windermere Road, London, ON, N6A 5A5, Canada.
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Efficacy of a biobehavioral intervention for hot flashes: a randomized controlled pilot study. Menopause 2018; 24:774-782. [PMID: 28266949 DOI: 10.1097/gme.0000000000000837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The need for effective nonhormonal treatments for hot flash management without unwanted side effects continues. The primary aim of this pilot study was to evaluate the effect of combining a nonhormonal pharmacologic agent with a behavioral treatment for hot flash reduction. METHODS Seventy-one postmenopausal women were randomized to one of four groups: venlafaxine 75 mg + hypnosis (VH) versus venlafaxine 75 mg + sham hypnosis (VSH) versus a placebo pill + hypnosis (PH) versus placebo pill + sham hypnosis (PSH). Women recorded hot flash severity and frequency in a daily diary, in real time. The intrapatient difference in hot flash score (frequency × severity) at 8 weeks was analyzed using a General Estimating Equation model, using VSH as the referent arm, controlling for baseline hot flashes. RESULTS The active arms including PH or VH were not statistically significantly different than VSH (P = 0.34, P = 0.05, respectively). Women in each active arm reported hot flash reductions of about 50%, with the PSH group reporting a 25% reduction. Women receiving the PSH reported statistically significantly smaller reductions in hot flash score than women in the referent VSH arm (P = 0.001). There were no significant negative side effects during the course of the study. CONCLUSIONS Hypnosis alone reduced hot flashes equal to venlafaxine alone, but the combination of hypnosis and venlafaxine did not reduce hot flashes more than either treatment alone. More research is needed to clarify whether combining hypnosis with a different antidepressant would provide synergistic benefits.
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Sun Y, Qin LH, Chen X, Yan X, Mao L, Bai W, Kang J. Effects of black cohosh and estrogen on core body and tail-skin temperatures in ovariectomized rats by telemetric monitoring with dual thermistor probes. Climacteric 2018; 21:153-159. [PMID: 29323578 DOI: 10.1080/13697137.2017.1415320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the effects of black cohosh and estrogen on the temperature in ovariectomized rats, the core body temperature (CBT) and tail-skin temperature (TST) were simultaneously monitored and the relationship between these two temperatures was explored. METHODS Twenty-four female Sprague-Dawley rats aged 8 weeks were randomly divided into four groups: sham-operated (SHAM), ovariectomized (OVX), OVX treated with estradiol valerate (OVX + E), and OVX treated with isopropanolic black cohosh extract (OVX + ICR). Rats were sham-operated or ovariectomized and were implanted with telemetry transmitters with dual thermistor probes. Two weeks after surgery, the animals were treated with drugs for 4 weeks. During the last week of the treatments, the dynamic temperature profiles of the CBT and TST were collected. RESULTS The average CBT and TST, TST fluctuation frequency, and the average amplitude fluctuation were significantly higher in OVX than in SHAM rats. In addition, dramatic fluctuations of TST in OVX rats occurred at the time points of the day when the CBTs were lower in OVX rats than in SHAM rats. Treatment of OVX rats with estradiol valerate or isopropanolic black cohosh extract markedly decreased the average CBT and TST, TST fluctuation frequency, and the average amplitude fluctuation. Moreover, CBT was found to be significantly higher, while TST was lower in OVX + E than in OVX + ICR rats. CONCLUSIONS Both black cohosh and estradiol treatments ameliorated the abnormal thermoregulation in OVX rats. In particular, black cohosh reduced CBT better than estradiol and estradiol reduced TST better than black cohosh.
