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Lee E, Anselmo M, Tahsin CT, Vanden Noven M, Stokes W, Carter JR, Keller-Ross ML. Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease. Am J Physiol Heart Circ Physiol 2022; 323:H1270-H1280. [PMID: 36367692 PMCID: PMC9744645 DOI: 10.1152/ajpheart.00477.2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.
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Affiliation(s)
- Emma Lee
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Miguel Anselmo
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Chowdhury Tasnova Tahsin
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | - William Stokes
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Manda L Keller-Ross
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota
- Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, Minnesota
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Biglia N, Bounous VE, De Seta F, Lello S, Nappi RE, Paoletti AM. Non-hormonal strategies for managing menopausal symptoms in cancer survivors: an update. Ecancermedicalscience 2019; 13:909. [PMID: 31123492 PMCID: PMC6445536 DOI: 10.3332/ecancer.2019.909] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 01/08/2023] Open
Abstract
Vasomotor symptoms, particularly hot flushes (HFs), are the most frequently reported symptom by menopausal women. In particular, for young women diagnosed with breast cancer, who experience premature ovarian failure due to cancer treatments, severe HFs are an unsolved problem that strongly impacts on quality of life. The optimal management of HFs requires a personalised approach to identify the treatment with the best benefit/risk profile for each woman. Hormonal replacement therapy (HRT) is effective in managing HFs but it is contraindicated in women with previous hormone-dependent cancer. Moreover, many healthy women are reluctant to take HRT and prefer to manage symptoms with non-hormonal strategies. In this narrative review, we provide an update on the current available non-oestrogenic strategies for HFs management for women who cannot, or do not wish to, take oestrogens. Since isoflavones have oestrogenic properties and it is not known if they can be safely consumed by women with previous hormone-dependent cancer, they were excluded. Selective serotonin reuptake inhibitors/selective serotonin-norepinephrine reuptake inhibitors, as well as other neuroactive agents, some herbal remedies and behavioural strategies are considered.
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Affiliation(s)
- Nicoletta Biglia
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, School of Medicine, University of Torino, Largo Turati 62, 10128 Torino, Italy
| | - Valentina E Bounous
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, School of Medicine, University of Torino, Largo Turati 62, 10128 Torino, Italy
| | - Francesco De Seta
- Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', University of Trieste, via dell'Istria 65/1, 34137 Trieste, Italy
| | - Stefano Lello
- Department of Woman and Child Health, Policlinico Gemelli Foundation, Largo Gemelli 1, 00168 Rome, Italy
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Anna Maria Paoletti
- Department of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, University Hospital of Cagliari, SS 554 km 4,500, 09042 Monserrato, Italy
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Uchida M, Kobayashi O. Novel effect of α-lactalbumin on the yohimbine-induced hot flush increase of the tail skin temperature in ovariectomized rats. Biosci Biotechnol Biochem 2018; 82:862-868. [PMID: 29504865 DOI: 10.1080/09168451.2018.1444976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
5-Hydroxytryptamine (5-HT) and noradrenaline have been thought to play important roles in the mechanism of hot flush. Then, to clarify the relation between serotonergic and adrenergic nervous systems on the mechanism of hot flush, the effect of paroxetine, 5-HT reuptake inhibitor (SSRI) was evaluated on the yohimbine-induced hot flush increase of tail skin temperature in ovariectomized female rats. Yohimbine (adrenaline α2 antagonist) significantly increased the tail skin temperature in course of time. Clonidine (adrenaline α2 agonist) significantly attenuated this effect. Paroxetine also significantly inhibited the increase of tail skin temperature by yohimbine. α-Lactalbumin having SSRI activity in vitro study also significantly inhibited the increase of tail skin temperature, but not significantly decreased the initial temperature. This difference may explain the different mechanism between paroxetine (SSRI) and α-lactalbumin, suggesting new mechanism of hot flush.
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Affiliation(s)
- Masayuki Uchida
- Food Science & Technology Research Laboratories, R&D Division, Meiji Co., Ltd., Tokyo, Japan
| | - Orie Kobayashi
- Food Science & Technology Research Laboratories, R&D Division, Meiji Co., Ltd., Tokyo, Japan
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Biglia N, Bounous VE, Susini T, Pecchio S, Sgro LG, Tuninetti V, Torta R. Duloxetine and escitalopram for hot flushes: efficacy and compliance in breast cancer survivors. Eur J Cancer Care (Engl) 2016; 27. [PMID: 26936232 DOI: 10.1111/ecc.12484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) might be an effective treatment for hot flushes (HFs) in breast cancer survivors (BCSs). This study aims to compare the efficacy and tolerability of duloxetine (SNRI) versus escitalopram (SSRI) in reducing frequency and severity of HFs in BCSs and to assess the effect on depression. Thirty-four symptomatic BCSs with emotional impairment received randomly duloxetine 60 mg daily or escitalopram 20 mg daily for 12 weeks. Patients were asked to record in a diary HF frequency and severity at baseline and after 4 and 12 weeks of treatment. Depression was evaluated through validated questionnaires (Beck Depression Inventory and Montgomery Asberg Depression Rating Scale) at baseline and after 4 and 12 weeks of treatment. Both drugs showed a significant reduction of HF frequency and severity after 12 weeks of treatment with no significant difference between the two groups. A significant improvement in depression symptoms was observed at the end of the study period within both the groups, without difference between the two drugs. In conclusion, escitalopram and duloxetine are both effective treatment for the relief of HFs in BCSs, with similar beneficial effect. A significant improvement of depression was obtained with no major side effects.