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Affiliation(s)
- Y Sun
- a Department of Obstetrics and Gynecology , Beijing Shijitan Hospital, Capital Medical University , Beijing , China
| | - L H Qin
- b Department of Anatomy and Embryology , Peking University Health Science Center , Beijing , China
| | - X Chen
- c Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - X Yan
- d Department of Clinical Research Institute , Peking University Health Science Center , Beijing , China
| | - L Mao
- c Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - W Bai
- a Department of Obstetrics and Gynecology , Beijing Shijitan Hospital, Capital Medical University , Beijing , China
| | - J Kang
- e Department of Physiology and Pathophysiology, School of Basic Medical Sciences , Peking University Health Science Center , Beijing , China
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Slyusareva EE, Khramova IA, Antonyuk MV. [The influence of trans-cranial electrical stimulation on the cells of the macrophagal system of the women presenting with the climacteric syndrome]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2018; 95:4-10. [PMID: 29985374 DOI: 10.17116/kurort20189534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The search for the harmless and effective methods for the drug-free correction of various vegetovascular manifestations associated with the climacteric syndrome (CS) is currently a serious challenge facing modern medicine. Dysfunction of the ovaries during the perimenopause is characterized by the impaired production of sex steroids. The estrogens and progesterone, in their turn, are able to interact with macrophages via the specific receptors of steroid hormones localized on the surface of these cells. In this context, the trans-cranial electrical stimulation (TES) technique is of great interest due to its strong influence on the functional state of the central nervous system, subcortical brain structures, the vegetative and hormonal balance. The immunotropic effects of TES therapy described in the literature provide a basis for anticipating its beneficial action on the functional activity of monocytes/macrophages in the women presenting with the climacteric syndrome. AIM The objective of the present study was to evaluate the influence of trans-cranial electrical stimulation on the state and stability of lysosomal membranes of blood monocytes and peritoneal macrophages, the secretory and synthetic activity of these cells in the women exhibiting the vegetovascular manifestations of the climacteric syndrome. MATERIAL AND METHODS The influence of the transcranial electrical stimulation (TES) technique on the stability of lysosomal membranes of blood monocytes and peritoneal macrophages, the secretory and synthetic activity of these cells was studied in 23 women at the age from 45 to 52 years presenting with vegetovascular manifestations of the climacteric syndrome. The control group was comprised of 16 healthy women of the same age. The state of blood monocytes and peritoneal macrophages was evaluated before and after the course of TES therapy. To determine stability of lysosomal membranes of blood monocytes and peritoneal macrophages and calculate the stability index (PSI), the isolated cells were cultured in a medium 199 supplemented by sterile 0.5% L-glutamine and 2.5% mixed human serum previously heated at 560 °C for 30 min and at 37 °C for 12-15 hours. The micro-method was employed to determine secreted lysozyme (Lsec) as well as total lysozyme (L total=L secreted plus L intracellular) following 4-6-fold freeze-thawing of the cultured cells. The data obtained on the levels of secreted and total lysozymes were used to calculate PSI by the formula: PSI=Lsec/Ltotal´100%. The increase in PSI above the optimal value (53- 58%) was regarded as giving evidence of labilization of the lysosomal membranes and the decrease of this parameter as the indicator of membrane stabilization. Based on the difference between the total lysozyme levels before and after cultivation, the amount of newly synthesized lysozyme (L int) was determined. RESULTS The results of the present study give evidence that the women with climacteric syndrome experience labilization of the blood monocytes and peritoneal macrophages; their lysozyme secretion increases while its synthesis decreases. In other words, the therapeutic application of the transcranial electrical stimulation technique contributed to the disappearance or reduction of 'hot flashes' and the change of these features to the level characteristic of the healthy women. CONCLUSIONS The data obtained extend our knowledge about the mechanisms underlying the action of TES therapy on the macrophagic cells; moreover, they allow to draw the conclusion that the course of medication with the application this technique not only decreases the intensity of manifestations of the climacteric syndrome but also corrects the function of the immune system during the perimenopause.
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Affiliation(s)
| | - I A Khramova
- Pacific State Medical University, Vladivostok, Russia
| | - M V Antonyuk
- Far Eastern Scientific Center of Physiology and Pathology of Breathing, Vladivostok, Russia
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Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause 2017; 23:1067-74. [PMID: 27404029 DOI: 10.1097/gme.0000000000000676] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the heterogeneity of temporal patterns of vasomotor symptoms (VMS) over the menopausal transition and identify factors associated with these patterns in a diverse sample of women. METHODS The Study of Women's Health Across the Nation is a multisite longitudinal study of women from five racial/ethnic groups transitioning through the menopause. The analytic sample included 1,455 women with nonsurgical menopause and a median follow-up of 15.4 years. Temporal patterns of VMS and associations with serum estradiol and follicle-stimulating hormone, race/ethnicity, body mass index, and demographic and psychosocial factors were examined using group-based trajectory modeling. RESULTS Four distinct trajectories of VMS were found: onset early (11 years before the final menstrual period) with decline after menopause (early onset, 18.4%), onset near the final menstrual period with later decline (late onset, 29.0%), onset early with persistently high frequency (high, 25.6%), and persistently low frequency (low, 27.0%). Relative to women with persistently low frequency of VMS, women with persistently high and early onset VMS had a more adverse psychosocial and health profile. Black women were overrepresented in the late onset and high VMS subgroups relative to white women. Obese women were underrepresented in the late onset subgroup. In multivariable models, the pattern of estradiol over the menopause was significantly associated with the VMS trajectory. CONCLUSIONS These data distinctly demonstrate heterogeneous patterns of menopausal symptoms that are associated with race/ethnicity, reproductive hormones, premenopause body mass index, and psychosocial characteristics. Early targeted intervention may have a meaningful impact on long-term VMS.
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Desvenlafaxine extended-release tablets in major depressive disorder and menopause-associated hot flushes: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hot flashes and the heart: an ongoing enigma. Menopause 2017. [DOI: 10.1097/gme.0000000000000934] [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]
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Yoshida N, Sugimoto K, Suzuki S, Kudo H. Change in oral health status associated with menopause in Japanese dental hygienists. Int J Dent Hyg 2017; 16:157-164. [DOI: 10.1111/idh.12282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Affiliation(s)
- N Yoshida
- Department of Dental Hygiene; Faculty of Health Care Science; Chiba Prefectural University of Health Sciences; Chiba Japan
| | - K Sugimoto
- Course for Oral Health Engineering; School of Oral Health Care Sciences; Faculty of Dentistry; Tokyo Medical and Dental University; Tokyo Japan
| | - S Suzuki
- Department of Clinical Laboratory Medicine; Faculty of Health Science Technology; Bunkyo Gakuin University; Tokyo Japan
| | - H Kudo
- Department of Clinical Laboratory Medicine; Faculty of Health Science Technology; Bunkyo Gakuin University; Tokyo Japan
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Chronic Osteoporotic Pain in Mice: Cutaneous and Deep Musculoskeletal Pain Are Partially Independent of Bone Resorption and Differentially Sensitive to Pharmacological Interventions. J Osteoporos 2017; 2017:7582716. [PMID: 28299231 PMCID: PMC5337358 DOI: 10.1155/2017/7582716] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/26/2017] [Indexed: 01/06/2023] Open
Abstract
Although the pathological changes in osteoporotic bones are well established, the characterization of the osteoporotic pain and its appropriate treatment are not fully elucidated. We investigated the behavioral signs of cutaneous and deep musculoskeletal pain and physical function; time-dependent changes in bone mineral density (BMD) and the emergence of the behavioral phenotype; and the effects of pharmacological interventions having different mechanisms of action (chronic intraperitoneal administration of pamidronate [0.25 mg/kg, 5x/week for 5 weeks] versus acute treatment with intraperitoneal morphine [10 mg/kg] and pregabalin [100 mg/kg]) in a mouse model of ovariectomized or sham-operated mice 6 months following surgery. We observed reduced BMD associated with weight gain, referred cutaneous hypersensitivity, and deep musculoskeletal pain that persisted for 6 months. Chronic bisphosphonate treatment, 6 months after ovariectomy, reversed bone loss and hypersensitivity to cold, but other behavioral indices of osteoporotic pain were unchanged. While the efficacy of acute morphine on cutaneous pain was weak, pregabalin was highly effective; deep musculoskeletal pain was intractable. In conclusion, the reversal of bone loss alone is insufficient to manage pain in chronic osteoporosis. Additional treatments, both pharmacological and nonpharmacological, should be implemented to improve quality of life for osteoporosis patients.