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Affiliation(s)
- N Biglia
- Gynaecology and Obstetrics Unit, Umberto I Hospital, Department of Surgical Sciences, University of Turin, Turin
| | - V E Bounous
- Gynaecology and Obstetrics Unit, Umberto I Hospital, Department of Surgical Sciences, University of Turin, Turin
| | - T Susini
- Breast Unit Department of Health Science, OB & GYN Section, AOU Careggi, School of Medicine, University of Florence, Florence
| | - S Pecchio
- Gynaecology and Obstetrics Unit, Umberto I Hospital, Department of Surgical Sciences, University of Turin, Turin
| | - L G Sgro
- Gynaecology and Obstetrics Unit, Umberto I Hospital, Department of Surgical Sciences, University of Turin, Turin
| | - V Tuninetti
- Gynaecology and Obstetrics Unit, Umberto I Hospital, Department of Surgical Sciences, University of Turin, Turin
| | - R Torta
- Psycho-Oncology Unit, Department of Neurosciences, University of Turin, Turin, Italy
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Bove R, Chitnis T, Houtchens M. Menopause in multiple sclerosis: therapeutic considerations. J Neurol 2013; 261:1257-68. [PMID: 24101131 DOI: 10.1007/s00415-013-7131-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/24/2013] [Indexed: 11/25/2022]
Abstract
While the onset of multiple sclerosis (MS) typically occurs during the childbearing years, many women living with MS are of perimenopausal age. There is frequent overlap between menopausal and MS-related symptoms and co-morbidities (e.g. sexual dysfunction, mood disorders and bladder function). Furthermore, some MS symptoms may be exacerbated by perimenopausal changes such as hot flashes or sleep disturbance. The MS neurologist may frequently be the first to become aware of these symptoms and to play a role in monitoring and managing them. In this review, we describe immunological and neurologic changes at menopause as they may impact MS. We then review common symptoms, including fatigue, depression, sexual function, pain and insomnia, and provide both behavioral and pharmacological suggestions for their management. Next, we discuss the need for osteoporosis and cancer screening in perimenopausal women with MS. Finally, we highlight important research gaps, including what effect, if any, the menopausal transition may play on MS disease course as well as the potential modulatory role of hormone replacement therapies.
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Affiliation(s)
- Riley Bove
- Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, 1 Brookline Place West, Suite 225, Brookline, MA, 02445, USA,
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Leitman DC, Christians U. MF101: a multi-component botanical selective estrogen receptor beta modulator for the treatment of menopausal vasomotor symptoms. Expert Opin Investig Drugs 2012; 21:1031-42. [PMID: 22616988 DOI: 10.1517/13543784.2012.685652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Women's Health Initiative Estrogen Plus Progestin clinical trial demonstrated the risks exceeded the benefits which have led to a decline in menopausal hormone therapy (MHT) by greater than 50%. MHT use was initiated long before there was a significant understanding of the molecular mechanisms of estrogens. It has become clear that the problem with the current estrogens in MHT is they act non-selectively as an agonist in all tissues that contain estrogen receptors. MF101 is an oral, botanically derived extract that was designed to selectively regulate estrogen receptor beta (ERβ) because the increased risk of breast and endometrial cancer is due to the activation of estrogen receptor alpha (ERα) by estrogens. Preclinical and clinical data support a role for selective ERβ agonists, such as MF101, for vasomotor symptoms without increasing cancer risks. AREAS COVERED The review covers the biological, pharmacological and clinical advantages of MF101, and the unique ability of MF101 to selectively target the ERβ pathway for the treatment of hot flashes (HF). EXPERT OPINION Preclinical and clinical studies indicate that MF101, a selective estrogen receptor beta agonist, represents a new class of drugs that is safe and effective for treating HF and nighttime awakenings.
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Affiliation(s)
- Dale C Leitman
- University of California, Department of Nutritional Science and Toxicology, 44 Morgan Hall Berkeley, CA 94720, USA.
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