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Gibson CJ, Thurston RC, Matthews KA. Cortisol dysregulation is associated with daily diary-reported hot flashes among midlife women. Clin Endocrinol (Oxf) 2016; 85:645-51. [PMID: 27059154 DOI: 10.1111/cen.13076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/14/2016] [Accepted: 04/02/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hot flashes are reported by 70-80% of women during the menopause transition. It has been proposed that cortisol dysregulation is involved in hot flashes, but the relationship between cortisol and hot flashes has received little empirical attention. This study examined the relationship between cortisol and daily self-reported hot flashes. DESIGN For 7 days, participants used electronic diaries to report their hot flash frequency, severity and bothersomeness, along with mood and health behaviours, multiple times each day. Participants also provided hair samples for cortisol assays at baseline and morning and bedtime saliva samples for salivary cortisol collection over 3 days during the observation period. Hierarchical linear regression was used to examine the relationships between cortisol and hot flashes. PARTICIPANTS Forty-four women (41% African American, 39% non-Hispanic White) who reported daily hot flashes were enrolled. MEASUREMENTS Salivary cortisol, hair cortisol and the frequency, severity and bothersomeness of daily diary-reported hot flashes were measured in this study. RESULTS Controlling for health and demographic variables, higher hair cortisol was associated with a higher frequency of hot flashes (β = 0·05, P = 0·01). A flatter diurnal cortisol slope was associated with greater hot flash severity (β = 0·09, P = 0·03) and bother (β = 0·10, P = 0·01). Hair cortisol was no longer significant after adjusting for depression or disturbed sleep; all other associations persisted. CONCLUSION Cortisol dysregulation was related to more frequent, severe and bothersome daily self-reported hot flashes. These findings support a potential role of the HPA axis in the aetiology and phenomenology of these common menopause symptoms.
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Affiliation(s)
- Carolyn J Gibson
- San Francisco VA Medical Center, San Francisco, CA, USA.
- University of California San Francisco, School of Medicine, San Francisco, CA, USA.
| | - Rebecca C Thurston
- Departments of Psychology, Psychiatry and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen A Matthews
- Departments of Psychology, Psychiatry and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Jaber RM, Khalifeh SF, Bunni F, Diriye MA. Patterns and severity of menopausal symptoms among Jordanian women. J Women Aging 2016; 29:428-436. [PMID: 27629589 DOI: 10.1080/08952841.2016.1213110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined 359 women aged 45-65 years who visited Jordan University Hospital between February and November 2014. The menopausal symptoms were assessed using a validated Arabic version of the menopause rating scale. The mean age at menopause was 49.4 years. Women aged 50-55 years more frequently exhibited hot flushes and vaginal dryness. Although premenopausal women were 1.5 times more likely to experience irritability, perimenopausal women were more likely to experience hot flushes, physical and mental irritability, sexual problems, vaginal dryness, and joint and muscular discomfort. Hence, health care providers should focus on women at all stages of life.
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Affiliation(s)
- Ruba M Jaber
- a Department of Family and Community Medicine , University of Jordan , Amman , Jordan
| | - Suha F Khalifeh
- a Department of Family and Community Medicine , University of Jordan , Amman , Jordan.,b Department of Family Medicine , University of Jordan Hospital , Amman , Jordan
| | - Fida Bunni
- b Department of Family Medicine , University of Jordan Hospital , Amman , Jordan
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